Umbilical wound in a newborn: processing algorithm

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

For timely recognition and elimination of the problem, each parent should be aware of such issues as the healing of the umbilical wound, when the umbilical wound heals, and how to care for or accelerate wound healing.

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

Immediately after birth, and also during the next 3-5 days of life, a nodule with the remainder of the umbilical cord is present at the site of the navel in the infant. From about the third to the fifth day, the residue mummifies (dries out) and falls off on its own, without any manipulation.

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

In fact, the reasons for the prolonged healing of the navel are not so few:

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

In any case, if the navel does not tighten for 4 weeks, then it is necessary to consult a pediatrician. [1]

Stages of healing of the umbilical wound

Immediately after the birth of the baby, the obstetrician fixes the umbilical cord with clamps and makes a tight bandage near the umbilical zone. After that, he cuts off, and the umbilical cord residue 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, do not ignore the procedures and consult a doctor in a timely manner, then healing will occur in about 2 weeks (this period can be extended up to 3-4 weeks).

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

If the navel area turns red, swells, an unpleasant odor or purulent, watery, bloody discharge is detected, then you should definitely consult a doctor: perhaps the healing mechanism has been disturbed and additional treatment will be required. [2]

Diseases of the umbilical wound

Inflammatory processes in the umbilical wound are called omphalitis. Such processes can proceed according to different pathological mechanisms, therefore they are divided into several types: it is catarrhal, necrotic and phlegmonous omphalitis. [3]

On average, normal epithelialization of the navel in a baby occurs within a couple of weeks. If we talk about the introduction of infection, then it can occur during the immediate postpartum treatment of the umbilical cord residue, or (most often) during subsequent home care. [4]

• Catarrhal omphalitis of the umbilical wound is accompanied by the appearance of "wet" secretions - this is a serous or serous-purulent liquid, 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” state causes the formation of granulations - this is the so-called “umbilical wound fungus”: we will talk about it in more detail below. With further proper care and treatment, the navel heals for several weeks. Therapeutic measures usually consist of frequent treatments with hydrogen peroxide, with the possible connection of other external antibacterial drugs. Ultraviolet irradiation of the wound surface is also recommended.
• Phlegmonous, or purulent inflammation of the umbilical wound proceeds with the transition of the inflammatory reaction to the skin and subcutaneous layer in the umbilical zone. There is a release of purulent secretion, swelling and redness of the umbilical wound, increased 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 paraumbilical vessels are affected: they become noticeable and can be traced in the form of strands in the upper and lower parts of the umbilical zone. The umbilical wound suppurates, the general well-being of the baby is disturbed: apathy, lethargy, loss of appetite, frequent regurgitation are observed. As a result, the body weight of the child also suffers. In such a situation, the pediatrician prescribes treatment. The wound is sequentially treated several times a day with hydrogen peroxide, alcohol with a concentration of 70%, a solution of potassium permanganate or brilliant green. With severe suppuration, apply napkins soaked in a hypertonic solution of sodium chloride, magnesium sulfate. The use of antibacterial agents, staphylococcal bacteriophage is recommended. From physiotherapeutic procedures, ultraviolet irradiation is practiced. With unsatisfactory general health of the infant, general therapy with semi-synthetic penicillin antibiotics, cephalosporin or aminoglycoside drugs is indicated. Treatment is carried out against the background of the prevention of dysbacteriosis.
• Necrotic inflammation, fortunately, is diagnosed infrequently - mainly with critically weak immunity in a baby. Pathology is characterized by the development of necrosis processes in the tissues: the skin acquires a purple-bluish tint, with further rejection and eventration of the internal organs. Pathology requires urgent intervention of the surgeon.

Fungus umbilical wound

Fungus is otherwise called a granuloma and is a process of growth of granulations. The wound at the same time takes the form of a cluster of beads, or grape berries. In general, such a phenomenon is not dangerous, but it can cause a lot of discomfort to the baby: the navel can get wet, bleed, and heal for a long time.

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

Self-medication with fungus in a baby 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 this step is ignored, then 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 a baby's life. Think about what you did wrong. Perhaps the crusts were removed too early, preventing them from getting wet, or they used too powerful antiseptics for processing, not recommended by the pediatrician. Perhaps the procedures were performed 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 the 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 be worried in such cases:

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

In these cases, you need to urgently consult a doctor.

The umbilical wound gets wet: the actions of the parents

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 the further development of the painful process. Parents should do the following:

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

As an antiseptic, Chlorophyllipt (liquid alcohol solution or spray, but not an oily solution), a fresh solution of furacilin, Baneocin can be used. If you don’t have these tools at hand, then you can use a solution of brilliant green or a weak solution of potassium permanganate. The treatment is repeated twice a day.

