UMEM Educational Pearls

Category: Pediatrics

Title: Omphalitis (submitted by Jim Lantry, MD)

Keywords: infectious disease, neonatal infections, umbilical disorders (PubMed Search)

Posted: 1/20/2012 by Mimi Lu, MD
Click here to contact Mimi Lu, MD

Omphalitis is an infection of the umbilical cord that progresses to invade the surrounding subcutaneous tissue, fat and abdominal wall musculature.  Anatomical defects such as a patent urachus or immulogical defects (LAD or neutropenia) should be suspected for severe, protracted omphalitis or for failure of cord separation beyond 2 weeks of life.
o   Incidence: developed countries the incidence is 0.5-1% of births; mean age of 3.2 days of life
o   Risk factors: a non-sterile delivery, maternal genital tract infection, prolonged rupture of membranes, prematurity, low birth weight, umbilical vein catherization and inappropriate stump hygiene.
o   Signs: periumbilical edema, erythema, tenderness and/or discharge
o   Pathogens: Staph epidermis, group A or group B Strep (perinatally), E-coli, Klebsiella or Pseudomonas. Tetanus is a possibility in developing countries
o   Complications: necrotizing fasciitis, myonecrosis, peritonitis, portal vein thrombosis, abscess, spontaneous bowel evisceration          
o   Treatment: septic work-up with culture of all fluids (urine, blood CSF) and implementation of broad spectrum antibiotics and aggressive fluid resuscitation
1) Lee PPW, Lee TL, Ho MHK, Chong PCY, So CC, Lau YL. An Infant with Severe Congenital Neutropenia Presenting with Persistent Omphalitis: Case Report and Literature Review. Hong Kong Journal of Pediatrics. 2010. 15(4): 289-298
2) Louie JP. Essential Diagnosis of Abdominal Emergencies in the First Year of Life. Emergency Medicine Clinics of North America. 2007. 25:1009-1040