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 Table of Contents  
ORIGINAL ARTICLE
Year : 2014  |  Volume : 4  |  Issue : 2  |  Page : 96-98

The normal position of the umbilicus in Nigerian new-borns


1 Departments of Surgery, Paediatric Surgery Unit, Obafemi Awolowo University Teaching Hospital, Ile Ife, Nigeria
2 Department of Paediatrics, Obafemi Awolowo University Teaching Hospital, Ile Ife, Nigeria

Date of Web Publication16-Oct-2014

Correspondence Address:
Oludayo A Sowande
Department of Surgery, Obafemi Awolowo University Teaching Hospital, PMB 5538, Ile Ife
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2278-9596.143086

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  Abstract 

Background: Congenital anomalies around the umbilicus are not uncommon. Surgical repair and reconstruction is often required in the neonatal period. Proper location of the neo-umbilicus after reconstruction is important. This study was designed to identify the normal location of the umbilicus in Nigerian newborns.
Material and Methods: The distance between the suprasternal notch and the umbilicus (SU), between the suprasternal notch and the pubic symphysis (SP), between the xyphoid process and the umbilicus (XU) and between the Xyphoid process and the pubic symphysis (XP) were measured using a measuring tape and the XU/XP and SU/SP ratio calculated.
Results: The mean XU/XP ratio was 0.66 ± 0.06 (range 0.43-0.83) while the mean SU/SP ratio is 0.79 ± 0.05. There was no significant difference in the XU/XP or SU/SP ratio between the two sexes. There was also no significant correlation between the birth weight, height, OFC, Gestational age with XU/XP ratio and SU/SP ratio in both sexes.
Conclusion: In conclusion, the umbilicus is located in 66% of the distance between the xyphoid process and the pubic symphysis or 79% of the distance between the suprasternal notch and the pubic symphysis in Nigerian neonates.

Keywords: Newborns, Nigerian, umbilicus position


How to cite this article:
Sowande OA, Elusiyan JB. The normal position of the umbilicus in Nigerian new-borns . Arch Int Surg 2014;4:96-8

How to cite this URL:
Sowande OA, Elusiyan JB. The normal position of the umbilicus in Nigerian new-borns . Arch Int Surg [serial online] 2014 [cited 2020 Oct 22];4:96-8. Available from: https://www.archintsurg.org/text.asp?2014/4/2/96/143086


  Introduction Top


The role of the umbilicus during fetal development is well-defined. It serves as a portal of connection between the placenta and the fetus and is intricately linked to the development of the gastrointestinal tract (GIT) and the urachus. Postnatally following the separation of the umbilical cord, the umbilicus forms a scar that may contribute to the aesthesis of the abdomen and suggested to be a symbol of fertility and fitness in the female. [1] In new-borns with major congenital anterior abdominal wall defects that is. major exomphalos, immediate neonatal reconstruction may not be possible due to the size discrepancy between the eviscerated viscus and the abdominal cavity especially where there is no facility for postoperative ventilation. In small sized defects however, the optimal management is surgical closure with creation of an aesthetically pleasing umbilicus where possible. Aesthetic consideration in umbilicoplasty include position, depth, shape and location. [2] Concerns about proper location of the umbilicus following surgery for congenital anomalies such as gastroschisis and exomphalos stem from the fact that it is an important anatomical reference point in the abdomen. The position of the umbilicus also contributes to the aesthetic beauty of the individual especially women. Loss, deviation, absence or abnormal characteristic of the umbilicus may possibly lead to embarrassment and psychological distress in the future. The umbilicus also serves as a natural reference point the absence of which the abdomen appears formless. In modern day surgery the umbilicus has assumed significant clinical importance. It serves as the primary portal for laparoendoscopic surgery both in adults and children. It also provides access for open minimal scar surgery in the newborns and the young children. [3],[4]

Studies in adults have shown that the umbilical position is variable but generally lies approximately at the level of the 3-4 th lumbar vertebra [5],[6] or 62.5% of the distance between the xyphoid process and the pubic symphysis. [7] This is not applicable in new-borns. Some studies in Caucasian and Asian newborns suggest that the location of the umbilicus is about 60% of the distance between the xyphoid process and the pubic symphysis [8],[9],[10] while others suggest that it's about 67% of the same distance. [11],[12]

This study was designed to identify the normal location of the umbilicus in Nigerian newborns and compare the findings with studies elsewhere.


