Umbilical wound in a newborn: algorithm of treatment

One of the first difficulties that young parents face is the umbilical wound of a newborn. A lot of questions immediately arise: how to care for it, what to lubricate it with, how to bathe it, etc. Of course, it is easy to harm the baby if you do not know the intricacies of caring for and treating the navel. What should you pay attention to, and what should both mom and dad know?

In order to recognize and eliminate the problem in a timely manner, every parent should be aware of such issues as how the umbilical wound heals, when the umbilical wound heals, and how to care for or speed up wound healing.

The terms of tissue tightening are not the same for all babies, however, standard terms can be identified, deviations from which are allowed within 1 to 3 days.

Immediately after birth, and also during the next 3-5 days of life, in place of the navel of the baby there is a knot with the remainder of the umbilical cord. From about the third to the fifth day, the remainder mummifies (dries up) and falls off by itself, without any manipulation.

The umbilical wound after the navel falls off heals according to the usual healing mechanism, within 7-21 days. That is, by the third or fourth week of the baby's life, the navel should heal completely. If this period is extended - for example, in a month-old child the umbilical wound is still present - then you should definitely consult a pediatrician.

In fact, there are quite a few reasons why the navel takes a long time to heal:

• initially large diameter of the umbilical cord (accordingly, the umbilical wound will be larger and will take longer to heal);
• umbilical hernia (is not just a wound, but a protrusion of the navel, which requires consultation with a pediatrician);
• improper cleaning of the umbilical wound (insufficient treatment of the wound surface, or, conversely, excessively thorough cleaning, damaging the barely formed skin);
• weak immune defense of the child's body (for example, if the mother suffered from long-term infectious diseases, vitamin deficiencies, anemia during pregnancy);
• healing pathologies (these can be skin and systemic diseases, infectious processes).

In any case, if the navel does not tighten within 4 weeks, then you need to consult a pediatrician. [ 1 ]

Stages of umbilical cord wound healing

Immediately after the baby is born, the obstetrician fixes the umbilical cord with clamps and makes a tight bandage near the umbilical area. After this, he cuts it off, and the umbilical cord remnant in the child dries out over time and falls off on its own, exposing the umbilical wound, which should be looked after until it is completely healed.

If all the rules of care are followed correctly, procedures are not ignored and a doctor is consulted in a timely manner, then healing will occur in about 2 weeks (it is permissible to extend this period to 3-4 weeks).

At first, the newborn baby will be observed by the local pediatrician and nurse: they will be able to answer all questions of interest regarding the treatment of the navel and its condition.

If the navel area becomes red, swollen, has an unpleasant odor, or has purulent, watery, or bloody discharge, you should definitely consult a doctor: the healing mechanism may have been disrupted and additional treatment will be required. [ 2 ]

Diseases of the umbilical wound

Inflammatory processes in the umbilical wound are called omphalitis. Such processes can occur through various pathological mechanisms, so they are divided into several types: catarrhal, necrotic and phlegmonous omphalitis. [ 3 ]

On average, normal epithelialization of the baby's navel occurs within a couple of weeks. If we talk about the introduction of infection, it can occur during the immediate postnatal treatment of the umbilical cord remnant, or (which is more common) during subsequent home care. [ 4 ]

