Omphalitis of newborn - Wikipedia, the free encyclopedia

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Omphalitis of newborn
From Wikipedia, the free encyclopedia

Is the medical term for inflammation of the umbilical cord stump in the neonatal newborn period, most
commonly attributed to a bacterial infection.[1] Typically immediately after an infant is born, the umbilical cord
is cut with a small remnant (often referred to as the stump) left behind. Normally the stump separates from the
skin within 345 days after birth.[2] A small amount of pus-like material is commonly seen at the base of the
stump and can be controlled by keeping the stump open to air to dry.[3] Certain bacteria can grow and infect the
stump during this process and as a result significant redness and swelling may develop, and in some cases the
infection can then spread through the umbilical vessels to the rest of the body.[3] While currently an uncommon
anatomical location for infection in the newborn in the United States, it has caused significant morbidity and
mortality both historically and in areas where health care is less readily available. In general, when this type of
infection is suspected or diagnosed, antibiotic treatment is given, and in cases of serious complications surgical
management may be appropriate.[3]

Contents
1 Signs and symptoms
2 Causes
3 Diagnosis
4 Prevention
5 Treatment
6 Epidemiology
7 References

Signs and symptoms

Clinically, neonates with omphalitis present within the first two weeks of life with signs and symptoms of a skin
infection (cellulitis) around the umbilical stump (redness, warmth, swelling, pain), pus from the umbilical
stump, fever, fast heart rate (tachycardia), low blood pressure (hypotension), somnolence, poor feeding, and
yellow skin (jaundice). Omphalitis can quickly progress to sepsis and presents a potentially life-threatening
infection. In fact, even in cases of omphalitis without evidence of more serious infection such as necrotizing
fasciitis, mortality is high (in the 10% range).

Causes
Omphalitis is most commonly caused by bacteria. The culprits usually are Staphylococcus aureus,
Streptococcus, and Escherichia coli.[2] The infection is typically caused by a combination of these organisms
and is a mixed Gram-positive and Gram-negative infection. Anaerobic bacteria can also be involved.[4]

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Diagnosis
In a normal umbilical stump, you first see the umbilicus lose its characteristic bluish-white, moist appearance
and become dry and black [2] After several days to weeks, the stump should fall off and leave a pink fleshy
wound which continues to heal as it becomes a normal umbilicus.[2]
For an infected umbilical stump, diagnosis is usually made by the clinical appearance of the umbilical cord
stump and the findings on history and physical examination. There may be some confusion, however, if a wellappearing neonate simply has some redness around the umbilical stump. In fact, a mild degree is common, as is
some bleeding at the stump site with detachment of the umbilical cord. The picture may be clouded even further
if caustic agents have been used to clean the stump or if silver nitrate has been used to cauterize granulomata of
the umbilical stump. Leukocyte Adhesion Deficiency is a rare (autosomal recessive disease) in which there is an
absence of CD18.

Prevention
During the 1950s there were outbreaks of omphalitis that then led to anti-bacterial treatment of the umbilical
cord stump as the new standard of care.[5] It was later determined that in developed countries keeping the cord
dry is sufficient, (known as "Dry Cord Care") as recommended by the American Academy of Pediatrics.[2] The
umbilical cord dries more quickly and separates more readily when exposed to air [2] However, each
hospital/birthing center has its own recommendations for care of the umbilical cord after delivery. Some
recommend not using any medicinal washes on the cord. Other popular recommendations include triple dye,
betadine, bacitracin, or silver sulfadiazine. With regards to the medicinal treatments, there is little data to
support any one treatment (or lack thereof) over another. However one recent review of many studies supported
the use of chlorhexidine treatment as a way to reduce risk of death by 23% and risk of omphalitis by anywhere
between 27-56% in community settings in underdeveloped countries.[6] This study also found that this
treatment increased the time that it would take for the umbilical stump to separate or fall off by 1.7 days.[6]
Lastly this large review also supported the notion that in hospital settings no medicinal type of cord care
treatment was better at reducing infections compared to dry cord care.[6]

Treatment
Treatment consists of antibiotic therapy aimed at the typical bacterial pathogens in addition to supportive care
for any complications which might result from the infection itself such as hypotension or respiratory failure. A
typical regimen will include intravenous antibiotics such as from the penicillin-group which is active against
Staphylococcus aureus and an aminoglycoside for activity against gram-negative bacteria. For particularly
invasive infections, antibiotics to cover anaerobic bacteria may be added (such as metronidazole). Treatment is
typically for two weeks and often necessitates insertion of a central venous catheter or peripherally inserted
central catheter.

Epidemiology
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The current incidence in the United States is somewhere around 0.5% per year; overall, the incidence rate for
developed world falls between 0.20.7%. In developing countries, the incidence of omphalitis varies from 2 to 7
for 100 live births.[7] There does not appear to be any racial or ethnic predilection.
Like many bacterial infections, omphalitis is more common in those patients who have a weakened or deficient
immune system or who are hospitalized and subject to invasive procedures. Therefore, infants who are
premature, sick with other infections such as blood infection (sepsis) or pneumonia, or who have immune
deficiencies are at greater risk. Infants with normal immune systems are at risk if they have had a prolonged
birth, birth complicated by infection of the placenta (chorioamnionitis), or have had umbilical catheters.

References
1. Jones, Kevin, MD, Neayland, Beverly, MD. "Brief Review of Omphalitis"
(http://www.medicine.nevada.edu/Residency/lasvegas/Pediatrics/documents/Omphalitis.pdf) (PDF). dead link. UNSOM
Department of Pediatrics. Retrieved 23 July 2013.
2. Cunningham, F. Williams Obstetrics:The Newborn (24 ed.). McGraw-Hill.
3. Rosenberg. Current Diagnosis & Treatment: Pediatrics (22e ed.).
4. Fleisher, Gary R. Textbook of Pediatric Emergency Medicine. Philadelphia: Lippincott Williams & Wilkins, 2006, p.
928.
5. Janssen, PA; Selwood, BL; Dobson, SR; Peacock, D; Thiessen, PN (January 2003). "To dye or not to dye: a randomized,
clinical trial of a triple dye/alcohol regime versus dry cord care.". Pediatrics 111 (1): 1520. PMID 12509548
(https://www.ncbi.nlm.nih.gov/pubmed/12509548).
6. Imdad, A; Bautista, RM; Senen, KA; Uy, ME; Mantaring JB, 3rd; Bhutta, ZA (31 May 2013). "Umbilical cord
antiseptics for preventing sepsis and death among newborns.". The Cochrane database of systematic reviews 5:
CD008635. doi:10.1002/14651858.CD008635.pub2 (https://dx.doi.org/10.1002%2F14651858.CD008635.pub2).
PMID 23728678 (https://www.ncbi.nlm.nih.gov/pubmed/23728678).
7. Bugaje, Mairo Adamu et al. "Omphalitis" (http://www.global-help.org/publications/books/help_pedsurgeryafrica20.pdf)
(PDF). Paediatric Surgery: A Comprehensive Text For Africa. Retrieved 23 July 2013.

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