Introduction

Umbilical granuloma (UG) is a common benign condition in neonates, typically presenting with persistent granulation tissue and discharge at the umbilical stump. Silver nitrate is the standard treatment but poses risks such as chemical burns and requires professional application. Common salt has emerged as a potential low-cost, accessible alternative.

Umbilical granuloma (UG) is a common benign condition affecting neonates, characterized by the proliferation of granulation tissue at the umbilical stump, often leading to persistent discharge and local inflammation. Although typically self-limiting, UG may require therapeutic intervention to promote healing and prevent complications. Traditionally, treatment involves the use of silver nitrate, an effective caustic agent; however, it is associated with potential adverse effects such as chemical burns and toxicity. Furthermore, its cost and the necessity for professional application have spurred interest in alternative treatments. Common salt (sodium chloride) presents a low-cost, accessible option that can be administered at home, making it particularly relevant in resource-limited settings.

Recent literature has explored the efficacy of common salt as an alternative to silver nitrate, with various clinical, observational studies, and case reports suggesting that salt offers a comparable resolution rate, with the added benefits of safety and ease of application. Despite numerous publications on the topic, a systematic review consolidating all available evidence has yet to be conducted. The absence of such an analysis underscores the need for a comprehensive review to provide a critical and complete overview of the use of common salt in treating UG.

Early research by ^{Öztaş et al. (2020}) and Gülcan et al. (2020) provided the first randomized evidence demonstrating that table salt achieves healing outcomes equivalent to those of silver nitrate while eliminating the risk of chemical burns. Complementary case reports by ^{Haftu et al. (2020}a, 2020b) reinforced these results, describing full lesion regression after short-term salt application, with no complications and full parental compliance-underscoring the method’s safety and feasibility for home use.

The broader review conducted by ^{Kraus, Matta, and Abou-Jaoude (2020}) synthesized international experiences and concluded that common salt application is an effective, simple, and universally accessible method. In the same vein, ^{Fawzi (2021}) confirmed that repeated application of table salt leads to complete epithelialisation in neonates without recurrence or infection.

A significant advance in the evidence base was made by ^{Banerjee, Munghate, and Bodhanwala (2023}), whose scoping review analyzed a range of studies, reporting success rates above 90%, minimal recurrence, and high parental satisfaction. Subsequently, Banerjee et al. (2024) published an open-label randomized controlled trial comparing silver nitrate and salt, finding equivalent healing outcomes but a superior safety profile for salt, positioning NaCl as a viable first-line treatment.

Further contributions from ^{Khaliq et al. (2024}) and ^{Mahmud, Sultana, and Rahman (2024}) expanded the scope by confirming that salt application is not only clinically effective but also feasible for use at household and community levels. ^{Ojeola and Oyeyemi (2025}) demonstrated similar outcomes in African children, highlighting salt’s global applicability and value in resource-constrained contexts. Additionally, ^{Sharma, Aggarwal, and Chaudhary (2025}) validated these findings in a hospital environment, confirming equivalence between the two treatments in controlled clinical settings.

Institutional guidelines are beginning to reflect this shift. The Sydney Children’s Hospitals Network (2025) now recognizes salt application as a safe and effective management option for uncomplicated umbilical granulomas, further supporting its integration into standard care practices.

Collectively, evidence from 2020 to 2025 indicates that common salt is an effective, low-cost, and safe alternative to silver nitrate, with the added advantages of home applicability, accessibility, and minimal risk of adverse reactions. This growing body of literature highlights a paradigm shift toward non-invasive, caregiver-administered interventions that promote healing while reducing healthcare dependency and costs. It also underscores the need for systematic synthesis of available data to establish standardized clinical guidance and inform global neonatal care practices.

Review Question (PICO):

P (Population): Infants with umbilical granuloma

I (Intervention): Topical application of common salt

C (Comparison): Silver nitrate or no treatment

O (Outcomes): Complete resolution rate, healing time, adverse events

This systematic review aims to evaluate the effectiveness, safety, and feasibility of common salt as a therapeutic alternative to silver nitrate in treating UG. Through this analysis, we seek to provide a clearer understanding of the role of common salt in managing this neonatal condition and its implications for clinical practice, especially in settings with limited resources and where self-medication is prevalent.

1. Methods

This article employs a systematic review methodology, adhering to established guidelines to ensure the quality and transparency of the scientific evidence analysis process.

2. Results

2.1 Study Selection Process

A total of 87 records were initially identified through searches in PubMed, Scopus, SciELO, LILACS, and Google Scholar. After removing duplicates and screening titles and abstracts, 35 full-text articles were assessed for eligibility. Applying the predefined inclusion and exclusion criteria resulted in 13 studies included in the final analysis (Figure 1). The included studies comprised 4 randomized controlled trials (RCTs), 5 observational studies, and 4 case reports.

