How is omphalitis diagnosed?

Updated: May 20, 2019
  • Author: Patrick G Gallagher, MD; Chief Editor: Santina A Zanelli, MD  more...
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The clinical picture of omphalitis is sufficiently characteristic that diagnosis can be made with fair certainty on clinical grounds. Determining whether associated complications such as necrotizing fasciitis, myonecrosis, sepsis, septic embolization, or intraabdominal complications are present is important; failure to recognize necrotizing fasciitis or myonecrosis may result in delay of appropriate surgical intervention.

In neonates with omphalitis and either delayed separation of the umbilical cord or neutropenia, the presence of a predisposing anatomic abnormality (eg, patent urachus) or an immunologic problem (eg, leukocyte adhesion deficiency or a neutrophil disorder) must be considered.

Persistence of a portion of the embryonic tract between the bladder and the umbilicus results in various urachal anomalies. A patent urachus, a free communication between the bladder and umbilicus, may result in persistent drainage from the umbilicus, which can be mistaken as a sign of infection. Incomplete obliteration of the urachal remnant may lead to the formation of an isolated extraperitoneal cyst, which can present with a secondary bacterial infection mimicking omphalitis. However, these cysts rarely present with secondary infections in the neonatal period.

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