What is omphalitis?

Updated: May 20, 2019
  • Author: Patrick G Gallagher, MD; Chief Editor: Santina A Zanelli, MD  more...
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Omphalitis is an infection of the umbilical stump. [1] It typically presents as a superficial cellulitis that can spread to involve the entire abdominal wall and may progress to necrotizing fasciitis, myonecrosis, or systemic disease. Omphalitis is uncommon in industrialized countries outside the setting of umbilical vessel catherization; however, it remains a common cause of neonatal mortality in less developed areas. It is predominantly a disease of the neonate, with only a few cases having been reported in adults. Risk factors for omphalitis included septic delivery, unplanned home delivery, maternal chorioamnionitis, prolonged rupture of membranes, low birth weight, and umbilical vessel catheterization.

Aerobic bacteria are present in approximately 85% of infections, predominated by Staphylococcus aureus, group A Streptococcus, Escherichia coli, Klebsiella pneumoniae, and Proteus mirabilis. [2, 3, 4, 5]  Methicillin-resistant S aureus has also been described in association with omphalitis. [6] In the past, studies emphasized the importance of gram-positive organisms (eg, S aureus and group A Streptococcus) in the etiology of omphalitis. This was followed by a series of reports that highlighted the role of gram-negative organisms in the etiology of omphalitis. These studies suggested that the change in etiology may have been caused by the introduction of prophylactic umbilical cord care using antistaphylococcal agents, such as hexachlorophene and triple dye (a widely adopted practice in the 1960s), with a subsequent increase in gram-negative colonization of the umbilical stump.

More recent reports implicate both gram-positive and gram-negative bacteria in the etiology of omphalitis. In some cases, anaerobic bacteria have been found. [7] Many cases are polymicrobial in origin. In some settings, application of herbal and other poultices, human milk, animal dung, ash, etc, may lead to contamination with pathogenic bacteria, including Clostridium tetani.

In addition to monitoring trends in incidence, monitoring the microbial etiology of omphalitis is important, as there have been trends toward returning to dry cord care in most settings, with application of topical antiseptic agents reserved for infants delivered in nonhygenic environments and in locales where neonatal mortality is high. This trend has been widely accepted, including by the World Health Organization (WHO) and the American Academy of Pediatrics (AAP). [8, 9]

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