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| {{Omphalitis}} | | {{Omphalitis}} |
| {{CMG}}
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| ==Overview==
| | '''For patient information click [[{{PAGENAME}} (patient information)|here]]''' |
| '''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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| ==Microbiology of omphalitis==
| | {{CMG}} |
| 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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| ==Causes==
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| ===Common Causes===
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| *Escherichia coli
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| *Klebsiella
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| *Staphylococcus aureus
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| *Streptococcus agalactiae
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| *Streptococcus pyogenes
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| *Improper cord care
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| ===Causes by Organ System===
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| {|style="width:82%; 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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| |-
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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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| | '''Dental'''
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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"| [[Carbuncle]], [[Folliculitis ]], [[Pilonidal cysts]]
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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"| [[Home births]], [[Improper cord care ]], [[Nonsterile delivery]]
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Gastroenterologic'''
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| |bgcolor="Beige"|
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| [[Meckel’sdiverticulum]], [[Patent urachus ]]
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| |-bgcolor="LightSteelBlue"
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| | '''Genetic'''
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| |bgcolor="Beige"| [[Infected urachal cyst]], [[Meckel’sdiverticulum]], [[Patent urachus ]]
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| |-
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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"| [[Cultural application of cow dung. ]], [[Home births]], [[Improper cord care ]], [[Infection due to navel piercing]], [[Nonsterile delivery]], [[Umbilical catheterization]]
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Infectious Disease'''
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| |bgcolor="Beige"| [[Aeromonas]], [[Anaerobic bacteria]], [[Aspergillus fumigatus]], [[Bacteroides fragilis ]], [[Candida species]], [[Carbuncle]], [[Chorioamnionitis]], [[Clostridium perfringens]], [[Clostridium sordellii]], [[Cultural application of cow dung. ]], [[Enterococcus faecalis]], [[Escherichia coli]], [[Folliculitis ]], [[Group B beta-hemolytic streptococci]], [[Herpes simplex virus]], [[Infected urachal cyst]], [[Infection due to navel piercing]], [[Klebsiella]], [[Mycobacterium abscessus]], [[P. vulgaris]], [[Peptostreptococcus ]], [[Pilonidal cysts]], [[Pityrosporum species]], [[Plesiomonas shigelloides ]], [[Proteus mirabilis]], [[Pseudomonas aeruginosa]], [[Pseudomonas putrefaciens ]], [[Sepsis]], [[Serratia marcescens]], [[Staphylococcus aureus]], [[Staphylococcus epididermis]], [[Streptococcus pyogenes]]
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Musculoskeletal/Orthopedic'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Neurologic'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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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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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Obstetric/Gynecologic'''
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| |bgcolor="Beige"| [[Chorioamnionitis]], [[Low birth weight ]], [[Prematurity]], [[Prolonged labor]], [[Prolonged rupture of membranes ]]
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Oncologic'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Ophthalmologic'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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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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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Psychiatric'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Pulmonary'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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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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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Rheumatology/Immunology/Allergy'''
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| |bgcolor="Beige"| [[Defects in natural killer cell (NK) activity]], [[Leukocyte adhesion deficiency]], [[Neonatal alloimmune neutropenia]]
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Sexual'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Trauma'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Urologic'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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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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| |}
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| ===Causes in Alphabetical Order===
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| *[[Aeromonas]]
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| *[[Anaerobic bacteria]]
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| *[[Aspergillus fumigatus]]
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| *[[Bacteroides fragilis ]]
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| *[[Candida species]]
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| *[[Carbuncle]]
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| *[[Chorioamnionitis]]
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| *[[Clostridium perfringens]]
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| *[[Clostridium sordellii]]
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| *[[Cultural application of cow dung. ]]
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| *[[Defects in natural killer cell (NK) activity]]
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| *[[Enterobacter sp]]
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| *[[Enterococcus faecalis]]
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| *[[Escherichia coli]]
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| *[[Folliculitis ]]
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| *[[Group B beta-hemolytic streptococci]]
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| {{col-break|width=33%}} | |
| *[[Herpes simplex virus]]
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| *[[Home births]]
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| *[[Improper cord care ]]
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| *[[Infected urachal cyst]]
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| *[[Infection due to navel piercing]]
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| *[[Klebsiella]]
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| *[[Leukocyte adhesion deficiency]]
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| *[[Low birth weight ]]
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| *[[Meckel’sdiverticulum]]
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| *[[Mycobacterium abscessus]]
| | ==[[Omphalitis overview|Overview]]== |
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| *[[Neonatal alloimmune neutropenia]]
| | ==[[Omphalitis historical perspective|Historical Perspective]]== |
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| *[[Nonsterile delivery]]
| | ==[[Omphalitis classification|Classification]]== |
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| *[[Proteus vulgaris]]
| | ==[[Omphalitis pathophysiology|Pathophysiology]]== |
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| *[[Patent urachus ]]
| | ==[[Omphalitis causes|Causes]]== |
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| *[[Peptostreptococcus ]]
| | ==[[Omphalitis differential diagnosis|Differentiating Omphalitis from other Diseases]]== |
| {{col-break|width=33%}}
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| *[[Pilonidal cysts]]
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| *[[Pityrosporum species]]
| | ==[[Omphalitis epidemiology and demographics|Epidemiology and Demographics]]== |
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| *[[Plesiomonas shigelloides ]]
| | ==[[Omphalitis risk factors|Risk Factors]]== |
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| *[[Prematurity]]
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| *[[Prolonged labor]]
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| *[[Prolonged rupture of membranes ]]
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| *[[Proteus mirabilis]]
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| *[[Pseudomonas aeruginosa]]
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| *[[Pseudomonas putrefaciens ]]
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| *[[Sepsis]]
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| *[[Serratia marcescens]]
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| *[[Staphylococcus aureus]]
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| *[[Staphylococcus epididermis]]
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| *[[Streptococcus pyogenes]]
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| *[[Umbilical catheterization]]
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| {{col-end}}
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| ==Epidemiology==
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| 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==
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| 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).
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| | ==[[Omphalitis natural history, complications and prognosis|Natural History, Complications and Prognosis]]== |
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| ==Diagnosis== | | ==Diagnosis== |
| 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.
| | [[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== | | ==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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| 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]].
| | ==Case Studies== |
| | | [[Omphalitis case study one|Case#1]] |
| ==Prevention== | | |
| 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.
| | {{WikiDoc Help Menu}} |
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| ==External links==
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| *[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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| {{WH}} | |
| {{WikiDoc Sources}} | | {{WikiDoc Sources}} |