Umbilical infection or omphalitis can affect very young infants. If left untreated, the infection can become quite life-threatening; antibiotic therapy and observation in the hospital are therefore almost always necessary. In countries with adequate hygiene standards and good medical care, umbilical infections are virtually no longer a contributor to infant mortality.
What is an umbilical infection?
Umbilical infection, or omphalitis, in newborn infants is inflammation caused by bacteria of the umbilical stump remaining after the umbilical cord is cut and the surrounding tissue of the abdominal wall. Mixed infections with different types of bacteria, which are part of the normal bacterial flora of humans, are often responsible for the complication of umbilical healing. Species commonly involved in umbilical infections are Staphylococcus aureus and Streptococcus, which occur on the skin, and the intestinal bacteria Escherichia coli, Klebsiella pneumoniae, and Proteus mirabilis.
Causes
Because the umbilical stump is an open wound for several weeks after delivery, it is relatively easy for germs to enter and possibly cause an umbilical infection. The germs usually originate from the mother and get onto the umbilicus during delivery or in the following days. The infant’s immature immune system often cannot yet cope with the normally harmless bacteria. As far as bacteria are concerned, a newborn is virtually a blank slate – in the largely germ-free environment of the uterus, its body has had little experience with bacteria. Risk factors for umbilical infection include low birth weight, other infectious diseases such as pneumonia or pre-existing sepsis, immune deficiency and poor general health. In normal-weight, healthy infants, risk factors include unusually long births and previous complications such as placental infections. An umbilical catheter inserted during the course of neonatal care also increases the risk of developing an umbilical infection.
Symptoms, complaints, and signs
Umbilical infection usually occurs immediately after birth. The condition can be recognized by the greasy, pus-filled umbilicus, which is usually red and very sensitive to touch. The infection can also cause general symptoms such as fever, fatigue and malaise. Affected children also drink little and usually refuse to eat. Bleeding and swelling may occur around the navel. As the infection progresses, the navel bulges forward and takes on a reddish-white color. If pus has formed, a cyst will also develop. This can rupture and lead to the pathogens being carried into the blood, which can result in complications such as superinfections and sepsis. Other possible consequences of an umbilical infection are peritonitis, abscesses in the gastrointestinal tract and thrombosis caused by bacteria. In severe cases, liver abscesses or inflammation of the inner lining of the heart develop. Omphalitis is a life-threatening disease and, if left untreated, can lead to the death of the infant. Symptoms develop in the first hours to days after birth and rapidly increase in intensity. If treatment is given before an abscess has formed, the signs of illness usually resolve quickly.
Diagnosis and course
Although mild redness and minor bleeding may be normal concomitants of umbilical healing: Signs of an umbilical infection should always be assessed by a pediatrician. Diagnosis of umbilical infection is made by examining the umbilicus. Redness of the skin, bloody or purulent discharge, swelling, warmth, and protrusion of the umbilicus are common symptoms of an incipient umbilical infection. In the advanced stages of umbilical infection, extreme protrusion of the umbilicus is often seen. Fever, accelerated heartbeat, low blood pressure and apathy occur. If left untreated, the infection can quickly pass into the blood and lead to sepsis and life-threatening bacterial infections of the organs. Peritonitis, liver abscesses, bacterial thrombosis (blockage of blood vessels), and endocarditis (inflammation of the inner lining of the heart) can be extremely dangerous consequences of an umbilical infection.
Complications
Umbilical infection is a life-threatening disease.For this reason, treatment must be given in any case, because usually there is no self-healing. In the worst case, the infant may die due to the umbilical infection. However, death can be avoided by observing d herygienic standards. The affected person usually experiences severe redness or swelling at the navel. A secretion may also be discharged from the navel during this process. The infection continues to spread throughout the body, so there is usually a fever and an increased pulse. Low blood pressure and difficulty breathing may also occur as a result of the umbilical infection. Furthermore, without treatment, damage to the liver and peritonitis will occur. Affected individuals may also develop and die from inflammation of the heart. In most cases, the relatives and parents also suffer from psychological stress or depression. The treatment of the umbilical infection is usually carried out with the help of antibiotics and leads relatively quickly to success. No complications occur in the process.
When should you go to the doctor?
The risk group of an umbilical infection includes infants. Therefore, parents or guardians in particular should initiate a visit to the doctor with their offspring if symptoms or irregularities occur. If strange and noticeable behavior of the newborn occurs, clarification by a physician is recommended. Weepiness, apathy or apathy are signs of an existing inconsistency. If feeding is refused, the body temperature rises or restlessness sets in, the infant needs medical help. In case of sleep disturbances, visual changes in the navel area, bleeding or swelling, consultation with a doctor is necessary. Redness of the skin around the navel or open wounds require medical attention. If the symptoms increase in extent or intensity, a visit to the doctor is required as soon as possible. In severe cases, there is a risk of sepsis and thus a life-threatening condition for the child. In poor hygienic conditions, the infant may die prematurely without medical treatment. Persistent exhaustion and malaise of the infant should be presented to a physician. If the infant barely responds to social interactions or other sensory stimuli in the environment, these are signs of an existing irregularity. Observations should be discussed with a physician so that clarification of the cause can occur and a treatment plan can be made to alleviate the symptoms.
