II. Definition
- Excess umbilical granulation tissue in newborns
- Follows Umbilical Cord separation
III. Signs
- Soft, granular red or pink tissue at base of Umbilicus
- Seropurulent discharge may be present
IV. Differential Diagnosis
- Umbilical Polyp
- Urachal Anomaly (Bladder communication)
- Omphalomesenteric duct anomaly (bowel communication)
- Umbilical Mass
- Ectopic Pancreas
- Umbilical Hernia
V. Management: Topical Treatments
- Apply Isopropyl Alcohol or Chlorhexidine to area
- Cryotherapy applied to Granuloma
-
Silver Nitrate 75% solution or stick
- Risk of Chemical Burn
- Technique
- Dry Skin of any umbilical exudate
- Protect surrounding skin with petroleum jelly
- Apply Silver Nitrate to Granuloma only
VI. Management: Double Ligature Technique
- Apply Povidone-Iodine (Betadine) to periumbilical area
- Tie stay Suture with 3-0 Silk
- Tied around protruding stump of Umbilical Granuloma
- Parents or assistant hold up stay Suture
- Raises Umbilical Granuloma
- Uncovers deeper base of Umbilical Granuloma
- Tie second ligature (3-0 silk) at base of exposed stump
- Additional Suture may be needed for large Granulomas
- Anticipate Granuloma will fall off in 7-14 days
- Complications: Bleeding (especially in friable lesions)
- Contraindications
- Large Granulomas with wide base
- Small, deep Umbilical Granulomas
- Very friable lesions
VII. Course
- Granulomas often persist >2 months without treatment
VIII. References
- Behrman (2000) Nelson Pediatrics, Saunders, p. 528
- Lotan (2002) Am Fam Physician 65(10):2067-8 [PubMed]