9 April 2008
note: This question is over 2 years old and may differ to any new research.
BestBETs produced the critically appraised topic (CAT) “Is silver nitrate the best agent for management of umbilical granulomas?” [1]. They report:
“The above papers suggest umbilical granulomas may be self-limiting and resolve with conservative management such as the application of salt. They also suggest that application of silver nitrate is not without risk.
Anecdotal evidence suggests that cleaning with Steret alcoholic wipes may be as effective as salt. If they are used then they should be applied at each nappy change. It may also be beneficial to fold the front of the nappy to expose the umbilicus.
There is no randomized controlled trial (RCT) that shows that conservative management is as effective as silver nitrate. A RCT to investigate this is being planned.”
ATTRACT have also answered a question on umbilical granuloma [2]. They report on a review article that states:
"The common treatment is application of a 75% silver nitrate stick, usually repeated two to three times over a number of clinic visits. Burns have been reported following spillage onto the surrounding tissues. During a 10-year period, 302 neonates were treated for UG using excision and application of absorbable hemostatic materials. Healing was uneventful in all cases, and no complications have been encountered to date. This technique is simple, safe, and inexpensive, and obviates the need for repeated outpatient visits".
GP Notebook (an eTextbook) has a section on umbilical granuloma [3]. With regard to management they state:
- if infection is suspected then take a swab for microscopy and culture. Localised umbilical infection may be treated with topical therapy e.g. fusidic acid cream tds.
- a persistent granuloma can be cauterised with the tip of a silver nitrate stick.
- the surrounding normal skin should be protected with petroleum jelly in order to prevent chemical burns.
- a patient may be reviewed after a week to check if a further application of silver nitrate is required.
References
1) BestBETs. Is silver nitrate the best agent for management of umbilical granulomas? 2001 (
http://www.bestbets.org/cgi-bin/bets.pl?record=00339)
2) ATTRACT. What is the best treatment for a neonatal umbilical granuloma? 2003. (
http://www.attract.wales.nhs.uk/question_answers.cfm?question_id=1455)
3) GP Notebook. Umbilical granuloma (
http://www.gpnotebook.co.uk/simplepage.cfm?ID=-1804926961&linkID=34556&cook=yes)
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