# Omphalitis (infected umbilical stump) - Category: emergency - Review status: reviewed (every claim checked against a document named on this page) - Sources: Omphalitis - StatPearls (NCBI Bookshelf NBK513338) - https://www.ncbi.nlm.nih.gov/books/NBK513338/ · Cached copy: data/reference/disease/umbilical-granuloma-NBK513338.html (the Omphalitis article is already on disk under that slug; a second copy under this one would add an unreviewed shared-article pair) · No dose - referral pathway, no medicine given in primary care - Verified date: 2026-08 ## Verified against - Omphalitis - StatPearls (NCBI Bookshelf NBK513338) - https://www.ncbi.nlm.nih.gov/books/NBK513338/ - Cached copy: data/reference/disease/umbilical-granuloma-NBK513338.html (the Omphalitis article is already on disk under that slug; a second copy under this one would add an unreviewed shared-article pair) - No dose - referral pathway, no medicine given in primary care ## Treatment metadata - Referral & safety-netting (no drug therapy) ## Complete treatment card ```text OMPHALITIS (INFECTED UMBILICAL STUMP) Sources: Omphalitis - StatPearls (NCBI Bookshelf NBK513338) - https://www.ncbi.nlm.nih.gov/books/NBK513338/ · Cached copy: data/reference/disease/umbilical-granuloma-NBK513338.html (the Omphalitis article is already on disk under that slug; a second copy under this one would add an unreviewed shared-article pair) · No dose - referral pathway, no medicine given in primary care Review status: REVIEWED against 2 sources listed above (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (3) - Pus or bleeding from the cord stump [bleeding · pus] - A bad smell from the discharge suggests anaerobes are involved - Floppiness, poor feeding, fever or an irritable baby mean sepsis and a worse outlook [fever · irritability · poor feeding · sepsis] SIGNS - what you find (3) - A newborn illness: the navel and the skin around it are tender, red and firm - It starts as skin-deep cellulitis and, left alone, can spread across the whole abdominal wall [cellulitis] - Redness spreading fast, or gas felt in the tissues, means necrotising fasciitis and an immediate surgical call [redness] TESTS (5) - Every suspected case needs a full blood count and cultures - Swab any pus from the stump before the first antibiotic dose - If the baby is systemically unwell, do the full newborn septic screen: chest film, urine dip and culture, and CSF - A high white cell count is nearly always present in leucocyte adhesion deficiency, because the cells cannot marginate - A child with repeated infections plus a navel infection in infancy needs the leucocyte adhesion molecules assayed IF NOT THIS - what else fits (5) - Usually the bedside picture alone settles it - Patent urachus: bladder drains straight to the navel, so the constant wetness gets mistaken for infection - Umbilical granuloma: soft, velvety, pinkish tissue appearing after week one that weeps and bleeds when knocked - Umbilical polyp: a firm lump of embryonic remnant that needs excising but is not infected - Funisitis: a wet, smelly cord stump with no surrounding cellulitis, following infection of the membranes in the mother Source StatPearls "Omphalitis" - disease-level clinical article Status traced to the source above 1. REFERRAL & SAFETY-NETTING (NO DRUG THERAPY) [1st line] Adult Source Omphalitis - StatPearls (NCBI Bookshelf NBK513338) - https://www.ncbi.nlm.nih.gov/books/NBK513338/ Why A red, tender umbilicus in a newborn is an admission, not a prescription. The antibiotics the article names are all parenteral and it gives no amounts, so no dose is printed here - the decision it supports is recognising it early and sending the baby the same day, because the infection crosses into sepsis and necrotising fasciitis quickly. Caution IT KILLS, AND IT KILLS FAST - omphalitis is infection of the umbilicus, of the tissue around it, or of both, almost always in the newborn period, and in most babies it stays confined to the area around the umbilicus. But it can move quickly to systemic infection and to death: mortality is put at somewhere between 7% and 15%. Recognising and treating it early is what prevents that. WHAT TO LOOK FOR - in a newborn: tenderness, redness and induration of the umbilicus and the tissue around it. There may also be pus or bleeding from the cord stump. And a smell is a specific clue - a foul-smelling discharge should make you suspect anaerobes. THE SIGNS THAT SAY IT IS ALREADY SEPSIS - lethargy, feeding poorly, fever, irritability: systemic features like these point to sepsis, and to a worse outlook. A newborn who has gone quiet and stopped feeding is the emergency, whatever the umbilicus looks like. THE SURGICAL EMERGENCY INSIDE THE MEDICAL ONE - where redness of the abdominal wall is spreading fast, or there is gas in the tissue around it, think necrotizing fasciitis and get a surgical opinion acutely. Suspect it too where intravenous antibiotics have produced no clinical improvement in 24 to 48 hours. The stakes are these: mortality of 60% to 85% has been reported where omphalitis is complicated by necrotizing fasciitis. SWAB BEFORE ANYONE STARTS ANTIBIOTICS - every baby in whom omphalitis is suspected needs a full blood count and a culture. Where there is pus at the umbilical stump, culture that too, and send it BEFORE the first dose of antibiotic goes in. And where the baby has systemic features, the full neonatal septic screen follows: urine culture, urinalysis, a chest radiograph, and culture of the cerebrospinal fluid. THE TREATMENT IS INTRAVENOUS AND NO AMOUNT IS STATED HERE - omphalitis needs broad- spectrum antibiotics given parenterally, covering gram-positive and gram-negative organisms alike; the recommended empiric start is an antistaphylococcal penicillin together with an aminoglycoside. For an uncomplicated case the parenteral course runs ten days, after which the switch to oral treatment depends on what the cultures grew. The article names no doses, so none are printed and no oral antibiotic is offered as a substitute for admission. WHEN ANAEROBIC OR RESISTANT COVER IS ADDED - where methicillin-resistant Staphylococcus aureus is prevalent locally, vancomycin goes in while the cultures are awaited. And where maternal chorioamnionitis is suspected, or the stump discharge smells foul, clindamycin or metronidazole is added to cover anaerobes. A SECOND EPISODE MEANS AN IMMUNE WORKUP - omphalitis is closely tied to leucocyte adhesion deficiency, so a suspected case needs working up in detail. In LAD the leucocytes marginate defectively, and a leucocytosis is almost always there. The test to ask for is an assay of those receptors, and it is essential in a child who keeps getting infections and who had omphalitis as a newborn. Delayed cord separation alongside it makes the case stronger. PREVENTION IS THE PART PRIMARY CARE OWNS - cut the cord with a sterile blade or sterile scissors. In developing countries the risk runs higher, and topical chlorhexidine has been shown to reduce it, and cheaply. In a hospital, where care is aseptic as a matter of routine, the risk is low and dry cord care is what is advised. The article names no strength for the chlorhexidine, so none is printed and no chlorhexidine row is offered. ASK WHAT WAS PUT ON THE STUMP - cord care done wrongly raises the risk of umbilical infection in its own right. Applying bentonite clay or cow dung to the stump, as some cultures do, has caused neonatal tetanus. Kohl, ash, henna and oils belong in the same question, and a stiff or poorly feeding baby after one of them is tetanus until proven otherwise. THE OTHER COMPLICATIONS, SO THEY ARE NOT MISSED LATER - sepsis is the commonest, and it can go on to septic shock and death. The rarer ones: portal vein thrombosis, septic umbilical arteritis, liver abscess, evisceration of the small bowel, intestinal gangrene, and peritonitis. 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