My check indicates it is umbilical granuloma, please what causes this and how do I manage it? Abena, Tema.

Dear Abena, The umbilicus serves as a connection between the baby and the mother in the womb, supplying the baby with oxygen, nutrients and other essential things the baby needs to survive and grow. After birth, the cord must be separated by cutting in a sterile manner.

Normally, when the umbilical cord is cut, a small stump remains which usually dries up and falls off without any complications. Sometimes, though, when the stump falls off, an umbilical granuloma forms.

Though the exact cause is unknown, this protruding umbilical mass is thought to be formed due to excessive inflammation in the base of the umbilical cord, likely due to infection which may result in delayed cord separation.  

An umbilical granuloma is an overgrowth of tissue during the healing process of the belly button. It is usually a soft pink or red lump and often oozes a small amount of clear or yellow fluid. An umbilical granuloma is very common in newborns and is usually painless and harmless.

There are no reports on the spontaneous regression of umbilical granuloma without treatment, even though some people recommend watchful waiting as a form of management without any intervention.

Fortunately, most umbilical granulomas can be treated easily with a tiny amount of a chemical called silver nitrate. This chemical burns off the tissue. There are no nerves in the growth, so the procedure doesn’t cause any pain.

Another treatment option is to place a little salt on the granuloma and keep it in place with a piece of gauze taped over the belly button. After 10 to 30 minutes, clean the area with a gauze pad soaked with warm water.

It is believed that the salt causes dehydration of the granuloma from osmosis leading to the death of the granuloma cells. It is recommended to repeat this salt application twice a day for two or three days.

Another treatment option which you were advised to use is applying copper sulphate (Blue Stone) to the umbilical granuloma once a day. The copper sulphate burns the granuloma just like silver nitrate does and is painless.

If silver nitrate or salt application or copper sulphate application doesn’t work, some of
the treatment options include:

• A small amount of liquid nitrogen can be poured into the granuloma to freeze it. The tissue then dissolves. This is usually done in the hospital or clinic setting.

• The growth can be tied off with a suture thread. Before long, it will dry out and disappear.

• In rare cases, surgery is needed to remove the granuloma and stop the spread of infection.
Home management advice include:

• Keep the belly button clean and dry during this time. Gently clean the belly button with warm water and soap.

• Exposing the belly button to air may be helpful, too. You can help by rolling down the front of the diaper so that it doesn’t cover the belly button.

•  Avoid placing your baby in bathwater until the belly button has healed.

Complications that can make umbilical granuloma worse is secondary infection. Pointers to infection include fever, bleeding around the granuloma, swelling or redness around the granuloma, pain or tenderness around the belly button, foul-smelling drainage from the belly button or a rash near the belly button.

 In these instances, the baby would need to be admitted and treated in a hospital.

The writer is a member of the Paediatric Society of Ghana and the Director of Medical Affairs at the Korle Bu Teaching Hospital