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Crowns navel in newborn: reasons
If a newborn has a belly button, this is a common reason for parents to worry. In some cases it can really be a serious pathology, but sometimes it's just a long healing navel. Parents should always know when the symptoms indicate the disease and you need to immediately contact the doctor.
Causes of the allocation of blood from the navel in a newborn
Why does the newborn have a navel? This problem appears in many parents already after discharge from the hospital, and raises many questions and concerns. But this does not always indicate a disease, sometimes it's just the features of healing the umbilical wound. When do not you worry? Children born physiological way without complications are discharged after three days from the hospital. As a rule, in most of the umbilical wound already begins to heal and dry, and in some even up to three days it disappears. But often it also happens that when caring for the umbilical wound can be damaged, or simply by bathing a little hurt the navel. At the same time, he can slightly heal, which is a normal reaction to an unhealed wound. How long does the navel have a newborn baby? It must be dry and clean, and for five to fifteen days must heal and fall away. It is this period that is considered normal for those cases when it can heal. If this lasts longer, then you should definitely contact the doctor.
What are the other reasons for the navel to be closed? The most common cause can be considered hemorrhagic disease of the newborn. The pathogenesis of the disease lies in the characteristics of the child's organism in relation to the hemostasis system. These features include functional deficiency of platelets, which can be the basis for the development of hemorrhagic conditions in newborns. In addition, attention should be paid to the reduced concentration in newborns of individual coagulation factors - II, VII, IX, X, XI, XII, antithrombin and plasminogen. All these features are also characteristic for the system of hemostasis of premature newborns. Physiological insufficiency of platelets or plasma coagulation factors can become pathological and lead to the development of hemorrhagic disease of newborns. There are some features of the child's body that contribute to the development of blood clotting disorders. A small decrease in factors II, VII, IX, X is observed in children in the first three days after birth. But this deficit is unstable, by the end of the first week of life the child can restore all the scarce factors. In the body of a pregnant woman, there is also a deficiency of vitamin K, which affects the formation of blood clots and reduces the rate of blood clotting in a newborn baby. In a small number of newborns (2-5% of all children), the level of K-vitamin-dependent clotting factors may be lower, which is one of the reasons for their bleeding. This may be due to the appointment of pregnant anticoagulants of indirect action, anticonvulsants, acetylsalicylic acid, as well as the pathological condition and toxicosis of a pregnant woman against a background of low estrogenic background, a violation of the formation or absorption of vitamin K in the intestines of the mother. Mother's milk in the first days of life can not compensate for vitamin K deficiency, since it is available in small quantities. Therefore, the important thing in the elimination of this deficiency is the colonization of the child's intestinal microflora, which produces this vitamin. That is why in children by the end of the second week of pregnancy, the deficit of K-vitamin-dependent factors is eliminated. And one of the most frequent and early symptoms of this disease is that symptom when it starts to heal the navel.
Another reason may be other forms of hemorrhagic diseases. Hereditary forms of hemorrhagic diseases of newborns can be caused both by a violation of the function of platelets, and by a decrease in the concentration of individual plasma clotting factors. Hereditary hemorrhages of a thrombocyte character - thrombocytopenic purpura. Hemorrhages occur only in cases of the most severe forms: hemorrhage from the navel, bleeding in the brain. Sometimes congenital hypoplastic thrombocytopenia can also occur.
Hereditary haemorrhages of a coagulation character are severe forms of hereditary deficiencies of plasma coagulation factors V, VII, VIII, IX, X, XI, XII, with the deficit of which hemorrhagic phenomena leading to the death of newborns. The cause of death of newborns are hemorrhages in the brain, profuse gastrointestinal bleeding, hemorrhages from the umbilical cord. With insufficient amount of XIII plasma factor in newborns, "umbilical syndrome" can manifest itself - a slow closure of the umbilical wound and bleeding from it within 2-3 weeks of life. With insufficient amount of this factor, newborns often have hemorrhages in the gastrointestinal tract, the brain and its membranes. The main share of hemorrhagic conditions in newborns belongs to the acquired forms. Some of them are associated with a violation of platelet function, the other is coagulative.
Secondary vitamin K-deficiency hemorrhagic syndrome: occurs in children with mechanical jaundice (atresia of the bile ducts and bile ducts, bile ducting syndrome), enteropathy, intestinal dysbacteriosis; is associated with impaired absorption of fat-soluble phylloquinones.
