Omphalitis

Omphalitis is an infection of the umbilical stump and the surrounding umbilical tissues. It most commonly affects newborns, usually within the first two weeks after birth, and can progress rapidly if not treated.

Typical signs include redness and swelling around the umbilicus, warmth, purulent or foul-smelling discharge, and fever. Infants may be irritable, feed poorly, or appear lethargic. In more severe cases, the redness may extend beyond the stump and systemic signs of illness or sepsis can develop.

Causes are typically bacterial, arising from skin flora and intestinal organisms. Common pathogens include Staphylococcus aureus, Group B Streptococcus, Escherichia coli, and Klebsiella, often in polymicrobial infection, especially in settings with limited hygiene.

Risk factors include nonsterile cord care, delayed separation of the umbilical cord, low birth weight or prematurity, poor hygiene, and warm or humid environments. Good cord care reduces risk, but even with good practices, omphalitis can occur.

Diagnosis is usually clinical, based on examination. In febrile or ill neonates, a sepsis workup may be performed, including blood tests (white blood cell count, CRP) and cultures. Imaging is reserved for suspected abscess or deeper infection.

Treatment requires prompt medical care. Neonates typically need hospitalization and intravenous antibiotics that cover common Gram-positive and Gram-negative organisms; older or milder cases may be treated with oral antibiotics. Abscesses or poor response to medical therapy may require drainage and wound care, along with stump hygiene and wound assessment.

Prevention focuses on clean, dry cord care after birth, avoiding ointments or substances on the stump, and good hand hygiene. Early recognition and treatment generally lead to favorable outcomes.