The Outcome of Salt Treatment for Umbilical Granuloma: A Systematic Review

Figures & data

Figure 1 Systematic flowchart of article selection.

Table 1 The Summary of Research Data and Findings

Author (Year of Publication)	Country	Source of Population	Intervention	Study Design	Result	Ref
Hossain et al (2010)	Bangladesh	Infants (48), age range 3–16 weeks who visited outpatient and diagnosed umbilical granuloma. Salt was applied at home with the care giver.	The caregiver was advised to apply cooking salt for 30 minutes and covered with adhesive plaster. This procedure was repeated two times per day for three days. Before and after applying salt, the area was cleaned with a cotton ball soaked in boiling water.	A prospective study was done to assess the therapeutic effect of common salt for umbilical granuloma as well as any adverse effects.	The 91.7% (44 of 48) patients had a perfect cure after three days of salt. 8.3% (4/48) patients were finally misdiagnosed as Granuloma for Polyp and because of this the true success rate of salt treatment can be taken as 100%.	[^Citation9]
SalehA (2015)	Saudi Arabia	50 infants to age of 3–16 weeks who visited to outpatient department with clinical evidence of umbilical granuloma. The salt was applied home by the care giver.	Mothers were counseled to apply salt in the following 4 steps. 1. Clean the granuloma with boiled water soaked cotton 2. Apply salt to cover the whole area of granuloma 3. Cover granuloma with adhesive plasters and kept for 30 minutes 4. Again clean the granuloma to remove the salt with warm water soaked cotton. Mothers advised to continue this procedure two times a day for 5 days.	A prospective study was done to evaluate the effect of salt on umbilical granuloma	50 of the infants had excellent response (complete regression of granuloma and total disappearance of discharge). The effectiveness of salt in was 100% cure rate.	[^Citation26]
Dhungel et al (2018)	Nepal	180 of 325 patients with an age range of 1–24 month with umbilical granuloma were treated with salt. Salt was applied by health professionals in outpatient Department	Umbilicus was cleaned by providing and was dried. A pinch of salt was applied in the umbilicus to cover the granuloma, then wrapped with cotton and cover with adhesive plaster to keep salt inside for 30 minutes. After the salt was cleaned, mothers stayed for 1 hour for observation. This was done in the outpatient department and continued two times in a day for 3 days.	A retrospective analysis of 325 patients underwent different treatment Salt (180), and Silver nitrate (145)	In those patients with salt treatment, 95% (171/180) of them had an excellent response with no side effects and no recurrence rate. Silver nitrate group, 87.6% (127/145) had excellent response, but in 19% of them had complications and the recurrence rate at 9% of them.	[^Citation23]
Badebarin et al (2018)	Iran	50 infants (3 weeks-4 months) diagnosed with umbilical granuloma. Salt treatment was home based after advise to mothers	Group I (25 of them) of neonates treated with salt after the umbilicus was cleaned by soaking cotton with boiled water before and after the salt was applied to the granuloma and the salt was kept for 30 minutes and this was repeated two times a day for 5 days after the mothers got training to do so. Group II (25 of them) was treated with electro cauterization under general anesthesia	A randomized clinical trial of 50 patients with two groups; group I (25, treated with salt) and group II (Electrical cauterization)	The response rate of salt and surgical was 96 and 100% respectively, with no recurrence rate and complications in the subsequent follow-up. The unresponsive patients of salt treatment, patients were treated with common salt for another five days, at the end of the 10th day, all patients had complete recovery.	[^Citation12]
Faranoush et al (2006)	Iran	105 infants diagnosed with clinical umbilical granuloma and the treatment were home based.	Infants were grouped into three. Group I-Salt treatment (the procedure was similar to above salt treatments), GroupII-70% alcohol, and Group III- clean with pure water. In the three of the groups, the procedure was repeated two times per day for three consecutive days’	A clinical trial was done on randomly divided 105 infants into three treatments Groups. Salt treatment, Alcohol and pure (control, tape water) treatment groups	The recovery rate of the infants was 100% (salt treatment group), 34.3% (Alcohol treatment group), and 14.3% (tape water treatment group). There was no recurrence rate of the granuloma in group I (salt), but 25.7% in group II (Alcohol) and 60% in group III (control, tape water) patients, the granuloma recur.	[^Citation24]
Fiaz et al (2017)	Pakistan	60 infants (2 weeks-4 months) with a clinical diagnosis of umbilical granuloma visited to the outpatient department.	Infants were grouped in two via lottery method. Group A (30) was treated with copper sulfate, which were applied by author and left for 10 minutes. Group B (30) was treated with salt for 3 days in two times per day, which was shown initially for the mother and continued for 3 days.	A comparative experimental study was done in 60 infants grouped into two via lottery method.	Significant frequency of excellent response was observed in the copper sulfate group (100%). The cure rate of salt in this study was 53.3%.	[^Citation2]
Annapurna et al (2015)	India	84 infants (age range 2 weeks-4 months) diagnosed with umbilical granuloma	Infants were grouped in two. Copper sulfate group (44) and salt group (40). Salt group treatment was made home based after parents instructed to apply salt to the granuloma for 30 minutes with the cleaning of the umbilicus before and after the salt. This was to be repeated two times per day for 3 days. Copper sulfate group-copper was applied once in a similar procedure to salt, but it was applied only once, kept for 10 minutes and was done in the outpatient department by the author.	Clinical trial on comparative effect of copper sulfate and salt (cooking/common)	Treatment response was followed after 1, 3 week and 1 month. On follow-up, 80% (32/40), of patients in the salt treatment group, and 95.5 (42/44) of patients in copper sulfate got a perfect cure from umbilical granuloma.	[^Citation27]
Farhat et al (2008)	Iran	40 infants (age less than one year)	Infants with clinical evidence were treated with salt. Group 1 (Case, 24 hours), and group II (control, 2 hours salt treatment)	Clinical trial on comparison of 2 hours and 24 hours salt treatment for umbilical granuloma	In both groups, no treatment failure and salt side effects or complications were observed.	[^Citation5]
Haftu et al (2020)	Ethiopia	3 weeks old infant	The mother was advised to apply salt to cover the whole granuloma and to leave it for 30 minutes with the covering of the area with plaster and gauze. The umbilicus was cleaned before and after the salt was applied and this continued every 12 hours for 5 days.	Case report	After the three doses of salt applied, the granuloma was shirked and there was so small dark dried fall off during cleaning. There was no complication, recurrence during 1, 3 weeks and 6 month follow-up.	[^Citation22]
Bagadia et al (2019)	India	17 infants were recruited for the outpatient department management	Salt was applied by health professionals in the outpatient department to the granuloma and occluded with adhesive plasters for 24 hours. On the next day, patients come for the removal of the plaster and the response was recorded. Patients were followed till three months for any complications and recurrences	Prospective observational study	All 17 cases responded well to this treatment approach with complete resolution of the granuloma within 24 hours. There were no complication and recurrences at 3 moths follow-up	[^Citation25]

Note: Ref., references.

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