  Materials and Methods Top


The study was carried out on 199 newborns (both inborn and out-born) at the postnatal ward of the Obafemi Awolowo University Teaching Hospital, Ile Ife in South Western Nigeria. The people of this area are mainly of the Yoruba ethnicity. Ethical approval from the institutional ethical committee was obtained and parental consents were verbally obtained before the study. Consecutive normal newborns within 15 days of birth were included in the study. Excluded were babies with obvious dysmorphism, anterior abdominal wall, chest or spinal anomalies as well as abdominal masses. Also babies whose parents did not consent were excluded.

The gestational age (weeks), birth weight (kg), full Length (cm), and the occipito-frontal circumference (OFC, cm) were recorded. The distance between the suprasternal notch and the umbilicus (SU), between the suprasternal notch and the pubic symphysis (SP), between the xyphoid process and the umbilicus (XU) and between the Xyphoid process and the pubic symphysis (XP) were measured using a measuring tape. Measurements were done with the baby in supine position with the limbs flat on the cot. All measurements were done by one of the authors to eliminate inter observer error.

The following ratios were then calculated

  1. XU/XP ratio
  2. SU/SP ratio


ll the data obtained were entered into a pro forma and analyzed using SPSS (Statistical Package for Social Sciences) version 16. Student's t-test was used to compare means, while correlation was calculated using the Pearson Correlation Coefficient. Statistical significance assumed at P < 0.05.


  Results Top


There were 106 males and 93 females. Their gestational age ranged between 28-41 weeks (36.61 SD 1.68 weeks). The mean birth weight was 3.06 SD 0.54kg (range 1.39-4.65kg). The mean postnatal age of the newborns at the time of measurement was 18.41 ± 16.28 hours. The mean XU/XP ratio was 0.66 ± 0.06 (range 0.43-0.83), while the mean SU/SP ratio was 0.79 ± 0.05. Other data are as shown in [Table 1]. There was no significant difference in the XU/XP or SU/SP ratio between the two sexes. There was also no significant correlation between the birth weight, height, OFC, gestational age with XU/XP ratio and SU/SP ratio in both sexes [Table 1]. [Figure 1] and [Figure 2] showed the distribution of the XU/XP ratio and the SU/SP ratio in the study population.
Table 1: The demographic characteristics and ratios of the newborn population studied

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Figure 1: Distribution of the SU/SP ratio in 199 newborns

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Figure 2: Distribution of the XU/XP ratio in 199 newborns

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  Discussion Top


In this study, two methods of locating the umbilicus were evaluated. In the first method the ratio of the distance between the xyphoid process and the umbilicus to the distance between the xyphoid process and the pubic symphysis was measured. The findings from this study indicate that in most babies in our own environment, the position of the umbilicus is located about 66% of the distance between the xyphoid process and the pubic symphysis. Previous studies in Caucasian and Asian babies using this method have suggested that the normal location of the umbilicus is between 59 and 61% of the distance between the xyphoid process and the pubic symphysis. [8],[9],[10] The findings in this study did not agree with that. Our findings is however similar to the findings in the Lee et al., and Mahmoud in American and Egyptian babies respectively. [11],[12] The number of babies used in their study is far less than in this study. In their study, they also found that following umbilicoplasty for exomphalos, the resultant umbilical scar tend to be located in abnormally higher location relative to the location found in the normal newborns. They suggested that the neo-umbilicus should be sited 2/3 rd of the xyphoid-pubic distance. The difference in the findings may suggest that it is important to consider possible racial and geographical differences in the anthropological characteristics of newborns. Most babies in this study were fed before the measurement.

