Kaylyn's Umbilical Granuloma and other Concerns

10 Days Old!

Today we returned to our pediatrician's office to have Kaylyn's weight checked again, to see that she was gaining weight normally. She weighed in at 8 pounds 5 ounces! Dr Tony was pleased (and impressed) at her weight gain since her last appointment just last week. No concern there! I asked him to take a look at her umbilical cord site as I was concerned with the amount of discharge I was finding on her clothing and I was worried it had become infected despite my efforts to keep it clean and treating it with rubbing alcohol to encourage drying it up.

Her cord stump had fallen off just yesterday but prior to that it was hanging by what looked like a dark red string. Now it looked more like a regular bellybutton with a pink fleshy ball inside of it. Dr Tony explained that Kaylyn had what is called umbilical granuloma. An umbilical granuloma is a small piece of bright red, moist flesh that remains in the umbilicus after cord separation when normal healing should have occurred. It is a small piece of scar tissue, usually on a stalk, that did not become normally covered with skin cells. It contains no nerves and has no feeling. It was normal for this granulation tissue to ooze fluid and have a slight yellow-green discharge,  but it is not accompanied by swelling, redness, warmth, tenderness, or a fever associated with infection. Basically the cord has dried and fallen off but there is still healing tissue in the new belly button.

To treat it, he used what looked like a long matchstick with silver nitrate on the tip. It cauterizes the area. He said this should resolve any discharge and I can continue to care for Kaylyn's new belly button just as I have been. Very rarely the cord will continue to ooze despite the apparent healing of the stump which is a condition called a patent urachus. The fluid that leaks is actually urine. The treatment is of course surgical closure of the connection. Another potential cause of persistent discharge from the umbilicus in young infants is a persistent yolk stalk (also known as omphalomesenteric duct, umbilical duct, or vitelline duct). It can leak intestinal contents because it is a direct connection from the small bowel to the umbilicus. Again, treatment is surgical. He highly doubts either of these conditions are anything to worry about now, but to keep an eye on Kaylyn's belly button just to be sure.

Dr Tony continued to do a normal newborn physical examination including checking Kaylyn's eyes, nose, ears, mouth, heart, and extremities. Part of checking the extremities included Dr Tony performing special maneuvers of the hip joint in which he was concerned that Kaylyn's left hip clicked during the procedure, indicating that her hip was out of position. I explained that I noticed before when I tried to put Kaylyn in footed pajamas that she always pulled her left leg up to the point it would get caught in the crouch area of the jammies instead of being inside the pant leg. He then ordered for a hip ultrasound to assess the hip joint. An x-ray does not show the bones in a young baby until at least 6 months of age, and therefore a hip ultrasound is preferred. The hip ultrasound will show the doctor the position and shape of the hip joint. Instead of the normal ball-in-socket joint, the ultrasound may show the ball outside of the socket, and a poorly formed (shallow) socket. If Kaylyn shows signs of some type of hip dysplasia then a special brace would need to be worn.

Another concern was that Dr Tony said he heard what appeared to be a faint trace of a heart murmur. He mentioned something about pin sized holes in the heart could be the cause. He went on more in detail but I was fixated on the words "heart murmur" and was already panicking a bit. He must have seen my alarm because he kept assuring me that it was probably nothing, and that these things correct themselves over time. To be sure, he also scheduled a echo cardiogram or "echo" of the heart. Due to Kaylyn's young age, he was able to get both appointments in for tomorrow.

My little ray of hope here is that Kaylyn was examined twice prior- once when she was a day old in the hospital and again just last week on the 17th and neither of those doctors found any issues. So I don't know if it was just them overlooking the problems, if the problems were not present then, or if Dr Tony is mistaken. I trust Dr Tony entirely. He was my brother's and my pediatrician growing up and Shaylee's pediatrician now, and I always found his prognosis more accurate than other doctors we have seen. So I am hoping that these issues, if present, really are nothing to worry about. But if there is an issue, you bet I am going to find out how they were overlooked by the other two doctors!

So tomorrow we have the appointments for the ultrasound and the echo. Its gonna be several hours of sitting at the hospital. Pray that all goes well!!