Köldökseb újszülöttben: a kezelés algoritmusa

One of the first difficulties faced by young parents is a newborn's umbilical wound. Immediately a lot of questions arise: how to care, what to lubricate, how to bathe, etc. Of course, it is easy to harm the baby if you do not know the subtleties of care and treatment of the navel. What should be paid attention to, and what does both mom and dad need to know?

To recognize and correct the problem in time, every parent should be aware of issues such as umbilical wound healing, when an umbilical wound heals, and how to care for or accelerate wound healing.

Tissue tightening terms are not the same in all babies, but standard terms can be distinguished, deviations from which are allowed within 1 to 3 days.

Immediately after birth, as well as during the next 3-5 days of life, a node with a remnant of the umbilical cord is present in the place of the navel. From about the third to the fifth day, the remnant mummifies (shrivels) and falls off by itself, without any manipulation.

The umbilical wound after the belly button falls off heals according to the usual healing mechanism, within 7-21 days. That is, by the third or fourth week of the baby's life, the umbilicus should heal completely. If this period is lengthened - for example, in a one-month-old baby umbilical wound is still present - then it is necessary to consult with a pediatrician.

In fact, the reasons for prolonged navel healing are not few:

• initially large diameter of the umbilical cord (accordingly, the umbilical wound will be larger and take longer to heal);
• Umbilical hernia (is not just a wound, but a bulge of the navel, which requires consultation with a pediatrician);
• Improper toilet of the umbilical wound (insufficient treatment of the wound surface, or, conversely, too thorough, damaging the barely formed skin);
• weak immune protection of the child's body (for example, if the mother during pregnancy suffered from prolonged infectious diseases, avitaminosis, anemia);
• healing pathologies (these may be skin and systemic diseases, infectious processes).

In any case, if the belly button does not tighten up over 4 weeks, you should get a consultation with your pediatrician. [1]

Stages of umbilical wound healing

Immediately after the baby is born, the obstetrician clamps the umbilical cord and makes a tight bandage near the umbilical area. He then cuts it off, and the umbilical cord remnant of the baby will eventually shrink and fall off on its own, exposing the umbilical wound, which should be cared for until it heals.

If all the rules of care to perform competently, do not ignore the procedures and timely consult with the doctor, then healing will occur in about 2 weeks (it is allowed to lengthen this period to 3-4 weeks).

At first, the newborn baby will be observed by a local pediatrician and a nurse: they will be able to answer all questions regarding the treatment of the navel and its condition.

If the navel area is reddened, swollen, unpleasant odor or purulent, watery, bloody discharge, then you should definitely consult a doctor: perhaps the healing mechanism is broken and additional treatment is required. [2]

Diseases of the umbilical wound

Inflammatory processes in the umbilical wound are called omphalitis. Such processes can proceed by different pathological mechanisms, so they are divided into several types: catarrhal, necrotic and phlegmonous omphalitis. [3]

On average, normal epithelialization of the baby's umbilicus occurs within a couple of weeks. If we talk about the introduction of infection, it can occur during the immediate postpartum treatment of the umbilical cord remnant, or (more often) during subsequent home care. [4]

