Delayed Umbilical cord Detachment: A Case Report

Umbilical cord separation generally occurs within the first 2 weeks after being born. Histological findings of this detachment involve a polymorphonuclear infiltration between the newborn epidermis and cord. Delayed umbilical cord separation (DCS), has been related to neutrophils migration and adherence disorders, which are usually seen in patients with severe recurrent infections.

Objective: To present a case of DCS and a review of the topic.

Case: Full-term infant born by caesarean section, with a birth weight of 3265 grams and an Apgar score of 9-9. Exclusively breastfed and a normal development during first month. At 30 days, assessment revealed umbilical cord still had not detached, but presented no other alterations.
Ultrasound ruled out persistent urachus, and blood analysis showed normal neutrophil count, and also normal migration and adhesion of granulocytes. Umbilical cord was finally removed through a surgical procedure with excellent outcome and no infections.
Furthermore, DCS has also been described in Leukocyte Adhesion Deficiency and Neonatal Alloimmune Neutropenia, both of them very rare diseases. At present, there is no consensus to establish when a particular study is needed. American pediatricians considered matter of concern a cord separation greater than 21 days. However, follow-up of a 28 newborns cohort with DCS greater than 1 month did not show immune abnormalities and an excellent long-term outcome. Additionally, factors that could influence DCS are caesarean section, hyperbilirubinemia and topical antibiotics and therefore could explain some cases of DCS with good outcome.

Conclusion: Although DCS has been historically associated with severe immune disorders, it can be present in healthy newborns. Nevertheless, DCS should be studied in high risk cases or when severe disease is suspected.