Management of the umbilical cord and umbilical wound V maternity hospital and after discharge from the maternity hospital.
Ear toileting is performed once a week as needed.
In case of illness - as prescribed by a doctor.
The baby's nutrition before birth comes from the mother's body through the placenta and umbilical cord. After the birth of the child cord remnant A disposable plastic clamp is applied. The umbilical cord stump dries out and mummifies when exposed to air without any treatment with antiseptics. Falling off of the umbilical cord stump with a plastic clamp placed on it usually occurs 10-14 days after the birth of the child.
When caring for the umbilical cord and umbilical wound, you must adhere to the following rules:
1. The main conditions for accelerating the process of drying out the umbilical cord and its falling off, as well as for preventing infection of the umbilical cord and umbilical wound - dryness and cleanliness.
2. Do not allow fat, urine, or feces to come into contact with the umbilical cord.
3. If the umbilical cord remains are contaminated, it must be washed with running water (or with soap) and wiped dry with a gauze cloth or a clean, ironed diaper.
5. Keep the navel area exposed to air more often (during feeding and when the child is awake).
6. When using a diaper, fix it below the navel area.
7. You can bathe a child with an umbilical cord, you can bathe him in unboiled water (adding “potassium permanganate” is not advisable - it dries the skin excessively, removes beneficial microflora, the risk of skin colonization by opportunistic and pathogenic microflora)
8. If signs of infection of the umbilical cord stump or umbilical wound appear (the appearance of pus from the umbilical cord stump or from the bottom of the umbilical wound, redness of the skin around the navel, unpleasant odor) - consultation with a pediatrician.
In most cases, when caring for the umbilical fossa area after the umbilical cord has fallen off, it is enough to follow dryness and cleanliness, bathe your child daily.
Only in isolated situations - with the development or threat of development of an inflammatory process, it is necessary to clean the umbilical wound until it heals using antiseptics.
Target: Therapeutic.
Equipment:
1. 3% hydrogen peroxide solution
2. 1% alcohol solution of brilliant green.
3. Sterile tweezers.
4. Sterile material (sterile cotton swabs).
5. Sterile rubber gloves.
6. Tray for waste material.
Sequencing:
1. Introduce yourself to the mother, explain the purpose and course of the upcoming procedure, and obtain verbal consent.
2. Prepare the necessary equipment.
3. Wash and dry your hands.
4. Wear sterile gloves.
5. Use sterile tweezers to take a sterile stick.
6. Moisten the stick with 3% hydrogen peroxide solution over the tray.
7. Separate the edges of the umbilical wound with a large and index fingers left hand
8. Insert a stick soaked in hydrogen peroxide into the umbilical wound strictly perpendicularly and treat the wound from the center to the periphery
9. Dispose of the stick into the waste tray (class B waste).
10. Dry the wound with another sterile stick.
11. Dispose of the stick into the waste tray (class B waste).
12. Moisten the third sterile stick with 1% alcohol solution brilliant green.
13. Spread the edges of the umbilical wound, treat it from the center to the periphery, without touching the skin.
14. Dispose of the stick into the waste tray (class B waste).
15. Disinfect and dispose of used material and gloves.
16. Remove gloves, wash and dry your hands.
The very first treatment of the navel is carried out 3 minutes after birth, because then the pulsation of blood vessels stops. The tail of the navel should completely fall off 5-8 days after birth, and by 10-15 days it will be covered with skin.
Omphalitis has several forms:
1. Weeping navel or catarrhal omphalitis. A clear fluid is released from the navel, which does not allow the navel to heal. The skin around the navel turns red;
2. Fungus. This form of omphalitis is more common in large children and in those newborns who have a thick umbilical cord;
3. Phlegmonous omphalitis. The child often spits up, eats poorly, does not gain weight, etc.;
4. Necrotizing omphalitis. In this form, the infection can spread to other tissues.
If the child’s mother asked for help in a timely manner, the prognosis will be favorable, but such children are often prone to portal hypertension. It is also worth remembering that we should monitor not only the physical ailments of our children, but also the psychological ones.
Upon discharge from the maternity hospital (as usual on the third day), each woman is explained how to properly care for a fresh umbilical wound.
The very first treatment of the navel is carried out 3 minutes after birth, because then the pulsation of blood vessels stops. The tail of the navel should completely fall off 5-8 days after the birth of the child, and by 10-15 days it will already be covered with skin.
How to care for the umbilical wound?
The navel area should always be dry and clean, because it is in a humid environment that microbes multiply faster, which, as a rule, lead to infection. It is necessary to treat the baby's navel twice a day, the first time during the morning toilet and the second time after bathing.
