Keywords: Omphalitis, necrotizing fasciitis, umbilical cord (PubMed Search)
Should you be concerned about erythema around the umbilical stump?!
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:
Should notice improvement within 12-24 hours, so if don’t or begin to observe
CONSULT SURERY for concern of necrotizing fasciitis which has a mortality rate of close to 60%!!!
Category: Airway Management
Keywords: ALTE, life threatening, child abuse, GERD (PubMed Search)
Definition: An episode that is characterized by some combination of apnea, color change, change in muscle tone, choking, gagging, or a fear in the observer that the infant has died.
- GERD is by far the most common underlying etiology
- Do NOT forget about child abuse
Workup: Dependent on your Hx/PE (Take into account the child’s age (<30 days or h/o prematurity), existence of prior ALTE episodes, general appearance, etc.)
One study showed the concordance of initial working to discharge diagnosis of GERD was 96%, and non-concordant diagnoses evolved within 24 hours
Dispo: The easy part! ADMIT!
Even well-appearing children with a “benign” diagnosis like GERD have been shown to benefit from admission. And there is a high likelihood that ALTE’s from a serious cause are likely to recur within 24hours.
A recent study looked at 176 infants who presented to the ED with an ALTE over a 5 year period. Essentially all were admitted.
Conclusion: The risk of subsequent mortality in infants presenting ALTE is substantial, and we should consider routine admission for all of these patients.
Doshi A, Bernard-Stover L, Kuelbs C, Castillo E, Stucky E. Apparent life-threatening event admissions and gastroesophageal reflux disease: The value of hospitalization. Pediatr Emerg Care, January 2012. 28(1): p. 17-21.
Shruti Kant, Jay D. Fisher, David G. Nelson, Shehma Khan. Mortality after discharge in clinically stable infants admitted with a first-time apparent life-threatening event. AJEM, April 2013. 31(4): p 17-21. 730-733 (DOI: 10.1016/j.ajem.2013.01.002)
Zuckerbraun NS, Zomorrodi A, Pitetti RD. Occurrence of serious bacterial infection in infants aged 60 days or younger with an apparent life-threatening event. Pediatr Emerg Care, January 2009. 25(1): p. 19-25.