Source: Manual of Ambulatory Pediatrics 2010
SOAP Note – Umbilical Granuloma
A small, moist, pink lesion that forms at the base of the umbilical cord.
I. Etiology: Believed to be the result of a mild infection
II. Subjective data
A. Umbilicus moist, oozing
B. Pink mass on umbilicus
C. Foul odor may be present.
D. History of mild infection with mucopurulent drainage or delayed drying of cord
III. Objective data
A. Soft, pink granulation tissue on umbilicus
B. Seropurulent discharge
C. Examine for bleeding, erythema, purulent discharge, edema of stump.
IV. Assessment
A. Diagnosis is made by typical appearance of granulation tissue.
B. Differential diagnosis
1. Umbilical polyp: Larger (7 to 10 mm), firmer mass
2. Patent urachus: Fistula between bladder and umbilicus that discharges urine when infant voids
V. Plan
A. Cauterize with silver nitrate stick. Do not touch surrounding skin with silver nitrate.
B. Wash umbilicus 3 to 5 minutes after cauterizing.
VI. Education
A. Keep diapers below umbilicus.
B. Watch for oozing, odor, bleeding.
VII. Follow-up
A. Recheck in 5 to 7 days to check healing.
B. Repeat cauterization if granuloma is still present.
VIII. Complications: Secondary infection
IX. Consultation/referral: Persistence of granuloma after repeat treatment with silver nitrate.