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Should all infants with delayed umbilical cord separation be investigated for leucocyte adhesion deficiency?
  1. Sarah Reynolds1,2,
  2. Devika Devlia3,
  3. Rebecca Stearns3,
  4. Theresa Cole4
  1. 1Neonatal Unit, John Radcliffe Hospital, Oxford, Oxfordshire, UK
  2. 2Home, Windsor, UK
  3. 3Department of Paediatrics, Wexham Park Hospital, Slough, UK
  4. 4Allergy and Immunology Department, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
  1. Correspondence to Dr Sarah Reynolds, Neonatal Unit, John Radcliffe Hospital, Oxford, Oxfordshire, UK; sarah.reynolds20{at}nhs.net

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While reviewing a well, term, 22-day old infant with prolonged jaundice you notice the umbilical cord is still attached. His mother is concerned; she has read that delayed cord separation can be associated with immune problems and wants you to test for these. Should you investigate, and how?

Structured clinical question

In infants with delayed umbilical cord separation (POPULATION), does investigating all for possible leucocyte adhesion deficiency (LAD) (INTERVENTION), compared with only those with signs of immune impairment (COMPARISON) act as an effective screening tool for LAD (OUTCOME).

Search

A Cochrane Library Search for produced no relevant reviews. PubMed searches for ‘umbilical cord separation AND time’ and ‘leucocyte adhesion deficiency’ yielded 404 (five relevant) and 724 (eight relevant) results (table 1). Non-English language, single case reports and papers relating to LAD in other species/animal models were excluded.

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Table 1

Summary

Commentary

To establish if there is benefit to investigating infants with delayed cord separation, we must define ‘delay’.

Cord separation occurs at the demarcation zone following infiltration of polymorphonuclear leucocytes and collection formation between the abdominal wall and the base of the drying stump.1 2

We reviewed five cohort studies (2023 infants). In the largest study (Oudesluys-Murphy3) of 911 neonates, separation times ranged from 1 to 29 with a mean of 7.4 days (SD±3.3). Mean separation times in other studies4–7 ranged from 7.4 to 13.9 days (longest reported 45 days). No studies followed infants beyond cord separation time, but none had severe/recurrent infection …

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Footnotes

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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