Umbilical Granuloma

Definition

• Benign granulation tissue at the umbilicus following umbilical cord stump separation

• Presents as a small, moist, pink to red nodule that may exude a clear or serous discharge

• Differentiated from an umbilical polyp, which requires referral

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Clinical Features

• Typically occurs in neonates after the cord stump falls off

• Non-tender lesion with persistent serous discharge

• Usually isolated with no systemic symptoms

• May be confused with urachal remnants if atypically large or persistent

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Investigations

• Clinical diagnosis based on characteristic appearance and history

• Consider further evaluation (eg, referral for surgical assessment) if the lesion is atypical, large or fails to respond to initial treatment

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Management

• First-line treatment:

  • Salt application: Apply a pinch of table salt twice daily for 30 minutes followed by rinsing; improvement expected within approximately 1 week

  • Silver nitrate cauterisation: Apply weekly using a protective barrier (eg, petroleum jelly) on surrounding skin to avoid chemical burns

• For persistent or large lesions:

  • Double ligature with sterile thread to cut off blood supply may be considered

  • Urgent referral if the granuloma remains unresolved or shows signs of secondary infection

• Supportive measures:

  • Allow exposure to air for drying and natural healing

  • Educate caregivers on the benign, self-limiting nature of the condition and proper nappy hygiene

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Notes

• Avoid the routine use of antiseptics or antibiotics unless there is clear evidence of infection

• Reassess the lesion after 2–3 weeks; lack of improvement may indicate an umbilical polyp or a urachal remnant requiring specialist evaluation

• Emphasise that umbilical granulomas generally respond well to conservative management and rarely lead to complications

• Parental reassurance is critical, as the condition typically resolves without significant intervention

• Maintain proper documentation and educate caregivers on signs to watch for in case the granuloma becomes infected or persists beyond expected resolution time