Do not use iodine for processing. In addition, there are other restrictions:

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

If any discharge from the umbilical wound is present, the infant should be changed frequently to avoid contact of the wound surface with contaminated clothing. With bathing, it is better to wait: you should not wet the affected area until it heals. For any suspicious moments, it is better to consult a doctor.

Umbilical wound treatment algorithm

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

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

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

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

As a standard, the procedure is repeated daily after bathing the baby. But in case of discharge or redness, the frequency of treatment is increased to 2 or 3 times a day. In addition, the local pediatrician or nurse should be informed about problems with tightening the umbilical wound.

Treatment of the umbilical wound with a clothespin

The procedures for processing the navel with and without a clothespin are practically the same:

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

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

The only inconvenience can be caused by a diaper: if it does not have a special hole for the navel, then it can touch the clothespin and interfere with normal healing. In such a situation, it is recommended to bend its front edge so that the navel, together with the clothespin, remains 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 moved apart with the thumb and forefinger. If this is not done, then the internal crusts can stagnate, and the wound can 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 on alcohol - it is very convenient to use a spray bottle (also sold at a pharmacy).

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

• mother washes her hands, wipes them;
• puts the child on the changing table, slightly expands the umbilical ring with the thumb and forefinger (this allows you to examine the wound for pus and other problems);
• splashes Chlorophyllipt directly into the wound;
• Removes crusts and droplets of the drug with a clean gauze cloth, then again sprinkles quite a bit of the solution.

Treatment with Chlorophyllipt 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 fall into the wound and do not stick to it. With no less success, it is allowed to use cotton pads.

Chlorophyllipt perfectly fights infection and promotes tissue healing. But this drug has one important drawback: it can cause allergies if the body has a tendency to such reactions. Therefore, before applying the remedy, you must first test it on a small area of \u200b\u200bthe 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, it perfectly heals weeping and festering wounds, and prevents the development of skin infections.

But Baneocin, in addition to positive properties, also has an impressive number 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 (found with prolonged use of the drug);
• dry skin.

These side effects may develop if the drug is used for more than seven days in a row. With a shorter term of use, negative signs are not observed.

How to properly apply Baneocin on the umbilical wound:

• The wound is treated with hydrogen peroxide - in a very small amount, after which the navel is blotted with a napkin.
• Sprinkle the navel with Baneocin.
• If the navel becomes wet, or there is a 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 advise using such a strong remedy without special need: Baneocin is indicated if an unpleasant odor is felt from the umbilical wound, or weeping or purulent discharge has appeared.

Streptocide

If the navel heals for a long time, or gets wet, then the time-tested drug Streptocid can be connected to the treatment of the wound. This is a well-known sulfanilamide preparation, which has a bacteriostatic effect against streptococci, meningococci, pneumococci, gonococci and Escherichia coli.

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

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

Streptocid is poured into the wound twice a day (can be used as a single agent, or alternated with other external medicines).

As a rule, with such treatment, the navel heals within 2-3 days.

Alcohol for the treatment of the umbilical wound

The umbilical wound is best treated 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 enough. A more concentrated drug can unnecessarily dry the baby's skin, which in the future can cause bleeding and prolonged healing of the wound process.

We must not forget that, in addition to the antiseptic and disinfectant action, medical alcohol also has a local irritating and tannic effect. Experts do not advise using 96% alcohol for skin treatment in children under 14 years of age.

The use of alcohol tinctures is allowed (again, with a concentration of not more than 70%). It can be tinctures of calendula, chamomile, propolis - naturally, the treatment is carried out provided that the baby does not have an allergic reaction.

Umbilical wound care

As the umbilical wound heals, measures must be taken to prevent its infection. [9]What are these measures:

• if you are bathing a baby, then boiled water should be used for the bath, or a little potassium permanganate should be added to it (until the water turns pale pink);
• it is useful to bathe a baby in a bath with the addition of decoctions of sage, chamomile, string;
• children's clothes that come into direct contact with the umbilical wound should be changed often, several times a day;
• the umbilical wound should not be covered with a diaper (it must be tucked up, or special varieties with a hole in the navel area should be used), it should not be sealed with a plaster or bandaged;
• the child’s clothes in contact with the navel should be carefully ironed with a hot iron after washing;
• the procedure for processing 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

Regarding bathing a baby with an unhealed umbilical wound, there are several opinions of doctors. Some of the experts recommend avoiding water procedures until the wound is healed, practicing only regular rubbing of the baby's skin with a wet diaper. Other doctors advise bathing the child 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 permanganate solution and wiping with a wet diaper. Perhaps they are right: it is better to wait 5-7 days than to try to eliminate healing complications later.

After any water procedure - whether it's bathing or wiping - it is necessary to process the navel.

As soon as the umbilical wound in the newborn heals, in the absence of complications, you can easily bathe the baby in ordinary tap water. If desired, it is allowed to add anti-inflammatory herbal decoctions to the bath, or a little manganese powder.