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Endgames Case Review

A baby with a discharging umbilical lesion

BMJ 2016; 355 doi: https://doi.org/10.1136/bmj.i5587 (Published 26 October 2016) Cite this as: BMJ 2016;355:i5587

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Re: A baby with a discharging umbilical lesion: A SAFER APPROACH TO UMBILICAL GRANULOMA WITH SILVER NITRATE STICK

A SAFER APPROACH TO UMBILICAL GRANULOMA WITH SILVER NITRATE STICK

Arturo Tozzi
Linda Ferraro
ASL NA2 Nord, Caivano, Naples, Italy

Neonatal umbilical granuloma is frequently treated with silver nitrate sticks. The tip is wetted before the treatment , because its two ingredients (silver and potassium nitrate) activate when they are mixed with moisture, such as a drop of water: the ensuing chemical reaction permanently destroys granulation tissues.

However, an excess of water may lead to lesions of health skin surrounding the granuloma: indeed, the silver nitrate solubility in water is very high (2160 g/l at 20 degrees, compared, e.g., to 345 of the common sodium clorure), and this causes very high concentrations of the harmful compound on the unaffected skin, leading to unwanted burns and lesions.

Here we propose not to wet the stick before the treatment. Indeed, the granuloma is frequently moist, and such small amount of very localized acqueous medium allows silver nitrate's reaction to take place just on the narrow surface of the pathological tissue, avoiding unwanted lesions on the health skin.

Competing interests: No competing interests

27 July 2019
Arturo Tozzi
Pediatrician
Linda Ferraro
ASL NA2 NORD, Caivano, Naples
Caivano, Naples, Italy