The umbilical cord is the lifeline of the fetus and of the neonate in the first few minutes after birth. Care of the cord and stump in the immediate neonatal period varies according to social, cultural, economic, and geographic factors. Measures taken to insure sterility in cutting, tying, and painting the umbilical cord may prevent serious diseases such as tetanus neonatorum. Care of the umbilical cord may be less than optimal in babies born at home in unsupervised "home delivery." Minor congenital anomalies of the umbilical cord, such as umbilical hernia, and major anomalies, such as gastroschisis and omphalocele, are reviewed in this article. Survival in babies with major anomalies of the cord has been improving steadily because of early diagnosis (including prenatal diagnosis), better operative procedures, and better understanding of the fluid and nutritional requirements of the neonate postoperatively. Diseases of the cord include omphalitis and, rarely, tumors.