From the Guidelines
Management of omphalitis requires prompt antibiotic therapy and supportive care, with a focus on reducing morbidity, mortality, and improving quality of life. The initial treatment involves broad-spectrum intravenous antibiotics such as ampicillin (50-100 mg/kg/day divided every 6 hours) plus gentamicin (4-7.5 mg/kg/day divided every 8-24 hours depending on gestational age) or a third-generation cephalosporin like cefotaxime (50 mg/kg/dose every 8-12 hours) 1. Antibiotic therapy typically continues for 7-10 days, with adjustments based on culture results and clinical response. Local umbilical care includes keeping the area clean and dry, applying topical antiseptics like chlorhexidine or povidone-iodine, and avoiding occlusive dressings. Severe cases may require surgical debridement of necrotic tissue or drainage of any abscess. Supportive measures include maintaining hydration, monitoring vital signs, and ensuring adequate nutrition. Close observation for signs of sepsis is essential, as omphalitis can rapidly progress to systemic infection, with case-fatality rates as high as 13% reported in some settings 1. The application of 4% chlorhexidine solution or gel to the umbilical cord stump within 24 hours after birth has been shown to significantly reduce the risk of omphalitis and neonatal mortality in community settings with high neonatal mortality rates 1. Key considerations in the management of omphalitis include:
- Prompt recognition and treatment of the infection to prevent progression to sepsis or other complications
- Use of broad-spectrum antibiotics to cover common pathogens such as Staphylococcus aureus, Streptococcus species, and gram-negative organisms
- Local umbilical care to promote healing and prevent further infection
- Supportive measures to maintain hydration, nutrition, and overall health
- Close monitoring for signs of sepsis or other complications, with aggressive treatment as needed. The aggressive approach is necessary because omphalitis results from bacterial invasion of the umbilical stump, which can quickly spread to cause peritonitis or sepsis if not properly treated 1.
From the Research
Management of Omphalitis
The management of omphalitis involves a combination of antibiotic administration and, in some cases, surgical intervention.
- Antibiotic administration is the primary treatment for omphalitis, with the goal of preventing the spread of infection and promoting healing 2.
- Surgical intervention may be necessary in cases where complications such as evisceration, necrotizing fasciitis, or peritonitis occur 3, 4.
- The choice of antibiotic should be guided by the results of culture and susceptibility tests, as there is a high rate of resistance to commonly used antibiotics 5.
- In some cases, oral antibiotics may be sufficient for treatment, while in other cases, intravenous antibiotics may be necessary 2.
Prevention of Omphalitis
Prevention of omphalitis is also an important aspect of management.
- The use of antiseptics, such as triple dye, has been shown to be effective in preventing omphalitis 6.
- Proper umbilical cord care, including keeping the cord clean and dry, can also help to prevent infection.
- Early recognition and treatment of omphalitis can help to prevent serious complications and improve outcomes 3, 4.
Complications of Omphalitis
Omphalitis can lead to serious complications, including: