This refers to the practices and measures taken to care for the umbilical cord stump in a newborn baby from the time of birth until it dries, detaches, and the umbilicus (navel or belly button) heals completely. Proper cord care is essential to prevent infection and promote normal healing.

Physiology of Cord Separation:

• After birth, the umbilical cord is clamped and cut, leaving a stump attached to the baby’s navel.

• This stump contains no nerves, so the baby does not feel pain when it is handled or when it detaches.

• The cord stump begins to dry out through a process called dry gangrene or mummification.

• It gradually changes color from a whitish-blue or yellowish-gray at birth to brown, and then to black as it dries.

• The stump typically shrivels, hardens, and falls off on its own within 1 to 3 weeks after birth (average is often 7-14 days, but can vary).

• After the stump falls off, there may be a small, raw-looking spot or a little moistness that will heal completely within a few more days.

Goals of Umbilical Cord Care:

• Prevent Infection (Omphalitis): This is the primary goal. The moist, dead tissue of the cord stump can be a breeding ground for bacteria if not kept clean and dry.

• Promote Healing and Separation: Allowing the natural drying process to occur.

• Minimize Discomfort for the Baby: Although the stump itself is not painful.

• Educate Parents/Caregivers: Ensuring they understand proper care techniques and signs of complications.

Recommended Cord Care Practices (WHO and other guidelines generally emphasize keeping the cord clean and dry):

1. Keep the Cord Stump Clean:

   • Wash hands thoroughly with soap and water before and after touching the cord stump or changing the baby’s diaper.

   • If the stump becomes soiled with urine or stool, gently clean it with plain water and a soft, clean cloth or cotton ball. Pat it dry thoroughly with a clean, absorbent cloth.

   • Avoid using soap directly on the stump unless specifically advised by a healthcare provider, as it can sometimes cause irritation or delay drying.

2. Keep the Cord Stump Dry (Dry Cord Care):

   • This is the cornerstone of modern recommended practice in most settings, especially where hygiene is good.

   • Air Exposure: Expose the stump to air as much as possible to help it dry out.

     • Fold the top edge of the diaper down (below the navel) to keep the stump uncovered and prevent irritation from the diaper and contamination with urine. Special newborn diapers often have a cutout for the cord.

     • Dress the baby in loose-fitting clothing that allows air to circulate around the stump. Avoid tight onesies or clothing that covers and presses on the stump.

   • Avoid Immersion Baths: Until the cord stump has fallen off and the navel is completely healed, it’s generally recommended to give sponge baths rather than immersing the baby in a tub. This helps keep the stump dry. Once healed, tub baths are fine.

3. Antiseptics – When and What? (Varies by setting and risk):

   • High-Resource Settings / Low Risk of Infection: For healthy, term newborns born in hygienic settings (e.g., hospitals in developed countries) with good home hygiene, dry cord care (keeping it clean with water and allowing it to air dry) without routine application of antiseptics is generally recommended. Routine use of alcohol or other antiseptics is often discouraged as it may kill beneficial bacteria and potentially delay cord separation.

   • Low-Resource Settings / High Risk of Infection: In areas with high rates of neonatal mortality due to infection, or where home hygiene conditions are poor, the WHO recommends daily application of 4% chlorhexidine digluconate (aqueous solution or gel) to the umbilical cord stump for the first 7 days of life for newborns born at home. For facility births in these settings, chlorhexidine application may also be recommended, especially if post-natal follow-up is limited. This has been shown to significantly reduce omphalitis and neonatal mortality.

   • Other Antiseptics (Less Commonly Recommended Now):

     • Rubbing Alcohol (Isopropyl Alcohol): Previously common, but now less recommended for routine care as it can irritate the skin and may delay cord separation. It may still be used by some providers or in specific situations.

     • Triple Dye (Gentian Violet, Brilliant Green, Proflavine Hemisulfate): Used in some regions, particularly in the past, for its antimicrobial properties. Can stain skin and clothing.

     • Povidone-Iodine: Generally not recommended due to concerns about potential iodine absorption and effects on thyroid function in newborns.

   • Always follow the specific advice of the baby’s healthcare provider regarding the use of any antiseptics.

4. Do Not Pull or Attempt to Remove the Stump:

   • Allow the cord stump to fall off naturally on its own. Pulling it off, even if it seems loose, can cause bleeding, pain, and increase the risk of infection.

5. Monitor for Signs of Infection or Other Complications:

   • Parents should be educated to observe the cord stump and surrounding skin at each diaper change.

Signs of Umbilical Cord Stump Infection (Omphalitis) or Other Problems – When to Contact a Healthcare Provider:

• Redness: Spreading redness of the skin around the base of the cord stump. A little pinkness right at the base where it’s detaching can be normal, but spreading redness is a concern.

• Swelling: Puffiness or swelling of the skin around the stump.

• Warmth: The skin around the stump feels unusually warm to the touch.

• Pus or Foul-Smelling Discharge: A yellowish or greenish discharge, or a bad odor coming from the stump (a slight moistness or a tiny bit of crusted yellowish material as it separates can be normal, but true pus is not).

• Tenderness: The baby cries or seems to be in pain when the area around the cord is touched.

• Fever: Axillary temperature of 100.4°F (38°C) or higher.

• Bleeding:

  • A few drops of blood when the stump falls off or if it gets snagged can be normal.

  • Continuous or active bleeding from the cord stump is not normal and requires medical attention.

• Delayed Separation: If the cord stump has not fallen off after 3-4 weeks (though some sources say up to 6-8 weeks warrants evaluation), consult a healthcare provider. This could indicate an underlying issue, such as an immune deficiency or umbilical abnormality (e.g., urachal remnant).

• Umbilical Granuloma: After the cord falls off, a small, moist, pinkish-red lump of scar tissue may remain. This is an umbilical granuloma. It may ooze a small amount of clear or yellowish fluid. Often resolves on its own, but if persistent or large, it may require treatment by a healthcare provider (e.g., silver nitrate application).

• Umbilical Hernia: A bulge at the navel that becomes more noticeable when the baby cries or strains. This is common and usually harmless, resolving on its own by a few years of age. However, it should be monitored by a healthcare provider.

Parental Education and Reassurance:

• Emphasize the importance of handwashing.

• Explain the natural process of cord drying and separation.

• Clearly describe the signs of infection and when to seek medical help.

• Reassure parents that the stump has no feeling and normal care will not hurt the baby.

• Provide clear, simple instructions, and offer opportunities for parents to ask questions and demonstrate understanding.