Back to Basics: Omphalitis


General → superficial cellulitis of umbilical cord with high mortality rate secondary to sepsis and abdominal wall necrotizing fasciitis

Pathophysiology → dangerous due to remnant of omphalomesenteric duct so if duct is patent infection can progress to liver and biliary system

Epidemiology → rare but more common in unsterile births and developing countries

Micro → poly-microbial with Gram positives, Gram negatives and anaerobes

Clinical → erythema around stump in newborn, foul discharge from stump, crying when cord is touched

Differential → granulation tissue v. normal umbilical discharge


• IV Antibiotics

o Anti-staph penicillin or vanco (consider MRSA biogram) or gentamycin

o Anaerobe coverage with Clindamycin or Flagyl

o +/- Anti-pseudomonal coverage

• <28 day old fever work up (CBC, Chem7, UA, Blood cultures, Urine culture, LP)

• Immediate surgical consult for evaluation for surgical debridement

• Admit


• Sepsis

• Abdominal wall necrotizing fasciitis


• If unclear if erythema is from diaper can remove diaper and observe for a short period of time to see if erythema progresses or clears as this is rapidly progressing

• A clinical diagnosis; any erythema on abdominal wall in the neonate gets a full septic work up + IV antibiotics + surgical consult + admission


Gallagher, PG.  Omphalitis Clinical Presentation.  Medscape Website.  Published January 2, 2016.  Accessed September 7, 2017.

Palazzi, DL, Brandt, ML.  Care of the umbilicus and management of umbilical disorders.  UpToDate Website.  Published Aug 2017.  Accessed September 7, 2017.