Omphalitis

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Description

Omphalitis, an infection of the umbilical stump, begins in the neonatal period as a


superficial cellulitis but may progress to necrotizing fasciitis, myonecrosis, or systemic
disease.
Epidemiology
 Episodes of omphalitis are usually sporadic, but rare epidemics occur.
 Mean age of onset is 5–9 days in term infants and 3–5 days in preterm infants.
 Incidence varies from 0.2 to 0.7% of live births in developed countries and up to
21% of live births in developing countries.
Risk Factors
 Low birth weight
 Prior umbilical catheterization
 Septic delivery
 Male sex
General Prevention
 There are multiple methods used for umbilical cord care, many of which are
acceptable.
 Antimicrobial agents applied to the umbilicus may decrease bacterial colonization
and prevent omphalitis, particularly in developing countries.
 Effective methods of umbilical cord care:
 Clean, dry cord care (AAP/WHO recommended)
 Triple dye
 Topical 4% chlorhexidine
 70% alcohol solution
 There is significant evidence to support the use of topical 4% chlorhexidine to
prevent omphalitis in developing countries, although it does delay time to cord
separation.
 There is no evidence that application of an antiseptic to the umbilical cord is
better than clean, dry cord care in a hospital setting.
Pathophysiology
 Potential bacterial pathogens normally colonize the umbilical stump after birth.
 These bacteria invade the umbilical stump, leading to omphalitis.
 Established aerobic bacterial infection, necrotic tissue, and poor blood supply
facilitate the growth of anaerobic organisms.
 Infection may also extend beyond the subcutaneous tissues to involve fascial
planes (fasciitis), abdominal wall musculature (myonecrosis), and umbilical and
portal veins (phlebitis).

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