Neonatal Omphalitis

Omphalitis is bacterial infection of the umbilical stump and surrounding tissues.

It can spread rapidly through umbilical vessels and fascial planes, causing sepsis, portal vein thrombosis or necrotising fasciitis.

Common organisms include Staphylococcus aureus, streptococci and Gram negative enteric bacteria.

• Periumbilical erythema
• Warmth
• Induration
• Tenderness
• Purulent or foul smelling discharge

Systemic disease may cause:

• Poor feeding
• Lethargy
• Temperature instability
• Apnoea
• Shock

Rapidly extending erythema, skin discoloration, crepitus or severe systemic toxicity suggests necrotising soft tissue infection.

Diagnosis is clinical.

Obtain:

• Blood culture
• Culture of purulent discharge
• FBC and inflammatory markers in significant disease

Admit significant infection.

Give IV antibiotics covering Staphylococcus aureus, streptococci and Gram negative organisms.

A practical regimen is:

Flucloxacillin plus gentamicin, adjusted for neonatal age and weight. This combination is specifically used where neonatal sepsis is associated with omphalitis or extensive staphylococcal skin disease.

Necrotising fasciitis requires immediate surgical assessment and aggressive broad spectrum antimicrobial therapy.