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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).
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.
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 …
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.
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