OMPHALITIS

Basel Zaid
AlQuds School Of Medicine
Pediatric Course-Sixth Year
Omphalitis “Case Hx”
 Pt ID : Mohammad .Y from Ramallah
 7 days male Product of NVSD, full term, BWt 3.66 Kg.
 Fever since yesterday (38.5-39.5) C
 Umbilical yellowish discharge surrounded by
erythema since yesterday.
 Hypoactivity in the past 2 days.
 (-) Vomiting, Diarrhea, Skin rash, Abnormal
movements, Cyanosis, Cough or runny nose.

 Maternal UTI in the last week of pregnancy.

 Exclusively Breast fed
 Immun: 1st Dose Hep B + BCG
Omphalitis (Case PE)
 Generally: Alert, mildly jaundice, NOT| in
respiratory distress. No Signs of dehydration

 HR 126 RR 39 Temp 38.8 C

 Wt 3.67 Ht 52 HC 37

 ENT : NL,, NO LAD

 No dysmorphic features
 Chest & Heart examination were NL
 ABD: soft, lax, NO Organomegaly.NL Genetalia.
 Extremity: No deformity, No Oedema
 Neuro Ex : NL, Normal Reflexes.
Omphalitis (Case Follow Up)
 Working Diagnosis : 1- Omphalitis 2-Sepsis 3-LAD
 CBC,ESR,CRP
 urine analysis+ urine culture
 blood culture--- CSF analysis and Culture
 Umbilical swab culture
 RBS
 BUN, Cr, TSB ,,serum electrolytes.
 Take weight daily
 Observe v/s “HR,Temp” and BP
 Observe O2 sat to be more than 92% all the time.
 Feeding as tolerated
 Omphalitis (Case Follow Up)
 Start on ATB : Oxacillin IV Q 6 hours+ Claforan IV Q
6 hours+ Fucidine cream topically
White blood cells 20 Erythrocyte Sedimentation Rate 40

Neutrophils granuloc% 58% C- Reactive Protein - CRP ++

Lymphocytes% 25% AST (GOT) 12

Red blood cells (RBC) --- ALT (GPT) 23

Haemoglobin (HGB) 17.9 Creatinine, serum 0.2

hematocrit (HCT) --- Urea 22

Mean cell volume (MCV) 101 Random blood sugar (RBS) 96

Mean cell haemoglobin (MCH) ----- Uric Acid ---

Mean cell haemoglobin

concentration (MCHC) --- Bilirubin, Total 8

Red blood cell distribution width ---- Alkaline phosphatase 295

Platelets 385 CSF Analysis “total cells” 25

Na 132 CSF WBC 20
K 4.7 CSF sugar 49
Introduction
 Omphalitis is an infection of the umbilical
stump.

 It typically present as a superficial cellulitis

i.e. as a red ‘flare’ in the periumbilical skin.

 The cellulitis may progress rapidly with

potentially serious consequences including
systemic disease e.t.c.
 Omphalitis is predominantly a disease of
the Neonates.
Epidemiology / Aetiology
 Internationally, overall incidence is < 1%

 Approximately 85% OF Cases are

polymicrobial in origin.

 Aerobic bacteria present in 85% of

infections predominated by Staphylococcus
aureus, Group A Streptococcus, Escherichia
coli, Klebsiella pneumoniae.

 Pseudomonas species have been implicated

in particularly rapid or invasive disease.
 LAD (Leukocyte adhesion
deficiency)

• Omphalitis occasionally manifests from an

underlying Immunologic disorder.

• These infants are subsequently diagnosed with

Leukocyte adhesion deficiency, a rare disorder
with AR pattern of inheritance. These infants
present with the following;
• 1-Leukocytosis
• 2- Delayed seperation of the umbilical cord
• 3-recurrent infections.
Clinical Features
 In term infant the, mean age at onset is 5-9 days.

 Patient present with redness and swelling (cellulitis)

around the umbilicus.
 Purulent or mal odorous discharge from the umbilicus.
 Baby is highly irritable.

 The cellulitis is rapidly progressive and may lead to

necrotizing fasciitis.
 Necrotizing fasciitis is characterized by abdominal
distension, fever and tachycardia.

 Despite the illness, most of the neonates at

presentation have good appetite and continue to suck.
Management
 History- detailed history of the pregnancy, labour,
delivery and neonatal course.
 Physical Examination
Physical signs vary with the extent of the disease.
 Local disease; signs of localized infection
include the fllg
 Purulent or mal odorous discharge from the umbilical stump
 Periumbilical erythema
 Edema
 Tenderness

 Extensive local disease; such as fasciitis or myonecrosis.

These signs may suggest infection by both aerobic or
anaerobic organisms.
 Periumbilical ecchymosis
 Crepitus
 Bullae
 Progression of cellulitis despite antimicrobial therapy
Baby O.T.with extensive local disease
& systemic disease
 Lab studies

 Obtain specimen from umbilical infection for Gram

stain & culture for aerobic and anaerobic organisms.
 Blood culture for aerobic and anaerobic organisms.
 CBC
 RBS –hypoglycaemia

 Other non specific lab tests. None has demonstrated

sensitivity or specificity sufficiently high to dictate
clinical care. These are;
 C-reactive protein level
 Erythrocyte Sedimentation rate
 Limulus lysate test, which detect endotoxin
 Treatment
Treatment

Medical Care Surgical Care

Antimicrobial Supportive
Steroids ?
Therapy Care
?
Antimicrobial therapy
 Parenteral antimicrobial coverage for gram -
positive and gram – negative organisms. A
combination of anti – Staphylococcal penicillin and
an Aminoglycoside is recommended.
 Anaerobic coverage is important in all patients.
 As with anti microbial therapy, local antibiotic
sensitivity patterns is considered.
 CLOXACILLIN + GENTAMICIN + FLAGYL

OR
CEPHALOSPORIN + GENTAMICIN +FLAGYL
forms the usual antimicrobial combination.
 Surgical care
 Early surgery may be life saving.

 It involves early and complete surgical

debridement of the affected tissues and
muscle.

 Excision of pre peritoneal tissue ( umbilicus,

umbilical vessels) is critically important in the
eradication of infection. These tissues can
harbour invasive bacteria and provide a route
for progressive spread of infection.
Prognosis
The prognosis for most infants is
variable.
• In most cases prognosis is Poor.

• Omphalitis with complications is

associated with mortality rate up to
80% in developed countries.
• In the less developed countries,
mortality is > 95%
Differential diagnosis
 Anterior abdominal wall cellulitis
 Neonatal septicaemia
 Burns
 Urachal cyst with 2º bacterial
infection.
THE END

THANK YOU .