From the Guidelines
Prolonged attachment of the umbilical cord stump beyond 3 weeks is considered delayed separation and requires medical attention. The most common cause of delayed separation is an underlying infection, which may require topical or systemic antibiotics depending on severity 1. Other potential causes include immune deficiencies, particularly leukocyte adhesion deficiency, which affects white blood cell function. In some cases, a granuloma may form at the base of the cord, which can be treated with silver nitrate application by a healthcare provider. Never attempt to pull off the stump, as this can cause bleeding and infection.
The management of the umbilical cord is crucial in preventing infant anaemia, especially in resource-poor settings 1. Delaying cord clamping for at least 1 minute is recommended for newborn infants not requiring resuscitation, as it can help reduce iron deficiency and improve child survival 1. However, the optimal timing of cord clamping may vary depending on the state of the infant, and a delay of at least 60 seconds with the infant placed between the mother's legs is recommended when a longer delay is not possible 1.
Some key points to consider in the management of prolonged umbilical cord attachment include:
- Keeping the cord clean and dry to prevent infection
- Seeking medical evaluation if the stump remains attached beyond 3 weeks
- Avoiding attempts to pull off the stump, as this can cause bleeding and infection
- Considering underlying infections or immune deficiencies as potential causes of delayed separation
- Using silver nitrate application to treat granulomas that may form at the base of the cord.
It is essential to prioritize the safety of both mothers and infants in the management of the umbilical cord, and to consider the potential benefits of delayed cord clamping in reducing infant anaemia and improving child survival 1.
From the Research
Prolonged Attachment of Umbilical Cord Stump
- The prolonged attachment of the umbilical cord stump can be influenced by the type of cord care used 2, 3.
- A study comparing topical human milk, povidone-iodine, and dry care found that babies in the dry care or topical human milk group had shorter cord separation times than those in the povidone-iodine group 2.
- Another study found that alcohol application was significantly associated with longer cord separation times (MD = 1.93 days, 95% CI: 0.80,3.06) compared to dry cord care 3.
- The World Health Organisation recommends dry cord care in countries with adequate obstetric care and low neonatal mortality rate 4.
- A study on the efficacy of different umbilical cord care regimens found that povidone-iodine has both good drying and antimicrobial effects in umbilical cord care, but its use has been reported to relate to transient neonatal hypothyroidism 5.
- Topical antimicrobials applied to the umbilical cord stump have been suggested as a new intervention against neonatal tetanus, with the application of antibiotics or disinfectants at delivery being protective against the disease 6.
- Dry cord care is a simple and effective way to shorten cord separation times, particularly in countries with limited resources, but may be associated with an increased risk of foul odor at the cord/surrounding tissues and E-coli colonization 3.