Khiati DA, Savasan S. What should be investigated in delayed umbilical cord separation: Two case reports. World J Clin Pediatr 2025; 14(4): 107842 [DOI: 10.5409/wjcp.v14.i4.107842]
Corresponding Author of This Article
Sureyya Savasan, Professor, Department of Hematology Oncology, Chilrdren's Hospital of Michigan, 3901 Beaubien Blvd., Detroit, MI 48201, United States. savas1s@cmich.edu
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Hematology
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Case Report
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Dec 9, 2025 (publication date) through Nov 3, 2025
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World Journal of Clinical Pediatrics
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2219-2808
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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
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Khiati DA, Savasan S. What should be investigated in delayed umbilical cord separation: Two case reports. World J Clin Pediatr 2025; 14(4): 107842 [DOI: 10.5409/wjcp.v14.i4.107842]
World J Clin Pediatr. Dec 9, 2025; 14(4): 107842 Published online Dec 9, 2025. doi: 10.5409/wjcp.v14.i4.107842
What should be investigated in delayed umbilical cord separation: Two case reports
Dhiaedin A Khiati, Sureyya Savasan
Dhiaedin A Khiati, Sureyya Savasan, Department of Hematology Oncology, Children's Hospital of Michigan, Detroit, MI 48201, United States
Author contributions: Khiati D conducted data acquisition; Savasan S conceptualized the case report, both authors contributed to writing and reviewing the manuscript. Both authors have read and given approval for the final manuscript.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: All Authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE checklist (2016), and the manuscript was prepared and revised according to the CARE checklist.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Sureyya Savasan, Professor, Department of Hematology Oncology, Chilrdren's Hospital of Michigan, 3901 Beaubien Blvd., Detroit, MI 48201, United States. savas1s@cmich.edu
Received: March 30, 2025 Revised: May 11, 2025 Accepted: August 22, 2025 Published online: December 9, 2025 Processing time: 216 Days and 16.7 Hours
Abstract
BACKGROUND
Delayed umbilical cord separation (UCS) defined as failure of umbilical cord fall beyond 3 weeks is seen in up to 10% of newborns. Since delayed UCS can be associated with leukocyte adhesion deficiency (LAD) or coagulation factor XIII deficiency, these children are commonly referred to hematology/oncology for further investigation. Although the incidence of urachal remnants (UR); also associated with delayed UCS, is more common (1.16%) than LAD (1:1000000 births), and coagulation factor XIII deficiency (1:5000000 births) it’s less commonly investigated.
CASE SUMMARY
Two otherwise healthy infants, a 6-week-old female and a 4-week-old male were seen at our hematology/oncology clinic for delayed UCS. In both cases the umbilical cords looked healthy, with no signs of infection or pus, but appeared to show small Umbilical Granulomas. They were both investigated for LAD type I and one was investigated for XIII deficiency, but both tests were negative. These infants however, were investigated via abdominal ultrasound which showed UR in both cases. These infants required no intervention.
CONCLUSION
This report demonstrates an often overlooked association between delayed UCS and UR and suggests abdominal ultrasound if necessary for diagnosis.
Core Tip: Patients with delayed umbilical cord separation (UCS) are often referred to hematology/oncology for investigation of possible Leucocyte adhesion deficiency (LAD) and/or factor XIII deficiency. We highlight the presence of another yet often overlooked association with delayed UCS, urachal remnants and therefore, suggest an abdominal ultrasound if any investigation is sought. Moreover, neither LAD nor factor XIII testing should be conducted routinely at the time of delayed UCS documentation, nor in the long term in cases without infections.
