In this article we will learn about Umbilical cord’s importance, types of umbilical care and medical problems associated with umbilical cord. Umbilical cord care and managing umbilical cord problems is an important part of newborn baby care routine.
What is Umbilical Cord?
Umbilical cord is baby’s lifeline (and supply chain!) inside the womb.
It is a long tortuous pipe made of blood vessels and jelly-like connective tissue. During pregnancy, it connects the baby to placenta, which is a special organ inside pregnant mother’s uterus. Through umbilical cord, the baby receives oxygen and nutrition from the mother. The cord also helps to dispose baby’s deoxygenated blood.
Clamping of umbilical cord
After birth, the umbilical cord is cut to separate the baby from the mother. The cord is clamped to stop the bleeding. In full term, vigorous babies the cord is clamped after a delay of 30- 60 seconds to allow the newborn to get beneficial red blood cells and iron stores from the placenta.
This practice of ‘Delayed Cord Clamping’ is avoided in sick, limp, or extreme preterm babies requiring immediate resuscitation. In such cases, the cord is cut and clamped immediately within 30 seconds of the birth.
The relation of delayed cord clamping doesn’t lead to Post-Partum Hemorrhage (bleeding after delivery) in mother or breathing difficulty in newborns. It may cause polycythemia (increased level of red blood cells) and increased bilirubin level in some babies, but these problems are usually minor and manageable.
Cord Blood Banking
Practice of collecting and storing cord blood in Cord Blood Banks has become increasingly popular over the last four decades.
In this procedure, after clamping umbilical cord, the medical staff member collects at least 40 ml cord blood in a container, which is then sent to the Cord Blood Bank for cold cryo-storage. Such banks are either Public (which are free, but the stored cord blood is for needy public and research) or Private (which are expensive and reserve the cord blood for future use for the donor or his/her family).
Cord blood is rich in undifferentiated stem cells, capable of differentiating into practically any other body tissue. Stem Cell Transplantation, which may be Autologous (from self) or Allogenic (from a matching individual, who may be related or unrelated), thus offers a viable alternative to Bone Marrow Transplantation.
It offers a great promise in treatment of many cancers, hemoglobin disorders, metabolic disorders, and immune deficiency disorders. It is a ray of hope for regenerative medicine in treating many difficult neurologic, orthopedic, cardiovascular, and old age-related disorders.
Falling off of the umbilical cord
The clamped umbilical cord stump is soft and translucent white in the beginning. As the days progress, it dries up, shrivels, turns yellowish and later purplish or black. It falls off on its own usually in 1- 2 weeks. Sometimes it may take up to 3 weeks to shed off.
Cord care in newborn
During the time when the cord stump has not fallen off, it needs umbilical care.
Dry Umbilical Care
Dry Umbilical Care is the mode advised by WHO and many expert bodies. Steps involved in this care are:
- Wash hands before touching the umbilical area.
- Keep the cord stump clean and dry, and do not allow it to get wet.
- Avoid body baths till the cord stump falls off.
- During that period, give sponge-baths with tepid water, keeping the stump area dry.
- If the stump gets soiled by baby’s urine or stool, clean it up with water and mild (preferably pH neutral) soap. Then it should be dried up with a clean cloth or gauze.
- The diaper should be put taking care that it is not touching or covering the umbilical stump.
- The falling cord should not be pulled out.
Wet Umbilical Care
Topical Antiseptic (70% alcohol or Povidone-Iodine or 4% Chlorhexidine) application or even Topical antibiotic application (Fucidic acid, Neomycin or Tetracycline) are used for umbilical care in some countries. But the studies have found no definitive advantage over Dry Umbilical Care. In fact, studies show that topical antiseptic or antibiotic use in umbilical care may delay the falling off of the cord.
Umbilical infection (Omphalitis)
Umbilical infection or Omphalitis is a potentially serious condition, affecting 1 in 200 newborns.
It is suspected if umbilical stump or its surrounding skin shows
- Redness or swelling or tenderness
- Cloudy, pus-like, or bloody discharge
- Bad smell
- Delayed cord separation (beyond 3 weeks)
In more serious cases, can also lead to systemic symptoms such as
- Lethargy or irritability
- Poor feeding
Umbilical infection is bacterial in origin and is treated with topical and systemic antibiotics.
In approx.1 in 500 newborns, after the umbilical cord falls off, a small round, red lump of raw scar tissue remains in the center of navel. This is called Umbilical Granuloma. Left untreated, it increases in size and raises the risk of umbilical infection.
Umbilical granuloma is treated with local application of silver nitrate or salt, which shrinks and dries it. Measures such as liquid nitrogen cauterization, suturing or surgery are needed in some cases.