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| {{SI}} | | __NOTOC__ |
| | {{Omphalitis}} |
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| | '''For patient information click [[{{PAGENAME}} (patient information)|here]]''' |
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| '''Omphalitis''' is the medical term for infection of the [[umbilical cord]] stump in the [[neonate|neonatal]] newborn period. While currently an uncommon source of [[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.
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| ==Epidemiology== | | ==[[Omphalitis overview|Overview]]== |
| 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.
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| ==Clinical manifestations== | | ==[[Omphalitis historical perspective|Historical Perspective]]== |
| 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.
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| Clinically, [[neonate]]s with omphalitis present within the first two weeks of life with signs and symptoms of infeciton ([[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).
| | ==[[Omphalitis classification|Classification]]== |
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| ==Microbiology of omphalitis== | | ==[[Omphalitis pathophysiology|Pathophysiology]]== |
| 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, thus, a mixed [[Gram-positive]] and [[Gram-negative]] infection. [[Anaerobic organism|Anaerobic]] bacteria can also be involved.
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| ==Diagnosis== | | ==[[Omphalitis causes|Causes]]== |
| 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|granulomata]] of the umbilical stump.
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| ==Differential Diagnosis of Omphalitis== | | ==[[Omphalitis differential diagnosis|Differentiating Omphalitis from other Diseases]]== |
| {|style="width:90%; height:100px" border="1"
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| |style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" | '''Cardiovascular'''
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| |style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | No underlying causes
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| |-bgcolor="LightSteelBlue"
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| | '''Chemical / poisoning'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Dermatologic'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Drug Side Effect'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Ear Nose Throat'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Endocrine'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Environmental'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Gastroenterologic'''
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| |bgcolor="Beige"| No underlying causes
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| |-bgcolor="LightSteelBlue"
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| | '''Genetic'''
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| |bgcolor="Beige"| No underlying causes
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| |-bgcolor="LightSteelBlue"
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| | '''Hematologic'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Iatrogenic'''
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| |bgcolor="Beige"| No underlying causes
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| |-bgcolor="LightSteelBlue"
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| | '''Infectious Disease'''
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| |bgcolor="Beige"| No underlying causes
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| |-bgcolor="LightSteelBlue"
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| | '''Musculoskeletal / Ortho'''
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| |bgcolor="Beige"| No underlying causes
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| |-bgcolor="LightSteelBlue"
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| | '''Neurologic'''
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| |bgcolor="Beige"| No underlying causes
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| |-bgcolor="LightSteelBlue"
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| | '''Nutritional / Metabolic'''
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| |bgcolor="Beige"| No underlying causes
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| |-bgcolor="LightSteelBlue"
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| | '''Oncologic'''
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| |bgcolor="Beige"| No underlying causes
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| |-bgcolor="LightSteelBlue"
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| | '''Opthalmologic'''
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| |bgcolor="Beige"| No underlying causes
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| |-bgcolor="LightSteelBlue"
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| | '''Overdose / Toxicity'''
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| |bgcolor="Beige"| No underlying causes
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| |-bgcolor="LightSteelBlue"
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| | '''Psychiatric'''
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| |bgcolor="Beige"| No underlying causes
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| | '''Pulmonary'''
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| |bgcolor="Beige"| No underlying causes
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| |-bgcolor="LightSteelBlue"
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| | '''Renal / Electrolyte'''
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| |bgcolor="Beige"| No underlying causes
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| |-bgcolor="LightSteelBlue"
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| | '''Rheum / Immune / Allergy'''
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| |bgcolor="Beige"| No underlying causes
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| |-bgcolor="LightSteelBlue"
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| | '''Trauma'''
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| |bgcolor="Beige"| No underlying causes
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| |-bgcolor="LightSteelBlue"
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| | '''Miscellaneous'''
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| |bgcolor="Beige"| No underlying causes
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| |}
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| ==Treatment== | | ==[[Omphalitis epidemiology and demographics|Epidemiology and Demographics]]== |
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| 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 a [[penicillin]] which is active against ''[[Staphylococcus aureus]]'' and an [[aminoglycoside]]. 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]].
| | ==[[Omphalitis risk factors|Risk Factors]]== |
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| ==Prevention== | | ==[[Omphalitis natural history, complications and prognosis|Natural History, Complications and Prognosis]]== |
| 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.
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| ==External links== | |
| *[http://www.emedicine.com/ped/topic1641.htm Emedicine]
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| [[Category:Bacterial diseases]]
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| [[Category:Inflammations]]
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| | ==Diagnosis== |
| | [[Omphalitis history and symptoms| History and Symptoms]] | [[Omphalitis physical examination | Physical Examination]] | [[Omphalitis laboratory findings|Laboratory Findings]] | [[Omphalitis CT|CT]] | [[Omphalitis other imaging findings|Other Imaging Findings]] | [[Omphalitis other diagnostic studies|Other Diagnostic Studies]] |
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| | ==Treatment== |
| | [[Omphalitis medical therapy|Medical Therapy]] | [[Omphalitis surgery|Surgery]] | [[Omphalitis primary prevention|Primary Prevention]] | [[Omphalitis secondary prevention|Secondary Prevention]] | [[Omphalitis cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Omphalitis future or investigational therapies|Future or Investigational Therapies]] |
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| {{WH}} | | ==Case Studies== |
| | [[Omphalitis case study one|Case#1]] |
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