Umbilical Cord Care

Topic Overview
After the umbilical cord is cut at birth, a stump of tissue remains attached to your baby's navel
(umbilicus). The stump gradually dries and shrivels until it falls off, usually between 1 and 2 weeks
after birth. It is important that you keep the umbilical cord stump and surrounding skin clean and dry.
This basic care helps prevent infection. It may also help the umbilical cord stump to fall off and the
navel to heal more quickly.
Cleaning
Gently clean your baby's umbilical cord stump and the surrounding skin at least once a day and as
needed during diaper changes or baths.
1. Soak a cotton swab in warm water and mild soap. Squeeze out the excess water. Gently wipe
around the sides of the stump and the skin around it. Your doctor may recommend using rubbing
alcohol instead of soap and water. If you use rubbing alcohol, first apply a gentle lotion around the
stump. This can help protect your baby's sensitive skin.
2. Wipe away any wet, sticky, or dirty substances.
3. Gently pat dry the area with a soft cloth.
The stump usually falls off in a week or two but sometimes it takes longer. Continue to clean around
the navel at least trice a day until the navel has completely healed.
Keeping the area dry
You can help your baby's umbilical cord stump fall off and heal faster by keeping it dry between
cleanings.
• Keep your baby's diaper folded below the umbilical cord stump. If folding does not work well, try
cutting out an area in the front of the diaper (before you put it on your baby) to keep the stump
exposed to air. It also helps prevent diaper contents, such as urine, from irritating the stump.
• Bathe your baby carefully. Keep the umbilical cord stump above the water level until the stump falls
off and heals. Many baby baths are gently sloped. This helps you position your baby for a sponge bath
and helps you keep the umbilical cord out of the water.
Knowing what to expect
• Most umbilical cord stumps look worse than they really are. Right after birth, an umbilical cord stump
usually looks white and shiny and may feel slightly damp. As the stump dries and heals, it may look
brown, gray, or even black. This is normal. Usually no problems will develop as long as you keep the
area clean and dry.
• The umbilical cord stump usually falls off in a week or two. Sometimes the stump falls off before the
first week. Other times, the stump may stay longer.
• You may notice a red, raw-looking spot right after the stump falls off. A small amount of fluid
sometimes tinged with blood may ooze out of the navel area. This is normal. The navel area should dry
out within a few days. It should dry completely and look mostly healed within 2 weeks after it falls off.
When to call a doctor
Call your baby's doctor if you see signs of an infection. These signs include:
• Pus around the base of the cord.
• Fluid that continues to ooze out of the navel area a few days after the stump falls off. (It is normal to
notice some fluid the first day or two after the stump falls off.)
• Red, tender skin around the base of the cord.
• Your baby crying when you touch the cord or the skin around it.
• Fever.
Also call your baby's doctor if you notice any other problems with the umbilical cord, such as:
• Swelling and moistness on your baby’s navel that lasts for more than 2 weeks after the umbilical
cord has fallen off. This may be a piece of extra tissue called an umbilical granuloma. This minor
problem usually is treated with medicine to dry the area. Sometimes a couple of stitches are also
needed.
• Bulging tissue around the navel, usually noticed after the umbilical cord falls off. This may be an
umbilical hernia, which usually goes away on its own. But it should be monitored by a doctor.

Newborn Assesment
A perinatal history, determination of gestational age, physical examination, and behavior assessment
form the basis for a complete newborn assessment.
The common physical characteristics included in the gestational age assessment are skin:
• Lanugo- Downy hair on the body of the fetus and newborn baby. It is the first hair to be produced by
the fetal hair follicles, usually appearing on the fetus at about five months of gestation. It is very fine,
soft, and usually unpigmented. Although lanugo is normally shed before birth around seven or eight
months of gestation, it is sometimes present at birth. This is not a cause for concern: lanugo will
disappear within a few days or weeks of its own accord.
SIGN PHYSICAL MATURITY SCORE SIGN
SCORE
-1 0 1 2 3 4 5

Lanugo
none sparse abundant thinning bald areas mostly bald

• Sole (plantar) creases - The first appearance of a crease appears on the anterior sole at the ball of
the foot. this may be related to foot flexion in utero, but is contributed to by dehydration of the skin.
Infants of non-white origin have been reported to have fewer foot creases at birth.

