Pediatric emergency medicine trisk 2557 2557

The umbilical cord remnant necroses and separates from the body at 1 to 3 weeks
of age. It is not unusual to have a small amount of moisture at the base. A slight
foul odor is also not unusual as long as there are no other local or systemic signs
of infection. The odor will generally improve with local care.
Omphalitis
Omphalitis is an infection of the umbilical cord that presents with purulent or
serosanguinous drainage from the umbilical stump. Complications can include
life-threatening necrotizing fasciitis, ascending infection to the liver and systemic
circulation, and staphylococcal scalded skin syndrome. In nonsterile births, there
is also the risk of tetanus contaminating the umbilical stump. Infection may
spread through the umbilical artery and contaminate the peritoneum, causing
infectious peritonitis, or may spread through the arterial system, causing loculated
infections along the iliac or femoral arteries. Signs include purulent and/or foulsmelling discharge from the umbilical stump. There may be associated
periumbilical edema, erythema, or induration in more extensive disease.
Parenteral antibiotics are required. Infants with necrotizing fasciitis may also
need surgical resection of the affected area.
Granuloma
The most common cause of umbilical discharge or moisture is a granuloma. It
typically presents after the cord has separated, and represents granulation tissue
that has not yet epithelized. A benign diagnosis, it must be distinguished from the
less common but more serious lesions of urachal or omphalomesenteric duct
anomalies. Treatment consists of local wound care and cauterization, most often
with silver nitrate. Caution is necessary when applying silver nitrate to avoid
surrounding skin, as it can burn the surrounding tissue. Persistent drainage after
cauterization should increase suspicion for other umbilical abnormalities.
Urachal Anomalies
Urachal anomalies can present at any age, although the neonatal period is the
most common age of presentation for a patent urachus. In this population, typical
presentation includes persistent, active serous drainage of the umbilical stump,
which may ultimately lead to redness and irritation. A patent urachus can be
complicated by urinary tract infections (UTIs). It can be confirmed by US or

voiding cystourethrogram. Symptomatic urachal anomalies are treated surgically
once any active infection has cleared. There is some controversy regarding the
management of asymptomatic anomalies; there may be increased risk of