• Catarrhal omphalitis of the umbilical wound is accompanied by the appearance of "wet" discharge - it is serous or serous-purulent fluid, periodically drying with the formation of crusts. The disease is caused by delayed epithelialization as a result of infection in the wound surface. Prolonged "wet" condition causes the formation of granulation - this is the so-called "umbilical wound fungus": we will talk more about it below. With further proper care and treatment, the umbilicus heals over several weeks. Therapeutic measures usually consist of frequent treatments with hydrogen peroxide, with the possible connection of other antibacterial drugs of external action. Ultraviolet irradiation of the wound surface is also recommended.
• Phlegmonous or purulent inflammation of the umbilical wound occurs with the transition of inflammatory reaction to the skin and subcutaneous layer in the periapical zone. There is a release of purulent secretion, swelling and redness of the umbilical wound, strengthening of the venous pattern on the anterior abdominal wall, the appearance of characteristic red stripes, which is associated with the expansion of the vascular network. In neglected cases, the umbilical vessels are affected: they become visible and traceable in the form of tracts in the upper and lower parts of the umbilical zone. Umbilical wound festering, violates the general well-being of the baby: there is apathy, lethargy, loss of appetite, frequent regurgitation. As a result, the body weight of the child suffers. In this situation, treatment is prescribed by a pediatrician. The wound several times a day consistently treated with hydrogen peroxide, alcohol concentration of 70%, a solution of manganese acid potassium or diamond green. In case of severe suppuration, napkins soaked in hypertonic solution of sodium chloride, magnesium sulfate are applied. The use of antibacterial agents, staphylococcal bacteriophage is recommended. Of physiotherapeutic procedures practiced ultraviolet irradiation. With unsatisfactory general well-being of the infant, general therapy with semi-synthetic penicillin antibiotics, cephalosporin or aminoglycoside preparations is indicated. Treatment is carried out against the background of prevention of dysbacteriosis.
• Necrotic inflammation, fortunately, is diagnosed infrequently - mainly with a critically weak immune system in the baby. Pathology is characterized by the development of necrosis in the tissues: the skin in this case acquires a purple-blue shade, with further rejection and probable euteration of internal organs. Pathology requires urgent intervention by a surgeon.

Umbilical wound fungus

Fungus is otherwise known as granuloma and is a process of granulation overgrowth. The wound in this case takes the form of a cluster of beads, or grape berries. In general, this phenomenon is not dangerous, but it can cause a lot of discomfort to the baby: the navel can get wet, bleed, and takes a long time to heal.

In any case, the intervention of a doctor in fungus should be mandatory. Treatment of this problem is different, depending on the stage of granulation processes. In mild cases, the doctor prescribes observation with further regular treatment of the navel with peroxide and antiseptic solution, cauterization with 5% silver nitrate or liquid nitrogen. If an infection is attached, the use of antibiotics in the form of ointments, solutions, sprays is indicated.

Self-treatment for fungus in a baby is unacceptable.

If the umbilical wound is bleeding

Most often blood is caused by improper removal of dried crusts: before removing them, they must be softened with hydrogen peroxide. If this step is ignored, the top layer can be damaged, exposing small vessels, which leads to a small bleeding. Pediatricians say that this slight bleeding is not a problem and can occur throughout the first week of your baby's life. Think about what you were doing wrong. You may have removed the crusts too soon without letting them soak, or you may have used overly powerful antiseptics not recommended by your pediatrician. Perhaps the procedures were carried out too often, or injury to the skin occurred due to constant contact of the navel with clothes or diapers. In some cases, the wound begins to bleed due to constant crying and pushing the baby - in this situation, it is necessary to review the diet (the baby may have colic).

It is possible to be alarmed in such cases:

• the umbilicus continues to bleed, even though 10 days have passed since the umbilical cord has fallen off;
• bleeding continues even after the drug treatment procedure;
• a fungus, or granulation, forms;
• bleeding is complemented by other unfavorable signs.

In these cases, urgent medical attention is required.

Wet umbilical wound: what parents should do

If suddenly the umbilical wound became constantly wet, then in this situation the main thing is not to fuss and take timely measures to prevent further development of the painful process. Parents' actions should be as follows:

• wash your hands, put the baby on his back;
• drop a drop of hydrogen peroxide, wait a few seconds, blot with a cotton pad while removing the peeling crusts;
• drop, sprinkle or spray antiseptic.

Chlorophyllipt (liquid alcohol solution or spray, but not oil solution), fresh solution of furacilin, Baneocin can be used as an antiseptic agent. If you do not have these means at hand, you can use a solution of brilliant green or a mild solution of manganese. The treatment is repeated twice a day.

