Umbilical Cord Infection: Causes, Signs, Risks And Treatment

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Umbilical cord infection, umbilical stump infection, or omphalitis is a bacterial infection in babies. It affects the umbilical stump and happens if it is not managed properly. This infection is a medical emergency as the bacteria easily spreads around the navel. Nearly one in 200 newborns are affected by omphalitis (1).

Omphalitis presents itself through superficial cellulitis (bacterial skin infection). An untreated stump infection may spread to the entire abdominal wall, leading to sepsis or other life-threatening conditions.

Read on to know more about umbilical stump infection in babies, its causes, risk factors, symptoms, treatment, and prevention.

Causes Of Omphalitis

Umbilical cord infection can be caused by anaerobic and aerobic bacteriaⁱXA type of bacteria that requires oxygen to grow and survive.  (2). An umbilical stump is a wound where the tissue undergoes devitalization (necrosis), making it a suitable medium for bacterial growth. Bacteria from the skin can invade the stump and cause omphalitis (3).

Group B streptococci, S.aureus, Klebsiella, and E.coli are common microorganisms causing umbilical cord infections. Umbilical stumps can also get contaminated with C.tetani, especially in the first three days of life.

Sometimes, omphalitis can be the initial presentation of neutrophilⁱXA type of white blood cell produced in the bone marrow that is essential for the immunity. disorders such as congenital neutropeniaⁱXA birth disorder characterized by insufficient levels of neutrophils required for immunity. and neonatal alloimmune neutropeniaⁱXA lethal disorder where maternal antibodies attack the fetus’ neutrophil cells. in babies. In such cases, neonates may also develop sepsis, meningitis, pneumonia, and cutaneous infections along with omphalitis.

Did you know?

In some cultures, cow dung application is done on the baby’s umbilicus. There is no scientific research to establish its efficacy or safety. The practice may lead to omphalitis in babies (2).

Risk Factors For Omphalitis In Babies

The following factors may increase the risk for umbilical cord infection in babies (2).

• Premature rupture of membranes
• Umbilical cord catheterization
• Septic delivery (non-sterile delivery) and maternal infections
• Low birth weight

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The following anatomical abnormalities can also increase the risk for omphalitis in neonates:

• Patent urachus is the remnant of the channel between the belly button (umbilicus) and bladder
• A urachal cyst is a sac-like tissue in the urachus that connects the umbilical cord and bladder
• Omphalomesenteric duct remnants

The application of unhygienic cord-cutting or clamping practices and the use of non-sterile instruments could increase the risk of cord infection in babies. The risk for cord infection reduces as the umbilical wound heals and the stump falls off.

Quick fact

Prolonged labor and home birth can also increase the risk of omphalitis in babies (2).

Signs And Symptoms Of Omphalitis

The following signs and symptoms may indicate umbilical cord infection in babies (1).

• Bleeding from the umbilical stump
• Erythema (red skin) around the navel
• Small bleeding or drops of blood leaking from the umbilical stump
• Blisters, sores, or pimples near the umbilical area
• Umbilical stump is not dry and clean even after following cord care measures for three or more days
• The cord is not fallen off beyond six weeks
• Pieces of red tissue are visible inside the navel
• Pus or cloudy discharge from the umbilicus
• Foul-smelling yellow discharge
• Inflammation and tenderness in the umbilical area

Serious infections can cause systemic signs that require immediate medical care (1).

• Fever

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• Lethargy
• Poor or refusal to feeding
• Poor muscle tone (floppiness)

Do not give any fever medications to newborns without a prescription. Fever in the neonatal period should be treated with prescribed medicines only.

How To Prevent Omphalitis?

Appropriate umbilical cord stump care before and after it falls off helps prevent omphalitis in many cases.. The first thing you should do in cord care is never to remove the cord with your hands. Let it fall on its own, even if it is about to fall. Ensure proper hygiene and clean your hands with soap and water before touching the umbilical area of your newborn.

The following tips are usually recommended for cord care (4).

1. Clean the umbilical area: You may gently clean the umbilical area twice a day. Rubbing with alcohol is not recommended by many experts since it may interfere with healing. You may use a wet cotton swab or moist cloth to clean the belly button. Secretions may ooze from the umbilicus for several days after the cord falls off. Clear and blood-tinged secretions are normal, and it stops eventually. 

2. Apply antibiotic ointment: Antibiotic ointments are recommended if pus is present. You may apply very little antibiotic ointment in the navel area after cleaning as per doctors’ recommendations. 

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3. Avoid tub baths: Avoid soaking the baby in bathwater or tub baths until the cord falls off and heals well. You may wipe your baby with a moist cloth or sponge. Avoid the use of talc or other baby powders on the cord after cleaning your baby. 

4. Fold diapers: Tie the diapers below the belly button and fold the elastic if required to allow air circulation. This may also help prevent skin irritation from wet or soiled diapers.

5. Avoid tight clothing: Avoid tight clothing across the umbilical cord. Loose-fitting baby clothes made of breathable materials help to maintain air circulation in the umbilical area. This also allows the stump to fall off naturally.

Usually, the discharge and pus in the umbilicus disappear within two to three days of treatment. The navel area becomes dry and healed within a week in most babies. You may seek medical care if the umbilical healing is prolonged after the stump falls off.

When To See A Doctor?

Seek medical care if your baby has any symptoms of umbilical cord infection. Immediate medical care is needed if the baby has umbilical bleeding for more than ten minutes. Bleeding for shorter durations that occurs for more than three days also requires medical care (1).

