Omphalitis

Background

• Acute infection of umbilical stump
• Rare

Clinical Features

• Erythema of skin around umbilical stump
• Purulent drainage
• Fever

Differential Diagnosis

• Cellulitis of abdominal wall
• Necrotizing fasciitis
• Neonatal sepsis

Neonatal Rashes

• Atopic dermatitis
• Candidiasis
• Diaper dermatitis
• Erythema toxicum neonatorum
• Neonatal acne
• Psoriasis
• Seborrheic dermatitis
• Tinea capitis
• Impetigo
• Contact dermatitis
• Perianal streptococcal dermatitis
• Milia
• Miliaria
• Mongolian spots
• Omphalitis
• Pustular melanosis
• Sucking blisters

Evaluation

• CBC, BMP
• Blood cultures
• Septic workup if febrile neonate (UA, CXR, LP)
• Imaging (ultrasound or CT) as indicated

Management

• IV fluids NS 20mL/kg bolus if ill appearing
• Antibiotics
  • Gentamycin
  • Ampicillin
  • Vancomycin
  • Consider clindamycin or metronidazole if concern for anaerobes
• Surgical consultation as indicated

Disposition

• Admit if febrile or ill appearing
• Consider discharge if very mild case and excellent follow-up assured

References

Harwood Nuss, EMedicine