- Email: [email protected]
The normal position of the umbilicus in the newborn: An aid to improving the cosmetic result in exomphalos major
The Normal Position of the Umbilicus in the Newborn: An Aid to Improving the Cosmetic Result in Exomphalos Major By Andrew M. Williams and Jeffrey L. Brain Cambridge, England
Background/Purpose: The aim of this study was to determine the normal position of the umbilicus and hence improve the cosmetic result of exomphalos major repair. Methods: The position of the umbilicus was determined in 50 neonates with respect to the xiphisternum and pubis. Results: The normal umbilical position is 60% of the way from the inferior border of the xiphisternum to the superior border of the pubis in the midline.
Conclusion: In the repair of exomphalos major, the most aesthetically pleasing result is obtained if the umbilicus is placed 60% of the way from the xiphisternum to the pubis. J Pediatr Surg 36:1045-1046. Copyright © 2001 by W.B. Saunders Company.
INDEX WORDS: Umbilicus, exomphalos.
I
N REPAIRING exomphalos major, the formation of an umbilicus is essential in producing the best cosmetic result. Before now, there has been no good evidence to suggest where this should be placed on the abdominal wall. The aim of this study was to determine the position of the umbilicus with respect to the xiphisternum and pubis in normal newborn children. The position of the umbilicus is a significant factor in making the abdomen aesthetically pleasing. The defect in babies with an exomphalos may extend from a few centimeters below the xiphisternum to a few centimeters above the pubis. It may therefore be difficult to select the most appropriate segment of skin from the margin of the exomphalos to create an umbilicus in a “normal” position when performing surgery. This may be particularly difficult if a silo has been used and the anatomy distorted at the time of definitive closure. We have found no data in the literature (Medline and associated journal searches) to help with this decision.
MATERIALS AND METHODS A random sample of 50 newborn babies was studied. Birth weight, gestation, length, body mass index, sex, and ethnic background were recorded. Measurements were made of the distances between the xiphisternum, superior and inferior borders of the umbilicus, and the pubis while the babies lay in a supine position. Results were analyzed using Spearman Rank Correlation, Kolmogorov-Smirnov and MannWhitney Tests.
Fig 1. The position of the umbilicus is normally distributed with the exception of one outlier.
the one child whose umbilical position lay away from the others, independent comments had been made that he had a “funny-looking abdomen.” If this baby is excluded, the position of the umbilicus has a normal distribution with a mean position of 59% (range, 50% to 65%).
The median position of the superior border of the umbilicus was found to be 59% of the way down on a line drawn from the xiphisternum to the pubis (Fig 1). In
From the Department of Paediatric Surgery, Addenbrooke’s Hospital, Cambridge, England. Address reprint requests to Jeffrey L. Brain, Department of Paediatric Surgery, Box 201, Addenbrooke’s Hospital, Hills Rd, Cambridge, CB2 2QQ, England. Copyright © 2001 by W.B. Saunders Company 0022-3468/01/3607-0015$35.00/0 doi:10.1053/jpsu.2001.24737
Journal of Pediatric Surgery, Vol 36, No 7 (July), 2001: pp 1045-1046
1045
RESULTS
1046
The mean umbilical diameter was 1.1 cm. No difference was found in the position of the umbilicus between sexes (33 boys and 27 girls). Similarly, the position remained constant irrespective of birth weight (median, 3.3 kg; range, 1.83 kg to 4.5 kg), body length (median, 51 cm; range, 45 cm to 62 cm), and gestation (median, 277; range, 245 to 296 days).
WILLIAMS AND BRAIN
DISCUSSION
The position of the umbilicus in the newborn infant is about 60% of the way from the lower border of the xiphisternum to the pubis and is independent of the variables measured in this study. This is where the new umbilicus should be placed in the repair of exomphalos major for the most aesthetically pleasing result.
Background/Purpose: The aim of this study was to determine the normal position of the umbilicus and hence improve the cosmetic result of exomphalos major repair. Methods: The position of the umbilicus was determined in 50 neonates with respect to the xiphisternum and pubis. Results: The normal umbilical position is 60% of the way from the inferior border of the xiphisternum to the superior border of the pubis in the midline.
Conclusion: In the repair of exomphalos major, the most aesthetically pleasing result is obtained if the umbilicus is placed 60% of the way from the xiphisternum to the pubis. J Pediatr Surg 36:1045-1046. Copyright © 2001 by W.B. Saunders Company.
INDEX WORDS: Umbilicus, exomphalos.
I
N REPAIRING exomphalos major, the formation of an umbilicus is essential in producing the best cosmetic result. Before now, there has been no good evidence to suggest where this should be placed on the abdominal wall. The aim of this study was to determine the position of the umbilicus with respect to the xiphisternum and pubis in normal newborn children. The position of the umbilicus is a significant factor in making the abdomen aesthetically pleasing. The defect in babies with an exomphalos may extend from a few centimeters below the xiphisternum to a few centimeters above the pubis. It may therefore be difficult to select the most appropriate segment of skin from the margin of the exomphalos to create an umbilicus in a “normal” position when performing surgery. This may be particularly difficult if a silo has been used and the anatomy distorted at the time of definitive closure. We have found no data in the literature (Medline and associated journal searches) to help with this decision.
MATERIALS AND METHODS A random sample of 50 newborn babies was studied. Birth weight, gestation, length, body mass index, sex, and ethnic background were recorded. Measurements were made of the distances between the xiphisternum, superior and inferior borders of the umbilicus, and the pubis while the babies lay in a supine position. Results were analyzed using Spearman Rank Correlation, Kolmogorov-Smirnov and MannWhitney Tests.
Fig 1. The position of the umbilicus is normally distributed with the exception of one outlier.
the one child whose umbilical position lay away from the others, independent comments had been made that he had a “funny-looking abdomen.” If this baby is excluded, the position of the umbilicus has a normal distribution with a mean position of 59% (range, 50% to 65%).
The median position of the superior border of the umbilicus was found to be 59% of the way down on a line drawn from the xiphisternum to the pubis (Fig 1). In
From the Department of Paediatric Surgery, Addenbrooke’s Hospital, Cambridge, England. Address reprint requests to Jeffrey L. Brain, Department of Paediatric Surgery, Box 201, Addenbrooke’s Hospital, Hills Rd, Cambridge, CB2 2QQ, England. Copyright © 2001 by W.B. Saunders Company 0022-3468/01/3607-0015$35.00/0 doi:10.1053/jpsu.2001.24737
Journal of Pediatric Surgery, Vol 36, No 7 (July), 2001: pp 1045-1046
1045
RESULTS
1046
The mean umbilical diameter was 1.1 cm. No difference was found in the position of the umbilicus between sexes (33 boys and 27 girls). Similarly, the position remained constant irrespective of birth weight (median, 3.3 kg; range, 1.83 kg to 4.5 kg), body length (median, 51 cm; range, 45 cm to 62 cm), and gestation (median, 277; range, 245 to 296 days).
WILLIAMS AND BRAIN
DISCUSSION
The position of the umbilicus in the newborn infant is about 60% of the way from the lower border of the xiphisternum to the pubis and is independent of the variables measured in this study. This is where the new umbilicus should be placed in the repair of exomphalos major for the most aesthetically pleasing result.