Omphalitis: How to know if the umbilical cord is infected?

La umbilical cord infection, also called granuloma, umbilical fungus or omphalitis is a chronic inflammation of the navel (omphalon), from which purulent, often foul-smelling material comes out.

Recurrent omphalitis is documented primarily in infants and children; however, umbilical inflammation can sometimes affect adults as well.

How can we detect omphalitis?

It is a fairly rare pathological condition in industrialized countries; however, in less developed areas where access to medication is not guaranteed, omphalitis remains a common cause of neonatal mortality.

Omphalitis begins with symptoms very similar to those of infectious cellulitis (redness, limited pain, swelling), so it is not uncommon for the two conditions to be confused.

Causes of umbilical cord infection

The cause of omphalitis is often a bacterial infection, so antibiotic therapy is the treatment of choice.

It is estimated that 70-75% of omphalitis are due to polymicrobial infections. The pathogens most involved in the etiopathogenesis are:

• Staphylococcus aureus (gram+)
• Group A beta-hemolytic streptococcus, such as Streptococcus pyogenes (gram+)
• Escherichia coli (gram-)
• Klebsiella pneumoniae (gram-)
• Proteus mirabilis (Gram-)

Patients with higher risk of omphalitis are newborns (especially premature babies), hospitalized patients undergoing invasive procedures, and the immunocompromised.

Sepsis and pneumonia are also predisposing factors for omphalitis. In the newborn,to fall of umbilical cord causes a small granular wound: this sore is a possible entry point for bacteria (omphalitis).

Symptoms of omphalitis

Recurring symptoms include foul-smelling discharge of pus from the navel, erythema, edema, tenderness, and limited pain. Affected babies often experience fever, hypotension, tachycardia, and jaundice. Among the rare complications we must not forget sepsis, septic embolization and death.

In most cases, omphalitis turns out to be a banal umbilical inflammation, which can be promptly resolved with topical application and/or parenteral administration of specific antibiotics.

The most common symptoms are listed below:

• Purulent and foul-smelling discharge from the navel (always present)
• periumbilical erythema
• Edema
• pressure pain
• Limited pain/burn

Complications (rarely occur)

When not treated properly, the symptomatic picture of omphalitis can be complicated: in this case, the patient may observe ecchymoses, petechiae, blistering skin lesions and orange peel appearance near the navel. The above symptoms are predictors of complications and suggest the involvement of multiple pathogens in the infection.

In some sporadic cases, the clinical picture of the patient can precipitate: the umbilical infection can spread to involve the entire abdominal wall.

Among other complications we also mention the myonecrosis, sepsis, septic embolization and death.

In case of complications due to omphalitis, the concomitance of several symptoms is often observed in the affected patient:

• altered body temperature (fever/hypothermia)
• disorders respiratory (apnea, tachypnea, hypoxemia, etc.)
• disorders gastrointestinal (for example, bloating)
• neurological alterations (irritability, hypo/hypertonia, etc.)
• drowsiness
• cardiovascular disorders (eg, tachycardia, hypotension, etc.)

Diagnostics and therapies

The diagnosis of omphalitis is clinical and consists of medical observation of the umbilical stump (in the newborn). The diagnostic assessment is obtained by blood tests and a biopsy of a sample.

When omphalitis is suspected, a differential diagnosis with congenital umbilical fistulas, also associated with purulent discharge from the navel.

The treatment of choice is antibiotic administration; supportive therapy may be associated to deal with secondary symptoms. They can only be prescribed by doctors.

Penicillins are especially indicated for the treatment of mild omphalitis caused by Staphylococcus aureus, while aminoglycosides are the therapy of choice for gram-negative infections.

For invasive infections, especially by anaerobes, it is recommended to combine multiple antibiotics, including metronidazole.

Antibiotic treatment of omphalitis in the newborn should last approximately de 10 to 15 daysdepending on the nature and severity of the infection.

Prevention of umbilical cord infection

For the prevention of omphalitis in the newborn, it is recommended apply antiseptic substances: antibiotics based on bacitracin or silver sulfadiazine directly on the umbilical stump.