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

Management

• 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

Complications

• Sepsis

• Abdominal wall necrotizing fasciitis

Pearls

• 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

Reference

Gallagher, PG.  Omphalitis Clinical Presentation.  Medscape Website.  Published January 2, 2016.  Accessed September 7, 2017.  http://emedicine.medscape.com/article/975422-clinical#b4

Palazzi, DL, Brandt, ML.  Care of the umbilicus and management of umbilical disorders.  UpToDate Website.  Published Aug 2017.  Accessed September 7, 2017.  https://www.uptodate.com/contents/care-of-the-umbilicus-and-management-o...