Umbilicitis

Umbilicitis
inflammation of the umbilical cord stump in the neonatal
newborn period
most commonly attributed to a bacterial infection
typically presents as a superficial cellulitis that can spread
to involve the entire abdominal wall and may progress to
necrotizing fasciitis, myonecrosis, or systemic disease.
most commonly caused by bacteria. The culprits usually
are Staphylococcus aureus, Streptococcus, and Escherichia
coli.The infection is typically caused by a combination of
these organisms and is a mixed Gram-positive and Gramnegative infection. Anaerobic bacteria can also be involved.

Treatment
Include parenteral antimicrobial coverage for grampositive and gram-negative organisms. A combination of
an antistaphylococcal penicillin vancomycin and an
aminoglycoside antibiotic is recommended.
If involvement of anaerobic microb is suspected,
metronidazole and clindamycin can provide with
anaerobic coverage.
supportive care for any complications which might
result from the infection itself such as hypotension or
respiratory failure.

neonatal conjunctivitis

Cause
Can be aseptic or septic origin.
Septic (infectious) caused by Neisseria gonorrhoeae,
Chlamydia trachomatis, HSV, staphylococcus
Aseptic (chemical) conjunctivitis is caused by chemical
irritants like silver nitrate eye drops or secondary to topical
prophylaxis of septic conjunctivitis.

Symptoms and Signs

Chemical conjunctivitis secondary to topical prophylaxis usually
appears within 6 to 8 h after instillation and disappears
spontaneously within 48 to 96 h.
Chlamydial ophthalmia usually occurs 5 to 14 days after birth. It
may range from mild conjunctivitis with minimal mucopurulent
discharge to severe eyelid edema with copious drainage and
pseudomembrane formation. Follicles are not present in the
conjunctiva, as they are in older children and adults.
Gonococcal ophthalmia causes an acute purulent conjunctivitis
that appears 2 to 5 days after birth or earlier with premature rupture
of membranes. The neonate has severe eyelid edema followed by
chemosis and a profuse purulent exudate that may be under
pressure. If untreated, corneal ulcerations and blindness may occur.
Conjunctivitis caused by other bacteria has a variable onset, ranging
from 4 days to several weeks.

Treatment & Prophylaxis

Chemical ophthalmia neonatorum is a self-limiting
condition and does not require any treatment.
Use of 1% tetracycline ointment or 0.5% erythromycin
ointment or 1% silver nitrate solution (Crede's method)
into the eyes of babies immediately after birth
Single injection of ceftriaxone IM or IV should be given
to infants born to mothers with untreated gonococcal
infection.

 In chlamydial ophthalmia, systemic therapy is the treatment

of choice, because at least half of affected neonates also
have nasopharyngeal infection and some develop chlamydial
pneumonia. Neonatal inclusion conjunctivitis caused by
Chlamydia trachomatis responds well to topical tetracycline
1% or erythromycin 0.5% eye ointment QID for three weeks.
Newborns with gonococcal ophthalmia neonatorum should
be treated for seven days with one of the following regimens
ceftriaxone, cefotaxime, ciprofloxacin, crystalline benzyl
penicillin
Herpes simplex conjunctivitis should be treated with
intravenous acyclovir for a minimum of 14 days to prevent
systemic infection.
Conjunctivitis due to other bacteria usually responds to
topical ointments containing polymyxin plus bacitracin,
erythromycin, or tetracycline.

Seborrheic dermatitis (SD)

Epidemiology

SD usually occurs in infants between the ages of 3 weeks and 12

months
It presents in the neonatal period in about 10% of children and affects
around 7% of children between their first and second year of life

Morphology: characterized by erythema, greasy scales, and

salmon-colored oval scaly patches.
Distribution: predilection for scalp (cradle cap), face,
forehead, eyebrows, trunk, intertriginous and flexural areas
including diaper area
Etiology: precise etiology is unknown, but the yeast Malassezia
furfur has been implicated on its pathogenesis

Treatment
Many dont require any treatment
Low potency topical steroids and petrolatum or mineral
oil may be considered particularly if itchy
Topical antifungal creams may help secondary
colonization with pityrosporum/yeast
Tar-containing and Selenium sulfide shampoos may be
used if the lesions persist.
Salicylic acid is not recommended because of concerns
about systemic absorption