From the Guidelines
Bleeding umbilical granuloma in a 6-week-old infant should be treated with silver nitrate application by a healthcare provider, as it is a effective and commonly used method to manage excessive granulation tissue. The treatment typically involves 1-3 applications of silver nitrate (75% concentration) directly to the granuloma, with each application spaced about 2-3 days apart 1. Before application, the surrounding skin should be protected with petroleum jelly to prevent chemical burns. It is essential to note that excessive granulation tissue is vascular, so it bleeds easily and is sometimes painful, as mentioned in the espen practical guideline: home enteral nutrition study 1.
Some key points to consider when treating an umbilical granuloma include:
- Keeping the umbilical area clean and dry between treatments
- Watching for signs of infection such as redness extending beyond the umbilicus, purulent discharge, fever, or increasing pain
- Using alternative treatments such as applying table salt to the granuloma twice daily for 3 days, or using triple dye or alcoholic wipes with each diaper change, if silver nitrate application is not effective
- Considering surgical removal if conservative measures fail after 2-3 weeks
It is crucial to prioritize the treatment of umbilical granuloma to prevent continued drainage and potential infection, as it can be a common complication in infants 1. The espen practical guideline: home enteral nutrition study provides valuable insights into the management of excessive granulation tissue, which can be applied to the treatment of umbilical granuloma in infants 1.
From the Research
Umbilical Granuloma in Infants
- Umbilical granuloma is a common condition in infants, characterized by an overgrowth of granulation tissue that persists at the base of the umbilical cord after its separation 2.
- The condition can cause inflammation, drainage, and bleeding, and may persist for more than 2 months if left untreated 3.
Treatment Options
- Various treatment options are available for umbilical granuloma, including:
- Silver nitrate application: a common treatment, but may cause burns if spilled onto surrounding tissues 3.
- Excision and application of absorbable hemostatic materials: a simple, safe, and inexpensive technique with no reported complications 3.
- Topical steroids, ethanol wipes, electrocautery, cryocautery, copper sulphate, and common salt: various studies have reported the effectiveness of these treatments, with common salt achieving resolution in >90% of cases in some studies 4.
- Surgical intervention: may be necessary in cases of underlying congenital abnormalities, such as omphalomesenteric duct cyst 5.
Diagnosis and Investigation
- Persistent umbilical discharge or abnormal discoloration around the umbilicus should be further investigated to rule out underlying congenital abnormalities 5.
- Histopathological examination can help distinguish umbilical granuloma from other umbilical anomalies 2.
Management and Prevention
- A systematic review of randomized controlled trials found that various interventions, including silver nitrate, topical steroids, and common salt, can be effective in treating umbilical granuloma, but salt application appears to be simple and effective with minimal complications 4.
- A protocol for a systematic review and meta-analysis of randomized controlled trials aims to investigate the safety and efficacy of all interventions for treating umbilical granuloma in neonates, including silver nitrate cauterisation, dry care, and surgical excision 6.