DIC-syndrome in newborns can occur with various pathological conditions, signifies a severe catastrophe. May be a cause of severe bleeding from the navel. At the same time there is marked clotting of blood, which closes the loose masses of fibrin and aggregates of blood cells vessels, and then, having exhausted the stock of procoagulants, the ability to coagulate disappears, leading to profuse bleeding. Causes of the development of DIC syndrome: septicemia, late toxicosis of pregnant women in the mother, physiological immaturity of the reticuloendothelial system in the fetus, asphyxia, acidosis, hypothermia, traumatic lesions during childbirth and the like.
The main phases of development: hypercoagulation and blood coagulation is already beginning inside the vessels, as well as hypocoagulation. In general, DIC syndrome is largely associated with the defeat and violation of blood flow in small vessels due to platelet adhesion, blood clots in the blood cells, cellular respiration disorder and acidosis, platelet pathology. In DIC syndromes of different genesis, the mechanism of bleeding is not the same: in some forms, platelet-microcirculatory disorders act on the foreground, while in others, coagulation shifts occur, in the third case, violations in all hemostasis. Hemorrhages are caused by consumption of clotting factors, fibrinogen blockade, platelets by products of fibrinogen fibrin degradation, increased vascular perceptibility as a result of hypoxia, activation of the kinin system, decrease in the number and function of platelets.
Risk factors
Risk factors for the development of problems with the navel are as follows:
- premature babies are more likely to develop hemorrhagic disease;
- adverse obstetric history: long-term infertility, somatic diseases, extragenital pathology;
- pathological course, pregnancy threat of interruption, urogenital diseases, acute respiratory viral infection, exacerbation of chronic foci, prolonged hypoxia;
- obstetric interventions, endometritis in childbirth;
- artificial feeding from the first days;
- children with hereditary pathologies of the hemorrhagic system;
- skin infections in children increase the risk of infection of the navel;
- congenital immunodeficiency and HIV infection;
- congenital pathologies of the gastrointestinal tract.
All these risk factors should be considered by the pediatrician first of all, warning parents of the consequences and possible pathologies.
Symptoms of the allocation of blood from the navel in a newborn
If it is a matter of simple trauma and the navel of the newborn krovit after bathing, the first signs can be in the form of a small amount of blood. This usually ends with the fact that after a few minutes the blood coagulates and everything passes. After that the navel again remains dry with small bloody masses around. If this does not happen again, there are no other manifestations of pathology and an increase in body temperature, then this is normal and eventually the navel will be prolonged and will heal.
When a newborn has a belly and a wrinkles on the navel or becomes wet and covers the navel, this is already a very serious cause for concern. In this case, we are talking about infection and inflammation with the development of omphalitis. It is inflammation of the skin and fiber around the navel caused by the bacterial flora. For newborns, this is a particularly dangerous condition, since children are often discharged home and the umbilical cord has not yet healed, or the navel has not disappeared at all. This can be a gateway to an infection that spreads very quickly here. Clinically, on the background of a rise in body temperature, one can see that a liquid starts to appear from the navel or it turns red. If the navel of the newborn kills and smells, then this can also be regarded as a symptom of omphalitis.
Hemorrhagic disease of newborns very often can manifest with the navel problem, since the newborn has a weak spot that has not completely healed yet. Therefore, if the navel crocks, especially in a premature baby, then you need to think about it. For this disease, a characteristic symptom of bleeding from other organs - the stomach, intestines, cerebral hemorrhage. Therefore, in the presence of bleeding from the navel and another focus of bleeding, it is more likely that a child may develop late hemorrhagic disease of the newborn.
Hereditary thrombocytopathy, in addition to the fact that the navel will be closed, may be accompanied by skin manifestations of hemorrhagic rash.
Symptoms of acute DIC syndrome are characterized by acute dysfunction and dystrophy of internal organs, hemocoagulation shock (syndrome), thromboembolism and hemorrhagic syndrome. Thromboembolic syndrome is observed in chronic, subacute, acute course of DVS-syndrome with a clinic of venous, arterial thrombosis caused by defects of the vascular wall (in children - infectious-toxic, immune-allergic vascular disease).
Hemorrhagic manifestations (local or common) develop into the hypocoagulant phase of acute DVS-syndrome. Local bleeding is when the navel is crocheted, which can become one of the first symptoms. Common hemorrhages are caused by local disorders: hematomas, petechiae on the skin, subcutaneous fat, cerebral hemorrhage, meninges, heart, pericardium, lungs, pleura, peritoneum, gastrointestinal, renal, hepatic bleeding. If it krovit from all possible places and together with it are formed in parallel thrombi, then this is the sign of the DIC-syndrome.
These are the main symptoms that can be accompanied by the appearance of spotting from the navel.
