Diagnosis
Umbilical granuloma can be diagnosed from physical examination. If there is a discharge around the navel and the granulation tissue is large enough to be visible with the open eye, umbilical granuloma is the first to be suspected. Open eye inspection and/or dermoscopy is commonly used to recognize the granular tissue at the site. If the granuloma is not visible with the open eye, gentle pressure on the surrounding site or a surgical tweezer can be used to expose the small granuloma hidden within the umbilical pit. An otoscope may also be used by physicians in order to expose a small, sessile granuloma. Other additional tests are usually not required, but if continued, ultrasonography (US) can be used for initial diagnosis of umbilical lesions. Treatment
Topical
Although there is no singular method of treatment for umbilical granulomas, some treatment options available include common salt, silver nitrate, corticosteroids, and cleaning with alcohol. Home care following treatments include gentle cleaning the navel area with soap and sterile water, followed by open exposure of the belly button to air. Silver nitrate
Silver nitrate is the most common treatment and practiced worldwide. Neonatology textbooks suggest silver nitrate as a first-line treatment option. The application of silver nitrate to granulomas was first noted in early 1800s as a cauterizing agent.Silver nitrate can be used as an antiseptic, an astringent, and as a caustic agent, depending on the indication. Its application requires medical personnel for treatment and may have unfavorable adverse effects if applied improperly.
One risk of utilizing this technique is burning the skin surrounding the granuloma. Following the procedure, the naval site is cleansed, left exposed to the air and the infant is discharged. Cyrocautery is more commonly used for freezing for post hysterectomy granulation tissue. However, though more expensive and complex, cryosurgery is an effective treatment for the indication of umbilical granulomas in infants as well. Prevention
Newborn naval care
In order to reduce the possibility of an infection or inflammation at the umbilical site, the World Health Organization (WHO) has advocated for the use of dry umbilical cord care in high resource settings. Dry cord care includes keeping the newborns umbilical area clean and exposed to air or loosely covered by a clean cloth. The remainder of the umbilicus should be cleaned once daily with soap and sterile water. Chlorhexidine is recommended in substitute of sterile water for areas in which infection risks are high.Diaper positioning can also influence infection risk. Keeping the diaper area clean and reducing moisture at the site can reduce the chance of developing an infection. Aim to position the diaper by rolling the top portion down to sit under the navel, keeping the site open and exposed to air. Cord clamping technique
The incidence of umbilical granuloma may be influenced by the method of cord clamping. It has been suggested that proximal cord clamping of the umbilical cord for 24 hours reduces the chance of infection at the naval site compared to other cord clamping practices. Timing
Umbilical cord clamping timing can vary in time intervals.