To begin with, the navel is treated with hydrogen peroxide. Dry the wound only with blotting movements using a sterile cotton ball or gauze pad. After these procedures, the navel is lubricated with brilliant green.
Until what point should the navel be treated?
This must be done until it heals and there are no crusts or any discharge on it. Also, do not stop processing if the hydrogen peroxide foams.
You should definitely call a doctor if your mother notices discharge from the wound on the umbilical wound and the skin around the navel turns red.
How to treat the navel with omphalitis?
Omphalitis has several forms:
1. Weeping navel or catarrhal omphalitis. A clear fluid is released from the navel, which does not allow the navel to heal. The skin around the navel turns red;
2. Fungus. This form of omphalitis is more common in large children and in those newborns who have a thick umbilical cord;
3. Phlegmonous omphalitis. The child often spits up, eats poorly, does not gain weight, etc.;
4. Necrotizing omphalitis. In this form, the infection can spread to other tissues.
Only catarrhal omphalitis can be treated at home, and all other forms only in a hospital under the supervision of a doctor.
With a simple form of omphalitis, treatment should begin with a peroxide solution. Next, a water or alcohol antiseptic is applied to the navel. The umbilical cord must be processed 4 times. You can bathe a newborn, but you must add a decoction of chamomile, string, or a weak solution of potassium permanganate (potassium permanganate) to the (boiled) water.
Also, for omphalitis, the pediatrician prescribes physical treatment, for example, microwave, ultraviolet irradiation, UHF. Sometimes a course of immunotherapy is required.
If the child’s mother seeks help in a timely manner, the prognosis will be favorable, but such children are often prone to portal hypertension. It is also worth remembering that we should monitor not only the physical ailments of our children, but also their psychological health.
After being discharged from the maternity hospital, the mother is left alone with the child and is faced with the need to look after him. Some phenomena can frighten a woman, in particular, many young mothers do not know how to properly care for the umbilical wound. Often babies have a problem in the form of a wet navel, how to deal with this?
Symptoms of a weeping navel
In the first minutes after birth, the baby's umbilical cord is clamped and cut. The cord remnant normally falls off within two to four days. In its place, an umbilical wound is formed, which becomes covered with a crust. Complete healing of the navel occurs within two to three weeks.
Normally, the healing process of the umbilical wound may be accompanied by slight weeping and the formation of yellowish crusts. But in the case of pronounced weeping and poor healing of the umbilical wound, they speak of the development of catarrhal omphalitis (wetting navel).
Bacteria (- and,) are to blame for the development of omphalitis, which penetrate into the tissues through the umbilical cord or umbilical wound. The activity of bacteria leads to the development of inflammation.
Symptoms of catarrhal omphalitis (weeping navel) are:
With long-term weeping, a mushroom-shaped growth of granulation tissue can form - this is called umbilical fungus. Catarrhal omphalitis does not affect general condition child. This form of the disease is the most favorable and often occurs among newborns.
Symptoms of purulent omphalitis in newborns
If the discharge from the umbilical wound becomes yellow and thick, this indicates the development purulent omphalitis. At the same time, the skin around the navel swells and turns red. When inflammation spreads to the peri-umbilical area, it develops phlegmonous omphalitis, which is characterized by severe swelling, redness of the skin around the navel, as well as protrusion of the umbilical area. The skin around the navel is hot to the touch, and when you press on this area, pus flows out of the umbilical wound.
A complication of this form of the disease is necrotizing omphalitis. This is a very rare condition, often found in weakened children. With necrotizing omphalitis, the inflammatory process spreads deep into the tissues. The skin in the umbilical area becomes purplish-bluish and soon peels off from the underlying tissue, forming a large wound. This is the most severe form of omphalitis, which can lead to sepsis.
Purulent omphalitis is severe, children become lethargic, do not breastfeed well, and there is an increase in temperature. Fortunately, purulent forms of omphalitis are quite rare.
Prevention and treatment of a weeping navel in newborns
If parents are faced with a problem such as a weeping navel, they should contact their pediatrician. The doctor will treat the umbilical wound and teach this manipulation to parents. For catarrhal omphalitis (weeping navel), the doctor can treat the disease at home. However, when purulent forms omphalitis, hospitalization of the baby is mandatory.
Treatment and prevention of a weeping navel is carried out as follows:
All newborns need to undergo this procedure once a day until the umbilical wound is completely healed. For babies with a weeping navel, manipulation can be performed two to three times a day.
