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Neonatal umbilical hernia

  Neonatal umbilical hernia is caused by incomplete or weak closure of the umbilical ring, with abdominal organs protruding outward through the umbilical ring to form under the skin. The size of the hernia sac varies, with a diameter of about 1cm most commonly, and occasionally more than 3-4cm. It is more common in low-birth-weight infants, with 75% of those weighing less than 1500g having an umbilical hernia. The contents of the hernia sac are omentum and part of the small intestine. Generally, the umbilical hernia is more prominent during crying, and it can be pushed back into place with a finger when the child is calm. It is not easy to become incarcerated. The abdominal muscles gradually develop within a year after birth, and most hernia rings gradually narrow and shrink, closing naturally with a good prognosis. Hernia sacs that are large and have not healed by the age of 4 may require surgical repair.

Contents

1. What are the causes of neonatal umbilical hernia
2. What complications can neonatal umbilical hernia lead to
3. What are the typical symptoms of neonatal umbilical hernia
4. How to prevent neonatal umbilical hernia
5. What laboratory tests are needed for neonatal umbilical hernia
6. Diet taboos for neonatal umbilical hernia patients
7. The routine method of Western medicine for treating neonatal umbilical hernia

1. What are the causes of neonatal umbilical hernia

  Umbilical hernia is a common disease in the neonatal period. The disease is more common in girls than in boys. It is characterized by a visible bulging, circular small lump at the umbilicus shortly after birth, which can be as small as a cherry and as large as a walnut. The small lump can disappear when the child is calm or lying down, but it will reappear when the child is sitting, standing, coughing, or crying. Sometimes it can swell up large and tense, and if gently pressed, it can be pushed back, and at the same time, one can hear a 'gurgling' sound, feeling that a stream of gas is squeezed back into the abdomen from the lump. This is umbilical hernia.

  Sometimes newborns cry and are restless, and when the clothes are unbuttoned to see the umbilical hernia protruding, parents think it is the cause of the crying. In fact, children with umbilical hernia generally do not suffer pain, and some may feel discomfort due to local swelling. It is rare for newborns to experience abdominal pain, vomiting, and other symptoms due to excessive swelling of the lump.

  The main reason for the occurrence of umbilical hernia is that the abdominal muscles of neonates are relatively underdeveloped compared to the intestinal muscles. Therefore, the child's belly is always bloated. Especially since the rectus muscles on both sides of the umbilicus have not yet been able to close together, the umbilicus is only covered by a thin scar-like skin, when the abdominal pressure increases significantly, the intestines in the abdominal cavity are pushed out through the umbilical orifice, forming an umbilical hernia.

  With the growth of age, the abdominal muscles gradually become more developed. Generally, the hernia hole can gradually become smaller and close by the age of 1 to 2 years, and later by the age of 3 to 4 years.

2. What complications can neonatal umbilical hernia easily lead to?

  The occurrence of neonatal umbilical hernia is mainly due to the incomplete closure of the peritoneum at the umbilical site after birth, leaving a gap. When the child cries, strains, or has constipation, the increased abdominal pressure causes the abdominal contents (mainly the small intestine and omentum) to protrude through the umbilical defect to the surface.

  If umbilical hernia is not treated in time, it can lead to decreased physical fitness and weakened resistance in infants, affecting their physical health and development. Moreover, if the umbilical hernia cannot be retracted for a long time, causing umbilical hernia incarceration, serious complications such as intestinal ischemia and necrosis may occur, leading to high fever, intestinal necrosis, obstruction, severe pain, and other symptoms. At the same time, for boys, hernia into the scrotum may compress the reproductive nerves, leading to poor development of the reproductive system.

3. What are the typical symptoms of neonatal umbilical hernia?

  Umbilical hernia is commonly known as 'gas navel' and is one of the most common diseases in neonates and infants. In fact, after the umbilical cord is detached, the scar area at the umbilicus, due to the umbilical cord passing through the abdominal wall during the fetal stage, is itself a congenital weak point of the abdominal wall. Moreover, because the abdominal muscles on both sides of the infant have not completely closed along the median line during the infancy period, leaving a defect, it is called 'umbilical ring' in medicine. Therefore, when the intra-abdominal pressure increases due to excessive crying, coughing, diarrhea, and other factors, the abdominal viscera, especially the small intestine, along with the peritoneum and abdominal wall skin, gradually protrude outward from the umbilicus, forming an umbilical hernia.

  The main clinical manifestation of umbilical hernia is the formation of an outwardly protruding mass at the umbilicus, which is often hemispherical or cylindrical in shape. The top of the mass has a small scar, known as the umbilical scar. The diameter of the mass usually does not exceed 4 centimeters, and its characteristic is that it is reducible, meaning that the mass becomes full and enlarged during crying, coughing, or standing, and it feels relatively firm when touched. When the child is calm or the parent presses on the mass with their hand, the mass shrinks or retracts into the abdominal cavity, accompanied by a gurgling bowel sound. After the mass shrinks or is retracted, there is local loose skin creases. The above description is typical of umbilical hernia. Sometimes the mass is quite large, especially when the child is crying and the abdominal pressure increases, the skin on the surface appears shiny and thin, causing some parents to worry that the umbilical hernia might be ruptured. In fact, due to the elasticity and toughness of the skin, there is no possibility of rupture unless caused by trauma. Most parents are very concerned about the size of the umbilical hernia mass, believing that the larger the mass, the more severe the condition. However, doctors pay more attention to the size of the umbilical ring. After the umbilical hernia mass is retracted, you can gently insert your index finger towards the umbilical center. At this time, you can feel a defect in the abdominal wall, which usually only allows the tip of the index finger to pass through (diameter less than 1 centimeter). If the umbilical ring is too large, the healing time will be delayed; if the umbilical ring is small, although it is beneficial for early recovery, it increases the chance of umbilical hernia incarceration.

