What is the cause of umbilical (navel) drainage?

From the Guidelines

Umbilical drainage is most commonly caused by bacterial colonization of the umbilical cord, with Staphylococcus aureus being the most frequently reported organism, and can lead to omphalitis, a potentially serious infection. The cause of umbilical drainage can be attributed to various factors, including:

• Bacterial colonization of the umbilical cord, which can occur from the mother's birth canal or from nonsterile hands of individuals assisting with delivery 1
• Contamination of the umbilical separation site by Clostridium tetani, which can lead to tetanus in neonates, particularly in countries with limited resources 1
• Other common pathogens, such as group A and group B Streptococci and Gram-negative bacilli, including Escherichia coli, Klebsiella species, and Pseudomonas species, can also contribute to umbilical drainage 1

To manage umbilical drainage, it is essential to prioritize proper umbilical cord care, which includes:

• Gentle cleansing with warm water and mild soap, followed by thorough drying
• Applying topical antibiotics, such as mupirocin or bacitracin, twice daily after cleaning if the drainage becomes purulent or has a foul odor
• Avoiding covering the stump with a diaper and keeping the area dry to promote air circulation
• Folding diapers below the stump to prevent bacterial growth and allow natural separation to occur through controlled inflammation and drying

In low-income communities, the application of 4% chlorhexidine solution or gel to the umbilical cord stump within 24 hours after birth has been shown to significantly reduce both omphalitis and neonatal mortality 1. However, in settings with low neonatal mortality, dry cord care is recommended by the World Health Organization (WHO) 1.

Severe cases of umbilical drainage, characterized by spreading redness, swelling, or fever, require immediate medical attention, as systemic antibiotics may be necessary to prevent serious complications, such as sepsis or necrotizing fasciitis 1.

From the Research

Causes of Umbilical Drainage

• Umbilical drainage, also known as omphalitis, can be caused by bacterial infections, with the most commonly isolated species being Escherichia coli, Klebsiella pneumoniae, Citrobacter freundii, and Enterobacter spp. 2
• The use of dry cord care, as opposed to antibacterial agents, may increase the risk of umbilical cord colonization with certain bacteria, such as Escherichia coli, coagulase-negative staphylococci, Staphylococcus aureus, and group B streptococci 3
• Delayed initiation of breastfeeding has been associated with an increased risk of omphalitis 2

Risk Factors for Omphalitis

• Vaginal colonization with potentially pathogenic bacteria during birth does not appear to predict omphalitis 2
• The incidence of omphalitis can be reduced through the use of antiseptics, such as chlorhexidine, on the umbilical cord stump 4, 5
• Omphalitis remains a clinical issue, and cessation of bacteriocidal care of the umbilical stump must be accompanied by vigilant attention to the signs and symptoms of omphalitis 3

Prevention and Treatment of Omphalitis

• Topical application of chlorhexidine to the umbilical cord has been shown to reduce neonatal mortality and omphalitis in community and primary care settings in developing countries 4, 5
• The use of other antiseptics, such as triple dye and alcohol, may also be effective in reducing bacterial colonization and omphalitis, but the evidence is less clear 3, 5