The umbilical cord remnant necroses and separates from the body at to weeks of age It is not unusual to have a small amount of moisture at the base A slight foul odor is also not unusual as long as there are no other local or systemic signs of infection The odor will generally improve with local care Omphalitis Omphalitis is an infection of the umbilical cord that presents with purulent or serosanguinous drainage from the umbilical stump Complications can include life-threatening necrotizing fasciitis, ascending infection to the liver and systemic circulation, and staphylococcal scalded skin syndrome In nonsterile births, there is also the risk of tetanus contaminating the umbilical stump Infection may spread through the umbilical artery and contaminate the peritoneum, causing infectious peritonitis, or may spread through the arterial system, causing loculated infections along the iliac or femoral arteries Signs include purulent and/or foulsmelling discharge from the umbilical stump There may be associated periumbilical edema, erythema, or induration in more extensive disease Parenteral antibiotics are required Infants with necrotizing fasciitis may also need surgical resection of the affected area Granuloma The most common cause of umbilical discharge or moisture is a granuloma It typically presents after the cord has separated, and represents granulation tissue that has not yet epithelized A benign diagnosis, it must be distinguished from the less common but more serious lesions of urachal or omphalomesenteric duct anomalies Treatment consists of local wound care and cauterization, most often with silver nitrate Caution is necessary when applying silver nitrate to avoid surrounding skin, as it can burn the surrounding tissue Persistent drainage after cauterization should increase suspicion for other umbilical abnormalities Urachal Anomalies Urachal anomalies can present at any age, although the neonatal period is the most common age of presentation for a patent urachus In this population, typical presentation includes persistent, active serous drainage of the umbilical stump, which may ultimately lead to redness and irritation A patent urachus can be complicated by urinary tract infections (UTIs) It can be confirmed by US or voiding cystourethrogram Symptomatic urachal anomalies are treated surgically once any active infection has cleared There is some controversy regarding the management of asymptomatic anomalies; there may be increased risk of