Diagnostics of the allocation of blood from the navel in a newborn
Diagnosis should primarily exclude serious diseases that may be accompanied by this symptom. If the navel crocks and there are no other symptoms, there is no need for invasive interventions or laboratory tests. When the body temperature rises or there are some purulent discharge from the navel together with bloody, then it is necessary to exclude infectious complications. A blood test can show changes in the inflammatory nature that will be manifested by an increase in ESR, an increase in the number of stab wedges.
For a more complete diagnosis in the history of the study should pay attention to the lack of bleeding from relatives and the normal course of pregnancy and labor in the mother. If there are no manifestations on the skin of relatives, then it is necessary to study the coagulogram.
With pathology in the coagulogram, prothrombin time, blood coagulation time and plasma recalcification are increased, and the level of prothrombin and factors IX, X are significantly reduced. The time of bleeding, the level of factors V and VIII, the number of platelets, the fragility of the vascular wall and the time of retraction of the clot remain normal, taking into account the age and maturity of the newborn. These studies exclude hemorrhagic diseases - almost all hereditary thrombocytopenia and DIC syndrome.
Instrumental diagnosis is rarely necessary, since all problems can be identified using laboratory indicators. Sometimes, if there is a suspicion of hemorrhage in the organs or brain, there may be a need for ultrasound or ultrasonography of the brain.
Differential diagnosis
Differential diagnosis should primarily exclude complex pathologies that threaten the life of the child due to bleeding. If the navel crocks the newborn boy, then it is necessary to conduct differential diagnosis with hemophilia. This hereditary disease can only occur in boys. In addition to the discharge of blood from the navel, it is accompanied by large hemorrhages in the brain, joints, and bleeding into the parenchymal organs. Bleeding does not stop at all.
Treatment of the allocation of blood from the navel in a newborn
The approach to treatment depends on what the symptoms are caused by. What to do if the newborn has a navel? First you can not smear anything before consulting a doctor and you can not wash it with water. If there are no purulent or mucous discharges and the navel is krovit because it has not yet healed, then you just need to properly process it. Than to process a belly-button of the newborn if he krovit? The most common and safe means is diamond green. It has the properties of an antiseptic and is capable of killing a pathogenic flora. To treat the navel, you need to wash your hands well and treat with an antiseptic. After that, grease the cotton swab in the solution and open the umbilical cord with two fingers and lubricate well with the diamond green. As a rule, one time is enough for all problems with the navel to pass.
When it comes to hemorrhagic pathologies or the DIC syndrome, then the treatment is complex with the inclusion of many drugs.
Treatment of DIC syndrome is difficult due to the multifactority of its occurrence. The main direction should be its prevention - the elimination of those factors that can cause it. List of medicines in the treatment of DIC syndrome: intravenous administration of heparin, disaggregants, protease inhibitors and plasminogen, blood substitutes, plasmotherapy, thrombolytic therapy. The use of this or that remedy will be effective only if the clinical situation is correctly evaluated, based on the basic laws of hemostasis and possible variants of violations in newborns. Filokhinony at the rate of 1 ml / kg of body weight twice a day for three days and two days - premature infants. Feeding of children with ground should be carried out at room temperature, breast milk. They are prescribed a solution of thrombin and androxone in epsilon-aminocaproic acid (a dry thrombin is dissolved in 50 ml of a 5% solution of epsilon-aminocaproic acid and 1 ml of 0.025% solution of androxone is added) or 0.5% sodium hydrogencarbonate solution 1 teaspoonful 3 times day. For urgent haemostatic action and increase in the factors of the prothrombin complex, it is necessary to introduce a single-group fresh-frozen plasma at the rate of 10-15 ml / kg with simultaneous iv injection of 3-5 mg of vikasol (vitamin K3) more efficiently with vitamin K1. In order to maintain hemodynamics, infusion therapy is performed.
- Heparin for blood clotting disorders in the case of development of DIC syndrome is considered the main means for treatment. The mechanism of action of heparin - promotes inactivation of thrombin due to the activation of antithrombin III, suppresses VIIa, Χa, ΧIIa, ΧIIa clotting factors, as well as plasmin and kallikrein. It inhibits the activity of hyaluranidase, thereby reducing the perceptivity of the vessels. The hypolipidemic effect of heparin is manifested by an increase in the activity of lipoprotein lipase. Suppresses the interaction of T- and B-lymphocytes (immunosuppressive effect). Inhibits the aggregation of platelets. It slightly increases the fibrinolytic activity of the blood. It inhibits the proliferation of the GMC of the vascular wall. Has anti-inflammatory and diuretic effects. Improves the collateral circulation. Heparin is practically not absorbed into the digestive tract, it is well absorbed when in and subcutaneous injection. Does not penetrate the placental barrier. Associated with LP, less - with blood proteins. Metabolism of heparin occurs in the liver, kidneys and connective tissue. In unmodified form is excreted by the kidneys with intravenous administration. Dosage of the drug - 100 units. Per kilogram of the child's body weight, the method of administration is subcutaneous, every six hours. Side effects - can lead to hemorrhagic syndrome, allergic reactions, headache, arthralgia, myalgia, urticaria, skin itch, toxic diarrhea. In addition, heparin causes inverse alopecia, hypotension, osteoporosis, hypoaldosteronism, hematomas at the site of injection, thrombocytopenia.