SIGN PHYSICAL MATURITY SCORE SIGN SCORE

-1 0 1 2 3 4 5
Plantar Surface heel-toe
40-50mm: -1 <40mm: -2 >50 mm
no crease faint red marks anterior
transverse crease only creases ant. 2/3 creases
over entire sole

• breast tissue and size – The breast bud consists of breast tissue that is stimulated to grow by
maternal estrogens and fatty tissue which is dependent upon fetal nutritional status. the examiner
notes the size of the areola and the presence or absence of stippling (created by the developing
papillae of Montgomery). The examiner then palpates the breast tissue beneath the skin by holding it
between thumb and forefinger, estimating its diameter in millimeters, and selects the appropriate
square on the score sheet.
SIGN PHYSICAL MATURITY SCORE SIGN
SCORE
-1 0 1 2 3 4 5
Breast imperceptable barely
perceptable flat areola
no bud stippled areola
1-2 mm bud raised areola
3-4 mm bud full areola
5-10 mm bud

• ear form and cartilage – The pinna of the fetal ear changes it configuration and increases in cartilage
content as maturation progresses. Assessment includes palpation for cartilage thickness, then folding
the pinna forward toward the face and releasing it. The examiner notes the rapidity with which the
folded pinna snaps back away from the face when released, then selects the square that most closely
describes the degree of cartilagenous development.
In very premature infants, the pinnae may remain folded when released. In such infants, the examiner
notes the state of eyelid development as an additional indicator of fetal maturation.
SIGN PHYSICAL MATURITY SCORE SIGN
SCORE
-1 0 1 2 3 4 5
Eye / Ear lids fused
loosely: -1
tightly: -2 lids open
pinna flat
stays folded sl. curved pinna;
soft; slow recoil well-curved pinna;
soft but ready recoil formed & firm
instant recoil thick cartilage
ear stiff

• Genitals-Male - The fetal testicles begin their descent from the peritoneal cavity into the scrotal sack
at approximately the 30th week of gestation. The left testicle precedes the right and usually enters the
scrotum during the 32nd week. Both testicles are usually palpable in the upper to lower inguinal canals
by the end of the 33rd to 34th weeks of gestation. Concurrently, the scrotal skin thickens and develops
deeper and more numerous rugae.
Testicles found inside the rugated zone are considered descended. In extreme prematurity the
scrotum is flat, smooth and appears sexually undifferentiated. At term to post-term, the scrotum may
become pendulous and may actually touch the mattress when the infant lies supine. Note: In true
cryptorchidism, the scrotum on the affected side appears uninhabited, hypoplastic and with
underdeveloped rugae compared to the normal side, or, for a given gestation, when bilateral. In such a
case, the normal side should be scored, or if bilateral, a score similar to that obtained for the other
maturational criteria should be assigned.

SIGN PHYSICAL MATURITY SCORE SIGN SCORE

-1 0 1 2 3 4 5
Genitals (Male) scrotum
flat, smooth scrotum empty,
faint rugae testes in upper canal,
rare rugae testes descending,
few rugae testes down,
good rugae testes pendulous,
deep rugae