Never hesitate to talk to the healthcare provider if your newborn looks ill or you are concerned that the child needs to be evaluated. You may also contact the doctor during office hours to clarify any queries and to know about umbilical cord care.

Diagnosis Of Omphalitis

After physical examination, the following tests are ordered for suspected omphalitis cases (2).

• Laboratory tests including complete blood count and culture are ordered for all babies with suspected omphalitis
• Culture of purulent discharge from the umbilical stump is often obtained before initiating treatment

Complete neonatal septic workup is required for babies with systemic symptoms. This may include:

• Chest X-ray
• Urinalysis
• Urine culture

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• Cerebrospinal fluid culture

Detailed blood counts and blood tests are done since omphalitisis closely linked to leukocyte adhesion disordersⁱXA rare hereditary immune disorder that causes failure of the immune system cells to heal an infection or tissue injury. (LAD). Usually, leukocytes should migrate to the umbilical stump and fight infections. Thus, it is essential to look for any defects or inability in immune functions in babies with umbilical cord infections.

Treatment For Umbilical Cord Infection

Treatment for omphalitis usually begins with broad-spectrum antibiotics to cover both gram-positive and gram-negative bacteria. Any of the following antibiotics are given according to the cause (2).

• Aminoglycosides and antistaphylococcal penicillin is prescribed for initial treatment
• Vancomycin is used for methicillin-resistant staphylococcus aureus (MRSA) infection
• Metronidazole or clindamycin is given to treat anaerobic bacteriaⁱXA type of bacteria that does not require oxygen to grow and may die upon exposure. if the baby has foul-smelling umbilical discharge.

The duration and dose of antibiotic therapy may depend on clinical response and complications. Uncomplicated omphalitis is usually treated with parenteral (IV) antibiotics for ten days and switched to oral therapy. Doctors may switch parenteral therapy to oral therapy based on culture results and improvement.

Complications Of Umbilical Cord Infection

Sepsis is the most common complication of cord infection. If left untreated, sepsis can lead to septic shock and death. Other rare complications may include (2):

• PeritonitisⁱXAn inflammation of the inner lining of the belly, the peritoneum, due to infection, surgery, or underlying condition.
• Liver abscess
• Intestinal gangrene
• Septic umbilical arteritis
• Portal vein thrombosis
• Small bowel evisceration
• Necrotizing fasciitis

Necrotizing fasciitisⁱXA rare fatal bacterial infection from a bite, cut, or wound, causing pain, fever, diarrhea, and dizziness. with omphalitis has been associated with mortality. Rapid progression of cord infection, systemic toxicity signs, and no clinical improvement for 24 to 48 hours despite intravenous antibiotic administration are common indications of necrotizing fasciitis in babies with omphalitis. Doctors may recommend prompt surgical care for debridementⁱXA removal process of damaged tissues while treating a wound. of umbilical structures in such cases.

How Long Does It Take To Recover?

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Babies with uncomplicated omphalitis usually have favorable outcomes. Most babies recover within a couple of weeks of antibiotic therapy if it is initiated in the early stages of cord infection. Hospitalization is required until intravenous medications are needed.

There is a 7-15%mortality rate in babies who develop complications other than necrotizing fasciitis. Babies with necrotizing fasciitis or omphalitis may have a higher risk for mortality of about 38 to 87%. Although prematurity, low birth weight, and septic delivery increase the risk for poor prognosis, the data is limited regarding the role of these factors in the mortality rate (2).

Infographic: What Factors Increase The Risk Of Omphalitis?

Umbilical cord infection or omphalitis is a bacterial infection in babies for several reasons, including improper management or handling of the umbilical cord. Check out the infographic below to learn about the factors that increase the risk of omphalitis in babies.

Illustration: Momjunction Design Team

Learn about the signs and symptoms of potential umbilical cord infection in babies from a medical expert and know when to seek medical attention

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Dr. Neema ShresthaMD

Dr. Neema Shrestha is a pediatrician with a special interest in the field of neonatology. She has an overall experience of five years working in the field. Currently working in Kathmandu, Nepal, she completed her MBBS from Kasturba Medical College, Manipal in 2008, Diploma in Child Health from D.Y. Patil University in 2011, MD from Nepal Medical College in 2015...more

Dr Bisny T. JosephMedical Doctor

Dr. Bisny T. Joseph is a Georgian Board-certified physician. She has completed her professional graduate degree as a medical doctor from Tbilisi State Medical University, Georgia. She has around 5 years of experience in various sectors of medical affairs as a physician, medical reviewer, medical writer, health coach, and Q&A expert. Her interest in digital medical education and patient education...more

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Rohit Garoo is a writer-turned-editor with over 9 years of experience in content writing, editing, and content marketing. He did his bachelors in Science at St. Xavier's College, Hyderabad, and masters in Business Administration at Osmania University. Also, he holds a certificate in Developmental Psychology from The University of Queensland and loves to expand his knowledge through certifications in various...more

Vidya TadapatriMSc (Biotechnology)

Vidya did her post-graduation in Biotechnology from Osmania University, Hyderabad. Her interest in scientific research and writing made her pursue a career in writing, in which she now has over five years of experience. She has done certified biotechnology-related training programs under renowned organizations such as Centre For Cellular & Molecular Biology and Department of Biotechnology. Vidya writes health-based articles...more