II. Physiology

  1. Umbilical vessels composed of 2 arteries and 1 vein
  2. Umbilicus separates within 2-3 weeks of delivery
    1. Dries and separates by 8 days in most infants
    2. Usually separation site heals by 15 days

III. Management: Routine care of Umbilicus

  1. Initial care: Clean cord and surrounding skin
    1. Sterile water or
    2. Mild cleanser with neutral pH (5.5 to 7.0)
  2. Ongoing cord care: Keep cord stump clean and dry
    1. Clean cord area with sterile water
      1. Keep cord area clean and dry
      2. Clean cord area when soiled with urine or stool
      3. Cleaning cord area with water alone is preferred
      4. Results in fastest cord separation
        1. No increased risk of Bacterial Infection
    2. Other cleaning or drying agents are not beneficial
      1. Background
        1. These agents do not shorten cord separation time
        2. These agents do not decrease risk of infection
      2. Agents to avoid
        1. Alcohol and other topical drying agents
        2. Topical Antibiotics (may prolong cord separation)
        3. Topical antiseptics (may prolong cord separation)
  3. References
    1. Gfatter (1997) Int J Clin Lab Res 27(4):238-43 [PubMed]
    2. Dore (1998) J Obstet Gynecol Neonatal Nurs 27:621-7 [PubMed]
    3. Medves (1997) Can J Public Health 88(6):380-2 [PubMed]

IV. Findings: Abnormalities of the Umbilical Cord

  1. Umbilical Granuloma
  2. Urachal Anomaly
  3. Omphalitis
    1. Infectious emergency
  4. Umbilical Hernia
    1. Usually closes by age 2 to 3 years
    2. Surgery indications
      1. Defect exceeds 3 cm
      2. Hernia persists beyond age 5 years
  5. Delayed separation of the Umbilical Cord (>3 weeks)
    1. Urachal Anomaly
    2. Leukocyte adhesion defect
  6. Single Umbilical Artery
    1. Incidence: 1% of newborns
    2. Associated with renal anomalies, IUGR and prematurity
    3. In the past, renal Ultrasound was performed at 2 to 4 weeks of life
      1. No longer recommended in isolated Single Umbilical Artery cases (unless other indications)
      2. Deshpande (2009) Arch Dis Child Fetal Neonatal Ed 94(4):F265-7 [PubMed]
  7. Short Umbilical Cord
    1. Requires more vigilant evaluation
      1. Monitor closely in first year of life
      2. Careful exam for comorbid malformations
    2. Associated with increased morbidity and mortality
      1. Chromosomal abnormalities
      2. Gastrointestinal malformations
      3. Cardiopulmonary malformations
      4. Overall Relative Risk of death in first year: 2.4
    3. References
      1. Krakowiak (2004) Obstet Gynecol 103:119-27 [PubMed]

Images: Related links to external sites (from Bing)

Related Studies (from Trip Database) Open in New Window

Ontology: Disorder of umbilicus (C1301340)

Concepts Sign or Symptom (T184)
SnomedCT 397320006
Spanish trastorno del ombligo, trastorno de omblico (trastorno), trastorno del ombligo (trastorno), trastorno de omblico
English Problem;umbilicus, Disorder of umbilicus (disorder), Disorder of umbilicus, problem with umbilicus

Ontology: Single umbilical artery (C1384670)

Definition (MSH) Congenital abnormality where one, instead of the usual two, UMBILICAL ARTERY connects the fetus to the placenta.
Concepts Congenital Abnormality (T019)
MSH D058529
ICD10 Q27.0
SnomedCT 123277001, 63070006, 204470001
Italian Arteria ombelicale singola, Arteria ombelicale unica, Cordone ombelicale a due vasi
Japanese 単一臍動脈, タンイツサイドウミャク
Czech Chybění pupeční arterie, jediná pupečníková tepna
English Two Vessel Cord, Single Umbilical Artery, Two Vessel Cords, Single Umbilical Arteries, Umbilical Artery, Single, Single Umbilical Artery [Disease/Finding], Two vessel cord, Two-vessel cord, single umbilical artery, umbilical cord complication - vascular anomalies single umbilical artery, single umbilical artery (diagnosis), Single artery AND vein of umbilical cord, Congenital absence of umbilical artery, Single umbilical artery (disorder), a.umbilicalis; single, artery; single umbilical, Single umbilical artery -RETIRED-, Single umbilical artery
French AOU (Artère Ombilicale Unique), Artère ombilicale unique, Cordon à deux vaisseaux
German Singulaere Nabelarterie, Singuläre Nabelschnurarterie, Singuläre Nabelarterie, Singulaere Nabelschnurarterie, Einzelnabelarterie
Spanish Arteria Umbilical Única, arteria umbilical única - RETIRADO - (concepto no activo), arteria umbilical única - RETIRADO -, arteria umbilical única (trastorno), arteria umbilical única, Arteria umbilical única
Russian ЕАП, ЕДИНСТВЕННАЯ АРТЕРИЯ ПУПОВИНЫ, PUPOCHNAIA ARTERIIA EDINSTVENNAIA, EAP, EDINSTVENNAIA ARTERIIA PUPOVINY, ПУПОЧНАЯ АРТЕРИЯ ЕДИНСТВЕННАЯ
Portuguese Artéria Umbilical Única, Artéria umbilicar única
Hungarian Egyetlen umbilicalis arteria
Polish Pojedyncza tętnica pępowinowa, Tętnica pępowinowa pojedyncza
Norwegian Enkel navlesnorarterie, Enkel navlearterie
Dutch a.umbilicalis; enkelvoudig, arterie; één enkele arteria umbilicalis, enkelvoudige navelstrengarterie