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Revision as of 19:40, 12 July 2013

{{CMG))

Overview

Omphalitis is the medical term for infection of the umbilical cord stump in the 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.

Microbiology of omphalitis

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 bacteria can also be involved.

Causes

Common Causes

Escherichia coli
Klebsiella
Staphylococcus aureus
Streptococcus agalactiae
Streptococcus pyogenes
Improper cord care

Causes by Organ System

Cardiovascular	No underlying causes
Chemical/Poisoning	No underlying causes
Dental	No underlying causes
Dermatologic	Carbuncle, Folliculitis , Pilonidal cysts
Drug Side Effect	No underlying causes
Ear Nose Throat	No underlying causes
Endocrine	No underlying causes
Environmental	Home births, Improper cord care , Nonsterile delivery
Gastroenterologic	Meckel’sdiverticulum, Patent urachus
Genetic	Infected urachal cyst, Meckel’sdiverticulum, Patent urachus
Hematologic	No underlying causes
Iatrogenic	Cultural application of cow dung. , Home births, Improper cord care , Infection due to navel piercing, Nonsterile delivery, Umbilical catheterization
Infectious Disease	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
Musculoskeletal/Orthopedic	No underlying causes
Neurologic	No underlying causes
Nutritional/Metabolic	No underlying causes
Obstetric/Gynecologic	Chorioamnionitis, Low birth weight , Prematurity, Prolonged labor, Prolonged rupture of membranes
Oncologic	No underlying causes
Ophthalmologic	No underlying causes
Overdose/Toxicity	No underlying causes
Psychiatric	No underlying causes
Pulmonary	No underlying causes
Renal/Electrolyte	No underlying causes
Rheumatology/Immunology/Allergy	Defects in natural killer cell (NK) activity, Leukocyte adhesion deficiency, Neonatal alloimmune neutropenia
Sexual	No underlying causes
Trauma	No underlying causes
Urologic	No underlying causes
Miscellaneous	No underlying causes

Causes in Alphabetical Order

Aeromonas

Anaerobic bacteria

Aspergillus fumigatus

Bacteroides fragilis

Candida species

Carbuncle

Chorioamnionitis

Clostridium perfringens

Clostridium sordellii

Cultural application of cow dung.

Defects in natural killer cell (NK) activity

Enterobacter sp

Enterococcus faecalis

Escherichia coli

Folliculitis

Group B beta-hemolytic streptococci

Herpes simplex virus

Home births

Improper cord care

Infected urachal cyst

Infection due to navel piercing

Klebsiella

Leukocyte adhesion deficiency

Low birth weight

Meckel’sdiverticulum

Mycobacterium abscessus

Neonatal alloimmune neutropenia

Nonsterile delivery

Proteus vulgaris

Patent urachus

Peptostreptococcus

Pilonidal cysts

Pityrosporum species

Plesiomonas shigelloides

Prematurity

Prolonged labor

Prolonged rupture of membranes

Proteus mirabilis

Pseudomonas aeruginosa

Pseudomonas putrefaciens

Sepsis

Serratia marcescens

Staphylococcus aureus

Staphylococcus epididermis

Streptococcus pyogenes

Umbilical catheterization

Epidemiology

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.

Clinical manifestations

Like many bacterial infections, 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 premature, sick with other infections such as blood infection (sepsis) or pneumonia, or who have 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 catheters.

Clinically, neonates 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).

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 caustic agents have been used to clean the stump or if silver nitrate has been used to cauterize granulomata of the umbilical stump.

Treatment

Treatment consists of antibiotic therapy aimed at the typical bacterial pathogens 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.

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.

