Umbilical Disorders with Dr. Rebeccah Brown
With Dr. Rebecca Brown · hosted by Dr. Em Gootee · StayCurrentMD
Cued at 1:30 · stops at 2:15 · press play
Educational content from recorded physician discussions — not medical advice. Talk to your (or your child's) care team about your situation.
More about omphalitis
same diagnosisOnly a few other public items share this diagnosis — nothing to add yet.
Only a few other public items share this expert — go deeper there →
Video
Pediatric Surgical Oncology Research Collaborative (PSORC): Studying Rare Pediatric Tumors
56 s · Published May 2026
Video
Update Course Rewind 2025: Hirschsprung + ARM: Rare but Real
1 min · Published May 2026
Video
Update Course Rewind 2025: Hirschsprung + ARM: Rare but Real
1 min · Published May 2026
Video
Pooling Patients to Study Rare Pediatric Tumors: An Introduction to PSORC
56 s · Published May 2026
Video
The fetal frontier: A review of current and emerging fetal therapies for genetic diseases
44 s · Published May 2026
Video
Indocyanine green assists with sentinel lymph node mapping in pediatric and adolescent patients
1 min · Published May 2026
What the experts said
Omphalitis is bacterial colonization of the umbilical stump, most commonly due to staph and strep from skin flora.
In advanced omphalitis cases, patients need hospital admission and pediatric surgery consultation.
Umbilical hernias are more common in African Americans, low birth weight infants, and premature infants.
Incarceration with umbilical hernias is rare, occurring in less than 0.2% of cases, and is more common with smaller defects.
In Tiffany Zinz's study of 308 umbilical hernia repairs, there was a higher incidence of complications if patients were less than 4 years of age versus greater than 4 years of age.
A literature review of 787 manuscripts (28 meeting quality criteria) showed that early surgical repair of umbilical hernias before age 4 was not indicated regardless of defect size.
In a 2020 study of 9,809 patients, the 3-year recurrence rate after umbilical hernia repair was twice as high in children less than 4 years of age versus those greater than 4 years of age.
If an umbilical hernia persisted at age 3, spontaneous closure occurred in 20% by age 4 and 35% by age 5.
Dr. Brown's opinion is that hernias with a huge defect that are proboscoid are probably not going to close spontaneously.
Indications for umbilical hernia repair include persistence after 5 years of age, signs or symptoms of incarceration, and consideration for large proboscoid hernias in patients about to start school.
Dr. Brown's approach is to repair umbilical hernias at 5 years regardless of size if they haven't closed, or earlier if the patient is having symptoms.
Umbilical hernia repair technique involves dissecting around the hernia sac, dividing it, trimming excess sac, closing the fascia with interrupted absorbable sutures (such as Vicryl), and recreating the umbilicus.
Umbilical granulomas are the most common umbilical masses in newborns.
Dr. Brown recommends neutralizing silver nitrate burns by applying water after silver nitrate application to prevent skin damage and keep it from spreading.
Bright red, pedunculated umbilical lesions that bleed easily are more difficult to treat and may represent polyps rather than simple granulomas.
The umbilical cord contains two umbilical arteries and one umbilical vein surrounded by Wharton's jelly (a gelatin-like extracellular matrix).
Umbilical cords usually fall off at 2 to 3 weeks after birth.
Delayed umbilical cord separation can be a manifestation of an immune deficiency.
Mild omphalitis cases (inflammation of the belly button) may be treated with alcohol drying, ampicillin, or amoxicillin with follow-up every 24 hours.
16% of patients admitted with omphalitis develop necrotizing fasciitis.
Necrotizing fasciitis from omphalitis presents with rapidly progressive umbilical edema, erythema, drainage, and has a high mortality rate.
Umbilical hernias can be associated with trisomy 13, 18, and 21.
Dr. Brown mentioned that if the fascial opening in an umbilical hernia is larger than 1.5 centimeters, it may not close by itself.
In Walker's studies, 96% of very small umbilical hernias (less than 0.5 centimeters) closed by six years, but no hernia greater than 1.5 centimeters closed by six years of age.
Unplanned emergency department returns within 30 days after umbilical hernia repair occurred at 2.5%, with rates twice as high for patients younger than 4 years old.
Asymptomatic umbilical hernia repair should be delayed until greater than 4 years of age.
In Rangel's study of 167,000 patients at 68 pediatricians' offices, 4,486 had umbilical hernia diagnosis at a median age of 1.6 months, with spontaneous closure occurring in 89% by age 5.
In Rangel's study, closure rates for smaller hernias (≤1 cm) were nearly 90%, while for larger hernias they were around 80%.
Rangel's study concluded that umbilical hernia repair should be delayed until age 5 years given the high incidence of spontaneous closure.
Proboscoid hernia occurs when the skin above the hernia grows and pushes through the opening in the abdominal wall.
It is recommended to correct proboscoid hernias before school age to avoid psychological issues for the child.
Dr. Brown prefers to perform umbilicoplasty in umbilical hernia repairs, excising excess skin and using a 4-0 monocryl purse-string suture close to the skin surface to create a cosmetically appealing umbilicus.
Umbilical granulomas are usually moist but commonly dry up and fall off spontaneously over time.
Umbilical granulomas often respond to silver nitrate treatment.