Omphalitis

What is Omphalitis?

Omphalitis is an infection that affects the belly button (or umbilicus) and the surrounding areas. It mostly happens in newborn babies and generally affects the region around the belly button. However, if not handled carefully, it can quickly evolve into a full-body infection and can be fatal, with a death rate of about 7-15%. It’s vital to identify and treat this infection early to prevent severe health problems and possible death associated with Omphalitis.

What Causes Omphalitis?

Right after a baby is born, their belly button (umbilicus) becomes home to various types of bacteria. Certain types of bacteria, called Gram-positive cocci, appear within a few hours, and are soon joined by many others. The tissue of the umbilical stump, which is not needed any longer, encourages these bacteria to grow rapidly. On top of that, the clotted blood vessels can let bacteria enter the bloodstream. This situation can possibly lead to an infection throughout the baby’s body.

Risk Factors and Frequency for Omphalitis

Omphalitis, an unusual condition after newborn age, mainly starts showing symptoms around three days on average. This issue is rather rare in developed countries, with an occurrence rate of around 0.7%. But, the story is different in developing countries where the rate of omphalitis in newborns delivered in hospitals can rise to 8%, and if born at home, up to a shocking 22%. This condition can be influenced by several factors.

• Some of these include low birth weight, a long period of broken water (ruptured membranes) before delivery, infection in the mother, using a catheter in the belly button (umbilical catheterization), and unclean conditions during childbirth.
• Other risks involve lengthy labor, home birth, poor care for the umbilical cord, and interestingly, the traditional practice of applying cow dung, noted in some developing nations.
• Certain problems with the immune system, such as faulty white blood cell (leukocyte) adhesion, weak white blood cell (neutrophil) mobility, low natural killer cell function, and interferon production can increase the risk of omphalitis.

If a child has a history of delayed separation of the umbilical cord stump, omphalitis after birth, and continual infections in infancy, there may be concerns about leukocyte adhesion disorder (LAD) and further examination is needed. Besides omphalitis, these children may often have repeated occurrences of pneumonia, soft tissue infections, and gum disease (gingivitis).

Signs and Symptoms of Omphalitis

Omphalitis is an infection predominantly seen in newborn babies, usually recognized by tenderness, redness, and hardness of the belly button and the nearby areas. At first, the condition could appear as a minor skin infection; however, if it’s not treated promptly, it can spread to cover the entire belly. Symptoms might include discharge or bleeding from the belly button, especially if the discharge smells bad, this could imply a serious infection. Other symptoms like feeling lethargic, not eating well, irritability, and fever might indicate severe infection, leading to a worse outcome. Rapidly spreading redness of the belly or bubbles in the tissues around the belly are signs of a potentially life-threatening condition called necrotizing fasciitis, which requires immediate surgical attention.

• Tenderness around the belly button
• Redness and hardness of the belly button and nearby areas
• Discharge or bleeding from the belly button
• Foul-smelling discharge (can indicate a severe infection)
• Lethargy
• Poor feeding
• Irritability
• Fever
• Rapidly spreading redness of the belly
• Bubbles in the tissues around the belly (requires immediate medical attention)

Testing for Omphalitis

If your doctor suspects your baby has omphalitis, an infection of the umbilical cord stump, they will need to run a few tests. This usually involves taking a complete blood count and sending away a sample of any pus from the stump. These tests are done before giving your baby any antibiotics, to be sure they are treating the right kind of bacteria. If your baby is also showing signs of infection throughout their body, like fever or weakness, they will need additional tests. This might include a chest X-ray, a urine test, and checking the fluid around their brain and spinal cord.

Omphalitis is often seen in babies with a condition called Leukocyte Adhesion Deficiency (LAD). Babies with LAD have a higher than normal number of white blood cells, but these cells aren’t able to stick to the blood vessel walls correctly. Because of this, it’s really important for a baby with a suspected case of omphalitis to be checked for LAD. This can be done through tests that look for the presence of molecules like LFA-1/Mac-1, p150, and p95 on white blood cells. These molecules are typically missing in children with LAD. So, if your baby had omphalitis as a newborn and gets infections frequently, they might need to be tested for this condition.