External links

Emedicine

Template:WH Template:WikiDoc Sources

@@ Line 1: / Line 1: @@
+__NOTOC__
 {{SI}}
+{{CMG))
+==Overview==
 '''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.
-==Epidemiology==
-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.
-==Clinical manifestations==
-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.
-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).
 ==Microbiology of omphalitis==
 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.
-==Diagnosis==
+==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.
+===Common Causes===
+*Escherichia coli
+*Klebsiella
+*Staphylococcus aureus
+*Streptococcus agalactiae
+*Streptococcus pyogenes
+*Improper cord care
-==Differential Diagnosis of Omphalitis==
+===Causes by Organ System===
-{|style="width:90%; height:100px" border="1"
+{|style="width:82%; height:100px" border="1"
 |style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" | '''Cardiovascular'''
 |style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | No underlying causes
 |-
 |-bgcolor="LightSteelBlue"
-| '''Chemical / poisoning'''
+| '''Chemical/Poisoning'''
+|bgcolor="Beige"| No underlying causes
+|-
+|-bgcolor="LightSteelBlue"
+| '''Dental'''
 |bgcolor="Beige"| No underlying causes
 |-
 |-bgcolor="LightSteelBlue"
 | '''Dermatologic'''
-|bgcolor="Beige"| No underlying causes
+|bgcolor="Beige"| [[Carbuncle]],  [[Folliculitis ]],  [[Pilonidal cysts]]
 |-
 |-bgcolor="LightSteelBlue"
@@ Line 45: / Line 50: @@
 |-bgcolor="LightSteelBlue"
 | '''Environmental'''
-|bgcolor="Beige"| No underlying causes
+|bgcolor="Beige"| [[Home births]],  [[Improper cord care ]],  [[Nonsterile delivery]]
 |-
 |-bgcolor="LightSteelBlue"
 | '''Gastroenterologic'''
-|bgcolor="Beige"| No underlying causes
+|bgcolor="Beige"|
-|-
+[[Meckel’sdiverticulum]],  [[Patent urachus ]]
 |-bgcolor="LightSteelBlue"
 | '''Genetic'''
-|bgcolor="Beige"| No underlying causes
+|bgcolor="Beige"| [[Infected urachal cyst]],  [[Meckel’sdiverticulum]],  [[Patent urachus ]]
 |-
 |-bgcolor="LightSteelBlue"
@@ Line 61: / Line 66: @@
 |-bgcolor="LightSteelBlue"
 | '''Iatrogenic'''
-|bgcolor="Beige"| No underlying causes
+|bgcolor="Beige"| [[Cultural application of cow dung. ]],  [[Home births]],  [[Improper cord care ]],  [[Infection due to navel piercing]],  [[Nonsterile delivery]],  [[Umbilical catheterization]]
 |-
 |-bgcolor="LightSteelBlue"
 | '''Infectious Disease'''
-|bgcolor="Beige"| No underlying causes
+|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]]
 |-
 |-bgcolor="LightSteelBlue"
-| '''Musculoskeletal / Ortho'''
+| '''Musculoskeletal/Orthopedic'''
 |bgcolor="Beige"| No underlying causes
 |-
@@ Line 76: / Line 81: @@
 |-
 |-bgcolor="LightSteelBlue"
-| '''Nutritional / Metabolic'''
+| '''Nutritional/Metabolic'''
 |bgcolor="Beige"| No underlying causes
+|-
+|-bgcolor="LightSteelBlue"
+| '''Obstetric/Gynecologic'''
+|bgcolor="Beige"| [[Chorioamnionitis]],  [[Low birth weight ]],  [[Prematurity]],  [[Prolonged labor]],  [[Prolonged rupture of membranes  ]]
 |-
 |-bgcolor="LightSteelBlue"
@@ Line 84: / Line 93: @@
 |-
 |-bgcolor="LightSteelBlue"
-| '''Opthalmologic'''
+| '''Ophthalmologic'''
 |bgcolor="Beige"| No underlying causes
 |-
 |-bgcolor="LightSteelBlue"
-| '''Overdose / Toxicity'''
+| '''Overdose/Toxicity'''
 |bgcolor="Beige"| No underlying causes
 |-
@@ Line 100: / Line 109: @@
 |-
 |-bgcolor="LightSteelBlue"
-| '''Renal / Electrolyte'''
+| '''Renal/Electrolyte'''
 |bgcolor="Beige"| No underlying causes
 |-
 |-bgcolor="LightSteelBlue"
-| '''Rheum / Immune / Allergy'''
+| '''Rheumatology/Immunology/Allergy'''
+|bgcolor="Beige"| [[Defects in natural killer cell (NK) activity]],  [[Leukocyte adhesion deficiency]],  [[Neonatal alloimmune neutropenia]]
+|-
+|-bgcolor="LightSteelBlue"
+| '''Sexual'''
 |bgcolor="Beige"| No underlying causes
 |-
 |-bgcolor="LightSteelBlue"
 | '''Trauma'''
+|bgcolor="Beige"| No underlying causes
+|-
+|-bgcolor="LightSteelBlue"
+| '''Urologic'''
 |bgcolor="Beige"| No underlying causes
 |-
@@ Line 116: / Line 133: @@
 |-
 |}
+===Causes in Alphabetical Order===
+{{col-begin|width=85%}}
+{{col-break|width=33%}}
+*[[Aeromonas]]
+*[[Anaerobic bacteria]]
+*[[Aspergillus fumigatus]]
+*[[Bacteroides fragilis ]]
+*[[Candida species]]
+*[[Carbuncle]]
+*[[Chorioamnionitis]]
+*[[Clostridium perfringens]]
+*[[Clostridium sordellii]]
+*[[Cultural application of cow dung. ]]
+*[[Defects in natural killer cell (NK)  activity]]
+*[[Enterobacter sp]]
+*[[Enterococcus faecalis]]
+*[[Escherichia coli]]
+*[[Folliculitis ]]
+*[[Group B beta-hemolytic streptococci]]
+{{col-break|width=33%}}
+*[[Herpes simplex  virus]]
+*[[Home births]]
+*[[Improper cord care ]]
+*[[Infected urachal cyst]]
+*[[Infection due to navel piercing]]
+*[[Klebsiella]]
+*[[Leukocyte adhesion deficiency]]
+*[[Low birth weight ]]
+*[[Meckel’sdiverticulum]]
+*[[Mycobacterium abscessus]]
+*[[Neonatal alloimmune neutropenia]]
+*[[Nonsterile delivery]]
+*[[Proteus vulgaris]]
+*[[Patent urachus ]]
+*[[Peptostreptococcus ]]
+{{col-break|width=33%}}
+*[[Pilonidal  cysts]]
+*[[Pityrosporum species]]
+*[[Plesiomonas shigelloides ]]
+*[[Prematurity]]
+*[[Prolonged labor]]
+*[[Prolonged rupture of membranes  ]]
+*[[Proteus mirabilis]]
+*[[Pseudomonas aeruginosa]]
+*[[Pseudomonas putrefaciens ]]
+*[[Sepsis]]
+*[[Serratia marcescens]]
+*[[Staphylococcus aureus]]
+*[[Staphylococcus epididermis]]
+*[[Streptococcus pyogenes]]
+*[[Umbilical catheterization]]
+{{col-end}}
+==Epidemiology==
+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.
+==Clinical manifestations==
+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.
+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).
+==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.
 ==Treatment==