Navel fungus is treated by cauterizing granulations with a 5% solution of silver nitrate. When phlegmonous omphalitis The baby is prescribed antibiotics internally, as well as externally in the form of ointments. In the necrotic form of the disease, in addition to antibacterial treatment surgical excision of dead tissue is performed.
What should you do if your belly button gets wet?
Unfortunately, good intentions do not always lead to speedy recovery. Thus, some manipulations can further aggravate poor healing of the umbilical wound.
What mistakes do parents often make when caring for their baby's belly button?
- You should refrain from bathing your child in bathtubs. It is enough to wipe the baby with a wet towel every day.
- Do not cover the navel with a band-aid, diapers, or clothing. Contacting the skin with air helps the wound dry out.
- Try to forcefully tear off the crusts.
- Treat the wound with an antiseptic more often than the doctor advised.
sterile tray;
tray for waste material;
craft bag with cotton balls, brushes and gauze napkins;
tweezers in disinfection solution;
medicines: 3% hydrogen peroxide solution, 5% potassium permanganate solution, 70% alcohol.
Check for clean diapers;
Treat the changing mattress with a disinfectant solution (macrocid-liquid, terralin, sidex);
Open the waste bin.
Wash and dry your hands, put on gloves.
Place diapers on the changing table.
Unwaddle the baby in the crib. (Wash it and dry the skin, if necessary).
9. Place the baby on the prepared changing table. Performing a manipulation
With your left hand, spread the edges of the umbilical ring.
Moisten the brush with 3% hydrogen peroxide solution by pouring it over the tray for used material.
Coat the umbilical wound generously with hydrogen peroxide in one motion, inserting the shaving brush perpendicular to the navel, rotating the shaving brush 360° in a comma-like motion.
With your left hand, spread the edges of the umbilical ring, dry the wound with a dry shaving brush (introducing the shaving brush perpendicular to the navel into the wound with a movement similar to a comma).
Throw the shaving brush into the waste tray.
Moisten a new shaving brush with 70% ethyl alcohol.
With your left hand, spread the edges of the umbilical ring, treat the wound with a movement similar to a point, introducing the shaving brush perpendicular to the navel.
Throw the shaving brush into the waste tray.
As prescribed by the doctor: use a brush moistened with a 5% solution of potassium permanganate to treat only the wound without touching the skin; point movement. Discard the shaving brush.
The final stage of the manipulation
Swaddle the baby.
Put him to bed.
Treat the changing table with disinfectant. solution.
Remove gloves, wash and dry your hands.
Schematic representation of manipulation
1) H2O2 2) dry 3)● alcohol 70° 4 ) ● K MnO4 5%
Giving a hygienic bath to a newborn baby
The first hygienic bath is carried out on the 2nd day after discharge from the hospital; Before the umbilical wound heals, use boiled water or a permanganate solution
potassium (2-3 weeks);
in the 1st half of the year they bathe daily for 5-10 minutes, in the 2nd half of the year you can bathe every other day.
The water temperature in the bath is 37-38.0 C; soap is used once a week.
Air temperature in the room is 22-24 C.
Bathed before the penultimate feeding.
Technical training
Two containers - with cold and hot water(or tap water).
Potassium permanganate solution (95 ml of water - 5 g of K Mn O4 crystals, the prepared solution is filtered through cheesecloth, and the crystals should not
get into the bath).
Rinse jug.
Bath.
Water thermometer.
"Mitten" made of terry cloth (flannel).
7.Baby soap (baby shampoo).
8. Sterile oil (baby cream, vegetable).
9. Diapers, vests. 10. Changing table.
11.Des. solution
Preparatory stage
Wash and dry your hands.
Lay out the diapers on the changing table.
Place the bath in a stable position (pre-treated with a disinfectant solution or washed with baby soap).
The bath is filled to 1/2 or 1/3 of its volume.
Add a 5% solution of potassium permanganate to a slightly pink solution.
Measure the temperature of the water with a thermometer.
Performing the manipulation:
Undress the child. After defecation, wash with running water. Throw dirty laundry into the waste bin.
Take the baby with both hands: place the baby on left hand an adult, bent at the elbow, so that the child’s head is on the elbow; With the same hand, grab the child’s left shoulder.
Place the baby in the bath, starting from the feet so that the water reaches the baby's nipple line.
The legs remain free after diving. Immersion level - up to the nipple line.
Wash the baby's neck and chest for several minutes.
Washing the body:
put on a mitten;
lather the mitten with gel, or soap, or shampoo;
gently soap the child’s body;
wash the baby’s folds with a soapy mitten;
rinse the baby.
