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Thursday, April 24, 2014
Newborn and Infant Care
Umbilical granuloma question
At 3 months of age, my daughter had an irritated belly button. The skin around it was raw, it was discharging some liquid. Her doctor continued to clean it, told us just to keep cleaning it w/alcohol. From 5 months to now 8 months, we`ve tried all kinds of ointments, steroid creams, and oral antibiotics. Her culture came back with 2 different types of bacteria, and it was in fact resistant to any medication. Last month, we were referred to a pediatric surgeon who told us our daughter had an umbilical granuloma, and she underwent surgery to have it removed. One month after surgery, she still has a red, irritated belly button, and it is still discharging a clear odorous liquid. Her pediatric surgeon doesn`t know what this is!! It looks like we`re back where we started and her belly button looks the same as it did when I first noticed her irritated skin,etc. at 2 months......Any ideas what this could be?
Your child's doctors have pursued the most common causes of umbilical drainage. Other likely problems whose hallmark sign is umbilical drainage stem from a problem with the urachus (yur-a-kus). Before the baby is born, this tube connects the bladder to the umbilicus. The top part of it becomes the bladder and the lower part becomes the urethra that carries urine from the bladder to outside the body. Typically it becomes a fibrous cord between 4-5 months gestation. However, it is not all that uncommon for a small opening to remain allowing urine to leak out of the umbilicus and irritating the skin on the abdomen. It also increases the risk for bladder infections in the baby.
The best way to diagnose it is with a computed tomography scan or CT scan of the abdomen. Other diagnostic tests may include an abdominal ultrasound and a voiding cystourethrogram or VCUG for short. All of these tests aim to provide images of the baby's anatomy so that the surgeon understands the extent of any problems prior to going to surgery.
The problem requires a surgical correction that is usually uncomplicated and successful. Consultation with a urologist and/or a gastrointestinal specialist at a major children's Medical Center may be helpful in identifying any problem involving the urinary tract system. Major Children's Medical centers in Ohio are in Columbus, Cincinnati and Cleveland. I hope this information helps.
Mary M Gottesman, PhD, RN, CPNP, FAAN
Professor of Clinical Nursing
College of Nursing
The Ohio State University