Umbilical Cord Care

Parents, especially new parents, tend to get concerned about their newborn's umbilical stump. The most important advice is to keep it clean and dry until it falls off.

The umbilical cord connects the developing fetus to the mother through the placenta from the sixth week of pregnancy until birth. As a lifeline, the cord supplies the developing fetus with oxygen, nutrients, and a means of waste elimination while in the womb. At birth, because the baby is able to breathe, eat, and void the bladder and bowel, the umbilical cord becomes unnecessary; so it is clamped and cut shortly after delivery. Since there are no nerve fibers in the cord, your newborn will not feel it.

It is important to provide proper care for this portion of remaining cord at the baby's navel until it heals and separates from the umbilicus -- usually within 2 weeks after birth. The stump will change from a yellow-green color to black as it dries out and may have an odor. Be aware that at this point it will not be possible to determine whether your child will grow up with a so-called "inny" or an "outy."

• During the first hour after delivery, usually following the baby's first bath, the umbilical stump (as it is now called) is treated with an antiseptic applied directly onto it, to decrease the chance for infection.
• Twenty-four hours after delivery, the clamp can be safely removed from the stump. It is a good idea to make sure the clamp is removed at the hospital, before the baby goes home. The clamp can get stuck during the home diaper changes and can pull on and injure the stump.
• After mother and baby are discharged from the hospital or 24 hours after delivery, your pediatrician may recommend wiping the stump and the surrounding skin area with rubbing alcohol 2-3 times a day until the stump falls off. But some research suggests that the stump may heal faster if left alone. It's important to follow your physician's advice.
• Keep the stump dry, and expose the stump to air as much as possible to help dry out the base. Keep the front of the diaper rolled out and down. Change wet or soiled diapers quickly to prevent irritation. In warm weather, dress your baby in a diaper and T-shirt to improve air circulation.
• Avoid bathing in a baby tub or sink until the stump falls off. Sponge baths are often the best way to wash the infant until this happens.
• Within the first two weeks, the cord usually falls off. When this happens, you may notice a small, pinkish area in the bottom of the belly button, which does not look like the rest of the skin. This is expected, and normal skin will grow over it. Once this happens, it is safe to give your baby a bath. Resist the temptation to pull off the stump yourself, even if it's hanging on by only a thread.
• Remember, it's normal to see a little crusting or even dried blood near the stump.

Any fever, a rectal temperature of 100.4° F or higher in a newborn is considered a medical emergency. You should contact your physician immediately. There are a couple of common conditions which should lead you to seek medical attention:

• Omphalitis: If you notice any redness, warmth, swelling, or tenderness in the skin around the belly button, or a lot of discharge from it (especially if it is foul smelling), you should call your pediatrician and go to the hospital's emergency department right away. This could be omphalitis, a potentially life-threatening infection of the umbilical stump and the surrounding area, which must be promptly checked and treated in the hospital.
• Umbilical granuloma: If you notice a persistent, yellow-green drainage from the belly button without any redness, warmth, swelling, or tenderness of the surrounding skin in a baby without a fever, it may represent an umbilical granuloma -- a small nodule of firm, pinkish-red tissue. The baby's doctor can treat this condition in the office. It is treated with silver nitrate applied to the umbilical stump with a cotton swab. The silver nitrate acts to cauterize and dry up the tissue at the base of the stump, allowing normal skin to grow over. This may be repeated until the granuloma is healed. After a treatment, a little bit of dark discharge from the area is nothing to worry about, and sometimes there is some temporary staining of the skin. Furthermore, the procedure is not painful to the baby. He or she cries because the medicine is applies with a stick inside the belly button.
• Persistent bleeding: As mentioned above, a little dried blood at the site is normal. If you notice that that there is persistent and significant bleeding from the umbilical stump, it may be a sign of a clotting problem, and you should see your doctor.

• The umbilical stump is what's left of the umbilical cord after it is cut in the delivery room.
• Keep the stump clean and dry until it falls off, usually by 2 weeks.
• Omphalitis is a potentially serious infection of the umbilicus.
• An umbilical granuloma is a common treatable condition.
• Persistent bleeding from the stump should be evaluated by a medical provider.