Washing head:
It is advisable to wash your hair last, as this procedure can cause a negative reaction in the child).
wet your hair (from the forehead to the back of your head) by pouring water from a ladle (jug);
apply shampoo or foam to hair;
Gently massaging your head, lather the shampoo or foam;
rinse off the soap suds with water from the forehead to the back of the head so that the soapy water does not get into the eyes;
turn the baby over the bath with his back up;
rinse the child with water from a jug
Remove the child from the water in a face down position.
Rinse with water from a jug and wash.
Throw a towel or diaper over the baby, place it on the changing table and dry the skin. Throw the wet diaper into the tank.
The final stage
Treat skin folds with vegetable oil.
Treat the umbilical wound, toilet the nasal and auditory passages.
Swaddle the baby.
Drain the water and treat the bath.
Wash and dry your hands.
New parents are especially sensitive. After all, it’s no secret that until it heals, there is a possibility of infection, and with it the development inflammatory processes skin and subcutaneous tissues. If this happens, they talk about a disease called navel omphalitis.
What pitfalls does this conceal? medical term? And why should its treatment be started as early as possible, and moreover, under the guidance experienced doctors?
What is omphalitis?
Omphalitis (from the Greek omphalos - “navel” + itis - ending indicating inflammation) is a disease affecting mainly newborn children. It manifests itself as inflammation of the bottom of the umbilical wound, the umbilical ring with the vessels adjacent to it, and the subcutaneous fatty tissue in the area of the umbilical ring. The disease develops approximately in the 2nd week of a baby’s life.
Omphalitis, along with other pathologies of the neonatal period, such as streptoderma, epidemic pemphigus, is not so rare. The problem is that untreated omphalitis has a destructive effect on the body, leading to such consequences as peritonitis, sepsis, phlebitis of the umbilical vessels, and phlegmon. Therefore, if you find that there is something wrong with the navel, immediately show your baby to the doctor so as not to delay treatment.
Causes
The only reason for the development of omphalitis is infection through a navel wound. Most often the culprits infectious infection become staphylococci or streptococci. Less commonly - gram-negative bacteria, representatives of which are Escherichia coli and diphtheria coli.
How does the infection get inside? There are several factors that provoke the development of omphalitis:
- Incorrect or insufficient treatment of the umbilical wound.
- Non-compliance hygiene standards while caring for the baby: treating the navel with the dirty hands of parents or medical staff, untimely washing of the baby after he defecated.
- Caring for a child is carried out by a sick person who can transmit the infection through airborne droplets.
- Development of diaper dermatitis. Child for a long time is in a diaper contaminated with urine or feces, the skin sweats. Rare bathing and lack of air baths make the situation worse.
- Primary infection with other skin infectious disease, for example, pyoderma or folliculitis.
- It is extremely rare that infection occurs directly during childbirth, when the umbilical cord is ligated.
Premature babies born in out-of-hospital aseptic conditions (for example, home birth), as well as those who have had a difficult pregnancy, are at greater risk of developing omphalitis. intrauterine development, aggravated by hypoxia, congenital abnormal pathologies.
A variety of forms of the disease and its symptoms
Omphalitis of the navel, depending on the severity of its occurrence, is classified into catarrhal, necrotic and phlegmonous. If the disease develops against the background of infection of the navel, omphalitis is called primary. In cases where the infection joins existing anomalies, such as fistulas, they speak of secondary omphalitis. Let's look at all the available forms in more detail.
"Wet navel"
The “simplest” form of the disease, which is also the most common, has the best favorable prognosis. Its generally accepted medical name- catarrhal omphalitis. As a rule, the umbilical cord falls off on its own within the first 10 days of life. In the area of the umbilical ring, epithelization begins to occur, that is, healing of the navel. A crust forms, which dries out by the end of the second week and also falls off, leaving a clean, pretty navel.
The healing of the umbilical wound takes place in several stages
However, if the wound gets infected, local inflammation does not allow it to heal properly. Instead, serous-purulent fluid is released, sometimes mixed with blood, and the wound healing process is delayed for several more weeks. Periodically, crusts cover the bleeding area, but after they fall off, proper epithelization does not occur. Just such a phenomenon is called a weeping navel.
Prolonged inflammation leads to the formation of a mushroom-like protrusion at the bottom of the navel, the so-called fungus. And although physical state newborns do not suffer particularly: the appetite is good, the child is gaining weight well, sleeps soundly, etc. - redness and swelling are observed around the umbilical ring, body temperature may rise to 37-37.2 O C.
