Background

Omphalitis is an infection of the umbilical stump.^[1] It typically presents as a superficial cellulitis around the umbilicus that can spread to involve the entire abdominal wall and may progress to necrotizing fasciitis, myonecrosis, or systemic disease.

Omphalitis is uncommon in industrialized countries outside the setting of umbilical vessel catheterization; however, it remains a common cause of neonatal mortality in less developed regions. It is predominantly a disease of the neonate, with only a few cases having been reported in adults. Risk factors for omphalitis include septic delivery, unplanned home delivery, maternal chorioamnionitis, prolonged rupture of membranes, low birth weight, and umbilical vessel catheterization.

Aerobic bacteria are present in approximately 85% of infections, predominated by Staphylococcus aureus, group A Streptococcus, Escherichia coli, Klebsiella pneumoniae, and Proteus mirabilis.^{[2, 3, 4, 5]} Methicillin-resistant S aureus has also been described in association with omphalitis and in some hospitals may be the predominant etiologic organism.^[6]

In the past, studies emphasized the importance of gram-positive organisms (eg, S aureus and group A Streptococcus) in the etiology of omphalitis. This was followed by a series of reports that highlighted the role of gram-negative organisms in the etiology of omphalitis. These studies suggested that the change in etiology may have been caused by the introduction of prophylactic umbilical cord care using antistaphylococcal agents, such as hexachlorophene and triple dye (a widely adopted practice in the 1960s), with a subsequent increase in gram-negative colonization of the umbilical stump.

