Umbilicus – Delayed Separation

Umbilicus – Delayed Separation: Excerpt from In A Page: Pediatric Signs and Symptoms

Umbilical cord separation usually occurs between 7 and 14 days of life. Delayed cord separation occurs after 2 weeks of life. Separation of the cord that occurs after 3 weeks of life is considered abnormal. The process of cord separation is chiefly due to the migration of neutrophils into the area, with digestion and necrosis of the umbilical cord.

Differential Diagnosis

• Vigorous use of antiseptics to clean the umbilical cord
  –Probably the most common etiology
  –Inhibits normal colonization of the umbilicus, which otherwise would allow chemotactic infiltration of neutrophils to mediate cord separation

• Immunodeficiencies
  –Leukocyte adhesion defects affecting chemotaxis (LAD I/II)
  –LAD is usually associated with significant systemic (sepsis) or local (omphalitis) infection, recurrent infections, or failure to thrive
  –Sialyl Lewis X antigen deficiency
  –Neonatal alloimmune neutropenia
  –Defective immune (gamma) interferon

• Prematurity
  –Gestational age less than 37 weeks
• Birth via cesarean section
  –Associated with delayed separation, possibly due to decreased bacterial colonization from delivery through a sterile surgical field, resulting in decreased infiltration of neutrophils, which is essential for cord separation
• Neonatal sepsis
• Urachal anomalies
  –More likely to be seen in otherwise healthy infants without signs of local or systemic infection
• Histiocytosis X

Workup and Diagnosis

• History
  –Duration of umbilical cord attachment
  –Risk factors for sepsis
  –Recurrent or severe infections, especially without pus formation or resistance to antibiotic therapy
  –Cleaning techniques for cord care and use of water vs antiseptics (e.g., alcohol, triple dye)
  –Gestational age at birth
  –Vaginal birth vs cesarean section
  –Family history, consanguinity of parents

• Physical exam
  –Signs of generalized neonatal infection/sepsis
  –Omphalitis or other signs of local umbilical infection
  –Drainage from the umbilical stump (seen in urachal anomalies)
• Labs
  –Total and differential white blood cell counts (LADs are characterized by leukocytosis)
  –T and B cell subset determination
  –Testing for leukocyte adhesion molecules; look for abnormal expression of CD18, CD11a, b, and c molecules
  –Functional tests for oxidative burst (zymosan-induced assay)
• Studies
  –Ultrasound, CT, or VCUG to search for urachal or genitourinary anomalies

Treatment

• Decreased use of antiseptics (alcohol) along with the implementation of simple cleaning of the cord with water decreases the length of time to umbilical cord separation without increasing the risk of infection
• Surgical excision of umbilical cord
• Treatment of sepsis and infection with antibiotics
• Transplantation of bone marrow or umbilical blood hematopoietic stem cells to correct LADs
• Surgical repair of any urachal anomalies
• Prevention of transmission of autosomal recessive, inherited conditions (such as LAD) by genetic counseling and testing

Book Source Details

• Book Title: In A Page: Pediatric Signs and Symptoms
• Author(s): Jonathan E. Teitelbaum, Kathleen O. Deantonis, Scott Kahan
• Year of Publication: 2007
• Copyright Details: In A Page: Pediatric Signs and Symptoms, Copyright © 2007 Lippincott Williams & Wilkins.

More About Soto's Syndrome

• Back to disease: Soto's Syndrome: Introduction
• Next Book Extract About Soto's Syndrome: GIGANTISM (Differential Diagnosis in Primary Care)
• More Book Extracts: All Online Books for Soto's Syndrome

More Medical Textbooks Online about Soto's Syndrome

Review other book chapters online related to Soto's Syndrome:

Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.

More About This Book: Title: In A Page: Pediatric Signs and Symptoms Authors: Jonathan E. Teitelbaum, Kathleen O. Deantonis, Scott Kahan Publisher: Lippincott Williams & Wilkins Copyright: 2007 ISBN: 1-4051-0427-9

 » Next page: GIGANTISM (Differential Diagnosis in Primary Care)

Rate This Website

What do you think about the features of this website? Take our user survey and have your say:

Website User Survey

Medical Tools & Articles:

Next articles:

• GIGANTISM (Differential Diagnosis in Primary Care)
• Acromegaly and gigantism (Professional Guide to Diseases (Eighth Edition))
• Acromegaly and gigantism (Handbook of Diseases)
• GIGANTISM (Differential Diagnosis in Primary Care)
• Follow patients with Staphylococcal aureus bacteremia closely for development of a new murmur (Avoiding Common Pediatric Errors)

Tools & Services:

• Bookmark this page
• Symptom Search
• Symptom Checker
• Medical Dictionary
• Give your feedback

Medical Articles:

• Disease & Treatments Search
• Misdiagnosis Center
• Full list of interesting articles

Forums & Message Boards

• Ask or answer a question at the Boards:
• I cannot get a diagnosis. Please help.
• Tell us your medical story.
• Share your misdiagnosis story.
• What is the best treatment for my condition?
• See all the Boards.

Enter your search terms Submit search form
Search The Web Search wrongdiagnosis.com

Common Health Mistakes

Symptom
Checker

Search Specialists by State and City