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Care of the umbilicus and management of umbilical disorders

Debra L Palazzi, MD, MEd
Mary L Brandt, MD
Section Editors
Teresa K Duryea, MD
Richard Martin, MD
Deputy Editor
Melanie S Kim, MD


At birth, the umbilical cord, which provided vascular flow between the fetus and placenta, is clamped and cut. Within the first week of life, the remnant umbilical cord stump separates from the neonate, creating the umbilicus (commonly referred to as the navel).

Infection, hernia, granulomas, and congenital anomalies can occur in the umbilicus and are more commonly seen in infancy.

The care of the umbilical cord after delivery and clinical problems associated with the umbilicus will be reviewed here.


Umbilical cord — The umbilical cord contains two arteries and one vein, which are surrounded and supported by gelatinous tissue called Wharton's jelly.

Thickness — At birth, the average diameter and circumference of the umbilical cord in a normal term infant is 1.5 and 3.6 cm, respectively [1,2]. Both thick and thin cords are associated with increased risk of significant pathology. (See 'Newborn examination' below.)

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Literature review current through: Nov 2017. | This topic last updated: Nov 29, 2017.
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  1. Moinian M, Meyer WW, Lind J. Diameters of umbilical cord vessels and the weight of the cord in relation to clamping time. Am J Obstet Gynecol 1969; 105:604.
  2. Patel D, Dawson M, Kalyanam P, et al. Umbilical cord circumference at birth. Am J Dis Child 1989; 143:638.
  3. Naeye RL. Umbilical cord length: clinical significance. J Pediatr 1985; 107:278.
  4. Ananth CV, Oyelese Y, Yeo L, et al. Placental abruption in the United States, 1979 through 2001: temporal trends and potential determinants. Am J Obstet Gynecol 2005; 192:191.
  5. Gilbert-Barness E, Drut RM, Drut R, et al. Developmental abnormalities resulting in short umbilical cord. Birth Defects Orig Artic Ser 1993; 29:113.
  6. de Laat MW, Franx A, Bots ML, et al. Umbilical coiling index in normal and complicated pregnancies. Obstet Gynecol 2006; 107:1049.
  7. Cullen T. Embryology, Anatomy, and Diseases of the Umbilicus Together with Diseases of the Urachus, WB Saunders, Philadephia 1916.
  8. Coetzee T. Clinical anatomy of the umbilicus. S Afr Med J 1980; 57:463.
  9. Friedman JM. Umbilical dysmorphology. The importance of contemplating the belly button. Clin Genet 1985; 28:343.
  10. Wildhaber BE, Antonelli E, Pfister RE. The giant umbilical cord. Arch Dis Child Fetal Neonatal Ed 2005; 90:F535.
  11. Iwasaki I, Yu TJ, Itahashi K, et al. Isolated well-formed intestinal tissue in the umbilical cord. A variant of cyst of omphalomesenteric duct. Acta Pathol Jpn 1986; 36:565.
  12. Ameh EA, Nmadu PT. Major complications of omphalitis in neonates and infants. Pediatr Surg Int 2002; 18:413.
  13. Ueno T, Hashimoto H, Yokoyama H, et al. Urachal anomalies: ultrasonography and management. J Pediatr Surg 2003; 38:1203.
  14. Bourke WG, Clarke TA, Mathews TG, et al. Isolated single umbilical artery--the case for routine renal screening. Arch Dis Child 1993; 68:600.
  15. Gornall AS, Kurinczuk JJ, Konje JC. Antenatal detection of a single umbilical artery: does it matter? Prenat Diagn 2003; 23:117.
  16. Thummala MR, Raju TN, Langenberg P. Isolated single umbilical artery anomaly and the risk for congenital malformations: a meta-analysis. J Pediatr Surg 1998; 33:580.
  17. Chow JS, Benson CB, Doubilet PM. Frequency and nature of structural anomalies in fetuses with single umbilical arteries. J Ultrasound Med 1998; 17:765.
  18. Deshpande SA, Jog S, Watson H, Gornall A. Do babies with isolated single umbilical artery need routine postnatal renal ultrasonography? Arch Dis Child Fetal Neonatal Ed 2009; 94:F265.
  19. de Boom ML, Kist-van Holthe JE, Sramek A, et al. Is screening for renal anomalies warranted in neonates with isolated single umbilical artery? Neonatology 2010; 97:225.