Cushing AH. Omphalitis: a review. Pediatr Infect Dis. 1985 May-Jun. 4 (3):282-5. [QxMD MEDLINE Link].
Airede AI. Pathogens in neonatalomphalitis. J Trop Pediatr. 1992 Jun. 38 (3):129-31. [QxMD MEDLINE Link].
Brook I. Microbiology of necrotizing fasciitis associated with omphalitis in the newborn infant. J Perinatol. 1998 Jan-Feb. 18 (1):28-30. [QxMD MEDLINE Link].
Mason WH, Andrews R, Ross LA, Wright HT Jr. Omphalitis in the newborn infant. Pediatr Infect Dis J. 1989 Aug. 8 (8):521-5. [QxMD MEDLINE Link].
Sawardekar KP. Changing spectrum of neonatal omphalitis. Pediatr Infect Dis J. 2004 Jan. 23 (1):22-6. [QxMD MEDLINE Link].
Sengupta M, Banerjee S, Banerjee P, Guchhait P. Outstanding Prevalence of Methicillin Resistant Staphylococcus aureus in Neonatal Omphalitis. J Clin Diagn Res. 2016 Sep. 10 (9):DM01-DM03. [QxMD MEDLINE Link]. [Full Text].
Brook I. Overview of anaerobic infections in children and their treatment. J Infect Chemother. 2024 Nov. 30 (11):1104-13. [QxMD MEDLINE Link].
[Guideline] Liljestrand J, Zupan J, et al, for the World Health Organization, Department of Reproductive Health and Research. Childbirth – labour, delivery and immediate postpartum care. In: Mattock N, Casna R, eds. Pregnancy, Childbirth, Postpartum and Newborn Care: A Guide for Essential Practice. 3rd ed. Geneva, Switzerland: WHO Press; 2015. [Full Text].
[Guideline] Stewart D, Benitz W, COMMITTEE ON FETUS AND NEWBORN. Umbilical Cord Care in the Newborn Infant. Pediatrics. 2016 Sep. 138 (3):799-804. [QxMD MEDLINE Link].
McKenna H, Johnson D. Bacteria in neonatal omphalitis. Pathology. 1977 Apr. 9 (2):111-3. [QxMD MEDLINE Link].
Geil CC, Castle WK, Mortimer EA Jr. Group A streptococcal infections in newborn nurseries. Pediatrics. 1970 Dec. 46 (6):849-54. [QxMD MEDLINE Link].
Nelson JD, Dillon HC Jr, Howard JB. A prolonged nursery epidemic associated with a newly recognized type of group A streptococcus. J Pediatr. 1976 Nov. 89 (5):792-6. [QxMD MEDLINE Link].
Gezon HM, Schaberg MJ, Klein JO. Concurrent epidemics of Staphlococcus aureus and group A Streptococcus disease in a newborn nursery. Control with penicillin G and hexachlorophene bathing. Pediatrics. 1973 Feb. 51 (2):383-90. [QxMD MEDLINE Link].
Kaplan RL, Cruz AT, Freedman SB, et al. Omphalitis and Concurrent Serious Bacterial Infection. Pediatrics. 2022 May 1. 149 (5):e467-74. [QxMD MEDLINE Link]. [Full Text].
Hester G, King E, Nickel A, Smedshammer S, Wageman K. Omphalitis Hospitalizations at a US Children's Hospital. Hosp Pediatr. 2022 Dec 1. 12 (12):e423-7. [QxMD MEDLINE Link].
Sawin RS, Schaller RT, Tapper D, Morgan A, Cahill J. Early recognition of neonatal abdominal wall necrotizing fasciitis. Am J Surg. 1994 May. 167 (5):481-4. [QxMD MEDLINE Link].
Güvenç H, Aygün AD, Yaşar F, Soylu F, Güvenç M, Kocabay K. Omphalitis in term and preterm appropriate for gestational age and small for gestational age infants. J Trop Pediatr. 1997 Dec. 43 (6):368-72. [QxMD MEDLINE Link].
Ameh EA, Nmadu PT. Major complications of omphalitis in neonates and infants. Pediatr Surg Int. 2002 Sep. 18 (5-6):413-6. [QxMD MEDLINE Link].
Feo CF, Dessanti A, Franco B, Ganau A, Iannuccelli M. Retroperitoneal abscess and omphalitis in young infants. Acta Paediatr. 2003. 92 (1):122-5. [QxMD MEDLINE Link].
Fraser N, Davies BW, Cusack J. Neonatal omphalitis: a review of its serious complications. Acta Paediatr. 2006 May. 95 (5):519-22. [QxMD MEDLINE Link].
Bokka SH, Behera BK, Mohanty MK. Falciform ligament abscess secondary to neonatal omphalitis, a potential complication of home delivery. J Indian Assoc Pediatr Surg. 2015 Jul-Sep. 20 (3):160. [QxMD MEDLINE Link].
Dongmo Miaffo DOE, Chafaaoui H, Assan BR, Mantho P, Ntankeu PP. Neonatal pyogenic liver abscess following omphalitis: A case report. Int J Surg Case Rep. 2023 Sep. 110:108711. [QxMD MEDLINE Link]. [Full Text].
Kosloske AM, Cushing AH, Borden TA, et al. Cellulitis and necrotizing fasciitis of the abdominal wall in pediatric patients. J Pediatr Surg. 1981 Jun. 16 (3):246-51. [QxMD MEDLINE Link].