• Genitals-Female - To examine the infant female, the hips should be only partially abducted, i.e., to
approximately 45° from the horizontal with the infant lying supine. Exaggerated abduction may cause
the clitoris and labia minora to appear more prominent, whereas adduction may cause the labia
majora to cover over them.
In extreme prematurity, the labia are flat and the clitoris is very prominent and may resemble the
male phallus. As maturation progresses, the clitoris becomes less prominent and labia minora become
more prominent. Nearing term, both clitoris and labia minora recede and are eventually enveloped by
the enlarging labia majora.
The labia majora contain fat and their size are affected by intrauterine nutrition. Over-nutrition may
result in large labia majora earlier in gestation, whereas under-nutrition, as in intrauterine growth
retardation or post-maturity, may result in small labia majora with relatively prominent clitoris and
labia minora late into gestation. These findings should be reported as observed, since a lower score on
this item in the chronically stressed or growth retarded fetus may be counter-balanced by a higher
score on certain neuro-muscular items.
Normal ranges for vital signs assessed in the newborn are as follows: heart rate, 120 to 160 beats per
minute; respirations, 30 to 60 respirations per minute; axillary temperature, 36.4 to 37.2 °C (97.5 to
99 °F); skin temperature, 36 to 36.5 °C (96.8 to 97.7 °F); rectal temperature, 36.6 to 37.2 °C (97.8 to
99 °F); and blood pressure at birth, 80—60/45—40 mm Hg.
Normal newborn measurements are as follows: weight range, 2500 to 4000 g (5 lb, 8 oz, to 8 lb, 13
oz), with weight dependent on maternal size and age; length range, 45 to 55 cm (18 to 22 in); and
head circumference range, 32 to 37 cm (12.5 to 14.5 in)–approximately 2 cm larger than the chest
circumference.
Commonly elicited newborn reflexes:
• Tonic neck - extensions of the arm and sometimes of the leg on the side to which the head is forcibly
turned, with flexion of the contralateral limbs; seen normally in the newborn.
• Moro - flexion of an infant's thighs and knees, fanning and then clenching of fingers, with arms first
thrown outward and then brought together as though embracing something; produced by a sudden
stimulus and seen normally in the newborn
• Grasp - flexion or clenching of the fingers or toes on stimulation of the palm or sole, normal only in
infancy.
• Rooting - A reflex seen in newborn babies, who automatically turn their face toward the stimulus and
make sucking (rooting) motions with the mouth when the cheek or lip is touched. The rooting reflex
helps to ensure breastfeeding.
• Sucking - sucking movements of the lips of an infant elicited by touching the lips or the skin near the
mouth.
• Blink - the involuntary movement of one or both eyelids of both eyes simultaneously
A score is given for each sign at one minute and five minutes after the birth. If there are problems with
the baby an additional score is given at 10 minutes. A score of 7-10 is considered normal, while 4-7
might require some resuscitative measures, and a baby with apgars of 3 and below requires
immediate resuscitation.
Sign 0 Points 1 Point 2 Points
A Activity (Muscle Tone) Absent
“floppy movement” Arms and Legs Flexed w/ little movement Active Movement
P Pulse Absent Below 100 bpm Above 100 bpm
G Grimace (Reflex Irritability) No Response Facial movement only (grimace) with stimulation Sneeze,
cough with stimulation, pulls away
A Appearance (Skin Color) Blue-gray, pale all over Normal, except for extremities Normal over entire
body
R Respiration Absent Slow, irregular,weak Good, crying

Sources:
• http://www.elsevier.com/wps/find/bookdescription.cws_home/692965/description#description
• http://books.google.com.ph/books?
id=apeLf0mPx1QC&pg=PA488&lpg=PA488&dq=newborn+assessment+by+pilliteri&source=bl&ots=V
4jiFLPwDa&sig=CzfUuuiqaZuA9rQn0XaUnbUb5qI&hl=tl&ei=G-7fS4G1NY-
asgOU24z3BA&sa=X&oi=book_result&ct=result&resnum=1&ved=0CAYQ6AEwAA#v=onepage&q&f=f
alse
• http://www.ballardscore.com/
• http://medical-dictionary.thefreedictionary.com
• http://kidshealth.org/parent/newborn/first_days/apgar.html