• Catarrhal omphalitis of the umbilical wound is accompanied by the appearance of "wet" discharge - this is a serous or serous-purulent fluid, periodically drying up with the formation of crusts. The disease is caused by a slowdown in epithelialization as a result of infection in the wound surface. A prolonged "wet" condition causes the formation of granulation - this is the so-called "umbilical fungus": we will talk about it in more detail below. With further proper care and treatment, the navel heals within a few weeks. Treatment usually consists of frequent procedures for treating with hydrogen peroxide, with the possible addition of other antibacterial drugs for external use. Ultraviolet irradiation of the wound surface is also recommended.
• Phlegmonous, or purulent inflammation of the umbilical wound occurs with the transition of the inflammatory reaction to the skin and subcutaneous layer in the umbilical area. There is a release of purulent secretion, swelling and redness of the umbilical wound, an increase in the venous pattern on the anterior abdominal wall, the appearance of characteristic red stripes, which is associated with the expansion of the vascular network. In advanced cases, the umbilical vessels are affected: they become noticeable and can be traced in the form of strands in the upper and lower parts of the umbilical area. The umbilical wound fester, the general well-being of the baby is disturbed: apathy, lethargy, loss of appetite, frequent regurgitation are observed. As a result, the child's body weight also suffers. In such a situation, treatment is prescribed by a pediatrician. The wound is successively treated several times a day with hydrogen peroxide, 70% alcohol, potassium permanganate solution or brilliant green. In case of severe suppuration, apply napkins soaked in a hypertonic solution of sodium chloride, magnesium sulfate. It is recommended to use antibacterial agents, staphylococcal bacteriophage. Physiotherapeutic procedures include ultraviolet irradiation. If the baby's general health is unsatisfactory, general therapy with semi-synthetic penicillin antibiotics, cephalosporin or aminoglycoside drugs is indicated. Treatment is carried out against the background of dysbacteriosis prevention.
• Necrotic inflammation, fortunately, is rarely diagnosed - mainly when the baby's immunity is critically weak. The pathology is characterized by the development of necrosis processes in tissues: the skin acquires a purple-blue tint, with subsequent rejection and probable eventration of internal organs. The pathology requires urgent surgical intervention.

Fungus of the umbilical wound

Fungus is otherwise called granuloma and is a process of granulation growth. The wound then takes the form of a cluster of beads or grapes. In general, this phenomenon is not dangerous, but it can cause a lot of discomfort to the baby: the navel can get wet, bleed, and take a long time to heal.

In any case, medical intervention in case of fungus should be mandatory. Treatment of this problem varies, depending on the stage of granulation processes. In mild cases, the doctor prescribes observation with further regular treatment of the navel with peroxide and antiseptic solution, cauterization with 5% silver nitrate or liquid nitrogen. When an infection occurs, the use of antibiotics in the form of ointments, solutions, sprays is indicated.

Self-medication for fungus in a child is unacceptable.

If the umbilical wound is bleeding

Most often, blood appears due to improper removal of dried crusts: before removing, they must be softened with hydrogen peroxide. If you ignore this step, the top layer may be damaged, exposing small vessels, which leads to slight bleeding. Pediatricians say that such slight bleeding is not a problem and can occur during the first week of the baby's life. Think about what you did wrong. Perhaps you removed the crusts too early, not letting them get wet, or used too strong antiseptics for treatment, not recommended by the pediatrician. Perhaps the procedures were carried out too often, or skin injuries occurred due to constant contact of the navel with clothing or a diaper. In some cases, the wound begins to bleed due to constant crying and straining of the baby - in such a situation, it is necessary to reconsider the diet (the child may have colic).

You can worry in the following cases:

• the navel continues to bleed, although 10 days have passed since the umbilical cord stump fell off;
• bleeding continues even after the drug treatment procedure;
• fungus or granulation is formed;
• bleeding is accompanied by other unfavorable symptoms.

In these cases, you must urgently consult a doctor.

The umbilical wound is oozing: what parents should do

If suddenly the umbilical wound began to constantly get wet, then in such a situation the main thing is not to fuss and take timely measures to prevent further development of the painful process. The parents' actions should be as follows:

• wash your hands, lay the baby on his back;
• add a drop of hydrogen peroxide, wait a few seconds, blot with a cotton pad, while simultaneously removing the peeling crusts;
• drip, sprinkle or spray antiseptic.

Chlorophyllipt (liquid alcohol solution or spray, but not oil solution), fresh furacilin solution, Baneocin can be used as an antiseptic. If you do not have these products at hand, you can use a solution of brilliant green or a weak solution of potassium permanganate. The treatment is repeated twice a day.

