UMEM Educational Pearls

Title: The Life-Treatening Umbilical Cord

Keywords: Omphalitis, necrotizing fasciitis, umbilical cord (PubMed Search)

Posted: 10/4/2013 by Joey Scollan, DO
Click here to contact Joey Scollan, DO

Should you be concerned about erythema around the umbilical stump?!

Yes!

Often parents will bring their neonate to the ED with concerns about the umbilical cord and it is just a simple granuloma or normal detachment. But is it omphalitis???

Omphalitis incidence is low in developed countries, but that means it’s easier, and no less catastrophic, to miss!

Omphalitis is a superficial cellulitis of the umbilical cord, but 10-16% progress to necrotizing fasciitis of the abdominal wall!!!

Always ADMIT and consider consulting surgery early in case of rapid progression…

Most often polymicrobial and should be treated with:

Anti-staphylococcal PCN, Vanc, & an Aminoglycoside
Also consider adding Metronidazole or Clindamycin for anaerobic coverage
Anti-pseudomonal coverage if toxic

Should notice improvement within 12-24 hours, so if don’t or begin to observe

Fever
Induration
Peau d’orange tisse
Tenderness
Violaceous discoloration
Crepitace
Increased erythema
Systemic signs of toxicity/shock

CONSULT SURERY for concern of necrotizing fasciitis which has a mortality rate of close to 60%!!!

References

1. Pérez, David Vila, et al. "Prognostic Factors in Pediatric Sepsis Study, from the Spanish Society of Pediatric Intensive Care." The Pediatric Infectious Disease Journal (2013).

2. Sawin RS, Schaller RT, Tapper D. Early Recognition of Neonatal Abdominal Wall Necrotizing Fasciitis. American Journal of Surgery. May 1994; 167: 481 – 484.

3. Ulloa-Gutierrez R, Rodriguez-Calzada H, Quesada L, Arguello A. Is it Acute Omphalitis or Necrotizing Fasciitis? Report of Three Fatal Cases. Pediatric Emergency Care. Sept 2005; 21(9): 600 – 602.