Description
Omphalitis, an infection of the umbilical stump, begins in the neonatal period as a
superficial cellulitis but may progress to necrotizing fasciitis, myonecrosis, or systemic
disease.
Epidemiology
Episodes of omphalitis are usually sporadic, but rare epidemics occur.
Mean age of onset is 5–9 days in term infants and 3–5 days in preterm infants.
Incidence varies from 0.2 to 0.7% of live births in developed countries and up to
21% of live births in developing countries.
Risk Factors
Low birth weight
Prior umbilical catheterization
Septic delivery
Male sex
General Prevention
There are multiple methods used for umbilical cord care, many of which are
acceptable.
Antimicrobial agents applied to the umbilicus may decrease bacterial colonization
and prevent omphalitis, particularly in developing countries.
Effective methods of umbilical cord care:
Clean, dry cord care (AAP/WHO recommended)
Triple dye
Topical 4% chlorhexidine
70% alcohol solution
There is significant evidence to support the use of topical 4% chlorhexidine to
prevent omphalitis in developing countries, although it does delay time to cord
separation.
There is no evidence that application of an antiseptic to the umbilical cord is
better than clean, dry cord care in a hospital setting.
Pathophysiology
Potential bacterial pathogens normally colonize the umbilical stump after birth.
These bacteria invade the umbilical stump, leading to omphalitis.
Established aerobic bacterial infection, necrotic tissue, and poor blood supply
facilitate the growth of anaerobic organisms.
Infection may also extend beyond the subcutaneous tissues to involve fascial
planes (fasciitis), abdominal wall musculature (myonecrosis), and umbilical and
portal veins (phlebitis).