From the Research
The best investigation of umbilical discharge is a comprehensive approach that includes a thorough physical examination, swab cultures, and ultrasound examination, as recommended by the most recent study 1. This approach allows for the identification of potential bacterial pathogens and the evaluation of underlying anomalies such as patent urachus, omphalomesenteric duct remnants, or abscess formation. The following steps should be taken:
- Perform a thorough physical examination to assess the characteristics of the discharge, including color, consistency, and odor.
- Obtain swab cultures to identify potential bacterial pathogens, particularly looking for Staphylococcus aureus, Streptococcus species, and gram-negative organisms.
- Use ultrasound examination to evaluate for underlying anomalies, as it is essential for guiding the child's management and preventing unnecessary surgical procedures 2.
- In cases of persistent or concerning discharge, consider using MRI to better visualize the umbilical structures and their connections to intra-abdominal organs.
- Perform blood tests, including complete blood count and C-reactive protein, to assess for systemic infection.
- If granulation tissue is present, consider applying silver nitrate, as it may be therapeutic and diagnostic, with resolution suggesting a simple granuloma.
- For recurrent or persistent discharge despite treatment, surgical exploration may be necessary for definitive diagnosis and management, as recommended by 1. It is crucial to note that early investigation is essential, as umbilical discharge can indicate serious underlying conditions requiring prompt intervention, particularly in neonates and infants where congenital anomalies are more common 3, 4, 5.