Lally KP, Atkinson JB, Woolley MM, Mahour GH. Necrotizing fasciitis. A serious sequela of omphalitis in the newborn. Ann Surg. 1984 Jan. 199 (1):101-3. [QxMD MEDLINE Link]. [Full Text].
Samuel M, Freeman NV, Vaishnav A, Sajwany MJ, Nayar MP. Necrotizing fasciitis: a serious complication of omphalitis in neonates. J Pediatr Surg. 1994 Nov. 29 (11):1414-6. [QxMD MEDLINE Link].
Moss RL, Musemeche CA, Kosloske AM. Necrotizing fasciitis in children: prompt recognition and aggressive therapy improve survival. J Pediatr Surg. 1996 Aug. 31 (8):1142-6. [QxMD MEDLINE Link].
Weber DM, Freeman NV, Elhag KM. Periumbilical necrotizing fasciitis in the newborn. Eur J Pediatr Surg. 2001 Apr. 11 (2):86-91. [QxMD MEDLINE Link].
Nazir Z. Necrotizing fasciitis in neonates. Pediatr Surg Int. 2005 Aug. 21 (8):641-4. [QxMD MEDLINE Link].
Bingöl-Koloğlu M, Yildiz RV, Alper B, et al. Necrotizing fasciitis in children: diagnostic and therapeutic aspects. J Pediatr Surg. 2007 Nov. 42 (11):1892-7. [QxMD MEDLINE Link].
Jamal M, Ateeque K, Quddusi MBK, Qamar FN. Life-threatening complication: the development of necrotising fasciitis in a preterm neonate with omphalitis. BMJ Case Rep. 2023 May 4. 16 (5):86-91. [QxMD MEDLINE Link].
O'Brien PH, Meredith HC, Vujic I, Schabel SI. Obstructive jaundice caused by cavernous transformation of the portal vein post neonatal omphalitis. J S C Med Assoc. 1979 May. 75 (5):209-10. [QxMD MEDLINE Link].
Perlemuter G, Béjanin H, Fritsch J, et al. Biliary obstruction caused by portal cavernoma: a study of 8 cases. J Hepatol. 1996 Jul. 25 (1):58-63. [QxMD MEDLINE Link].
Orloff MJ, Orloff MS, Girard B, Orloff SL. Bleeding esophagogastric varices from extrahepatic portal hypertension: 40 years' experience with portal-systemic shunt. J Am Coll Surg. 2002 Jun. 194 (6):717-28; discussion 728-30. [QxMD MEDLINE Link].
Yuldashev RZ, Aliev MM, Maksudov MF, Khaydarov UO, Shokhaydarov S. Angiographic patterns of portal venous system in children with extrahepatic portal hypertension and its etiological and clinical relevance. Pediatr Surg Int. 2023 Feb 1. 39 (1):97. [QxMD MEDLINE Link].
Yaz I, Ozbek B, Bildik HN, et al. Clinical and laboratory findings in patients with leukocyte adhesion deficiency type I: A multicenter study in Turkey. Clin Exp Immunol. 2021 Oct. 206 (1):47-55. [QxMD MEDLINE Link]. [Full Text].
Kambli PM, Bargir UA, Yadav RM, et al. Clinical and Genetic Spectrum of a Large Cohort of Patients With Leukocyte Adhesion Deficiency Type 1 and 3: A Multicentric Study From India. Front Immunol. 2020. 11:612703. [QxMD MEDLINE Link]. [Full Text].
Iglesias-Deus A, Pérez-Muñuzuri A, Urisarri A, Bautista-Casasnovas A, Couce ML. Umbilical cord and visceral hemangiomas diagnosed in the neonatal period: A case report and a review of the literature. Medicine (Baltimore). 2016 Oct. 95 (42):e5196. [QxMD MEDLINE Link].
Gras-Le Guen C, Caille A, Launay E, et al. Dry Care Versus Antiseptics for Umbilical Cord Care: A Cluster Randomized Trial. Pediatrics. 2017 Jan. 139 (1):[QxMD MEDLINE Link].
Karumbi J, Mulaku M, Aluvaala J, English M, Opiyo N. Topical umbilical cord care for prevention of infection and neonatal mortality. Pediatr Infect Dis J. 2013 Jan. 32 (1):78-83. [QxMD MEDLINE Link].
Imdad A, Mullany LC, Baqui AH, et al. The effect of umbilical cord cleansing with chlorhexidine on omphalitis and neonatal mortality in community settings in developing countries: a meta-analysis. BMC Public Health. 2013. 13 Suppl 3 (Suppl 3):S15. [QxMD MEDLINE Link].
Sinha A, Sazawal S, Pradhan A, Ramji S, Opiyo N. Chlorhexidine skin or cord care for prevention of mortality and infections in neonates. Cochrane Database Syst Rev. 2015 Mar 5. 2015 (3):CD007835. [QxMD MEDLINE Link]. [Full Text].
Mullany LC, Arifeen SE, Khatry SK, et al. Impact of Chlorhexidine Cord Cleansing on Mortality, Omphalitis and Cord Separation Time Among Facility-Born Babies in Nepal and Bangladesh. Pediatr Infect Dis J. 2017 Oct. 36 (10):1011-3. [QxMD MEDLINE Link].
Sazawal S, Dhingra U, Ali SM, et al. Efficacy of chlorhexidine application to umbilical cord on neonatal mortality in Pemba, Tanzania: a community-based randomised controlled trial. Lancet Glob Health. 2016 Nov. 4 (11):e837-e844. [QxMD MEDLINE Link].
