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Newborn and Infant Care

Umbilical granuloma and staph infect

09/20/2006

Question:

My almost 4 week old has an umbilical granuloma & also 2 positive cultures, 1 for staph. My dr has used silver nitrate x 2 different occasions & she is being treated with antibiotics for the infection. The skin around her belly button is raw appearing & is still bleeding some, especially when cleaning with alcohol pad. Is this normal and how many more times can you use the silver nitrate. Also, any more advice you have regarding this would be great. She has another appt in 2 days...so, the sooner, the better if you can respond. Thanks a lot.

Answer:

Umbilical granulomas are small pieces of tissue that remain on your baby's belly button after the umbilical cord has fallen off. They are composed of capillaries (the smallest, finest blood vessels) and fibroblasts (cells that produce the structural fibers and ground substance of connective tissues). Granulomas are normally pink in color and may be small, roundish masses close to the skin or round masses on the end of a short stalk. Both types produce sticky mucus that can irritate the skin. They may be confused with umbilical polyps that are bright red. Polyps have many different types of tissue in them than do granulomas.

Umbilical granulomas occur once in every 500 births. We do not know why some babies develop umbilical granulomas and other do not. They occur regardless of good umbilical care practices. There is also no known way to prevent their occurrence.

In terms of treatment, umbilical granulomas on a stalk respond best to being double tied off with suture thread. Otherwise, silver nitrate is the most common treatment. Several applications of silver nitrate may be needed. Silver nitrate burns the granuloma tissue, which has no pain fibers, so it is painless, unless it leaks onto normal skin, where it can create a painful burn. If several applications does not resolve the problem, then surgical removal is necessary. Polyps require surgical removal because they do not respond to silver nitrate treatment. Surgical removal is usually without any complications and is a minor, easily performed surgery.

The most common agent of skin infections in newborns is Staphylococcus aureus. It is not surprising that the skin around the umbilicus became infected given the friction from clothing and diapers, irritation from mucus, and normally low newborn immunity. So it was a good thing your baby's doctor cultured the skin and the baby is getting antibiotics.

What concerns me is that you describe the skin as raw and red and that you are applying alcohol to it. This must be very painful for the baby. Alcohol is also not a great skin cleanser. I would suggest that you discuss using Hibiclens (chlorhexidine) in place of alcohol with the baby's doctor. Hibiclens binds with Gram positive bacteria, such as Staphylococcus aureus, and kills the bacteria. Hibiclens does not burn. You could place a towel under your baby, make a solution of one part warm water and 2 parts Hibiclens to squirt over the raw skin, let it sit for a minute, then squirt it off with plain warm water, and pat the skin dry. Your baby's doctor may also suggest a protective ointment or cream for the raw skin.

I hope this information helpful and that your baby's skin heals rapidly and without further problems.

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Response by:

Mary M Gottesman, PhD, RN, CPNP, FAAN Mary M Gottesman, PhD, RN, CPNP, FAAN
Professor of Clinical Nursing
College of Nursing
The Ohio State University