From the Guidelines
A palpable cord in a newborn is typically related to the umbilical cord stump, and its care is crucial to prevent infection and promote healing. The management of the umbilical cord is an essential part of newborn care, as highlighted in the study by Stewart et al. 1. According to this study, the American Academy of Pediatrics provides guidelines for umbilical cord care in newborn infants.
When considering the care of the umbilical cord, it's essential to note that delayed cord clamping for at least 1 minute after term delivery has been shown to decrease anemia in infancy and improve neurodevelopmental outcomes, as discussed in the guidelines for intraoperative care in cesarean delivery by the Enhanced Recovery After Surgery Society 1. However, the primary concern with a palpable cord in the context of newborn care is not typically about the timing of cord clamping but rather about the signs of potential infection or other complications at the umbilical stump.
Key points to consider in the care of a palpable cord in a newborn include:
- Monitoring for signs of infection such as redness, swelling, or discharge around the umbilical stump
- Keeping the umbilical stump clean and dry to promote healing
- Avoiding the use of topical antimicrobial agents unless specifically recommended by a healthcare provider, as they may not be necessary and could potentially delay healing
The most appropriate recommendation for a palpable cord in a newborn is to follow the guidelines for umbilical cord care as outlined by the American Academy of Pediatrics, which emphasizes the importance of keeping the cord stump clean and dry. This approach is supported by the study by Stewart et al. 1, which provides evidence-based recommendations for umbilical cord care in newborn infants. It's also crucial to be aware of the potential benefits and risks associated with delayed cord clamping, as discussed in the guidelines by the Enhanced Recovery After Surgery Society 1, although this is more relevant to the immediate post-delivery period rather than the subsequent care of a palpable cord.
From the Research
Palpable Cord
- A palpable cord can be associated with various conditions, including soft-tissue palpable lesions and umbilical cord prolapse.
- In the context of soft-tissue palpable lesions, ultrasound (US) imaging is often used as the first imaging option for evaluation 2, 3.
- For umbilical cord prolapse, a palpable or visible cord is a key diagnostic feature, and prompt delivery is usually necessary to prevent severe fetal morbidity and mortality 4.
- In cases of lipomatous soft-tissue tumors, magnetic resonance imaging (MRI) is recommended for masses that are deep to fascia or larger than 5 cm in subcutaneous tissue to guide the need for biopsy or excision 5, 6.
Diagnostic Approaches
- Ultrasound imaging is an ideal triaging tool for superficial soft tissue masses, allowing for the identification of benign lesions such as superficial lipomas and ganglia 3.
- For indeterminate cases or those suspected to be malignant, second-level options such as MRI, percutaneous fine-needle aspiration or biopsy, and surgical-excision biopsy may be necessary 2.
- In cases of lipomatous soft-tissue tumors, understanding the diagnostic MRI appearance can help avoid unplanned excisions of sarcomas 6.
Management
- The management of suspicious soft tissue tumors requires careful planning by a multidisciplinary team involving specialized surgeons and pathologists at a tumor center 3.
- For umbilical cord prolapse, prompt delivery is usually necessary, and the fetal presenting part should be elevated off the cord either manually or by filling the bladder while awaiting delivery 4.