  20. Stewart D, Benitz W. Umbilical Cord Care in the Newborn Infant. Pediatrics 2016; 138.
  21. World Health Organization. WHO Recommendations on Postnatal Care of the Mother and Newborn. WHO Press; Geneva, 2014.
  22. Sinha A, Sazawal S, Pradhan A, et al. Chlorhexidine skin or cord care for prevention of mortality and infections in neonates. Cochrane Database Syst Rev 2015; :CD007835.
  23. Imdad A, Bautista RM, Senen KA, et al. Umbilical cord antiseptics for preventing sepsis and death among newborns. Cochrane Database Syst Rev 2013; :CD008635.
  24. Gras-Le Guen C, Caille A, Launay E, et al. Dry Care Versus Antiseptics for Umbilical Cord Care: A Cluster Randomized Trial. Pediatrics 2017; 139.
  25. Centers for Disease Control and Prevention (CDC). Neonatal tetanus--Montana, 1998. MMWR Morb Mortal Wkly Rep 1998; 47:928.
  26. Mullany LC, Darmstadt GL, Khatry SK, et al. Impact of umbilical cord cleansing with 4.0% chlorhexidine on time to cord separation among newborns in southern Nepal: a cluster-randomized, community-based trial. Pediatrics 2006; 118:1864.
  27. Mullany LC, Shah R, El Arifeen S, et al. Chlorhexidine cleansing of the umbilical cord and separation time: a cluster-randomized trial. Pediatrics 2013; 131:708.
  28. Pezzati M, Biagioli EC, Martelli E, et al. Umbilical cord care: the effect of eight different cord-care regimens on cord separation time and other outcomes. Biol Neonate 2002; 81:38.
  29. Wilson CB, Ochs HD, Almquist J, et al. When is umbilical cord separation delayed? J Pediatr 1985; 107:292.
  30. Razvi S, Murphy R, Shlasko E, Cunningham-Rundles C. Delayed separation of the umbilical cord attributable to urachal anomalies. Pediatrics 2001; 108:493.
  31. Vane DW, West KW, Grosfeld JL. Vitelline duct anomalies. Experience with 217 childhood cases. Arch Surg 1987; 122:542.
  32. Crankson SJ, Ahmed GS, Palkar V. Patent omphalomesenteric duct of the vermiform appendix in a neonate: congenital appendicoumbilical fistula. Pediatr Surg Int 1998; 14:229.
  33. Thirunavukarasu P, Sathaiah M, Sukumar S, et al. Meckel's diverticulum--a high-risk region for malignancy in the ileum. Insights from a population-based epidemiological study and implications in surgical management. Ann Surg 2011; 253:223.
  34. Gleason JM, Bowlin PR, Bagli DJ, et al. A comprehensive review of pediatric urachal anomalies and predictive analysis for adult urachal adenocarcinoma. J Urol 2015; 193:632.
  35. Naiditch JA, Radhakrishnan J, Chin AC. Current diagnosis and management of urachal remnants. J Pediatr Surg 2013; 48:2148.
  36. Ashley RA, Inman BA, Routh JC, et al. Urachal anomalies: a longitudinal study of urachal remnants in children and adults. J Urol 2007; 178:1615.
  37. Widni EE, Höllwarth ME, Haxhija EQ. The impact of preoperative ultrasound on correct diagnosis of urachal remnants in children. J Pediatr Surg 2010; 45:1433.
  38. Walker SH. The natural history of umbilical hernia. A six-year follow up of 314 Negro children with this defect. Clin Pediatr (Phila) 1967; 6:29.
  39. Hall DE, Roberts KB, Charney E. Umbilical hernia: what happens after age 5 years? J Pediatr 1981; 98:415.
  40. Meier DE, OlaOlorun DA, Omodele RA, et al. Incidence of umbilical hernia in African children: redefinition of "normal" and reevaluation of indications for repair. World J Surg 2001; 25:645.
  41. Cilley R. Disorders of the umbilicus. In: Pediatric Surgery, Grosfeld J, O'Neill J, Coran A, Fonkalsrud E (Eds), Mosby Inc., Philadelphia 2006.
  42. Katz DA. Evaluation and management of inguinal and umbilical hernias. Pediatr Ann 2001; 30:729.
  43. Colige A, Sieron AL, Li SW, et al. Human Ehlers-Danlos syndrome type VII C and bovine dermatosparaxis are caused by mutations in the procollagen I N-proteinase gene. Am J Hum Genet 1999; 65:308.
  44. Young ID, Harper PS. The natural history of the severe form of Hunter's syndrome: a study based on 52 cases. Dev Med Child Neurol 1983; 25:481.
