Umbilical Cord Infection?

umbilicalI got a call from some friends the other day regarding their new daughter’s umbilical cord. This is a common problem that many new parents encounter and also a common problem that I see in the ER. The issue relates to infection. Infection of the umbilical cord is a serious problem and ALWAYS requires medical intervention. However, in the normal process of the umbilical cord falling off it often looks pretty horrible sometimes resembling infection.  So how to tell?  Hopefully this post will help some parents with that very question.  

The Good, the Bad, & the Ugly

First the good

Even though it may look bad at some stages, this is a diagram of the normal umbilical cord detachment and healing process. Under normal circumstances the umbilical cord falls off on its own accord around 2-3 weeks of life. Sometime it is sooner and sometimes it is later.

The bad (but not that bad)

Sometimes when the umbilical cord has fallen off there is still some healing tissue in the new belly button. This tissue is called granulation tissue (or an umbilical granuloma) and often looks pretty horrible. Under the normal process of healing, this granulation tissue oozes fluid and has a slight yellow-green discharge. Let me assure you that in the absence of other more concerning signs this is nothing to worry about. Most times you can just leave it alone or clean the belly button several times per day with alcohol and it will heal up just fine. Sometimes your doctor might put a medicine on the umbilical cord to try and dry it up to allow it to heal faster. This medicine is called silver nitrate and is generally applied with a Q-tip.

This is a nice example of an umbilical cord granuloma. The granuloma is the beefy red area in the middle of the belly button and the area responsible for the discharge. Notice that the skin around the umbilicus looks pretty normal.

The ugly – infection of the umbilical cord

Infection of the umbilical cord has some overlap with an umbilical granuloma in that there may be a yellow-green discharge from the belly button. However, with infection you also see redness and swelling of the skin surrounding the umbilicus. Generally the skin is also tender to the touch and may express pus when you push on it. More importantly though, most kids will have generalized symptoms when they get infection of the umbilical cord – fever, fussiness, vomiting, lethargy, not feeding, not making urine, etc. If your baby has discharge from the umbilicus and some of these more worrisome symptoms you should seek medical care as soon as possible.

Here is a great example of an infected umbilicus (the medical word is omphalitis). The child with this umbilicus is likely running a fever, very irritable and fussy, and cries when the area is touched. An untreated umbilical cord infection is serious. From the umbilical cord, the infection can spread along the skin of the abdomen, down into the abdomen, and eventually into the blood. If your baby is having some of the “ugly” symptoms get it checked out as soon as possible.

Umbilical Cord Granuloma

Home treatments

The best home treatment is to leave it alone and try to keep it dry.  I would try this for a few days to a week if you think that you child has an umbilical granuloma.  Many will spontaneously resolve on their own.  If that does not work, alcohol wipes are probably the treatment of choice.  Simply use an alcohol wipe to clean the umbilicus with each diaper change.  In a study looking at the effectiveness of this home treatment, 2 out of 3 granulomas resolved at home without any additional treatment.  One last home therapy involves applying a topic antibiotic (like triple antibioic ointment) to the umbilicus several times per day.

Medical Treatments

The classic medical treatment is silver nitrate.  Below is a picture of silver nitrate, which comes attached to the end of a Q-tip.  The silver nitrate is a chemical, that when combined with moisture, reacts to form heat.  This in effect “burns” the granuloma tissue.  Care must be taken to avoid contacting normal skin, because if there is moisture present, it can react with the normal skin as well.  Some people have expressed concerns about the silver nitrate causing burns to the skin surrounding the umbilicus.  However most reviews suggest that this a very rare event and not serious when it does occur.  Probably the most significant complication of this relatively safe procedure is secondary infection.

Some people advocate using a string to “tie” the granuloma off.  This basically cuts off the blood supply to the granuloma at the point past the string causing the granuloma tissue to die.  This overall appears to be safe, although it may be associated with slight pain and carries the risk of a secondary infection.

My Experience… As a Parent

Baby #1

For the first baby, we did nothing for the umbilical cord.  Doing this allowed the cord to do what billions of cords before it did – fall off naturally.  Of course, this takes time though.  It was our experience that the cord took about 3-4 weeks to completely fall off and it fell off in 3 or 4 different segments.  All along, there was a small amount of drainage but never any redness, swelling, fever, or other worrisome signs of infection.

Baby #2

Now with baby #2, the hospital convinced us that we needed to use the “triple dye,” pictured below.  This is basically a purple drying agent which helps the cord fall off faster.  True, the cord did fall off in about 6-7 days.  However, the dye really only dries out the external part of the cord.  The part further down still goes through the natural course of falling off.  So this means the same oozing that we experienced before.  In the grand scheme of things not sure the purple dye made much difference.  Probably just one more unnecessary thing the hospitals can tack on your bill.

Notice the purple dye on the cord and staining the skin.
Normal oozing from belly button (taken at 2 weeks)

Baby #3

We have now been blessed with our third son.  Decided to go back to the tried-and-true method of doing nothing for the cord… no alcohol, no triple dye, nothing but good ol’ mother nature.  The first picture is a picture of the cord on day 2.  The cord fell off all by itself on about day 8.

Cord at 2 days of life.