Iodine should not be used for treatment. In addition, there are other restrictions:

• Do not wipe the navel with a handkerchief, napkin or even a finger - these actions can provoke the development of infection;
• Do not put pressure on the wound, cover it with a diaper, put a band-aid on top.

If there is any discharge from the umbilical wound, the baby should be changed frequently to avoid contact of the wound surface with contaminated clothing. With bathing it is better to wait: you should not wet the affected area until it heals. In case of any suspicious moments, it is better to consult a doctor.

Algorithm of umbilical wound treatment

What you should have on hand to properly treat an umbilical wound:

• cotton swabs, cotton pads;
• pipette and, if necessary, antiseptic preparation [5] (Chlorophyllipt, diamond green solution, chlorhexidine bigluconate [6], [7], [8], etc.);
• 3% hydrogen peroxide.

The treatment is carried out not before, but after bathing the baby. The procedure itself consists of the following steps:

• you need to wash your hands thoroughly with soap and water;
• drop 1-2 drops of hydrogen peroxide from a dropper into the navel area, wait a few seconds;
• Use a cotton swab or disk to remove the crusts and secretions that have separated;
• if necessary, apply an antiseptic preparation.

The standard procedure is repeated daily after bathing the baby. But in case of discharge or redness, the frequency of treatment is increased to 2 or 3 times a day. In addition, about problems with tightening of the umbilical wound, you need to inform the district pediatrician or nurse.

Treatment of the umbilical wound with a clothespin

The procedures for treating the navel with and without a clothespin are virtually the same:

• apply a few drops of peroxide to the area below the clothespin, wait about half a minute;
• remove softened crusts with a cotton pad;
• the area is treated in a circular fashion with a cotton swab soaked in a solution of brilliant green.

Many parents fear that they will hurt the baby or accidentally tear off the clothespin. Such fears are in vain: the procedure is painless for the baby, and the clothespin together with the mummified residue will fall off on its own without any consequences.

The only inconvenience may be the diaper: if it does not have a special hole for the navel, it may touch the clothespin and prevent normal healing. In such a situation, it is recommended to fold up the front edge of the diaper so that the navel and the clothespin remain open.

After the clothespin falls off, the procedure is carried out according to the same scheme, treating the wound itself. For better penetration of antiseptic, the edges of the wound surface should be slightly pulled apart with the thumb and forefinger. If this is not done, the internal crusts may stagnate and the wound may become infected.

Chlorophyllipt

A wonderful natural antibacterial remedy, authorized for use literally from birth is Chlorophillipt, which is produced in the form of an oil and alcohol solution. To treat the umbilical wound, you will need Chlorophyllipt on alcohol - it is very convenient to use a spray bottle (also sold in the pharmacy).

The principles of treatment with Chlorophyllipt spray are the same as when using other preparations:

• mom washes her hands, wipes them off;
• puts the baby on the changing table, slightly widens the umbilical ring with thumb and forefinger (this allows you to examine the wound for pus discharge and other problems);
• sprays Chlorophyllipt directly into the wound;
• With a clean gauze cloth, remove the crusts and drops of preparation, then spray again with a little solution.

Chlorophyllipt treatment can be carried out 1-2 times a day (necessarily - in the evening after bathing). To clean the navel is better to use not absorbent cotton, but bandages or gauze, so that small fibers do not get into the wound and do not stick to it. With no less success is allowed to use cotton disks.

Chlorophyllipt perfectly fights infection and promotes tissue healing. But this drug has one important disadvantage: it can cause allergies, if the body has a tendency to such reactions. Therefore, before applying the remedy, it is necessary to pre-test it on a small area of skin: if there is no reaction, then you can safely carry out the treatment of the umbilical wound.

Baneocin

Doctors often recommend Baneocin for lubrication of the umbilical wound: this drug is based on the action of antibiotics, perfectly heals wet and festering wounds, prevents the development of skin infections.

