The umbilical cord of the newborn usually separates and sloughs by the end of the second postnatal week.1 However, a wide variation exists in the age at which cord separation occurs in healthy infants with regard to ethnicity, geographical location, and methods of cord care. A marked delay in cord separation raises the suspicion of leukocyte adhesion deficiency (LAD), a rare disorder leading to defective neutrophil function.2 Patients with LAD type I have been found to have a history of delayed umbilical cord separation and omphalitis in infancy.3 As this immunologic disorder has a high morbidity and mortality, screening and early detection are recommended. This has prompted increased referrals for screening for immune defects. Two infants in whom an alternate diagnosis for the delayed cord separation was made are described.
The first case was a healthy male infant born at 41 weeks' gestation by cesarean section, weighing...
Comments
Umbilical Cord and LAD
From what we hear in the AAAAI meetings, and reading carefully the initial descriptions of LAD, it seems that the teaching of delayed umbilical cord separation as an important clue for the diagnosis of LAD should be changed to neonatal omphalitis. This change would discriminate better for the suspicion of LAD, and less unnecessary flow cytometry tests would be performed.
Persistent Cord
In my practice, the common causes for persistent cord include: 1) Failure of a parent to clean the base of the cord well – sometimes difficult if the cord is matted down or has a deep unexposed crevice. Or, 2) prolonged use of alcohol (past when the cord is obviously hard and firm – usually by the 3rd or 4th day).
Both of the above factors stimulate cellular infiltration and exudate formation which keep the cord alive and vascularized at its base, thus prolonging separation. The reminder and fine explanation concerning urachal abnormalities was very useful and informative.
When umbilical exudate appeared soupy, I used to use a BUN dip-stick to check for the presence of urine, apparently a rare event. The BUN stick is no longer available, but ultra sound is .... time marches on.