2. 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
3. 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.
4. 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
5. 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
6. 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.
7. 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.
8. 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.
9. 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.
10. 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
12. 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
13. Treatment
Treatment
Medical Care Surgical Care
Antimicrobial Supportive
Steroids ?
Therapy Care
?
14. 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.
15. 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.
16. 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%