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omphalitis
Etiology:
- risk factors
- premature infants
- infection (sepsis, pneumonia, chorioamnionitis))
- immunodeficiency
- prolonged birth labor
- umbilical catheter
- orgasnisms
- Staphylococcus aureus
- Streptococcus
- Escherichia coli
- Klebsiella pneumoniae
- Proteus mirabilis
- infection is typically caused by a mix of these organisms & a mix of Gram-positive & Gram-negative organisms
- anaerobic bacteria can be involved
Pathology:
- infection of the umbilical cord stump in the neonatal
Clinical manifestations:
- poor feeding or feeding intolerance
- urine or stool discharge from the umbilicus suggests an underlying anatomic abnormality
Laboratory:
- Gram stain & culture for aerobic & anaerobic organisms
- blood cultures for aerobic & anaerobic organisms
- complete blood count (CBC) with differential
- neutrophilia or neutropenia may be present
- thrombocytopenia may be present
- if sepsis or DIC suspected
- peripheral blood smear
- prothrombin time (INR)
- activated partial thromboplastin time
- fibrinogen in plasma
- D-dimer in plasma
- chemistry panel may indicate
- serum glucose: hypoglycemia
- serum calcium: hypocalcemia
- carbonate in serum: metabolic acidosis
Radiology:
- abdominal radiography may reveal intra-abdominal wall gas
- abdominal ultrasound
- may reveal fascial thickening & fluid accumulation between subcutaneous fat and muscle
- may detect anatomic abnormality
- abdominal CT (see ultrasound above)
Management:
- intravenous antibiotics
- Gram-positive & Gram-negative coverage
- antistaphylococcal penicillin & an aminoglycoside [2]
- add metronidazole for anaerobes
- clindamycin may be substituted for antistaphylococcal penicillin for Staphylococcus & anaerobe coverage
- supportive care
- ventilatory assistance & supplemental oxygen for hypoxemia or apnea unresponsive to stimulation
- fluids, vasoactive agents, or both (as indicated) for hypotension
- blood products: platelets, fresh frozen plasma, or cryoprecipitate for disseminated intravascular coagulation (DIC) & clinical bleeding
- treat infants at centers capable of supporting cardiopulmonary function
- prognosis
- monitor patients for progression of disease
- early surgical intervention may be lifesaving
- in uncomplicated cases, erythema of the umbilical stump improves within 12-24 hours after initiation of antimicrobial therapy
General
skin infection
References
- Wikipedia: Omphalitis
http://en.wikipedia.org/wiki/Omphalitis
- Gallagher PG and Rosenkrantz T
Medscape (eMedicine): Omphalitis
http://emedicine.medscape.com/article/975422-overview