- Etamsylate is a haemostatic drug that is used for bleeding as a quick-acting drug. The drug promotes the formation of mollecules that do not pass well through the vessels, which reduces bleeding. In addition, etamzilate exhibits hemostatic effect. Dosage of the drug - 12.5% solution of 2 milliliters per glucose, the method of administration is the best - it is infusional drip.
- The use of antibiotics in the treatment of omphalitis, which is accompanied by the discharge of blood from the navel is mandatory.
Ceftibuten is an oral cephalosporin of the third generation, which does not perish in the presence of bacteria that contain lactamases. The drug is well absorbed when taken internally and immediately divided into fractions, circulating through the blood throughout the day. The mechanism of action of cefbutene is the activation of enzymes that contribute to the destruction of the bacterial wall and the exit of the endotoxin of the bacterium (a violation of the synthesis of polysaccharides in the wall of the cell of the microorganism). All this together ensures the death of the pathogen in omphalitis and prevents the development of further infection. Dosage - 9 mg / kg in children.
Given that the approach to treatment is very differentiated, it is very difficult to disassemble all the drugs necessary to treat a child with complicated symptoms of DIC. Therefore, only the main principles of treatment with a mandatory individual approach are taken into account.
Alternative treatment
Alternative therapies can be used if the navel simply covers and does not heal for a long time. Often parents are interested in whether it is possible to bathe a newborn, if the navel crocks? Bathing is a hygienic procedure that should be performed in any case, especially if there are problems with the navel. Do not swim only if there are signs of inflammation or redness. In other cases, you can bathe the baby and use anti-inflammatory herbs.
- Grass and chamomile grass very well cleans the skin of the baby and has antiseptic properties. For brewing you need to take a hundred grams of herbaceous grass and a hundred grams of chamomile and pour hot water. You need to insist for twenty minutes, then add to a warm bath before bathing. To rub the navel or intensively wash with soap and a washcloth is not recommended, you can simply wash the baby in warm water with herbs.
- Nails also have good antiseptic properties. For a bath it is better to take 50 grams of marigold flowers and to insist in water. You need to add to the bath and carefully bathe the child.
- Infusion of sage and oak bark should be prepared in the following way: 30 grams of oak bark and 50 grams of sage leaves to insist, add to vodichku before bathing and after the bath can lubricate the baby's skin with this solution with the addition of two drops of olive oil without much effort in the navel.
Homeopathic treatment of this pathology is not used, because the condition is acute and passes with proper care, if there is no disease.
Prevention
Preventing the appearance of any problems with the navel in newborns, including when it comes to bloody discharge, is the proper care of the child. It is very important for a normal healing navel to do nothing, not to injure, keep it dry and clean.
The most physiological means of preventing any hemorrhagic manifestations is the early application of the baby to the breast after childbirth. A specific method of preventing hemorrhagic manifestations is the use of vitamin K. Dosage for term infants is 0.5 ml, and for a greater amount of vitamin, since the depot of this vitamin has not yet had time to accumulate - the dose is 1 mg. It is believed that for children on artificial feeding should be used for 1 mg of vitamin K, since artificial mixtures do not contain enough of this vitamin. This prevents late manifestations of hemorrhagic disease.
Forecast
The prognosis can be favorable with the timely diagnosis and differentiation of the navel disease or hemorrhagic disease. Otherwise, there may be complications with the risk of developing sepsis and DIC syndrome, which has a fairly high percentage of deaths.
To heal the navel of a newborn can be due to simple trauma, in which case simple hygienic measures can help in the treatment. But if this symptom is accompanied by a skin rash of hemorrhagic nature, an increase in body temperature, a violation of the general condition of the child, then you should always contact the doctor.
Medical expert editor
Portnov Alexey Alexandrovich
Education: Kiev National Medical University. A.A. Bogomolets, Specialty - "General Medicine"
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