Phlegmonous omphalitis
This form of the disease is said to occur when the “wet navel” has not received sufficient care, and the inflammation has spread to nearby tissues. Reddened skin accompanied by swelling subcutaneous tissue, causing the stomach to appear slightly bloated. The venous pattern in the anterior area is more clearly visible abdominal wall. If, in addition to everything, red stripes are observed, lymphangitis may develop, a disease that affects the capillaries and lymphatic vessels.
If the infection has spread to the umbilical tissue, do not self-medicate. The child must be examined by a qualified specialist
A characteristic symptom of phlegmonous omphalitis is pyorrhea. In the process of pressing in the navel area, purulent contents are released. Ulcers may form at the site of the umbilical fossa. Such complications also affect the baby’s well-being: the child eats poorly, is capricious, and often burps. He is lethargic, the thermometer is rapidly rising - up to 38 O C.
Necrotizing omphalitis
The most unfavorable course of the disease, but, fortunately, it is quite rare, mainly in weakened children with clear signs immunodeficiency and delay in physical and psycho-emotional development. The skin of the abdomen is not just hyperemic. It becomes dark purple, sometimes bluish, as the suppuration spreads deeper and deeper.
The baby does not have the strength to fight the infection, so the disease is rarely accompanied by elevated temperature. Rather, on the contrary, it is below 36 O C, and the child himself moves little, the reaction is inhibited. Any complications are dangerous for the baby’s life, since bacteria entering the systemic bloodstream (so-called septic infection) can provoke the development of the following diseases:
- osteomyelitis - inflamed Bone marrow, and with it all the bone elements;
- enterocolitis - inflammation of the mucous membrane intestinal tract;
- peritonitis - inflammation of the peritoneum and organs abdominal cavity;
- purulent pneumonia;
- phlegmon of the abdominal wall (accumulation of pus).
Treatment of necrotic (gangrenous) omphalitis is carried out only in hospital aseptic conditions, often with surgical intervention.
Diagnostics
The primary diagnosis is made immediately during an examination of the baby by a pediatrician, neonatologist or pediatric surgeon. However, to make sure there are no complications that we talked about earlier, an additional procedure is prescribed. instrumental diagnostics:
- Ultrasound of the abdominal organs;
- Ultrasound of soft tissues;
- X-ray of the abdominal cavity with a survey examination.
Even if the diagnosis was made by a neonatologist, the child is mandatory examines pediatric surgeon.
Examination of the baby by a pediatric surgeon is mandatory
The discharged fluid, especially with impurities of pus, is taken for analysis (bacteria culture) for precise definition infectious pathogen. This is important, because having determined what type of infection we are dealing with, as well as its sensitivity to antibacterial agents, the doctor will be able to select the group of antibiotics that will be most effective in treatment.
How is omphalitis treated?
At home they treat only simple form omphalitis. This requires local treatment of the umbilical wound up to 4 times a day. First, 2-3 drops of hydrogen peroxide are dripped into the wound and the contents are removed with hygienic sticks. Then drying and simultaneous antiseptic measures occur: the wound is treated with a brilliant green solution, furatsilin, chlorophyllipt, dioxidin or 70% alcohol. The baby is bathed in a pale pink solution of potassium permanganate.
In severe cases, antibiotic therapy is mandatory, as well as local application antiseptic ointments(Vishnevsky's liniment, baneocin) in the form of applying a bandage to the wound. It is possible to inject antibiotics directly into the inflammation site. The fungus of the navel is cauterized according to indications with silver nitrate (lapis).
A drainage can be placed on the wound - a special tube through which a good outflow of pus is ensured. According to indications, detoxification solutions are used intravenously, administration of gamma globulin, as well as excision ( surgical removal) necrotic tissue areas. Ulcers are also removed surgically.
The baby is prescribed medications to boost immunity and vitamin therapy.
If the doctor deems it appropriate, physiotherapeutic treatment methods such as ultraviolet irradiation, UHF therapy or helium-neon laser are used.
Consequences
The prognosis for the treatment of catarrhal omphalitis in newborns is very favorable and ends full recovery. As for phlegmonous or necrotizing omphalitis, it all depends on how quickly treatment begins and whether all possible methods therapy. Risk fatal outcome in septic infections is always high.
Preventive measures
- change the diaper promptly;
- wash the child as needed during the day;
- treat the umbilical wound daily with hydrogen peroxide and brilliant green until it is completely healed;
- All manipulations for caring for the navel should be carried out with hands washed with soap;
- If purulent discharge becomes noticeable in the wound or lumps appear, immediately show the child to the doctor.
