omphalitis

Etiology

• risk factors
  • premature infants
  • infection (sepsis, pneumonia, chorioamnionitis))
  • immunodeficiency
  • prolonged birth labor
  • umbilical catheter
• orgasnisms
  • Staphylococcus aureus
  • Streptococcus
  • Escherichia coli
  • Klebsiella pneumoniae
  • Proteus mirabilis
  • infection is typically caused by a mix of these organisms & a mix of Gram-positive & Gram-negative organisms
  • anaerobic bacteria can be involved

Pathology

• infection of the umbilical cord stump in the neonatal

Clinical manifestations

• poor feeding or feeding intolerance
• urine or stool discharge from the umbilicus suggests an underlying anatomic abnormality

Laboratory

• Gram stain & culture for aerobic & anaerobic organisms
• blood cultures for aerobic & anaerobic organisms
• complete blood count (CBC) with differential
  • neutrophilia or neutropenia may be present
  • thrombocytopenia may be present
• if sepsis or DIC suspected
  • peripheral blood smear
  • prothrombin time (INR)
  • activated partial thromboplastin time
  • fibrinogen in plasma
  • D-dimer in plasma
• chemistry panel may indicate
  • serum glucose: hypoglycemia
  • serum calcium: hypocalcemia
  • carbonate in serum: metabolic acidosis

Radiology

• abdominal radiography may reveal intra-abdominal wall gas
• abdominal ultrasound
  • may reveal fascial thickening & fluid accumulation between subcutaneous fat and muscle
  • may detect anatomic abnormality
• abdominal CT (see ultrasound above)

Management

• intravenous antibiotics
  • Gram-positive & Gram-negative coverage
  • antistaphylococcal penicillin & an aminoglycoside
  • add metronidazole for anaerobes
  • clindamycin may be substituted for antistaphylococcal penicillin for Staphylococcus & anaerobe coverage
• supportive care
  • ventilatory assistance & supplemental oxygen for hypoxemia or apnea unresponsive to stimulation
• fluids, vasoactive agents, or both (as indicated) for hypotension
• blood products: platelets, fresh frozen plasma, or cryoprecipitate for disseminated intravascular coagulation (DIC) & clinical bleeding
• treat infants at centers capable of supporting cardiopulmonary function
• prognosis
  • monitor patients for progression of disease
  • early surgical intervention may be lifesaving
  • in uncomplicated cases, erythema of the umbilical stump improves within 12-24 hours after initiation of antimicrobial therapy

More general terms

• skin infection