I missed the article last year that I've exerpted below. It's a good one to know about. A few observations:
- I found it on findarticles.com - which has free full text of many journals - including some medical journals.
- This study is interesting, since it brings up the issue (again) of whether prophylaxis of the cord is appropriate. In our area, we have good representation of both of the study arms. One hospital stopped applying triple-dye a few years ago – and the other still uses triple-dye as a component of routine neonatal care.
In the group of kids who don't get the trople-dye .. I am seeing far more cords that seem to last for a very long time. The kid who comes in a at two weeks of age with a cord still on is not so rare as it once was. These cords often have an umbilical granuloma at the base, and are often "sealed" with the abdominal skin .. so the base of the cord never dries out and just sits there … barely viable yet .. rotting slowly.
A little alcohol and some manipluation (for drying .. not necessarily for antibacterial effect) seems to work well to dry these out in another day or so .. though I sometimes have to tie off the granulomas if they continue to weep.
Our study suggests that omphalitis remains a clinical entity and that there is potential risk in discontinuing bacteriocidal treatment of the umbilical cord stump. Cessation of bactericidal care of the umbilical stump must be accompanied by vigilant attention to the signs and symptoms of omphalitis. In our study, some infants were treated after discharge with local antibiotics in response to developing symptoms of infection The initial presentation of NF is one of foul-smelling umbilical discharge, erythema, and induration around the umbilicus, with rapid progression to frank gangrene