Figure 1 PRISMA flow diagram 

2.3 Observational Studies

These studies highlighted the practical feasibility of home-based salt application, reporting high resolution rates (85-97%) and minimal adverse effects.

Case Reports: Individual cases confirmed the safety and efficacy of caregiver-administered salt treatment.

Table 1 Characteristics of Included Studies 

2.4 Methodological Quality Assessment of the Studies

The methodological quality of included studies was assessed using JBI tools for quantitative studies and the CARE checklist for case reports (Table 2). Most RCTs were rated as high quality, with clear randomization, control groups, and defined outcome measures. Observational studies and case reports showed moderate to high quality but were limited by small sample sizes, lack of control groups, and potential selection bias.

Table 2 Methodological Quality of Included Studies 

2.5 Summary Table of Extracted Data

Table 3 presents a summary of the data extracted from the included studies, focusing on primary outcomes such as resolution rate, healing time, and adverse events. The variables were categorized according to the study design, allowing for a more detailed analysis.

Table 3 Summary of Extracted Data 

3. Discussion

This systematic review critically evaluated the current literature on the use of common salt (sodium chloride) as a therapeutic alternative to silver nitrate for the treatment of umbilical granuloma (UG) in neonates. The findings consistently demonstrate that topical salt application achieves high resolution rates - ranging from 85% to 100% - with a highly favorable safety profile and practical feasibility for home use, offering efficacy comparable to conventional silver nitrate treatment (^{Banerjee et al., 2024}; Gülcan et al., 2020; ^{Öztaş et al., 2020}; ^{Khaliq et al., 2024}).

Conclusion

This systematic review concludes that common salt (sodium chloride) is an effective, safe, and accessible therapeutic alternative to silver nitrate for the treatment of umbilical granuloma in neonates. Evidence derived from randomized controlled trials (^{Banerjee et al., 2024}; Gülcan et al., 2020; ^{Öztaş et al., 2020}; ^{Khaliq et al., 2024}), observational studies (^{Fawzi, 2021}; ^{Mahmud et al., 2024}; ^{Ojeola & Oyeyemi, 2025}, 2024), and case reports (^{Haftu et al., 2020}, 2021; ^{Sharma et al., 2025}) consistently demonstrates high rates of resolution, minimal adverse events, and feasibility of home-based application, even when performed by caregivers with limited training.

The reviewed studies highlight several key advantages of salt therapy. First, its comparable efficacy to silver nitrate confirms its potential as a first-line treatment, particularly in low-resource settings where access to professional care and specialized medical supplies may be limited (^{Banerjee et al., 2023}; ^{Kraus et al., 2020}). Second, the low cost and wide availability of salt make it a sustainable intervention for both hospital and home environments, reducing financial and logistical barriers for families (Mahmud et al., 2025; Sydney Children’s Hospitals Network, 2025). Third, cultural acceptance and caregiver compliance were consistently reported as high, indicating that salt therapy is practical, socially acceptable, and capable of empowering families in neonatal care management (^{Ojeola & Oyeyemi, 2025}; Haftu et al., 2021).

Despite these strengths, methodological limitations exist. Several observational studies lacked control groups and employed small sample sizes, while some randomized trials had limited follow-up periods, potentially underestimating late adverse events or recurrences (^{Fawzi, 2021}; Gülcan et al., 2020; ^{Khaliq et al., 2024}). Variability in application techniques, outcome definitions, and study settings further complicates direct comparisons. Therefore, although current evidence supports salt as a clinically viable alternative, additional high-quality, multicenter randomized controlled trials with standardized protocols and extended follow-up are necessary to strengthen global recommendations.

From a public health perspective, adopting common salt for umbilical granuloma management has the potential to significantly reduce reliance on hospital services, decrease healthcare costs, and improve neonatal care accessibility in underserved regions (^{Mahmud et al., 2024}; Sydney Children’s Hospitals Network, 2025). Its implementation could be integrated into primary care programs, family health initiatives, and caregiver education materials, ensuring safe and effective home-based treatment.

In conclusion, topical application of common salt represents an evidence-based, low-cost, and safe therapeutic alternative to conventional silver nitrate treatment for umbilical granuloma. The consistency of results across diverse geographical and clinical contexts underlines its potential for broader clinical adoption. Future research should prioritize rigorous comparative studies with larger sample sizes, uniform outcome measures, and longer-term follow-up to validate these findings and promote standardized clinical guidelines for neonatal care worldwide (^{Banerjee et al., 2023}; ^{Kraus et al., 2020}).

Author´s contribution

Conceptualization, F.C.; data curation, F.C., D.M., M.F. and I.B.; formal analysis, F.C.; methodology, F.C. and D.M.; supervision, F.C.; validation, D.M., M.F. and I.B.; visualization, F.C.; writing- original draft, F.C.; writing- review & editing, D.M., M.F. and I.B.

Conflict of interests

The authors declare no conflict of interests.