DELAYED SEPARATION OF UMBILICAL CORD

DELAYED SEPARATION OF UMBILICAL CORD

There is no standard definition of delayed cord separation, probably due to the variations seen in normal cord separation.
Separation of the cord beyond 3-4 weeks of age is generally considered to be significantly delayed.

Conditions that are associated with delayed separation of the umbilical cord include:

1.    Prematurity
2.   low birthweight,
3.   administration of topical antimicrobial agents: Topical antimicrobials and/or isopropyl alcohol are usually applied after delivery. Studies have shown longer time to separation of the cord with use of antiseptic topical agents such as chlorhexidine, 70% alcohol, and triple dye.
4.  systemic antibiotics for neonatal infections
5.  delivery by cesarean route
6.   infections
7.    immune disorders including leukocyte adhesion deficiency type 1 &3
8.    omphalomesenteric and urachal remnants 
9.    infants with delayed cord separation and presentation of omphalitis or skin infections should be investigated for immunologic disorders, including leukocyte adhesion deficiency.
10.    Factor 13 deficiency.
11.  Hypothyrodism
    

Investigations:

1.    CBC may show high WBC count (>20 X 109/L) in the absence of infection.
2.    CD11a , CD18a
3.    Factor XIII assay.
4.    Free t4 ,TSH
5.    Pelvi abdominal Ultrasound