Treatment Options for Omphalitis

Omphalitis, an infection in the belly button area, needs to be treated with strong antibiotics, often given through a drip in your vein. These antibiotics need to work against a range of bacteria, both the ‘gram-positive’ and ‘gram-negative’ types. It’s typical to start treatment with a type of antibiotic that fights against a bacteria called staphylococcus, plus another antibiotic called an aminoglycoside. Staphylococcus can sometimes be hard to treat with common antibiotics, if that’s the case, another antibiotic called vancomycin may be needed.

If your doctor suspects that the infection came from a condition during your birth known as chorioamnionitis, or if there’s a bad smell coming from the infected area, they may prescribe clindamycin or metronidazole. These are antibiotics that treat a type of bacteria, known as anaerobes, that thrive in environments without oxygen.

The length of time you need to take these potent antibiotics will be based on how well you respond to the treatment and if any other health issues come up during your hospital stay. For cases of omphalitis that aren’t too severe, the usual treatment involves a 10-day course of antibiotics given through a drip, followed by a course of antibiotics taken by mouth that is chosen based on which specific bacteria are causing your infection.

What else can Omphalitis be?

Omphalitis, or inflammation of the navel (belly button), is usually diagnosed through a clinical examination. However, other conditions can sometimes be confused with omphalitis. These include:

• A patent urachus, a condition where there’s a direct link between the bladder and belly button leading to an infection-like continuous drainage from the umbilicus.
• Umbilical granulomas, which are often mistaken for an infection as they can cause drainage or bleeding when they become frail, usually seen after the first week of life. These can be spotted due to their soft, pink and velvety texture.
• Umbilical polyps, firm lumps formed from residual embryological tissues that typically need surgical removal but are not infectious.

In situations where only the umbilical cord shows signs of infection, it’s known as funisitis, not omphalitis. Funisitis, often a result of maternal infection during pregnancy, only affects the outer surface of the cord without involving the vessels inside. It’s noticeable when the umbilical cord stump is wet and has a bad smell, but without any surrounding skin infection.

Possible Complications When Diagnosed with Omphalitis

It’s crucial to identify and treat omphalitis early to avoid its severe complications. The most common complication is sepsis which can evolve into septic shock and even cause death. Some other rare complications include inflammation of the peritoneum, death of intestinal tissue, protrusion of the small intestine through a surgical wound, abscesses in the liver, inflammation and clotting of blood vessels in the umbilical cord and blockage of the main vein that carries blood from the intestines to the liver. Although it’s not common, a severe type of tissue infection called necrotizing fasciitis can happen.

This complication should be suspected if the infection is rapidly worsening and there are signs of body-wide illness. It should also be considered if there’s no improvement after 24-48 hours of receiving intravenous antibiotics. It’s alarming to note that in people with omphalitis who also develop necrotizing fasciitis, the death rates have been reported to be between 60% and 85%. If there’s suspicion of necrotizing fasciitis, in addition to a wide variety of antibiotics, an immediate consultation with a surgeon for the removal of the infected tissues and the affected part of the abdominal wall is essential.

Main Complications of Omphalitis:

• Sepsis (can lead to septic shock and death)
• Peritonitis (inflammation of the peritoneum)
• Intestinal gangrene (death of intestinal tissue)
• Small bowel evisceration (protrusion of the small intestine through a surgical wound)
• Liver abscess
• Septic umbilical arteritis (inflammation and clotting of blood vessels in the umbilical cord)
• Portal vein thrombosis (blockage of the main vein that carries blood from the intestines to the liver)
• Necrotizing fasciitis (severe type of tissue infection)

Please note that immediate medical attention is crucial in case of any of the above complications.

Preventing Omphalitis

Avoiding omphalitis, which is an infection of the umbilical cord in newborns, involves clean practices during childbirth and proper care of the baby’s umbilical cord. The umbilical cord should be cut with a clean, germ-free blade or scissors. Hospitals, where cleanliness is a standard practice and the risk of omphalitis is low, typically suggest ‘dry cord care,’ which means leaving the cord exposed to air to dry and fall off naturally.

In places where the risk of this infection is higher, like in some developing countries, a cheap and effective way to prevent omphalitis is to apply an antiseptic called chlorhexidine to the baby’s umbilical cord area. According to research, this method has been successful in reducing the risk of omphalitis and also overall infant mortality when compared to dry cord care.

It’s important to note that some traditional practices can actually increase the risk of umbilical cord infection. For example, applying cow dung or a type of clay known as bentonite to the umbilical stump has been linked to a serious infection called neonatal tetanus.