  Unlike inguinal hernia, the vast majority of umbilical hernia children have no other discomfort, and occasionally have indigestion or intestinal spasm. Only a few may develop hernia incarceration, that is, the herniated intestine is trapped at the umbilical ring. At this time, the herniated mass becomes hard, painful to touch, and difficult to return. The child may cry repeatedly, often vomit, and an abdominal X-ray may show signs of intestinal obstruction. In such cases, parents should take their children to the hospital early to prevent the trapped intestine from developing strangulated necrosis.

  There are also a few children with atypical umbilical hernia, where the protruding mass is above or below the umbilicus, or even on the side of the original umbilicus.

4. How to prevent neonatal umbilical hernia

  The occurrence of neonatal umbilical hernia is mainly due to the incomplete closure of the fascia at the umbilicus after birth, leaving a gap. When the child cries, strains, or has constipation, which increases abdominal pressure, abdominal contents (mainly small intestine and omentum) protrude through the umbilical defect. To prevent the occurrence of this disease, the following measures can be taken:

  1. Strict aseptic operation should be performed when cutting the umbilical cord, and nursing should be strengthened after the umbilical cord is cut. Pay special attention to the phenomenon of umbilical cord bleeding within 24 hours to prevent the cord from being loosened and slipped.

  2. Keep the umbilicus dry and clean, do not let water or urine soak it.

  3. Avoid excessive crying, which can reduce intraperitoneal pressure and prevent the occurrence of umbilical hernia.

5. What kind of laboratory tests are needed for neonatal umbilical hernia

  The most important clinical manifestation is the reducible mass at the umbilicus, especially more obvious during crying in infants. Generally, there are no other symptoms. The diagnosis of this disease is usually based on clinical manifestations and signs, and most cases can be diagnosed without the need for special examinations.

  Generally, it is only necessary to take an abdominal X-ray to understand whether there are signs of intestinal obstruction.

6. Dietary taboos for neonatal umbilical hernia patients

  Since the diet of newborns mainly consists of breast milk or formula milk, there are generally no special dietary restrictions. Pay attention to reasonable feeding, prevent constipation in babies. The diet should be light and easy to digest, eat more vegetables and fruits, and properly match the diet, ensuring adequate nutrition. In addition, patients should also pay attention to avoiding spicy, greasy, and cold foods.

7. Conventional methods of Western medicine for treating neonatal umbilical hernia

  The treatment principles for umbilical hernia in infants and adults are different. For infantile umbilical hernia, regardless of the size of the umbilical ring, early active non-surgical treatment should be adopted in the absence of special circumstances.

  Under normal circumstances, the umbilical ring can continue to narrow within the first 18 months after birth, therefore, there is a possibility of spontaneous healing for infantile umbilical hernia, and most cases do not require any treatment and can heal spontaneously within 2 years. Some statistics show that as age increases, the abdominal muscles become more developed, and the umbilical ring also gradually becomes smaller and closes. According to statistics, 90% close and heal within the first 6 months after birth, and 95% within a year.

  1. Non-surgical Therapy Generally no treatment is required. For individual children who are fond of crying and have frequent incarceration, it can be tried.

  (1) Compression Method

  Use a 9-10cm wide elastic band of appropriate length, sew it into a circular shape; let the baby lie flat, return the umbilical hernia; place the cotton ball (of the same size as the hernia) or the convex side of half a ping pong ball against the umbilical hernia, and fix it with the elastic band.

  (2) Adhesive Plaster Method

  A coin, button, or round wooden piece slightly larger than the umbilical ring can be wrapped in gauze and pressed on the umbilical ring, then fixed with a wide adhesive plaster. The width of the adhesive plaster is 5cm, and the waist and back areas passed by the adhesive plaster can be padded with gauze to prevent skin damage. The operation should first return the hernial contents to the abdominal cavity, making the hernial sac empty, avoiding the protrusion of hernial contents, and facilitating the closure of the umbilical orifice. It is generally changed once every 1-2 weeks and can be used continuously for 3-6 months. Attention should be paid to the care of the local skin, and the umbilical orifice should be reduced each time it is pasted, so that it can gradually heal.

  2. Surgical Therapy During the normal development of infants and young children, umbilical hernias can disappear quickly, and only a few cases require surgical treatment, so there is no need to rush into surgery.

  (1) Indications

  The following conditions may consider surgery:

  ① Large hernia with umbilical orifice diameter over 2cm.

  ② No cure after one year of conservative treatment, age over 2 years.

  ③ Incarcerated, with adhesion between the visceral organs and the hernial sac.

  ④ Abdominal pain, suggesting adhesion of the greater omentum.

  (2) Surgical Method

  Make a semicircular skin incision below the umbilical hernia, separate the subcutaneous tissue, free the hernial sac, and excise the hernial sac from under the umbilical skin, suture the peritoneum, and then suture the margins of the two sides of the rectus sheath with thick silk thread on the central line, suture the skin layer by layer. Cover the incision with sterile gauze and fix it with a wide adhesive plaster to eliminate the tension of the abdominal wall.

  (3) Prevention and Treatment of Postoperative Complications

  Subcutaneous hematoma is a common postoperative complication, which is often caused by local bleeding after the hernial sac is stripped, forming a hematoma that gradually expands to the anterior abdominal wall. Improper treatment can lead to infection and the formation of an abscess. The way to avoid it is to stop bleeding carefully and thoroughly; after the operation, a cotton ball of the same size as the umbilical fossa should be placed and compressed bandaged. Small hematomas can be absorbed spontaneously, while large hematomas can be opened partially to remove blood clots and coagula, compressed bandaged, and systemic antibiotic treatment should be applied at the same time.

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