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Omphalitis is an infection of the umbilical cord that progresses to invade the surrounding subcutaneous tissue, fat and abdominal wall musculature. Anatomical defects such as a patent urachus or immulogical defects (LAD or neutropenia) should be suspected for severe, protracted omphalitis or for failure of cord separation beyond 2 weeks of life.
o Incidence: developed countries the incidence is 0.5-1% of births; mean age of 3.2 days of life
o Risk factors: a non-sterile delivery, maternal genital tract infection, prolonged rupture of membranes, prematurity, low birth weight, umbilical vein catherization and inappropriate stump hygiene.
o Signs: periumbilical edema, erythema, tenderness and/or discharge
o Pathogens: Staph epidermis, group A or group B Strep (perinatally), E-coli, Klebsiella or Pseudomonas. Tetanus is a possibility in developing countries
o Complications: necrotizing fasciitis, myonecrosis, peritonitis, portal vein thrombosis, abscess, spontaneous bowel evisceration
o Treatment: septic work-up with culture of all fluids (urine, blood CSF) and implementation of broad spectrum antibiotics and aggressive fluid resuscitation
References:
1) Lee PPW, Lee TL, Ho MHK, Chong PCY, So CC, Lau YL. An Infant with Severe Congenital Neutropenia Presenting with Persistent Omphalitis: Case Report and Literature Review. Hong Kong Journal of Pediatrics. 2010. 15(4): 289-298
2) Louie JP. Essential Diagnosis of Abdominal Emergencies in the First Year of Life. Emergency Medicine Clinics of North America. 2007. 25:1009-1040