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Omphalitis Follow-up

  • Author: Patrick G Gallagher, MD; Chief Editor: Ted Rosenkrantz, MD  more...
 
Updated: Jan 02, 2016
 

Further Outpatient Care

Routine postsurgical follow-up care is indicated. Infants developing portal vein thrombosis require follow-up care for complications associated with portal hypertension.

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Further Inpatient Care

Examine the patient with omphalitis frequently, and immediately debride any tissue that shows signs of advancing infection or necrosis.

Postoperatively, inspect the gross appearance of the tissue on the perimeter of the debrided area several times a day or more frequently if the infant has any unresolved signs of systemic infection.

Monitor aminoglycoside levels, and adjust dose accordingly.

Monitor and manage metabolic abnormalities, which are common in any ill neonate.

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Inpatient & Outpatient Medications

Intravenous antimicrobial therapy with an antistaphylococcal penicillin, aminoglycoside, and clindamycin or metronidazole if indicated, are administered during hospitalization.

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Transfer

Critically ill infants, including those who may require surgical intervention, may require transfer to an ICU equipped to treat infants. Transport the patient with advanced life support technology in place and qualified personnel in attendance. Options for further treatment or intervention must be immediately available. (See Transport of the Critically Ill Newborn.)

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Deterrence/Prevention

Antimicrobial agents have been applied to the umbilicus to decrease bacterial colonization and to prevent omphalitis and associated complications.

Several effective umbilical cord care regimens are available, including the following:

  • Triple dye applied once daily until cord separation
  • Triple dye applied once, then alcohol applied daily until cord separation
  • Triple dye applied once, then no further antimicrobial treatment
  • Povidone-iodine applied daily until cord separation
  • Silver sulfadiazine applied daily until cord separation
  • Bacitracin ointment applied daily until cord separation
  • Chlorhexidine 4% applied once, with no further antimicrobial treatment
  • Chlorhexidine 4% applied daily until cord separation
  • Salicylic sugar powder (97% powdered sugar, 3% salicylic acid) applied daily until cord separation

Routine topical therapy may be indicated in developing countries where omphalitis is more common.

Topical therapy is also commonly used in attempts to control outbreaks of omphalitis.

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Patient Education

Referral for psychosocial counseling may assist the family in coping with a critically ill infant. For patient education resources, see Children's Health Center, as well as Umbilical Cord Care.

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Contributor Information and Disclosures
Author

Patrick G Gallagher, MD Professor, Departments of Pediatrics, Pathology and Genetics, Division of Neonatal-Perinatal Medicine, Yale University School of Medicine and Yale-New Haven Children's Hospital

Patrick G Gallagher, MD is a member of the following medical societies: American Academy of Pediatrics, American Society for Clinical Investigation, American Society for Clinical Investigation, American Society of Hematology, Connecticut State Medical Society, Society for Pediatric Research, American Society of Human Genetics

Disclosure: Nothing to disclose.

Coauthor(s)

Samir S Shah, MD, MSc Director, Division of Hospital Medicine, Attending Physician in Hospital Medicine and Infectious Diseases, James M Ewell Endowed Chair, Cincinnati Children's Hospital Medical Center; Professor, Department of Pediatrics, University of Cincinnati College of Medicine

Samir S Shah, MD, MSc is a member of the following medical societies: American Academy of Pediatrics, American College of Epidemiology, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, Phi Beta Kappa, Society for Pediatric Research

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Brian S Carter, MD, FAAP Professor of Pediatrics, University of Missouri-Kansas City School of Medicine; Attending Physician, Division of Neonatology, Children's Mercy Hospital and Clinics; Faculty, Children's Mercy Bioethics Center

Brian S Carter, MD, FAAP is a member of the following medical societies: Alpha Omega Alpha, American Academy of Hospice and Palliative Medicine, American Academy of Pediatrics, American Pediatric Society, American Society for Bioethics and Humanities, American Society of Law, Medicine & Ethics, Society for Pediatric Research, National Hospice and Palliative Care Organization

Disclosure: Nothing to disclose.

Chief Editor

Ted Rosenkrantz, MD Professor, Departments of Pediatrics and Obstetrics/Gynecology, Division of Neonatal-Perinatal Medicine, University of Connecticut School of Medicine

Ted Rosenkrantz, MD is a member of the following medical societies: American Academy of Pediatrics, American Pediatric Society, Eastern Society for Pediatric Research, American Medical Association, Connecticut State Medical Society, Society for Pediatric Research

Disclosure: Nothing to disclose.

Additional Contributors

Shelley C Springer, JD, MD, MSc, MBA, FAAP Professor, University of Medicine and Health Sciences, St Kitts, West Indies; Clinical Instructor, Department of Pediatrics, University of Vermont College of Medicine; Clinical Instructor, Department of Pediatrics, University of Wisconsin School of Medicine and Public Health

Shelley C Springer, JD, MD, MSc, MBA, FAAP is a member of the following medical societies: American Academy of Pediatrics

Disclosure: Nothing to disclose.

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Anatomic relationship between the umbilicus and its embryologic attachments.
A case of omphalitis (left) associated with extensive myonecrosis (right).
A case of omphalitis associated with bullous impetigo due to Staphylococcus aureus.
 
 
 
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