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Omphalitis 2

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  • Urachus : ibrous remnant of the allantois, a canal that drains the urinary bladder of the fetus that joins and runs within the umbilical cord

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  • 1. OMPHALITISBasel ZaidAlQuds School Of MedicinePediatric Course-Sixth Year
  • 2. Omphalitis “Case Hx” Pt ID : Mohammad .Y from Ramallah 7 days male Product of NVSD, full term, BWt 3.66 Kg. Fever since yesterday (38.5-39.5) C Umbilical yellowish discharge surrounded by erythema since yesterday. Hypoactivity in the past 2 days. (-) Vomiting, Diarrhea, Skin rash, Abnormal movements, Cyanosis, Cough or runny nose. Maternal UTI in the last week of pregnancy. Exclusively Breast fed Immun: 1st Dose Hep B + BCG
  • 3. Omphalitis (Case PE) Generally: Alert, mildly jaundice, NOT| in respiratory distress. No Signs of dehydration HR 126 RR 39 Temp 38.8 C Wt 3.67 Ht 52 HC 37 ENT : NL,, NO LAD No dysmorphic features Chest & Heart examination were NL ABD: soft, lax, NO Organomegaly.NL Genetalia. Extremity: No deformity, No Oedema Neuro Ex : NL, Normal Reflexes.
  • 4. Omphalitis (Case Follow Up) Working Diagnosis : 1- Omphalitis 2-Sepsis 3-LAD CBC,ESR,CRP urine analysis+ urine culture blood culture--- CSF analysis and Culture Umbilical swab culture RBS BUN, Cr, TSB ,,serum electrolytes. Take weight daily Observe v/s “HR,Temp” and BP Observe O2 sat to be more than 92% all the time. Feeding as tolerated
  • 5. Omphalitis (Case Follow Up)  Start on ATB : Oxacillin IV Q 6 hours+ Claforan IV Q 6 hours+ Fucidine cream topicallyWhite blood cells 20 Erythrocyte Sedimentation Rate 40Neutrophils granuloc% 58% C- Reactive Protein - CRP ++Lymphocytes% 25% AST (GOT) 12Red blood cells (RBC) --- ALT (GPT) 23Haemoglobin (HGB) 17.9 Creatinine, serum 0.2hematocrit (HCT) --- Urea 22Mean cell volume (MCV) 101 Random blood sugar (RBS) 96Mean cell haemoglobin (MCH) ----- Uric Acid --- Mean cell haemoglobinconcentration (MCHC) --- Bilirubin, Total 8Red blood cell distribution width ---- Alkaline phosphatase 295Platelets 385 CSF Analysis “total cells” 25Na 132 CSF WBC 20K 4.7 CSF sugar 49
  • 6. Introduction Omphalitis is an infection of the umbilical stump. It typically present as a superficial cellulitis i.e. as a red ‘flare’ in the periumbilical skin. The cellulitis may progress rapidly with potentially serious consequences including systemic disease e.t.c. Omphalitis is predominantly a disease of the Neonates.
  • 7. Epidemiology / Aetiology Internationally, overall incidence is < 1% Approximately 85% OF Cases are polymicrobial in origin. Aerobic bacteria present in 85% of infections predominated by Staphylococcus aureus, Group A Streptococcus, Escherichia coli, Klebsiella pneumoniae. Pseudomonas species have been implicated in particularly rapid or invasive disease.
  • 8. LAD (Leukocyte adhesion deficiency)• Omphalitis occasionally manifests from an underlying Immunologic disorder.• These infants are subsequently diagnosed with Leukocyte adhesion deficiency, a rare disorder with AR pattern of inheritance. These infants present with the following;• 1-Leukocytosis• 2- Delayed seperation of the umbilical cord• 3-recurrent infections.
  • 9. Clinical Features In term infant the, mean age at onset is 5-9 days. Patient present with redness and swelling (cellulitis) around the umbilicus. Purulent or mal odorous discharge from the umbilicus. Baby is highly irritable. The cellulitis is rapidly progressive and may lead to necrotizing fasciitis. Necrotizing fasciitis is characterized by abdominal distension, fever and tachycardia. Despite the illness, most of the neonates at presentation have good appetite and continue to suck.
  • 10. Management History- detailed history of the pregnancy, labour, delivery and neonatal course. Physical Examination Physical signs vary with the extent of the disease.  Local disease; signs of localized infection include the fllg  Purulent or mal odorous discharge from the umbilical stump  Periumbilical erythema  Edema  Tenderness  Extensive local disease; such as fasciitis or myonecrosis. These signs may suggest infection by both aerobic or anaerobic organisms.  Periumbilical ecchymosis  Crepitus  Bullae  Progression of cellulitis despite antimicrobial therapy
  • 11. Baby O.T.with extensive local disease& systemic disease
  • 12. Lab studies Obtain specimen from umbilical infection for Gram stain & culture for aerobic and anaerobic organisms. Blood culture for aerobic and anaerobic organisms. CBC RBS –hypoglycaemia Other non specific lab tests. None has demonstrated sensitivity or specificity sufficiently high to dictate clinical care. These are;  C-reactive protein level  Erythrocyte Sedimentation rate  Limulus lysate test, which detect endotoxin
  • 13. Treatment Treatment Medical Care Surgical CareAntimicrobial Supportive Steroids ?Therapy Care ?
  • 14. Antimicrobial therapy Parenteral antimicrobial coverage for gram - positive and gram – negative organisms. A combination of anti – Staphylococcal penicillin and an Aminoglycoside is recommended. Anaerobic coverage is important in all patients. As with anti microbial therapy, local antibiotic sensitivity patterns is considered. CLOXACILLIN + GENTAMICIN + FLAGYL ORCEPHALOSPORIN + GENTAMICIN +FLAGYL forms the usual antimicrobial combination.
  • 15. Surgical care Early surgery may be life saving. It involves early and complete surgical debridement of the affected tissues and muscle. Excision of pre peritoneal tissue ( umbilicus, umbilical vessels) is critically important in the eradication of infection. These tissues can harbour invasive bacteria and provide a route for progressive spread of infection.
  • 16. Prognosis The prognosis for most infants is variable. • In most cases prognosis is Poor. • Omphalitis with complications is associated with mortality rate up to 80% in developed countries. • In the less developed countries, mortality is > 95%
  • 17. Differential diagnosis Anterior abdominal wall cellulitis Neonatal septicaemia Burns Urachal cyst with 2º bacterial infection.
  • 18. THE ENDTHANK YOU .