Treatment and therapy
If the umbilical infection presents in the very early stages, local disinfectant measures can stop the inflammation. Typically, however, an umbilical infection requires hospitalization for about two weeks. A combination of antibiotics that fight the different types of bacteria involved is administered intravenously. Penicillin is often supplemented by aminoglycosides and agents effective against anaerobic germs. Due to the constant monitoring of vital functions possible in the hospital, the course of the infection can be closely monitored. Any complications are thus detected early and treated in time. In addition to antibiotic therapy, blood pressure stabilizing measures, ventilation and further steps to stabilize the general condition are often required. Possible complications of an umbilical infection also include abscesses (encapsulated foci of pus) or the death of skin and muscle tissue (necrosis) in the area around the umbilicus. In these cases, surgical interventions to remove foci of pus and necrotic tissue are urgently needed.
Outlook and prognosis
The prognosis for umbilical infection is very favorable. However, complications of the infection, if left untreated, result in mortality rates of 7% to 15%. The dreaded sepsis often occurs in about 4% of newborns who develop a localized form of omphalitis. The death rate in such cases is still very high despite current advances in modern medicine. In the case of sepsis, the mortality rate is 30% to 40% in normally born infants, whereas in premature infants the mortality rate is around 50% and more. This prognosis indicates the very high need for timely diagnosis of the disease. Omphalitis is a pathology that can be easily seen despite the rapid prevalence of inflammation.Therefore, mothers of affected children should already be able to diagnose it based on visual assessment of the belly button. The unforeseen diagnosis of the disease and the resulting delay in the treatment of omphalitis often lead to disability or even death of affected children. Therefore, above all, timely diagnosis and effective treatment has a very important significance. Consequences and complications occur when the bacteria migrate to the umbilical cord, which is a direct access to the blood flow. Thus, complications develop that significantly increase the risk of death.
Prevention
Umbilical hygiene measures can be effective in preventing umbilical infection. However, people are generally much more relaxed about navel care today than in previous generations. For example, it is generally no longer recommended to cover or bandage the umbilicus, nor is bathing discouraged. Silver powder or disinfectants are no longer part of normal navel care. It is important to keep the navel dry, airy, clean and free of urine and stool. The umbilical stump should only be touched with washed hands. If it is necessary to clean the umbilicus directly, sterile compresses moistened with water or alcohol are recommended.
Aftercare
As long as the umbilical infection has not completely healed, the diaper of infants should be closed slightly below the navel. Otherwise, there is a risk of the belly button becoming infected again through excretions. Similarly, adult sufferers should also wear clothing as loosely as possible. This is because covering would significantly delay the drying out and healing of the navel. If the belly button oozes, affected persons should apply some navel powder and keep the inflamed navel as dry as possible in this way. A special antibiotic navel powder can also be used. There are also air-permeable umbilical compresses available to keep the navel dry. The most important thing in follow-up care is to keep the belly button dry and, most importantly, to protect it from chafing. Creams or perfumed oils should never be used for aftercare navel care, because they would only irritate and soften the sensitive skin. If affected persons use a special powder for faster drying, all powder residues should be carefully removed from the inflamed navel once a day. This is best done with the help of a sterile compress previously soaked in diluted calendula essence. Any crusts should not be removed, otherwise there is a possibility of injuring the sensitive navel. If, despite careful aftercare, redness, wetness or even suppuration appears for a longer period of time, it is advised to consult a doctor.
What you can do yourself
If an umbilical infection has been detected, parents should first ensure strict personal hygiene in the child to prevent further spread of the infection. The doctor may prescribe suitable ointment, which parents can apply to the affected area. Accompanying this, close medical supervision is important. Parents should consult closely with the doctor and inform him of any complications. If the inflammation becomes more severe or other symptoms are added, for example fever or increasing malaise, it is best to visit the doctor’s office immediately. Further self-help measures focus on applying antibiotic and antiseptic ointments according to the doctor’s instructions. In addition, care should be taken to ensure that the child consumes sufficient fluids. If this is taken into account, a rapid recovery can be expected. Nevertheless, serious complications such as necrosis may develop in individual cases. Then the child must be treated surgically. After such an operation, rest and warmth in bed are important. In addition, the child should be checked for allergies so that unforeseen complications do not arise when painkillers and anti-inflammatory drugs are used.
