Early Human Development,
31 (1992) 167-169
167
Elsevier Scientific Publishers Ireland Ltd. EHD 01353
Umbilical cord insertion: normal location in neonates Leonardo Salgado and Joaquin E. Paz Centro de Education Medica e Investigation
Clinica. Sector Genetica, Galvan 4102, (1431) Buenos Aires (Argentina)
(Accepted 2 September 1992)
The distances between the xyphoid appendix and the insertion point of the umbilical cord (Xv> and between the xyphoid appendix and upper edge of the pubic symphysis (XP) were measured in 201 newborn infants. The mean ratio XUXP was 0.62 (S.D. 0.044) with no differences between sexes nor correlations with weight or length. Ratios lying between 0.53 and 0.71 can be considered as within the normal range. Key wor&: neonates; anthropometry;
umbilical cord position
Introduction It has been recognised that a low insertion of the umbilical cord is one of the features of the Fraser syndrome, including anterior placement or stenosis of the anus, a widely placed symphysis pubis and urogenital anomalies such as bladder extrophy [ 1). Data on the normal location of the anus relative to the external genitalia have been published [2] but there is no reference to the normal position of the umbilicus. The aim of this work was to establish a reliable method of measuring umbilical cord position and the normal values in neonates for that measure. Material and Methods Two-hundred one consecutive live infants (96 males and 105 females) were examined, within 48 h of birth. Lengths and weights were measured by standard methods. Correspondence to: Joaquin E. Paz, Centro de Education Medica e Investigation Clinica (CEMIC), Sector Genetica, Galvan 4102, (1431) Buenos Aires, Argentina. 037%3782/92/$05.00 0 1992 Elsevier Scientific Publishers Ireland Ltd. Printed and Published in Ireland
168
With the infant in the supine extended position distances between the xyphoid appendix and the insertion point of the umbilical cord (Xv) and between the xyphoid appendix and the upper edge of the pubic symphysis (XP) were measured using a steel metric tape and their ratio used as a measure of the umbilical cord position. Student’s t-test was used comparing the ratios XU/XP between sexes and a standard multiple regression method was used to test the relationship between the XU/XP ratio as dependent variable with weight and length. Results The mean XU/XP ratio in males was 0.63 (SD. 0.04) and in females 0.62 (S.D. 0.04). Thus, for the rest of the analysis, measures of both sexes were pooled. The mean ratio XU/XP was 0.62 and ratios lying between 0.53 and 0.71 can therefore be considered as normal values being within two standard deviations of the mean. There was no correlation between the XULXP ratio and weight or length (Table I). Discussion The distance between the insertion of the umbilical cord and the external genitalia and the distance separating these from the anus, are the anthropometric expression of the developmental degree reached by simultaneous processes of mesenchimatous proliferation [2]. Thus, it is not surprising that a factor altering this proliferation could produce shortening of both distances. As both sexes showed no difference between their XU/XP ratio, separate values for sexes are not proposed nor does it appear necessary to correct for weight and length. The two measurements needed to obtain the proposed ratio are made in a single
TABLE I Correlation matrix and multiple regression results for the XU/XP ratio, weight and length. Correlation matrix Variable
XUlxP
Lwsb
Weight
0.05 -0.02
0.85
Len%b
Multiple regression: Dependent variable: XU/XP Independent variable
Coeffkient
t-value
P-value
Weight Length
o.oooo2 -0.ooo43
1.71 -1.57
0.09 0.12
R2 = 0.005.
169
act. The ratio itself is the only calculation involved and no special tables are needed to interpret the results. While we are not proposing this measurement should be done routinely it could be useful in those cases where doubt about the normal position of the umbilical cord insertion point arises. References 1 2
Ramsing, M., Rehder, H., Holzgreve W., Meinecke P. and Lenz W. (1990): Fraser syndrome (cryptophtalmos with syndactyly) in the fetus and newborn. Clin. Genet., 37, 84-96. Reisner, S.H., Sivan, Y., Nitzan, M. and Merlob, P. (1984): Determination of anterior displacement of the anus in newborn infants and children. Pediatrics, 73, 216-217.
