Umbilical granulomas: a randomised controlled trial

• umbilical granulomas

The Archimedes section has previously contained a brief section on the treatment of umbilical granulomas.¹ We have now conducted a randomised controlled trial of the management of umbilical granulomas. The trial compared silver nitrate cauterisation with the use of alcoholic wipes at each nappy change (conservative management). The impetus for this work was a series of three burns to the anterior abdominal wall after silver nitrate cauterisation, seen in a single London hospital over a two year period.

The trial aimed to show equivalence between the two treatment modalities. On the basis of equal efficacy, we intended to change practice to conservative management. More than 40 infants were referred, but a large number of parents chose conservative management rather than randomisation. Difficulty in recruitment meant there were inadequate numbers to show statistical significance within the limited time span available.

The salient results were that two of three granulomas resolved over a three week period without cauterisation. Those infants whose granulomas did not resolve went on to treatment with cauterisation following a protocol that involved drying the area both before and after silver nitrate application, surrounding the umbilicus with white soft paraffin, and leaving the area exposed for 10 minutes after application. This resulted in resolution in all remaining cases without harm due to delay in treatment.

On the basis of this work, we suggest a change in current practice to initial conservative management followed by cauterisation only when conservative treatment fails.