weekly_question 17/4/2022

[Admin]

A primary care physician refers a 3-week newborn with delayed separation of the cord to see you. Which has been associated with delayed cord separation?

A Term delivery

B Leukocyte Adhesion Deficiency 1

C Vaginal delivery

D Severe Combined Immune Deficiency

E Dry umbilical care

[Admin]

correct answer
B Leukocyte Adhesion Deficiency 1

Umbilical cord separation occurs in the first two weeks of life (5.8 to 10.9 days). There is wide variation in the time it takes for the event. Delayed separation of the umbilical cord is defined as separation after 3 weeks, although there is some variability in the definition. Histological studies show this event occurs with granulocyte influx and phagocytosis at the base of the cord. There is much debate about the care of the umbilicus at birth. A 2013 Cochrane review suggests there is no clear data to support any single antiseptic practice, but treatment with alcohol or chlorhexidine does delay cord separation. The WHO recommends dry care.

Pediatric surgeons may be involved in the evaluation of patients with delayed separation. Infants born by c-section tend to have a longer time to separation (3 days). This is thought to result from decreased bacterial contamination and therefore less leukocytes attracted to the cord. Both chlorhexidine and alcohol treatment appear to delay cord separation (1-2 days) compared to dry care. Prematurity is also associated with delayed cord separation. Urachal anomalies rarely can be associated with delayed separation. LAD 1 is a disorder of neutrophils due to a genetic defect in the beta subunit of the integrin molecule ITGB2. Patients have a complete absence of neutrophils at the site of inflammation, causing recurrent bacterial infections and sepsis. These patients may present with omphalitis and delay in separation of the umbilical cord. These patients require stem cell or bone marrow transplantation. SCID (Severe Combined ImmunoDeficiency) often presents in infancy, but not with delayed cord separation.

[Ahmed Azzam]

B

[Spider32]

B

[Pedsurgkb]

B

[Ismailmohamed]

B

[Ahmednabilps]

b

[Admin]

correct answer
B Leukocyte Adhesion Deficiency 1

Umbilical cord separation occurs in the first two weeks of life (5.8 to 10.9 days). There is wide variation in the time it takes for the event. Delayed separation of the umbilical cord is defined as separation after 3 weeks, although there is some variability in the definition. Histological studies show this event occurs with granulocyte influx and phagocytosis at the base of the cord. There is much debate about the care of the umbilicus at birth. A 2013 Cochrane review suggests there is no clear data to support any single antiseptic practice, but treatment with alcohol or chlorhexidine does delay cord separation. The WHO recommends dry care.

Pediatric surgeons may be involved in the evaluation of patients with delayed separation. Infants born by c-section tend to have a longer time to separation (3 days). This is thought to result from decreased bacterial contamination and therefore less leukocytes attracted to the cord. Both chlorhexidine and alcohol treatment appear to delay cord separation (1-2 days) compared to dry care. Prematurity is also associated with delayed cord separation. Urachal anomalies rarely can be associated with delayed separation. LAD 1 is a disorder of neutrophils due to a genetic defect in the beta subunit of the integrin molecule ITGB2. Patients have a complete absence of neutrophils at the site of inflammation, causing recurrent bacterial infections and sepsis. These patients may present with omphalitis and delay in separation of the umbilical cord. These patients require stem cell or bone marrow transplantation. SCID (Severe Combined ImmunoDeficiency) often presents in infancy, but not with delayed cord separation.