Cord care of the newborn

During pregnancy, the umbilical cord connects the baby with the placenta (a structure in the womb that develops during pregnancy to nourish the baby and help him or her discard waste). The blood vessels in the umbilical cord carry nourishment from the mother to the baby. At birth, the umbilical cord is detached from the baby because it no longer serves a purpose. What remains is a small stump at the baby's navel, typically about an inch long. The stump needs daily care until it falls off, usually within one to three weeks. In some cases, such as when a baby is born with defective white blood cells, it may take longer.


Hospital care
Nursery personnel may put a clamp on the umbilical stump. The clamp is typically left in place for about 24 hours to help form a protective crust that prevents bleeding. Don't use ointments once the clamp is removed -- they delay healing by keeping the area moist.

Home care
A small amount of bleeding the first few days is normal. As the protective crust forms, moving the cord may cause tiny cracks in the drying Wharton's jelly (a gel-like substance made of primitive connective tissue of the umbilical cord). If the bleeding continues or increases, call your baby's doctor.
The doctor will probably recommend giving your baby sponge baths until the cord falls off. New parents commonly dab the umbilical stump with a sterile gauze pad or cotton swab dipped in rubbing alcohol or an alcohol wipe after baths and diaper changes. However, a recent study found that using rubbing alcohol may kill off all bacteria -- even the "good" bacteria that help the cord dry and fall off. In the study, cords that weren't treated with rubbing alcohol fell off in an average of eight days, while the cords treated with rubbing alcohol fell off in 10 days. There were no infections reported in either group. Many newborn nurseries now recommend no special treatment for cord care.

If your baby's doctor recommends using rubbing alcohol, remember to gently pull up the umbilical stump and swab the base. If the rubbing alcohol contacts any of your baby's surrounding skin, gently sponge it off. It's important to be gentle. Rarely, too much cleaning can hamper the natural process of the stump falling off by itself.

Keep the umbilical stump dry by folding the top of your baby's diaper so it stays below the stump. Fold your baby's undershirt above the stump. Because wet or soiled diapers may delay healing, it's important to change your baby's diaper often. Don't cover the area with a dressing or bandage, which may also delay healing.

Carefully inspect the area for signs of infection, including:

foul-smelling drainage
red skin at the base of the stump or around the naval
warmth to the touch
pimples, blisters or red streaks around the navel
crying when the cord or surrounding skin is touched
If you suspect an infection or your baby has a fever (100.4°F rectally or 99°F under the armpit), call your baby's doctor.

After the cord falls off, the navel area is usually healed. Occasionally, however, there may be a small pink area that oozes a little blood. If this happens, it's important to continue to keep the area clean and dry. It should heal on its own within a few days.

You may see a small protrusion of umbilical tissue in the navel area when your baby cries or strains. This is known as a hernia, a condition that usually disappears on its own by about age 6 or 7. It's important to discuss the condition with your child's doctor during routine well-child visits, but treatment isn't typically necessary. However, if your child begins to vomit, seems irritable or has a distended abdomen, call the doctor immediately. These may be symptoms of a rare condition known as umbilical hernia incarceration, in which the protruding tissue becomes trapped between layers of muscle.


Considerations
Although infections are rare, keeping the area clean and intact is a helpful preventive measure. If the umbilical stump hasn't fallen off after three weeks, contact your baby's doctor.
Sometimes, a small growth known as an umbilical granuloma develops on the stump. This growth is typically dull, moist, and red or pink in color. It's usually associated with persistent discharge. If your baby develops an umbilical granuloma, call the doctor. It may need to be treated with silver nitrate, a drying medication.