  45. LaFranchi SH, Murphey WH, Foley TP Jr, et al. Neonatal hypothyroidism detected by the Northwest Regional Screening Program. Pediatrics 1979; 63:180.
  46. Tank ES, Hatch DA. Hernias complicating chronic ambulatory peritoneal dialysis in children. J Pediatr Surg 1986; 21:41.
  47. Blumberg NA. Infantile umbilical hernia. Surg Gynecol Obstet 1980; 150:187.
  48. Papagrigoriadis S, Browse DJ, Howard ER. Incarceration of umbilical hernias in children: a rare but important complication. Pediatr Surg Int 1998; 14:231.
  49. Okada T, Yoshida H, Iwai J, et al. Strangulated umbilical hernia in a child: report of a case. Surg Today 2001; 31:546.
  50. Zens T, Nichol PF, Cartmill R, Kohler JE. Management of asymptomatic pediatric umbilical hernias: a systematic review. J Pediatr Surg 2017; 52:1723.
  51. Brandt ML. Pediatric hernias. Surg Clin North Am 2008; 88:27.
  52. Pomeranz A. Anomalies, abnormalities, and care of the umbilicus. Pediatr Clin North Am 2004; 51:819.
  53. Brødsgaard A, Nielsen T, Mølgaard U, et al. Treating infants for umbilical granuloma with topical clobetasol propionate cream. Acta Paediatr 2015; 104:e49.
  54. Aydin M, Orman A, Deveci U, Taskin E. Topical clobetasol propionate may not be safe for treating umbilical granuloma in infants. Acta Paediatr 2015; 104:e49.
  55. Sheth SS, Malpani A. The management of umbilical granulomas with cryocautery. Am J Dis Child 1990; 144:146.
  56. Larralde de Luna M, Cicioni V, Herrera A, et al. Umbilical polyps. Pediatr Dermatol 1987; 4:341.
  57. Oğuzkurt P, Kotiloğlu E, Tanyel FC, Hiçsönmez A. Umbilical polyp originating from urachal remnants. Turk J Pediatr 1996; 38:371.
  58. Avolio L, Cerritello A, Verga L. Heterotopic pancreatic tissue at umbilicus. Eur J Pediatr Surg 1998; 8:373.
  59. Ito F, Ando H, Watanabe Y, et al. An accessory lobe of the liver disturbing closure of the umbilical ring. Pediatr Surg Int 1999; 15:394.
  60. Skinner MA, Grosfeld JL. Inguinal and umbilical hernia repair in infants and children. Surg Clin North Am 1993; 73:439.
  61. Veloso FT, Cardoso V, Fraga J, et al. Spontaneous umbilical fistula in Crohn's disease. J Clin Gastroenterol 1989; 11:197.
  62. Cushing AH. Omphalitis: a review. Pediatr Infect Dis 1985; 4:282.
  63. Rotimi VO, Duerden BI. The development of the bacterial flora in normal neonates. J Med Microbiol 1981; 14:51.
  64. Harnden A, Lennon D. Serious suppurative group A streptococcal infections in previously well children. Pediatr Infect Dis J 1988; 7:714.
  65. McKenna H, Johnson D. Bacteria in neonatal omphalitis. Pathology 1977; 9:111.
  66. Sawardekar KP. Changing spectrum of neonatal omphalitis. Pediatr Infect Dis J 2004; 23:22.
  67. Mir F, Tikmani SS, Shakoor S, et al. Incidence and etiology of omphalitis in Pakistan: a community-based cohort study. J Infect Dev Ctries 2011; 5:828.
  68. Davies EG, Isaacs D, Levinsky RJ. Defective immune interferon production and natural killer activity associated with poor neutrophil mobility and delayed umbilical cord separation. Clin Exp Immunol 1982; 50:454.
  69. Mason WH, Andrews R, Ross LA, Wright HT Jr. Omphalitis in the newborn infant. Pediatr Infect Dis J 1989; 8:521.
  70. Hayward AR, Harvey BA, Leonard J, et al. Delayed separation of the umbilical cord, widespread infections, and defective neutrophil mobility. Lancet 1979; 1:1099.
  71. Güvenç H, Aygün AD, Yaşar F, et al. Omphalitis in term and preterm appropriate for gestational age and small for gestational age infants. J Trop Pediatr 1997; 43:368.
  72. Chamberlain JW. Omphalitis in the newborn. J Pediatr 1936; 9:215.
  73. Brook I. Bacteriology of neonatal omphalitis. J Infect 1982; 5:127.
  74. Faridi MM, Rattan A, Ahmad SH. Omphalitis neonatorum. J Indian Med Assoc 1993; 91:283.
  75. Brook I. Cutaneous and subcutaneous infections in newborns due to anaerobic bacteria. J Perinat Med 2002; 30:197.
  76. Hsieh WS, Yang PH, Chao HC, Lai JY. Neonatal necrotizing fasciitis: a report of three cases and review of the literature. Pediatrics 1999; 103:e53.