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Should you be concerned about erythema around the umbilical stump?!
Yes!
Often parents will bring their neonate to the ED with concerns about the umbilical cord and it is just a simple granuloma or normal detachment. But is it omphalitis???
Omphalitis incidence is low in developed countries, but that means it’s easier, and no less catastrophic, to miss!
Omphalitis is a superficial cellulitis of the umbilical cord, but 10-16% progress to necrotizing fasciitis of the abdominal wall!!!
Always ADMIT and consider consulting surgery early in case of rapid progression…
Most often polymicrobial and should be treated with:
- Anti-staphylococcal PCN, Vanc, & an Aminoglycoside
- Also consider adding Metronidazole or Clindamycin for anaerobic coverage
- Anti-pseudomonal coverage if toxic
Should notice improvement within 12-24 hours, so if don’t or begin to observe
- Fever
- Induration
- Peau d’orange tisse
- Tenderness
- Violaceous discoloration
- Crepitace
- Increased erythema
- Systemic signs of toxicity/shock
CONSULT SURERY for concern of necrotizing fasciitis which has a mortality rate of close to 60%!!!