Treatment for Infected Umbilicus in Newborn (Omphalitis)
The initial treatment for a newborn with an infected umbilicus (omphalitis) should include a full diagnostic evaluation and immediate empiric antibiotic therapy with intravenous ampicillin plus an aminoglycoside (such as gentamicin) to cover common causative organisms including Staphylococcus aureus, Group A and B streptococci, and gram-negative bacilli. 1, 2, 3
Clinical Assessment and Diagnosis
Omphalitis presents with varying degrees of severity:
- Grade 1: Funisitis/umbilical discharge (unhealthy cord with purulent, malodorous discharge)
- Grade 2: Omphalitis with abdominal wall cellulitis (periumbilical erythema and tenderness)
- Grade 3: Omphalitis with systemic signs of infection
- Grade 4: Omphalitis with necrotizing fasciitis (umbilical necrosis with periumbilical ecchymosis) 1
Diagnostic Workup
Before initiating antibiotics, obtain:
- Blood culture
- Complete blood count (CBC) with white blood cell differential and platelet count
- Chest radiograph if respiratory symptoms are present
- Lumbar puncture if the infant is stable enough and sepsis is suspected 1
- Culture of purulent umbilical discharge 4
Antibiotic Therapy
First-line Treatment:
- Ampicillin (initial dose: 100 mg/kg/day divided q12h) PLUS
- Gentamicin (initial dose: 4-5 mg/kg/day) 5, 3
This combination provides coverage against the most common pathogens:
- Staphylococcus aureus (most frequent cause)
- Group A and B streptococci
- Gram-negative bacilli (E. coli, Klebsiella, Pseudomonas) 2, 4
Alternative Regimens:
- For penicillin-allergic patients: Vancomycin plus ceftazidime
- In areas with high MRSA prevalence: Consider vancomycin instead of ampicillin 6
Duration of Therapy
- Uncomplicated omphalitis: 10-14 days of antibiotics 3, 6
- Omphalitis with systemic involvement or complications: May require longer treatment (14-21 days) 3
- Reassess after obtaining culture results to narrow antibiotic spectrum if a specific organism is identified 6
Local Wound Care
- Keep the umbilical area clean and dry
- In high-resource settings with low neonatal mortality, dry cord care is appropriate
- In settings with high neonatal mortality, application of 4% chlorhexidine solution or gel to the umbilical cord stump may be beneficial 1
Monitoring and Follow-up
- Monitor vital signs and clinical status closely
- Evaluate response to antibiotics within 24-48 hours
- Watch for complications including intra-abdominal abscesses, peritonitis, portal vein thrombophlebitis, and necrotizing fasciitis 2, 7
Complications and Surgical Considerations
Surgical consultation is indicated for:
- Necrotizing fasciitis
- Intra-abdominal abscess
- Peritonitis
- Intestinal complications 7
Important Considerations
- Mortality rates can reach 13% with higher rates when necrotizing fasciitis develops 2
- Prompt recognition and treatment are crucial for survival 8
- In areas with high MRSA prevalence, empiric coverage should include MRSA-active agents 4
- Therapeutic drug monitoring for aminoglycosides may be necessary to minimize nephrotoxicity, particularly in premature or low birth weight infants 3
Remember that omphalitis is a potentially life-threatening emergency, and any delay in treatment may increase morbidity and mortality. Early recognition and aggressive management are essential for optimal outcomes.