Semrau KEA, Herlihy J, Grogan C, et al. Effectiveness of 4% chlorhexidine umbilical cord care on neonatal mortality in Southern Province, Zambia (ZamCAT): a cluster-randomised controlled trial. Lancet Glob Health. 2016 Nov. 4 (11):e827-e836. [QxMD MEDLINE Link].
Imdad A, Bautista RM, Senen KA, Uy ME, Mantaring JB 3rd, Bhutta ZA. Umbilical cord antiseptics for preventing sepsis and death among newborns. Cochrane Database Syst Rev. 2013 May 31. 2013 (5):CD008635. [QxMD MEDLINE Link]. [Full Text].
Goldenberg RL, McClure EM, Saleem S. A review of studies with chlorhexidine applied directly to the umbilical cord. Am J Perinatol. 2013 Sep. 30 (8):699-701. [QxMD MEDLINE Link].
Shariff JA, Lee KC, Leyton A, Abdalal S. Neonatal mortality and topical application of chlorhexidine on umbilical cord stump: a meta-analysis of randomized control trials. Public Health. 2016 Oct. 139:27-35. [QxMD MEDLINE Link].
Sankar MJ, Chandrasekaran A, Ravindranath A, Agarwal R, Paul VK. Umbilical cord cleansing with chlorhexidine in neonates: a systematic review. J Perinatol. 2016 May. 36 Suppl 1 (Suppl 1):S12-20. [QxMD MEDLINE Link].
Osrin D, Colbourn T. Chlorhexidine and newborn omphalitis and mortality - Authors' reply. Lancet Glob Health. 2017 Mar. 5 (3):e272-e273. [QxMD MEDLINE Link].
Hodgins S. Chlorhexidine and newborn omphalitis and mortality. Lancet Glob Health. 2017 Mar. 5 (3):e270-e271. [QxMD MEDLINE Link].
Al-Shehri H. The Use of Alcohol versus Dry Care for the Umbilical Cord in Newborns: A Systematic Review and Meta-analysis of Randomized and Non-randomized Studies. Cureus. 2019 Jul 8. 11 (7):e5103. [QxMD MEDLINE Link]. [Full Text].
Coscia A, Boscarino G, Di Chiara M, et al. Umbilical cord medication in healthy full-term newborns: a before-after uncontrolled quality improvement study. Eur J Pediatr. 2021 Feb. 180 (2):505-11. [QxMD MEDLINE Link]. [Full Text].
Kirk AHP, Yang J, Sim WC, Chia LYX, Lau Y. Systematic Review of the Effect of Topical Application of Human Breast Milk on Early Umbilical Cord Separation. J Obstet Gynecol Neonatal Nurs. 2019 Mar. 48 (2):121-30. [QxMD MEDLINE Link].
López-Medina MD, López-Araque AB, Linares-Abad M, López-Medina IM. Umbilical cord separation time, predictors and healing complications in newborns with dry care. PLoS One. 2020. 15 (1):e0227209. [QxMD MEDLINE Link]. [Full Text].
Shaniv D, Bolisetty S, Young TE, et al. Neonatal Drug Formularies-A Global Scope. Children (Basel). 2023 May 8. 10 (5):[QxMD MEDLINE Link]. [Full Text].

Media Gallery

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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#author-disclosures{display:block}#author-disclosures.modal-layer{position:relative}#author-disclosures .modal-content{max-height:none}#author-disclosures .close-modal{display:none}

Author

Patrick G Gallagher, MD Director, Center for Perinatal Research, Wexner Research Institute, Nationwide Children's Hospital; Professor of Pediatrics, Physiology, and Cell Biology, Ohio State University College of Medicine

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

Disclosure: Nothing to disclose.

Coauthor(s)

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

Samir S Shah, MD, MSCE is a member of the following medical societies: Academic Pediatric Association, American Academy of Pediatrics, American Pediatric Society, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, Society for Pediatric Research, Society of Hospital Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

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

Santina A Zanelli, MD Associate Professor, Department of Pediatrics, Division of Neonatology, University of Virginia Health System

Santina A Zanelli, MD is a member of the following medical societies: American Academy of Pediatrics, American Epilepsy Society, Society for Neuroscience, 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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