In this study we also measured the distance between the suprasternal notch and the umbilicus and the pubis respectively in order to relate it to the location of the umbilicus. The study revealed that the umbilicus is located about 79% of the distance between the suprasternal notch and the pubic symphysis. This provides a new ratio which may be used in place of the XU/XP ratio. Moreover our findings suggest that SU/SP ratio correlates well with the XUXP ratio. The suprasternal notch may be easily identified than the xyphoid process in the newborns and may serve as a better reference point.

While there are various techniques of creating a neoumbilicus, proper location may be challenging as the primary condition may have caused significant distortion in the abdomen. Where primary repair is possible in the neonatal period, a baseline knowledge of the normal location of the umbilicus in normal newborns may help. Study such as this will help in this regards.

A limitation to this study may be that the authors did not determine the centrality of the position of the umbilicus but was assumed to be in the midline in all the babies.

In conclusion the location of the umbilicus in normal newborns is variable. It is located in 66% of the distance between the xyphoid process and the pubic symphysis or 79% of the distance between the suprasternal notch and the pubic symphysis in Nigerian newborns. This information could be useful in the proper location of neo-umblicus in Nigerian neonates.

 
  References Top

1.
Sinkkonen A. Umbilicus as a fitness signal in human. FASEB J 2009;23:10-2.  Back to cited text no. 1
[PUBMED]    
2.
Lee MJ, Mustoe TA. Simplified technique for creating a youthful umbilicus in abdominoplasty. Plast Reconstr Surg 2002;109:2136-40.  Back to cited text no. 2
    
3.
Soutter AD, Askew AA. Transumbilical laparotomy in infants: A novel approach for a wide variety of surgical disease. J Pediatr Surg 2003;38:950-2.  Back to cited text no. 3
    
4.
Tajiri T, Ieiri S, Kinoshita Y, Masumoto K, Nishimoto Y, Taguchi T. Transumbilical approach for neonatal surgical diseases: Woundless operation. Pediatr Surg Int 2008;24:1123-6.  Back to cited text no. 4
    
5.
Park S, Hata Y, Ito O, Tokioka K, Kagawa K. Umbilical reconstruction after repair of omphalocele and gastroschisis. Plast Reconstr Surg 1999;104:204-7.  Back to cited text no. 5
    
6.
Matarasso A. Abdominoplasty. In: Bahman G, Wilkins EG, editors. Plastic Surgery. Vol. 5. St. Louis: Mosby; 2000. p. 2783-821.  Back to cited text no. 6
    
7.
Abhyankar SV, Rajguru AG, Patil PA. Anatomical localization of the umbilicus: An Indian study." Plast Reconstr Surg 2006;117:1153-7.  Back to cited text no. 7
    
8.
Williams AM, Brain JL. The normal position of the umbilicus in the newborn: An aid to improving the cosmetic result in exomphalos major. J Pediatr Surg 2001;36:1045-6.  Back to cited text no. 8
    
9.
Davari H, Nazem M. The normal position of umbilicus in the newborn: An aid to improve cosmetic result in exomphalos major. J Res Med Sci 2004;1:34-8.  Back to cited text no. 9
    
10.
Onal E, Turan O, Karabulut R, Hirfanoglu I, Turkyilmaz C, Sonmez K, et al. Where should the normal position of the umbilicus be in the neonate? Eur J Pediatr Surg 2010;20:339-40.  Back to cited text no. 10
    
11.
Lee SL, DuBois JJ, Greenholz SK, Huffman SG. Advancement flap umbilicoplasty after abdominal wall closure: Postoperative results compared with normal umbilical anatomy. J Pediatr Surg 2001;36:1168-70.  Back to cited text no. 11
    
12.
El-Afifi MA. Simultaneous advancement flap umbilicoplasty and omphalocele repair. Egypt J Surg 2003;22:403-6.  Back to cited text no. 12
    


    Figures

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