Clinical Picture

Omphalitis
Lancet 2004; 364: 1522 Prakash Manikoth, Mariam George, Avirat Vaishnav, Mohammed Jaffer Sajwani
Neonatal Intensive Care Unit
(P Manikoth MRCP, A baby boy was brought to the hospital at 6 days of age
M George MD) and Department
with swelling and discharge from the umbilicus. We
of Paediatric Surgery
(A Vaishnav FRCS, examined him, and found a febrile, irritable infant with
M J Sajwani FRCS), Royal extensive erythema, induration and tenderness around a
Hospital, Seeb, Oman black umbilicus (figure). We started broad spectrum
Correspondence to: antibiotics. A complete blood count showed neutrophilic
Dr Prakash Manikoth
leucocytosis and culture of the umbilical stump culture
manikoth@omantel.net.om
grew E coli, Enterococcus, and Bacteroides species which
were sensitive to the antibiotics he received. 24 h later he
developed generalised seizures and required ventilatory
support. We excised the umbilicus and did a fasciotomy
of the abdominal wall. However, the baby developed
severe sepsis with hypotension and renal failure. Despite
aggressive management with vasopressors and
peritoneal dialysis, he died 2 days later.
Necrotising fascitiis is a rare complication of
omphalitis in the newborn with a high morbidity and
mortality. It is polymicrobial in aetiology and early
recognition and prompt management with antibiotics,
surgical debridement, and intensive care are essential
for a good outcome.

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