Omphalitis is an infection around the umbilical stump that first manifests as redness and erythema and can progress to life threatening sepsis. The devitalized stump provides a fertile medium for bacterial growth. Common infective agents include Staph. aureus, Streptococcus spp. and E. coli spp. Infection is linked to handling and poor hygiene and a rash of cases in the 1950s lead to regular local anti-bacterial treatment of the stump.
Risk factors for omphalitis:
- Maternal – prolonged rupture of the membranes, maternal infection, amnionitis
- Delivery – non-sterile birth, inappropriate cord care
- Neonatal – low birth weight, delayed cord separation, leukocyte adhesion deficiency, neonatal alloimmune neutropaenia
In developed countries the incidence of infection is low, in the region of 0.7%, and so “dry cord care” is recommended. Allowing the stump to air dry speeds up the separation process. In low income countries the incidence is much higher, up to 6%, and so this standard does not apply. One study, in Nepal, found that the use of 4% aqueous chlorhexidine decreased incidence of omphalitis by 75% and mortality by 24% when compared to the Westernized ideal of “dry cord care”. Better hygiene also decreases the incidence of neonatal tetanus. When an education initiative stopped the Kenyan Maasai from routinely smearing the umbilical stump with cattle dung the death rate from tetanus dropped from 82 per 1000 to 0.75 per 1000 infants.
Whilst mild cases may respond to good hygiene it can progress to necrotizing fasciitis of the abdominal wall if left unchecked. Because of this most cases require admission, close monitoring and treatment with parenteral antibiotics.