Umbilical Cord in Newborns - Guideline for the Care of the

Publication: 01/03/2006  --
Last review: 07/09/2018  
Next review: 07/08/2021  
Clinical Guideline
CURRENT 
ID: 717 
Approved By: Clinical Guidelines Committee 
Copyright© Leeds Teaching Hospitals NHS Trust 2018  

 

This Clinical Guideline is intended for use by healthcare professionals within Leeds unless otherwise stated.
For healthcare professionals in other trusts, please ensure that you consult relevant local and national guidance.

Umbilical Cord in Newborns - Guideline for the Care of the

To be used by Nurses, Midwives and Health Care Assistants involved in the care of the Newborn

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Introduction

The umbilical cord is a unique tissue consisting of two arteries and one vein covered by a mucoid connective tissue (Wharton’s jelly) which is covered by a thin layer of mucous membrane.

Following delivery the cord quickly starts to dry out, harden and turn black (dry gangrene) and this is helped by exposure to air. The umbilical vessels remain patent for several days.

Colonisation of the area begins soon after birth as a result of non-pathogenic organisms passing from mother to baby via skin to skin contact.

Separation of the umbilical cord continues at the junction of the cord and skin of the abdomen with leucocyte infiltration and subsequent digestion of the cord. During this process small amounts of cloudy mucoid material may collect at the junction which may be confused with pus. The cord may also be moist within this process. Separation should complete within 5-15 days.

After the cord has separated a small amount of mucoid material is still present until complete healing has occurred.

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Practice Elements

At Delivery

To minimise contamination

  • Use of strict hand washing procedures before and after vaginal examinations
  • Ensure baby is placed on a clean surface to cut the cord
  • If gloves have been contaminated during delivery, change prior to cutting cord
  • Use of sterile instruments to cut and clamp cord

Reduce excessive bleeding

  • Cord should be cut no closer than 3cm to stump

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Following Delivery

To encourage non-pathogenic colonisation

  • Early skin to skin contact following delivery

To reduce cross infection

  • Minimal intervention by health care workers

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Cord Care

To reduce cross infection

  • Strict hand washing prior to handling of the baby
  • Use plain water to clean the surrounding area
  • If cord contaminated with urine or faeces, use cotton wool soaked in water to clean cord. Dry with a clean towel

To encourage the drying process

  • Leave the cord exposed to the air
  • Ensure the baby is wearing clean loose clothing
  • Fold down the nappy to expose the cord - the umbilicus should always be outside the nappy. This is even more important if umbilical lines in situ.

Note: CX powder is not required for well term babies nursed with their mothers on the post natal wards. Since 1998, the WHO has advocated the use of dry umbilical cord care in high-resource settings. Application of select antimicrobial agents to the umbilical cord does not provide clear benefit in the hospital setting or in high-resource countries, where reducing bacterial colonization may have the unintended consequence of selecting more virulent bacterial strains.

World Health Organization. Care of the Umbilical Cord: A Review of the Evidence. Geneva, Switzerland: World Health Organization; 1998.

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Babies on NICU and Transitional Care

Babies separated from their mother within the first 24hours of life are more susceptible to infection.
Follow the guidelines above. In addition follow the infection control guidance on the Neonatal unit- e.g. Octenisan washes where appropriate.

Observation

  • The umbilical cord should be kept outside of the nappy wherever possible. It should always be kept uncovered when umbilical lines are in situ.
  • Observations of all babies should be made regularly for signs of infection and recorded daily in the notes if an umbilical central line is present.

Signs of Local Infection

  • Redness, erythema, oedema and tenderness of surrounding area
  • Bleeding of cord
  • Offensive  mucoid discharge from the umbilicus

Systemic infection

  • Poor feeding, floppiness, pyrexia alongside other local signs of infection
  • Purulent discharge (pus) from the cord or base of umbilicus

Treatment of infection

Local Infection

Send any bacterial swabs with a labelled request form to Microbiology (MRSA screening swabs are not sufficient)

Oral Flucloxacillin electronic Medicines Compendium information on Flucloxacillin x 5days if no risk factors for MRSA or recent screen negative

Discuss alternatives with Microbiology if baby has been colonised with MRSA.

Systemic Infection

Needs MRSA risk assessment prior to starting iv treatment. If high risk discuss antibiotic choice with microbiologist. If baby has purulent discharge or signs of spreading periumbilical cellulitis, perform a blood culture and umbilical swab and start on IV Flucloxacillin electronic Medicines Compendium information on Flucloxacillin and Gentamicin, Gentamicin may be reviewed with the results of blood cultures in 36hours.

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Provenance

Record: 717
Objective:

Aims

To reduce the risk of cross infection, and contamination of the umbilicus.

Objectives

• To ensure the use of aseptic technique at delivery
• To keep the umbilicus and surrounding area clean and dry
• To reduce expenditure on non-evidence based current practice

Clinical condition:

Umbilical Care

Target patient group: Newborns
Target professional group(s): Secondary Care Nurses
Allied Health Professionals
Adapted from:

Evidence base

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Approved By

Clinical Guidelines Committee

Document history

LHP version 1.0

Related information

Not supplied

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