Iodine cannot be used for processing. In addition, there are other restrictions:

• you must not wipe your navel with a handkerchief, napkin, or especially with your finger - these actions can provoke the development of an infectious process;
• You must not put pressure on the wound, cover it with a diaper, or put a bandage on top.

If there is any discharge from the umbilical wound, the baby should be changed frequently to avoid contact of the wound surface with contaminated clothing. It is better to wait with bathing: do not wet the affected area until it heals. In case of any suspicious moments, it is better to consult a doctor.

Algorithm for treating the umbilical wound

What should be on hand for proper treatment of the umbilical wound:

• cotton swabs, cotton pads;
• pipette and, if necessary, an antiseptic drug [ 5 ] (Chlorophyllipt, brilliant green solution, chlorhexidine bigluconate [ 6 ], [ 7 ], [ 8 ], etc.);
• hydrogen peroxide with a concentration of 3%.

The treatment is carried out not before, but after bathing the baby. The procedure itself consists of the following steps:

• you need to wash your hands thoroughly with soap;
• drip 1-2 drops of hydrogen peroxide from a pipette into the navel area, wait a few seconds;
• remove the separated crusts and discharge with a cotton swab or disc;
• If necessary, apply an antiseptic.

The procedure is usually repeated daily after bathing the baby. However, if discharge or redness appears, the frequency of treatment is increased to 2 or 3 times a day. In addition, problems with the umbilical wound tightening should be reported to the local pediatrician or nurse.

Treatment of the umbilical wound with a clamp

The procedures for treating the navel with and without a clamp are practically the same:

• Apply a few drops of peroxide to the area below the clothespin and wait for about half a minute;
• remove softened crusts with a cotton pad;
• The area is treated with a circular cotton swab dipped in a solution of brilliant green.

Many parents are afraid that they will hurt the baby or accidentally tear off the clothespin. Such fears are in vain: the procedure is painless for the baby, and the clothespin along with the mummified remnant will fall off on its own without any consequences.

The only inconvenience may be caused by the diaper: if it does not have a special hole for the navel, it may touch the clamp and interfere with normal healing. In such a situation, it is recommended to bend its front edge so that the navel and clamp remain open.

After the moment the clothespin falls off, the procedures are carried out according to the previous scheme, treating the wound itself. For better penetration of the antiseptic, the edges of the wound surface should be slightly spread apart with the thumb and index finger. If this is not done, the internal crusts may stagnate, and the wound may become infected.

Chlorophyllipt

An excellent natural antibacterial agent, approved for use literally from birth, is Chlorophyllipt, which is produced in the form of an oil and alcohol solution. To treat the umbilical wound, you will need Chlorophyllipt in alcohol - it is very convenient to use a spray bottle (also sold in pharmacies).

The principles of treatment with Chlorophyllipt spray are the same as when using other preparations:

• Mom washes her hands and wipes them;
• places the baby on the changing table, slightly widens the umbilical ring using the thumb and index finger (this allows you to examine the wound for purulent discharge and other problems);
• spray Chlorophyllipt directly into the wound;
• Use a clean gauze napkin to remove crusts and drops of the preparation, then spray a little more solution.

Chlorophyllipt treatment can be carried out 1-2 times a day (necessarily in the evening after bathing). To clean the navel, it is better to use not cotton wool, but a bandage or gauze, so that small fibers do not get into the wound and do not stick to it. Cotton pads can be used with no less success.

Chlorophyllipt fights infection well and promotes tissue healing. But this drug has one major drawback: it can cause an allergy if the body is prone to such reactions. Therefore, before using the product, it is necessary to test it on a small area of skin: if there is no reaction, then you can safely treat the umbilical wound.

Baneocin

Doctors often recommend Baneocin for lubricating the umbilical wound: this drug is based on the action of antibiotics, perfectly heals weeping and festering wounds, and prevents the development of skin infections.

