From the Guidelines
Omphalitis is a medical emergency that requires prompt treatment with broad-spectrum antibiotics, and prevention strategies include proper umbilical cord care with chlorhexidine, particularly in low-resource settings where the incidence of omphalitis is higher 1. The diagnosis of omphalitis can be made based on clinical presentation, which may include signs of infection such as purulent discharge, erythema, and tenderness around the umbilical cord stump. The severity of omphalitis can be classified into four grades, ranging from funisitis to necrotizing fasciitis 1.
Treatment
Treatment of omphalitis typically involves the use of broad-spectrum antibiotics, such as a combination of ampicillin and gentamicin, administered intravenously for 7-10 days 1. Severe cases may require surgical debridement of necrotic tissue. Local care includes keeping the area clean and dry, applying topical antiseptics like chlorhexidine 0.5% solution, and avoiding alcohol-based products.
Prevention
Prevention strategies for omphalitis include proper umbilical cord care with chlorhexidine, particularly in low-resource settings where the incidence of omphalitis is higher 1. Handwashing before handling the newborn and avoiding home births in unsanitary conditions are also important preventive measures.
Risk Factors
Risk factors for omphalitis include unhygienic delivery conditions, prolonged labor, premature rupture of membranes, and low birth weight. In low-income communities, omphalitis occurs in up to 8% of infants born in hospitals and in as many as 22% of infants born at home, with moderate to severe cases in 17% and associated with sepsis in 2% 1.
Mortality
Omphalitis is a medical emergency with mortality rates of up to 13% if untreated, as the infection can rapidly progress to sepsis, necrotizing fasciitis, or peritonitis due to the direct vascular connection between the umbilical vessels and the newborn's circulation 1. Some key points to consider in the management of omphalitis include:
- Prompt treatment with broad-spectrum antibiotics
- Proper umbilical cord care with chlorhexidine
- Handwashing before handling the newborn
- Avoiding home births in unsanitary conditions
- Monitoring for signs of infection and sepsis
- Surgical debridement of necrotic tissue in severe cases It is essential to prioritize the prevention and treatment of omphalitis, particularly in low-resource settings, to reduce the risk of morbidity and mortality associated with this condition 1.
From the Research
Diagnosis of Omphalitis
- Omphalitis is diagnosed based on clinical presentation, which includes erythema and induration around the umbilical stump, and purulent drainage may be present 2
- Fever and signs of systemic illness may occur, or there may only be signs of localized soft tissue infection 2
- Underlying urachal abnormalities should be considered in the infant with umbilical drainage 2
- Diagnosis can be confirmed by taking cultures and starting antibiotic treatment is necessary 3
Treatment of Omphalitis
- Treatment of omphalitis consists primarily of antibiotic administration, with surgical intervention rarely needed 2
- Antibiotics are typically administered intravenously, but there may be a role for oral antibiotics in some lower risk infants with omphalitis 2
- Topical antiseptics, such as triple dye, can be effective in preventing omphalitis, but may delay cord separation 4
- In resource-constrained environments, omphalitis can be managed in the community with minimal need for hospital referral, using topical gentian violet or oral cephalexin as monotherapy or combination therapy 5
- Debridement and supportive care may also be necessary in some cases 6
Prevention of Omphalitis
- Antiseptics, such as triple dye, can be effective in preventing omphalitis 4
- Maintaining cleanliness and hygiene around the umbilical stump can help prevent omphalitis 6
- Avoiding umbilical vein catheterisation (UVC) or ensuring proper cleanliness measures are taken during UVC can help prevent omphalitis 6