Umbilical Cord Infections

The umbilical cord is the lifeline between the baby and mother during pregnancy.  

After a baby is born, a healthcare provider will clamp and cut the umbilical cord.  This will leave behind a small umbilical stump, which typically dries up and falls off within the first few weeks of the baby’s life.

Due to their immature immune system, newborn infants are more susceptible to infections. After the cord is cut, it becomes vulnerable to colonization by various bacteria, potentially leading to an umbilical cord infection.

The risk of these infections increases when a woman’s amniotic membrane ruptures 2 hours or more before delivery.  When the amniotic sac ruptures, it exposes the baby and the umbilical cord to bacteria that can enter the uterus via the vagina.  Similarly, the risk of a cord infection increases if the mother has a urinary tract or vaginal infection.  As a result, healthcare providers will closely monitor these pregnancies to detect signs of infections and take appropriate measures to prevent or manage any potential complications related to umbilical cord infections.  In some cases, immediate delivery may be recommended to reduce the risk of infection for both the baby and the mother.

Types

Several types of umbilical cord infections can occur in neonates (babies less than a month old):

• An umbilical Abscess is a pus collection within or around the cord. When bacteria enter the cord stump or surrounding area, the body’s immune system response leads to the formation of pus, which consists of dead white blood cells, bacteria, and tissue debris.  Treatment typically involves incision and drainage of the abscess; sometimes, antibiotics may be prescribed.
• Umbilical Cellulitis is an infection confined to the subcutaneous tissue around the umbilical stump. The subcutaneous tissue is a sort of “cushion” and is the layer of tissue located beneath the skin and above the deeper layers of muscle and organs.  Treatment typically involves oral or intravenous antibiotics to target the bacteria and reduce inflammation.
• Umbilical Granuloma is not an infection but an overgrowth of tissue that can form once the umbilical cord has fallen off.  It occurs when the tissue at the site of the cord stump fails to heal properly, resulting in a small, fleshy, pinkish, or reddish ball of moist tissue.  Bacteria can colonize the granuloma, resulting in a local infection.   These granulomas are more likely to develop if it takes longer than two weeks for the cord to fall off.  Umbilical granulomas are usually harmless and often treated with cauterization and an application of silver nitrate to dry out the tissue.
• Omphalitis is a rare but serious medical condition that occurs when bacterial growth in the umbilical stump continues to develop, untreated, for days after birth.  Omphalitis can quickly progress and result in life-threatening complications if not promptly diagnosed and managed.
• Necrotizing Fasciitis is commonly called the “flesh-eating bacteria” and is extremely rare. This aggressive and potentially life-threatening infection multiplies rapidly and releases toxins that cause extensive tissue damage and disrupt blood flow, leading to tissue death.  Treatment usually involves the surgical removal of the dead tissue to stop the infection’s progression and intravenous antibiotics to target the causative bacteria. Necrotizing fasciitis is considered a medical emergency and requires immediate medical attention.

Signs of an Infected Umbilical Stump

If any of these signs are observed in a newborn, it is important to consult a healthcare professional promptly to ensure proper evaluation and appropriate management:

1. Increased bleeding from the cord.
2. Discharge or pus coming from the cord.
3. A foul-smelling odor coming from the cord area.
4. Redness around the belly button or the base of the cord stump.
5. A rash or blisters on or around the cord stump.
6. Elevated body temperature or the baby develops a fever.
7. A baby appears unusually fussy or tired.
8. Sudden changes in the baby’s behavior or feeding patterns.

Consult with your Doctor

Any infection in a newborn should be taken seriously, and you should consult with your doctor immediately.  If your doctor is unavailable, go to the nearest emergency room or urgent care center.  Do not delay!

Prompt medical attention and close follow-ups are important in effectively managing umbilical cord infections and minimizing complications.

Consequences of an Umbilical Cord Infection

Umbilical cord infections are serious infections that can spread rapidly, leading to severe consequences.

As the bacteria from the umbilical stump multiplies, it can reach the blood vessels and cause inflammation and damage to the vessel walls.  Once the bacteria reaches the bloodstream, it can spread throughout the body to various organs and tissues.  This usually results in a systemic infection[1].   Systemic infections can be severe and potentially cause significant harm to the body.  The bacteria can multiply and release toxins, leading to widespread inflammation and damage to tissues and organs.  This can result in a range of systemic symptoms, such as fever, chills, fatigue, organ dysfunction, and, in severe cases, sepsis, a life-threatening disorder.

Prevention

Early recognition is key to preventing an umbilical cord infection.  Minimize the risk of complications associated with umbilical cord infections can be achieved through the following strategies:

1. Wash your hands before touching the umbilical cord.
2. Avoiding the use of unclean instruments to cut the cord.
3. Educating parents on appropriate cord care techniques before discharge from the hospital.
4. Avoid picking or pulling off the umbilical cord.
5. Refraining from using powders or other home remedies on the cord.
6. Following the pediatrician’s advice on how to keep the cord clean.
7. Roll down diapers so they do not rub against the cord.
8. Pay attention to changes in the shape or appearance of the umbilical cord stump.
9. The hospital and pediatrician’s office should provide information regarding recognizing the signs of cord inflammation and instructions to seek immediate medical attention if needed.

Dry Air Cord Care

A few years ago, hospitals applied an antiseptic to the baby’s umbilical cord stump and covered it with sterile gauze.  Today, the common practice is to let the cord air dry.  Air drying is reported as a safe and effective way to help prevent cord infection in healthy babies[2].  Here are some tips for dry air caring for the umbilical cord stump:

1. Wash your hands thoroughly before touching the cord.
2. Allow the umbilical cord stump to remain uncovered by folding down the top edge of the diaper to keep it away from the stump. This will help the area stay dry.
3. Until the stump falls off, avoid immersing your baby in water, such as in a tub or swimming pool. Instead, give sponge baths to keep the stump dry.
4. Monitor the stump for signs of infection, such as increased redness, swelling, discharge, or a foul odor. If you notice any of these signs, contact your healthcare provider immediately.
5. Handle your baby’s diaper changes carefully to avoid disturbing the stump. Fold the diaper below the stump, leaving it exposed.
6. Dress your baby in loose-fitting, breathable clothing to prevent moisture accumulation around the stump.
7. Avoid using powders, ointments, or creams on the stump, as they can trap moisture and hinder drying. The aim is to keep it as dry as possible.
8. It may take a week or two to dry up and fall off naturally. Be patient and allow the healing process to take its course.

In conclusion, early recognition and treatment of umbilical cord infections are essential to prevent the serious complications of this disease. 

One study[3] reported that 90% of cord infections occurred in the 1^st week of life.  These infections account for approximately 36% of mortality worldwide in neonates.[4]  Omphalitis has been reported as having a mortality rate of 7–15%[5].  However, this rare condition affects less than 1% of newborn babies in developed nations. 

It is essential to be vigilant about umbilical cord care and regularly monitor the stump for signs of an infection.  Seek prompt medical attention if any concerning symptoms arise.  Early diagnosis and appropriate treatment can significantly reduce the risk of complications and potentially life-threatening outcomes associated with severe cord infections.

Always consult a healthcare professional to evaluate and manage any suspected umbilical cord infection in a newborn.

Author: Karen Synesiou, Infertility Portal, Inc.