Umbilical hernia in neonates

Please note that some guidelines may be past their review date. The review process is currently paused. It is recommended that you also refer to more contemporaneous evidence.

Umbilical hernias are common in the neonatal period and represent a central fascial gap beneath the umbilicus through which abdominal contents may protrude, covered by skin.

This gap is a consequence of delayed contraction of the encircling fibromuscular umbilical ring.

Umbilical hernias are more common in:

• preterm infants
• Down syndrome
• increased intra-abdominal pressure (such as ascites)
• congenital hypothyroidism.

Although the hernia may be prominent with straining or crying, it should be easily reducible. Incarceration, strangulation and evisceration are rare complications.

Surgical correction is only considered for those who have large defects that are still open at several years of age.

Differential diagnosis of umbilical hernia

• Paraumbilical hernias usually sited just above the umbilicus require surgical review.
• Exomphalos herniation of viscera into the base of the umbilical cord covered by fused amniotic membrane and peritoneum this requires urgent surgical referral.
• Epigastric hernia presents as a tender lump in the midline of the epigastrium.

Investigation

No investigations are required in uncomplicated cases.

Management

Most children with an umbilical hernia require no intervention. Although some hernias may initially increase in size over the first few months of life, more than 90 per cent will have closed by two years of age.

Surgery beyond this age is usually on cosmetic grounds although the risk of incarceration is increased in adulthood.

Dressings to cover the hernia (such as coins and strapping) are ineffectual and may traumatise surrounding skin.