References

Check out this article regarding the use of silver nitrite versus conservative management with alcohol. It basically shows that 2 out of 3 kids can effectively be managed with just alcohol to the umbilicus with each diaper change(nappy in the UK). Silver nitrate can be used for those who fail conservative home therapy.

Here is another article describing some common home remedies and over-the-counter medications that you can use for simple umbilical granulomas before going to the doctor for silver nitrate.

Some people have expressed concerns about the silver nitrate causing some burns to the skin surrounding the umbilicus. This article notes that this is very rare and even if it does happen it does not cause any significant problems.

Comments

  1. What a nice find! Your blog is informative and easy to ready. I sincerely appreciate the references and articles. I have a 9 day old infant whose cord fell off on day four and started bleeding after the initial two days of oozing. The pediatrician at his weight/bili check performed the silver nitrate, and that worked for a day. It started bleeding again yesterday, after our first trip in the car (carseat). We have the diaper folded down and wearing only loose gowns. We are going to try the alcohol and air for the weekend and seek help if that doesn’t work. It was great to read some more information on home therapy, since we find ourselves on the weekend and unable to visit without an emergency visit. Thanks, I’ve bookmarked you!

  2. Alexander says:

    Many thanks for such an informative article. Our 2-week old still has the cord attached, and today we noticed a small amount of yellowish-greenish discharge beneath the stump. We saw pediatrician yesterday (for a two week check up), and he did not seem to notice anything wrong with it, but we got a bit worried today, so we’ll probably go to urgent care tomorrow (because it’s a weekend) to make sure it’s not an infection. At least, after reading your article, my mind has been put at ease (since other than small amount of discharge and mild smell I do not see any signs of infection). Thanks again.

  3. A follow-up for my previous post: we took our 2-week old to a pediatrician, and he said that everything looked fine. He was a bit concerned with the smell (said it was it was stronger than normal), so he took a sample for the lab and promised they would call us in case something is wrong, but other than that he did not find it alarming. For our untrained eyes, it looked awful: the substance beneath the almost fallen off umbilical cord was whitish-yellowish-greenish; but after a day, once it stated to dry out, it looked more normal. We’ll wait for the test results from the lab, but so far, it does not seem that bad.

  4. I took my month old daughter to the doctor today because I was concerned about the look of her belly button after her cord just fell off just last night. My doctor said that she has granulation tissue showing and that there’s nothing to worry about. Her belly button looks very similar to that picture. The doctor suggested that I stop using alcohol and advised that I use neosporin and cover it with a bandaid for about 48 hours. He said it should heal in a week. This article was very helpful and it eased my worries. Thank you.

  5. This subject is so scary for me and my fiance considering we have just lost a child to spina bifida this past october. We thank God for the gift he had given us on 9/10/09.. Our son Roland Lucas.. We have Been freakin out about his belly buttton considering it fell off after only 5 days but the articles i have been reading ESPECIALLY this one have been extremely enlightening and help full.
    We are still going to consult his pediatrician as soon as possible about the issue but the information you have on this page will help us not worry so much in the mean while.. thanks!

    -just a “thank you” from an extremely young and tired family.

  6. very usefull information

  7. Hi, thanks very much for the posting, i have a 2 weeks old daughter and the cord fell off 2 days back and today i saw a yellow discharge which was bothering me since this morning. after reading your posting seems like this is common, iam cleaning it often with alchollic wipe.

  8. Outstanding, that is exactly what I needed to know (and couldn’t find definitive guidance with images elsewhere on the web). Much appreciated Doc!

  9. My son is now a month and he had the same problem with his belly button,after three days old I noticed the umbilical cord detatchment came right off and was bleeding.I was worried and carried him to the pediatrics,i saw a bit of greenish yellowih discharge too.He is now doing better and up to this day I was still worried if it would have taken a toll on him in the future but after reading this article I feel a lot better towards this matter because it is a very common thing.

  10. Thanks for your blog, it put my mind at ease about how my baby’s belly button has been looking.

  11. Thanks a lot for this post. Was scared on seeing blood around the cord after 10 days. The pictures are perfect. Exactly what I was looking for.

  12. thank ou so much! your blog is informative and personal and very helpful:) thank you for saying everything in a calm, matter-of-fact way. yours is about the tenth site i clicked on, just trying to find pictures of what a newly fallen off chord SHOULD look like and what it shouldnt because i was NOT prepared for what i saw lol! thank you so much for sharing and easing my mind- you were a God-send!!

  13. Great article. Super easy to understand for a brand newparent like me :) Our baby is 15 days old and lost hr umbilical cord last night. I noticed a little yellowish oozeand was very concerned. I will follow the advice and keep my eye out for other worrisome symptoms – but for now I can rest assured.

  14. Thanks for the information,,,it was very helpful and looking at these images made me feel some much better. My baby’s umbilical cord is not infected, as I suspected.

  15. Hi,
    I’m a new mum,First of all I would like to thank for this information.When My baby was 2 months old he had that umbilical cord granuloma,so we were so worried.I applied a antibacterial cream under GP advice,there was discharged,then we went A&E.The dr did the medical treatment with silver nitrate only one time,I kept the area dry and clean each and every nappy change.Around 5 months old it was completely disappeared.Dr said,Actually it is a normal condition but this takes time,main thing keep the belly button clean and dry and put pampas under the umbilical area……tc
    thanks

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