What should be investigated in delayed umbilical cord separation: Two case reports

Delayed umbilical cord separation (UCS) defined as failure of umbilical cord fall beyond 3 weeks is seen in up to 10% of newborns. Since delayed UCS can be associated with leukocyte adhesion deficiency (LAD) or coagulation factor XIII deficiency, these children are commonly referred to hematology/oncology for further investigation. Although the incidence of urachal remnants (UR); also associated with delayed UCS, is more common (1.16%) than LAD (1:1000000 births), and coagulation factor XIII deficiency (1:5000000 births) it's less commonly investigated.

Two otherwise healthy infants, a 6-week-old female and a 4-week-old male were seen at our hematology/oncology clinic for delayed UCS. In both cases the umbilical cords looked healthy, with no signs of infection or pus, but appeared to show small Umbilical Granulomas. They were both investigated for LAD type I and one was investigated for XIII deficiency, but both tests were negative. These infants however, were investigated via abdominal ultrasound which showed UR in both cases. These infants required no intervention.

This report demonstrates an often overlooked association between delayed UCS and UR and suggests abdominal ultrasound if necessary for diagnosis.