What is the cause of umbilical (navel) drainage?

From the Guidelines

Umbilical drainage is best managed by keeping the area clean and dry while allowing it to heal naturally, as supported by the American Academy of Pediatrics guidelines 1. To manage umbilical drainage, it is essential to clean the area with water and mild soap during diaper changes, then thoroughly dry it.

• Avoid covering the stump with a diaper to promote air circulation, which helps prevent bacterial colonization and subsequent infection.
• The umbilical cord provides an ideal medium for bacterial growth, with sources of potentially pathogenic bacteria including the mother's birth canal and local bacterial sources at the site of delivery 1.
• Staphylococcus aureus is the most frequently reported organism, but other common pathogens include group A and group B Streptococci and Gram-negative bacilli, highlighting the importance of proper hygiene and care. If you notice yellow or greenish drainage with a foul odor, redness extending beyond the base, or if the infant develops a fever, seek medical attention immediately as these may indicate infection (omphalitis) 1. For treatment of infected umbilical areas, topical antibiotics like mupirocin or systemic antibiotics such as amoxicillin-clavulanate may be prescribed depending on severity, as these have been shown to be effective in managing bacterial infections.
• Never apply alcohol, hydrogen peroxide, or other harsh substances to the umbilical area as these can delay healing and cause irritation, instead opting for gentle cleaning and drying techniques. The umbilical cord typically separates within 7-14 days after birth, and some drainage during this process is normal, but it is crucial to monitor for signs of infection and seek medical attention if necessary, as tetanus in neonates can result from umbilical cord colonization, particularly in countries with limited resources 1.

From the Research

Umbilical Drainage

• Umbilical cord care is crucial in preventing infections and promoting healing in newborns 2, 3, 4, 5, 6
• The umbilical cord is a structure made of blood vessels and connective tissue that connects the baby and placenta in utero, and its care is essential in preventing omphalitis and sepsis 2
• Studies have shown that topical application of chlorhexidine to the umbilical cord reduces neonatal mortality and omphalitis in community and primary care settings in developing countries 2
• However, in hospital settings in developed countries, there is insufficient evidence to support the application of an antiseptic to the umbilical cord compared with dry cord care 2, 6
• Dry cord care is recommended in countries with adequate obstetric care and low neonatal mortality rate, as it provides the fastest and safest umbilical cord healing 3, 4
• Other cord-care regimens, such as salicylic sugar powder and green clay powder, have been shown to be effective in promoting early cord detachment and reducing omphalitis 6
• Topical antimicrobials, such as antibiotics and disinfectants, applied to the umbilical cord stump have been shown to protect against neonatal tetanus 5
• Hand washing by the delivery attendant and prior maternal immunization with tetanus toxoid are also important in preventing neonatal tetanus 5

Umbilical Cord Care Regimens

• Chlorhexidine: reduces neonatal mortality and omphalitis in community and primary care settings in developing countries 2
• Dry cord care: recommended in countries with adequate obstetric care and low neonatal mortality rate 3, 4
• Salicylic sugar powder: promotes early cord detachment and reduces omphalitis 6
• Green clay powder: promotes early cord detachment and reduces omphalitis 6
• Topical antimicrobials: protects against neonatal tetanus 5
• Antibiotics and disinfectants: protects against neonatal tetanus 5

Outcomes

• Cord separation time: varies depending on the cord-care regimen used 2, 6
• Omphalitis: reduced with the use of chlorhexidine, salicylic sugar powder, and green clay powder 2, 6
• Sepsis: none of the newborns developed sepsis in the study by 6
• Death: none of the newborns died in the study by 6
• Cord bleeding: higher with the use of salicylic sugar powder 6
• Compliance and satisfaction: varies depending on the cord-care regimen used 6