But Baneocin, in addition to its positive properties, also has an impressive range of side effects:

• allergic reactions in children, which manifest themselves in the form of redness, rashes, itching;
• toxic effect on hearing and the urinary system (detected with prolonged use of the product);
• dry skin.

The above side effects may develop if the drug is used for more than seven days in a row. No negative signs are observed with a shorter term of use.

How to properly apply Baneocin to the umbilical wound:

• Treat the wound with hydrogen peroxide - in a very small amount, then blot the navel with a napkin.
• Sprinkle the navel with Baneocin.
• If the navel is wet or there is discharge, then repeat the application of the product 3-4 times a day. With normal healing of the umbilical wound, it is enough to apply the drug once a day.

As a rule, doctors do not recommend using such a strong remedy without special need: Baneocin is indicated if an unpleasant odor is felt from the umbilical wound, or if wet or purulent discharge appears.

Streptocide

If the navel takes a long time to heal or is wet, then the time-tested drug Streptocide can be added to the wound treatment. This is a well-known sulfanilamide drug that has a bacteriostatic effect on streptococci, meningococci, pneumococci, gonococci and E. coli.

How to use this drug? It is used externally only:

• the tablet must be crushed into powder;
• pour a small amount of powder into the umbilical opening.

Streptocide is poured into the wound twice a day (it can be used as a single agent or alternated with other external medications).

As a rule, with this type of treatment, the navel heals within 2-3 days.

Alcohol for treating the umbilical wound

It is better to treat the umbilical wound with effective, but not aggressive external agents. If you intend to use medical alcohol for the procedure, then you should not take the 96% option. A 70% alcohol solution is quite sufficient. A more concentrated preparation can excessively dry out the baby's skin, which in the future can cause bleeding and prolonged healing of the wound process.

It should not be forgotten that, in addition to its antiseptic and disinfectant properties, medical alcohol also has a local irritant and tanning effect. Experts do not recommend using 96% alcohol to treat the skin of children under 14 years of age.

It is allowed to use alcohol tinctures (again, with a concentration of no more than 70%). These can be tinctures of calendula, chamomile, propolis - naturally, the treatment is carried out provided that the baby does not have an allergic reaction.

Caring for the umbilical wound

As the umbilical wound heals, it is necessary to take measures to prevent infection. [ 9 ] What do these measures consist of:

• if you are bathing a baby, you should use boiled water for the bath, or add a little potassium permanganate to it (until the water turns pale pink);
• it is useful to bathe the baby in a bath with the addition of decoctions of sage, chamomile, and succession;
• baby clothes that come into direct contact with the umbilical wound should be changed frequently, several times a day;
• the umbilical wound must not be covered with a diaper (it must be tucked in, or special types with a hole in the navel area must be used), it must not be covered with a bandage or a bandage must not be attached;
• After washing, baby's clothes that come into contact with the navel must be carefully ironed with a hot iron;
• The procedure for treating the navel is performed in compliance with all hygienic conditions - in a clean, ventilated room, on a clean towel, sheet or diaper.

Bathing with an umbilical wound

There are several opinions of doctors regarding bathing a baby with an unhealed umbilical wound. Some specialists recommend avoiding water procedures until the wound has healed, practicing only regular wiping of the baby's skin with a damp diaper. Other doctors advise bathing the baby using a pinkish solution of potassium permanganate or boiled water, and it is undesirable to wet the navel area.

Most parents find a "golden mean" by alternating bathing in a potassium permanganate solution and wiping with a wet diaper. They may be right: it is better to endure for 5-7 days than to try to eliminate healing complications later.

After any water procedure – be it bathing or wiping – it is necessary to treat the navel.

Once the newborn's umbilical wound has healed, in the absence of complications, you can bathe the baby in ordinary tap water without any problems. If desired, you can add anti-inflammatory herbal decoctions or a little potassium permanganate powder to the bath.