Delayed Separation of the Umbilical Cord Attributable to Urachal Anomalies

Abstract

The umbilical cord of the newborn usually separates and sloughs by the end of the second postnatal week.1 However, a wide variation exists in the age at which cord separation occurs in healthy infants with regard to ethnicity, geographical location, and methods of cord care. A marked delay in cord separation raises the suspicion of leukocyte adhesion deficiency (LAD), a rare disorder leading to defective neutrophil function.2 Patients with LAD type I have been found to have a history of delayed umbilical cord separation and omphalitis in infancy.3 As this immunologic disorder has a high morbidity and mortality, screening and early detection are recommended. This has prompted increased referrals for screening for immune defects. Two infants in whom an alternate diagnosis for the delayed cord separation was made are described. ### Case 1 The first case was a healthy male infant born at 41 weeks' gestation by cesarean section, weighing 8 lbs, 2 oz. He had no history of local or systemic infections at 3 months of age. His growth and development were appropriate for age. Physical examination revealed an active, well-appearing infant with mild eczema of the cheeks and a firmly attached, dry umbilical cord (Fig 1). There was no erythema, induration, or discoloration of the umbilicus or abdominal wall. On investigation, total and differential blood counts were normal, with normal T and B cell subpopulations. Evaluation for leukocyte adhesion markers revealed normal expression of CD18 and CD 11 a, b, and c molecules on leukocyte cell surfaces, excluding an adhesion defect. Ultrasound showed a well-demarcated, extraperitoneal, subumbilical cyst. There were no other genitourinary abnormalities. Complete surgical excision of …