Omphalitis Workup

Updated: May 20, 2019
  • Author: Patrick G Gallagher, MD; Chief Editor: Santina A Zanelli, MD  more...
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Workup

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 complete blood cell (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

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:

Other studies and/or procedures

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.

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

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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.

  • Computed tomography 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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Staging

Staging of neonatal omphalitis is as follows [48] :

  • Grade 1: Funisitis with purulent umbilical discharge that may be malodorous

  • Grade 2: Funisitis with purulent umbilical discharge that may be malodorous with periumbilical abdominal wall cellulitis

  • Grade 3: Funisitis with purulent umbilical discharge that may be malodorous, the presence of periumbilical abdominal wall cellulitis, and systemic involvement, including sepsis, shock, disseminated intravascular coagulation, multiple organ dysfunction

  • Grade 4: Funisitis with purulent umbilical discharge that may be malodorous; the presence of periumbilical abdominal wall cellulitis, ecchymosis, crepitus, bullae; with evidence of involvement of superficial and deep fascia and associated muscle; and with systemic involvement, including sepsis, shock, disseminated intravascular coagulation, multiple organ dysfunction

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