But Baneocin, in addition to positive properties, has an impressive number of side effects:

• Allergic reactions in children, which manifest themselves in the form of redness, rashes, itching;
• toxic effect on hearing and urinary system (detected with prolonged use of the drug);
• dry skin.

These adverse symptoms may develop if the drug is used for more than seven consecutive days. No adverse symptoms are observed with a shorter term of use.

How to properly apply Baneocin to the umbilical wound:

• Treat the wound with hydrogen peroxide - in a very small amount, then blot the navel with a tissue.
• Sprinkle Baneocin on the navel.
• If the umbilicus is wet or there is discharge, repeat the application of the product 3-4 times a day. If the umbilical wound is healing normally, it is enough to apply the product once a day.

As a rule, doctors do not advise to use such a strong remedy without special need: Baneocin is indicated if the umbilical wound has an unpleasant odor, or appeared wet or purulent discharge.

Streptocide

If the navel heals for a long time, or is wet, then the time-tested drug Streptocide can be included in the treatment of the wound. This is a well-known sulfonamide drug that has a bacteriostatic effect against streptococci, meningococci, pneumococci, gonococci and Escherichia coli.

How to use this drug? It is used only externally:

• the tablet should be crushed into powder;
• pour a small amount of powder into the umbilical opening.

Streptocide is poured into the wound twice a day (can be used as a mono-medication, or alternate with other external medications).

As a rule, with such treatment, the navel heals already within 2-3 days.

Alcohol to treat the umbilical wound

It is better to treat the umbilical wound with effective, but not aggressive external remedies. If you intend to use medical alcohol for the procedure, you should not take a 96% version. A 70% alcohol solution is quite enough. A more concentrated preparation can excessively dry the baby's skin, which can later cause bleeding and prolonged healing of the wound process.

It should be remembered that, in addition to antiseptic and disinfectant action, medical alcohol also has a local irritant and tannic effect. Specialists do not recommend using 96% alcohol for skin treatment in children under 14 years of age.

It is allowed to use alcohol tinctures (again, with a concentration of no more than 70%). These can be tinctures of calendula, chamomile, propolis - of course, the treatment is carried out on condition that the baby does not have an allergic reaction.

Umbilical wound care

As the umbilical wound heals, measures must be taken to prevent it from becoming infected. [9] What these measures are:

• If you bathe your baby, you should use boiled water for the bath, or add a little potassium permanganate (until the water is pale pinkish in color);
• It is useful to bathe the baby in a bath with the addition of decoctions of sage, chamomile, succession;
• baby clothes that come in direct contact with the umbilical wound should be changed frequently, several times a day;
• The umbilical wound can not be covered with a diaper (it must be tucked in, or use special varieties with a hole in the navel area), can not be taped or bandaged;
• baby's clothes in contact with the navel, after washing should be thoroughly ironed with a hot iron;
• the procedure of navel treatment is carried out under all hygienic conditions - in a clean, ventilated room, on a clean towel, sheet or diaper.

Bathing with an umbilical wound

There are several doctors' opinions about bathing a baby with a non-healed umbilical wound. Some of the experts recommend avoiding water procedures until the wound tightens, practicing only regular wiping of the baby's skin with a wet diaper. Other doctors advise bathing the baby using a pinkish solution of potassium permanganate, or boiled water, and it is undesirable to wet the navel area.

Most parents find a "golden mean", alternating between bathing in a solution of manganese and wiping with a wet diaper. Perhaps they are right: it is better to be patient for 5-7 days than to try to eliminate complications of healing later.

After any water procedure - be it bathing or wiping - you should be sure to treat the navel.

As soon as the umbilical wound in a newborn heals, if there are no complications, you can easily bathe the baby in ordinary tap water. If desired, it is allowed to add anti-inflammatory herbal decoctions to the bath, or a little manganese powder.