31 (1992) 167-169
167
Elsevier Scientific Publishers Ireland Ltd. EHD 01353
Umbilical cord insertion: normal location in neonates Leonardo Salgado and Joaquin E. Paz Centro de Education Medica e Investigation
Clinica. Sector Genetica, Galvan 4102, (1431) Buenos Aires (Argentina)
(Accepted 2 September 1992)
The distances between the xyphoid appendix and the insertion point of the umbilical cord (Xv> and between the xyphoid appendix and upper edge of the pubic symphysis (XP) were measured in 201 newborn infants. The mean ratio XUXP was 0.62 (S.D. 0.044) with no differences between sexes nor correlations with weight or length. Ratios lying between 0.53 and 0.71 can be considered as within the normal range. Key wor&: neonates; anthropometry;
umbilical cord position
Introduction It has been recognised that a low insertion of the umbilical cord is one of the features of the Fraser syndrome, including anterior placement or stenosis of the anus, a widely placed symphysis pubis and urogenital anomalies such as bladder extrophy [ 1). Data on the normal location of the anus relative to the external genitalia have been published [2] but there is no reference to the normal position of the umbilicus. The aim of this work was to establish a reliable method of measuring umbilical cord position and the normal values in neonates for that measure. Material and Methods Two-hundred one consecutive live infants (96 males and 105 females) were examined, within 48 h of birth. Lengths and weights were measured by standard methods. Correspondence to: Joaquin E. Paz, Centro de Education Medica e Investigation Clinica (CEMIC), Sector Genetica, Galvan 4102, (1431) Buenos Aires, Argentina. 037%3782/92/$05.00 0 1992 Elsevier Scientific Publishers Ireland Ltd. Printed and Published in Ireland
168
With the infant in the supine extended position distances between the xyphoid appendix and the insertion point of the umbilical cord (Xv) and between the xyphoid appendix and the upper edge of the pubic symphysis (XP) were measured using a steel metric tape and their ratio used as a measure of the umbilical cord position. Student’s t-test was used comparing the ratios XU/XP between sexes and a standard multiple regression method was used to test the relationship between the XU/XP ratio as dependent variable with weight and length. Results The mean XU/XP ratio in males was 0.63 (SD. 0.04) and in females 0.62 (S.D. 0.04). Thus, for the rest of the analysis, measures of both sexes were pooled. The mean ratio XU/XP was 0.62 and ratios lying between 0.53 and 0.71 can therefore be considered as normal values being within two standard deviations of the mean. There was no correlation between the XULXP ratio and weight or length (Table I). Discussion The distance between the insertion of the umbilical cord and the external genitalia and the distance separating these from the anus, are the anthropometric expression of the developmental degree reached by simultaneous processes of mesenchimatous proliferation [2]. Thus, it is not surprising that a factor altering this proliferation could produce shortening of both distances. As both sexes showed no difference between their XU/XP ratio, separate values for sexes are not proposed nor does it appear necessary to correct for weight and length. The two measurements needed to obtain the proposed ratio are made in a single
TABLE I Correlation matrix and multiple regression results for the XU/XP ratio, weight and length. Correlation matrix Variable
XUlxP
Lwsb
Weight
0.05 -0.02
0.85
Len%b
Multiple regression: Dependent variable: XU/XP Independent variable
Coeffkient
t-value
P-value
Weight Length
o.oooo2 -0.ooo43
1.71 -1.57
0.09 0.12
R2 = 0.005.
169
act. The ratio itself is the only calculation involved and no special tables are needed to interpret the results. While we are not proposing this measurement should be done routinely it could be useful in those cases where doubt about the normal position of the umbilical cord insertion point arises. References 1 2
Ramsing, M., Rehder, H., Holzgreve W., Meinecke P. and Lenz W. (1990): Fraser syndrome (cryptophtalmos with syndactyly) in the fetus and newborn. Clin. Genet., 37, 84-96. Reisner, S.H., Sivan, Y., Nitzan, M. and Merlob, P. (1984): Determination of anterior displacement of the anus in newborn infants and children. Pediatrics, 73, 216-217.
