Neonatal umbilical diseases

　　1. Umbilical inflammation refers to acute inflammation caused by bacterial invasion and proliferation at the umbilical stump. Staphylococcus aureus is the most common, followed by Escherichia coli, Pseudomonas aeruginosa, hemolytic streptococcus, etc. Mild cases may have slight redness and swelling around the umbilicus and skin, accompanied by a small amount of serous purulent secretion. Severe cases may have significant redness, hardness, and purulent secretion around the umbilicus and skin, often with an odor.

　　2. Umbilical hernia is caused by incomplete closure or weakness of the umbilical ring, or the protrusion of abdominal viscera through the umbilical ring to form a hernia sac, which varies in size.

　　3. Umbilical granuloma refers to the formation of small granuloma tissue locally due to foreign body stimulation (such as talcum powder crust) or infection after umbilical cord amputation, with the surface of the umbilical granuloma tissue being moist, with some mucus or purulent exudate.

　　1. Peritonitis: Umbilical inflammation is usually asymptomatic or has no systemic reaction if treated promptly. When the umbilical infection is severe, the baby may have systemic symptoms such as fever, even peritonitis and sepsis, and must be treated in the hospital.

　　2. Eczema umbilical granuloma, also known as umbilical polyp, is caused by the residual mucosa at the umbilical end of the yolk stalk. Sometimes, the umbilical area of the child may be accompanied by eczema or umbilical inflammation. When the mucosa of the umbilical polyp is rubbed or damaged, blood-stained secretions may flow out. Electric coagulation therapy is effective, and complications usually do not occur.

　　3. Umbilical enterostoma: If more mucus is seen flowing from the baby's navel, sometimes containing fecal-like matter, and even hearing the navel exhale and smelling feces, this is a less common umbilical enterostoma. Umbilical enterostoma is a fistula formed between the ileum and the umbilicus due to the incomplete closure of the yolk stalk. Through this fistula, intestinal contents such as mucus, intestinal gas, and feces can flow to the navel, causing the above symptoms.

　　One, Umbilical inflammation

　　Mild cases may have slight redness and swelling around the umbilicus and skin, accompanied by a small amount of serous purulent secretion. Severe cases may have redness and hardness around the umbilicus and skin, with purulent secretion and a large amount, often with an odor. The size of the umbilical hernia sac varies, with most being about 1 cm in diameter, and occasionally more than 3 to 4 cm. The surface of the umbilical granuloma tissue is moist, with some mucus or purulent exudate, which can spread to the surrounding skin or tissue, causing cellulitis of the abdominal wall, subcutaneous gangrene, peritonitis, sepsis, and portal vein inflammation. Later, it may develop into portal hypertension and liver cirrhosis.

　　Two, Umbilical hernia in infants

　　It is relatively common, mostly easy to recover, and incarcerated hernia is rare. When crying, standing, and straining, a lump swells out of the umbilicus, generally with a diameter of 1 to 2 centimeters, without other symptoms, often found unintentionally during bathing or changing clothes.

　　Three, Umbilical granuloma

　　1. After the umbilical cord falls off, a pink granuloma appears in the middle of the navel. The size of the umbilical granuloma varies from child to child.

　　2. Umbilical granuloma can also cause symptoms such as pus and bleeding.

　　3. When the mother's finger touches it, the baby often cries out in pain.

　　After bathing, use 75% alcohol to wipe and disinfect. During disinfection, let the baby's umbilical cord root be exposed, and then use a cotton swab soaked with 75% alcohol to wipe in the order of the umbilical cord root and the surrounding skin of the umbilical cord. Items that come into contact with the umbilical cord residual end, such as clothes and diapers, must be kept clean and dry. Replace them in time if they are found to be damp. Pay special attention to avoid contamination from urine and feces. Keep the umbilical area clean and follow up regularly.

　　1. Neonatal umbilical cellulitis:Due to the recent amputation of the umbilical cord, there are still 'wounds' that have not healed completely and necrotic residual tissue in the local area. In addition, the neonate's immune system is not yet mature, and its resistance is poor, so bacteria can take advantage of this opportunity to invade and cause suppurative infection - umbilical cellulitis. The most common is that after the umbilical cord falls off, there are a small amount of purulent or mucoid secretions, the surrounding skin is slightly red, not swollen, without obvious tenderness, and in severe cases, there is 'combined umbilical cellulitis and abdominal wall infection'. In addition to purulent secretions in the umbilical area, there are also redness and swelling around the umbilical area, and the scope is relatively wide. The affected area is tender, and umbilical abscesses form. The child has symptoms such as crying, fever, decreased appetite, increased white blood cell count, and other systemic manifestations. If these children are not treated in time, they may develop sepsis or peritonitis.

