Sir.—Primary care clinicians must offer anticipatory guidance to parents regarding separation and care of the umbilical stump. Most cords uneventfully separate within 5 to 14 days of birth.1,2 The exact mechanism of cord separation is unknown; however, a combination of factors may contribute to its timing. Bacterial colonization, drying, necrosis, infarction, and granulocyte influx all influence cord separation, independently or in conjunction with one another. Prolonged retention of the umbilical cord may be a source of concern and anxiety to both parents and physicians. Some authors note that delayed separation may be associated with serious disorders of neutrophil function3,4,5 and histiocytosis.6 The following case of an infant with unusually delayed separation (10 weeks) prompted a literature review for guidance regarding management options. As the published information is scant and contradictory, we conducted a poll of practicing pediatricians to evaluate their preferences in managing these cases.
ANHALT H, MARINO RV, ROSENFELD W. Retained Umbilical Stump: Clinical Approaches and Separation Anxiety. Am J Dis Child. 1992;146(12):1413-1414. doi:10.1001/archpedi.1992.02160240023005