Omphalitis
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2008-07-15T04:12:38Z
OhanaUnited
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[[WP:AWB/T|Typo fixing]], Replaced: pencillin → penicillin using [[Project:AutoWikiBrowser|AWB]]
'''Omphalitis''' is the medical term for infection of the [[umbilical cord]] stump in the [[neonate|neonatal]] newborn period. While currently an uncommon anatomical location for [[infection]] in the newborn in the [[United States]], it has caused significant morbidity and mortality both historically and in areas where [[health care]] is less readily available.
==Epidemiology==
The current incidence in the United States is somewhere around 0.5% per year. There does not appear to be any racial or ethnic predilection.
==Clinical manifestations==
Like many [[bacteria]]l [[infection]]s, omphalitis is more common in those patients who have a weakened or deficient [[immune system]] or who are hospitalized and subject to invasive procedures. Therefore, infants who are [[prematurity|premature]], sick with other infections such as blood infection ([[sepsis]]) or [[pneumonia]], or who have [[immunodeficiency|immune deficiencies]] are at greater risk. Infants with normal immune systems are at risk if they have had a prolonged [[birth]], birth complicated by infection of the placenta ([[chorioamnionitis]]), or have had umbilical [[catheter]]s.
Clinically, [[neonate]]s with omphalitis present within the first two weeks of life with signs and symptoms of infection ([[cellulitis]]) around the umbilical stump (redness, warmth, swelling, pain), [[pus]] from the umbilical stump, [[fever]], fast heart rate ([[tachycardia]]), low blood pressure ([[hypotension]]), somnolence, poor feeding, and yellow skin ([[jaundice]]). Omphalitis can quickly progress to [[sepsis]] and presents a potentially life-threatening infection. In fact, even in cases of omphalitis without evidence of more serious infection such as [[necrotizing fasciitis]], mortality is high (in the 10% range).
==Microbiology of omphalitis==
Omphalitis is most commonly caused by bacteria. The most common bacteria are ''[[Staphylococcus aureus]]'' and ''[[Streptococcus]]'', ''[[Escherichia coli]]'', and ''[[Klebsiella pneumoniae]]''. The infection is typically caused by a mix of these organisms and is a mixed [[Gram-positive]] and [[Gram-negative]] infection. [[Anaerobic organism|Anaerobic]] bacteria can also be involved.
==Diagnosis==
Diagnosis is usually made by the clinical appearance of the umbilical cord stump and the findings on history and [[physical examination]]. There may be some confusion, however, if a well-appearing neonate simply has some redness around the umbilical stump. In fact, a mild degree is common, as is some bleeding at the stump site with detachment of the umbilical cord. The picture may be clouded even further if [[caustics|caustic]] agents have been used to clean the stump or if [[silver nitrate]] has been used to [[cauterization|cauterize]] [[granuloma]]ta of the umbilical stump.
==Treatment==
Treatment consists of [[antibiotic]] therapy aimed at the typical bacterial [[pathogen]]s in addition to supportive care for any complications which might result from the infection itself such as [[hypotension]] or [[respiratory failure]]. A typical regimen will include [[intravenous]] [[antibiotics]] such as from the [[penicillin|penicillin-group]] which is active against ''[[Staphylococcus aureus]]'' and an [[aminoglycoside]] for activity against gram-negative bacteria. For particularly invasive infections, antibiotics to cover anaerobic bacteria may be added (such as [[metronidazole]]). Treatment is typically for two weeks and often necessitates insertion of a [[central venous catheter]] or [[peripherally inserted central catheter]].
==Prevention==
Each [[hospital]]/[[birthing center]] has its own recommendations for care of the [[umbilical cord]] after delivery. Some recommend not using any medicinal washes on the cord. Other popular recommendations include triple dye, [[betadine]], [[bacitracin]], or [[silver sulfadiazine]]. There is little data to support any one treatment (or lack thereof) over another.
==External links==
*[http://www.emedicine.com/ped/topic1641.htm Emedicine]
[[Category:Bacterial diseases]]
[[Category:Inflammations]]
[[ru:Омфалит]]