　　2. Umbilical cauliflower:Under normal circumstances, structures such as the yolk sac, etc., in the process of fetal development and after the umbilical cord is cut, or become closed, fibrotic, or disappear, leaving only a skin scar indentation - the umbilicus. An umbilical cauliflower is a polypoid growth that appears in the umbilical area of children when the distal mucosa (intestinal mucosa) of the patent yolk sac does not completely disappear after closure. The polypoid growth that appears on the wound surface is cherry red, smooth, and moist, and may have a small amount of 'pus-like' secretion. If locally rubbed, it may bleed.

　　3. Umbilical sinus:It also originates from the remnants of the embryonic yolk sac. There is a fistula in the umbilical area, which is blind-ended. Clinical manifestations are similar to those of an umbilical cauliflower.

　　4. Enterocele:After birth, due to the patent vitelline duct, there is a fistula connecting the umbilical area to the small intestine, often accompanied by Meckel's diverticulum of the small intestine. Clinical manifestations include excessive secretion in the umbilical area, even with fecal-like fluid flowing out of the umbilical area. Radiographic examination of the umbilical area shows that the contrast medium enters the small intestine to confirm the diagnosis.

　　5. Urachal fistula:After birth, due to the patent urachus, the umbilical urachus is connected to the bladder. There is a lot of clear secretions in the umbilical area, especially when children cry and urinate. Radiographic examination shows that the contrast medium enters the bladder to confirm the diagnosis.

　　Diet should include coarse vegetables and fruits rich in plant fiber, and moderately consume rough grains with a lot of residue, such as standard flour, brown rice, sweet potatoes, mung beans, jelly, tubers, corn, oatmeal, etc.; eat a variety of fresh fruits and vegetables, especially watermelons, bananas, pears, apples, bitter melon, cucumbers, water chestnuts, cabbage, celery, luffa, and chrysanthemum flowers; eat some dried fruits rich in fats, such as pine nuts, sesame seeds, walnuts, peanuts, etc.; cool water and honey also help defecation; eat less meat and animal organs, which are high in protein and cholesterol, and eat less spicy and irritating foods.

　　Newborns who have umbilical effusion (referring to the umbilicus being moist and having secretion) soon after birth often have this phenomenon, some of which recover after treatment in a short period of time, some of which do not heal for a long time, and a few children even have feces or urine-smelling liquid flowing out of the umbilicus.

　　Diseases that can cause umbilical effusion in infants include:

　　1. Umbilical Caruncle:It is the residual mucous membrane of the umbilicus during fetal development, which is more common clinically, with the outer surface color slightly red, looking like a small piece of pink meat, located in the center of the navel, with continuous secretion, and sometimes a small amount of blood-like substance is exuded when touched.

　　2. Vitelline Duct Fistula:It is a residual duct of the vitelline duct that has not closed, with a fistula below the central navel, and feces-like matter flows out from the hole.

　　3. Urachal Fistula:It is a residual duct of the urachus that has not closed, with a fistula below the central navel, and liquid with a urine smell flows out from the hole.

　　The symptoms of umbilical effusion can disappear after surgical treatment for the above three conditions, correcting deformities.

　　4. Umbilical Erysipelas:It is often caused by umbilical cord contamination after the umbilical cord is cut, and this disease is a common disease in newborns. In addition to the umbilical pus-like secretion, the umbilical cord area may sometimes be red and swollen, and in severe cases, it can cause large areas of inflammation of the abdominal wall and sepsis. Treatment requires the use of antibiotics, and the umbilical cord can be cleaned with 75% alcohol, and umbilical cord powder can be applied externally. For those who have formed abscesses, it is necessary to open the incision in time to remove the pus. Prevent infants from picking at their umbilicus to cause umbilical cord injury and secondary infection, and can also be treated as umbilical erysipelas.

　　5. Umbilical Granuloma:It is a cherry red swelling formed by the wound not healed after the umbilical cord is cut, which is often located in the center of the navel, about the size of a grain of rice to a soybean, and its surface, when observed under a magnifying glass, is like a clump of small seedlings just grown. Treatment can be 20% potassium nitrate burn, and if necessary, electric burn or surgical excision.

　　6. Navel Eczema:Infants sometimes have eczema around the navel, with small red papules or skin erosion inside or around the navel, with varying amounts of secretion. Due to itching, it often combines with scratches around the umbilicus. Treatment can be 1% furazolidone solution to clean the eczema area, then apply 40% zinc oxide oil, and can clean and apply the medicine 1-2 times a day.

　　If the cause of the umbilical effusion is not removed, it is difficult to eliminate the umbilical effusion. Therefore, the first treatment for umbilical effusion in infants is to identify the cause as soon as possible within a short period of time, and give appropriate symptomatic treatment based on the treatment of the cause, to reduce and avoid the progression of the disease.