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Omphalitis Workup

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

Laboratory Studies

Routinely obtain specimens from umbilical infection and submit specimens for Gram stain and culture for aerobic and anaerobic organisms. If myonecrosis is suspected, obtain specimens from the involved muscle rather than the wound surface.

Obtain blood cultures for aerobic and anaerobic organisms.

Obtain a CBC count with manual differential. Neutrophilia or neutropenia may be present in acute infection. An immature-to-total neutrophil ratio greater than 0.2 may be a useful indicator of systemic bacterial infection in the first few days of life. Thrombocytopenia may be present.

Other nonspecific laboratory tests, either alone or in combination with a defined scoring system, have been evaluated for their usefulness in rapid detection of bacterial infection in neonates, although none has demonstrated sensitivity or specificity sufficiently high to dictate clinical care. The tests include the following:

  • C-reactive protein levels
  • Procalcitonin
  • Erythrocyte sedimentation rate
  • Neutrophil CD64
  • Limulus lysate test, which detects endotoxin

The following laboratory studies are suggested in neonates in whom sepsis and disseminated intravascular coagulation (DIC) are suspected:

  • Peripheral blood smear
  • Prothrombin time
  • Activated partial thromboplastin time
  • Fibrinogen
  • Fibrinogen split products or D-dimer

Other abnormalities associated with serious systemic infection include the following:

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Imaging Studies

The following imaging studies may be indicated:

  • Abdominal radiography may reveal intra-abdominal wall gas.
  • Ultrasonography may reveal fascial thickening and fluid accumulation between subcutaneous fat and muscle in cases with fascial involvement. It may also be useful in the detection of anatomic abnormalities.
  • CT scanning of the abdomen may determine the presence and extent of muscle and/or fascial involvement and potentially aid in detection of anatomic abnormalities.
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Procedures

Lumbar puncture may be warranted in infants in whom sepsis is suspected.

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Histologic Findings

Analysis of biopsy specimens may reveal necrotizing fasciitis, which is an acute inflammatory infiltrate found in subcutaneous fat and connective tissue, or myonecrosis, which is an acute inflammatory process surrounding muscle bundles, many of which are no longer viable.

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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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