From the Guidelines
If there is purulence (pus) at the umbilical stump, this indicates an infection called omphalitis which requires prompt medical attention, and the most recent and highest quality study recommends against using topical antibiotic ointment or creams on umbilical catheter insertion sites because of the potential to promote fungal infections and antimicrobial resistance 1. When managing umbilical care with purulence, it is essential to prioritize the prevention of further infection and promote healing.
- Clean the area with warm water and mild soap three times daily.
- Avoid using alcohol or hydrogen peroxide as these can delay healing.
- The infant should be evaluated by a healthcare provider immediately as oral antibiotics are typically necessary. Some key points to consider in the management of omphalitis include:
- Common regimens for oral antibiotics include amoxicillin-clavulanate (20-40 mg/kg/day divided every 8 hours) or cephalexin (25-50 mg/kg/day divided every 6-8 hours) for 7-10 days 1.
- In severe cases with spreading redness, fever, or irritability, hospitalization for intravenous antibiotics may be required.
- Until the infection resolves, keep the area dry, avoid immersing in water, and use sponge baths instead of tub baths.
- Fold diapers below the stump to prevent irritation and promote air circulation. It is crucial to note that omphalitis is serious because the umbilical vessels provide a direct route to the bloodstream, potentially leading to systemic infection, and the application of 4% chlorhexidine solution or gel to the umbilical cord stump within 24 hours after birth can result in a significant reduction in both omphalitis and neonatal mortality, especially in settings with high neonatal mortality rates 1.
From the Research
Umbilical Care with Purulence
- Umbilical cord care is crucial in preventing infections and promoting healing in newborns 2, 3, 4.
- The application of antimicrobials to the umbilical cord can reduce the risk of omphalitis and neonatal mortality, especially in developing countries 2, 4.
- Chlorhexidine is an effective antiseptic for umbilical cord care, reducing the risk of omphalitis by 27-56% and neonatal mortality by 23% 2.
- However, the use of antiseptics may increase cord separation time, with chlorhexidine increasing it by 1.7 days compared to dry cord care 2.
- In hospital settings, there is insufficient evidence to support the use of antiseptics for umbilical cord care, with dry cord care being a suitable alternative 2, 3.
- A study comparing topical human milk, povidone-iodine, and dry care found no significant differences in the incidence of omphalitis, but babies in the dry care or topical human milk group had shorter cord separation times 5.
Prevention of Infections
- Keeping the umbilical cord clean and dry is essential in preventing infections, especially in developed countries 3, 4.
- The use of antiseptics may not be necessary in developed countries, but it can be life-saving in developing countries 4.
- Vaccination of pregnant women against tetanus and the use of disinfectants can reduce the risk of serious bacterial infections in babies in poor countries 4.
Umbilical Cord Care Practices
- A survey of Slovenian pediatric centers found that umbilical cord care practices follow general international recommendations, with a correlation between the clinical condition of the umbilicus and the frequency of care and antiseptic usage 3.
- The study recommended adjustments to umbilical cord care depending on the clinical condition of the umbilicus to prevent complications 3.