An umbilical infection or omphalitis can cause very young infants. Left untreated, the infection can be life-threatening, so antibiotic therapy and hospital observation are almost always necessary. In countries with adequate hygiene standards and good medical care, umbilical infections are virtually eliminated in infant mortality.

What is an umbilical infection?

Navel infection or omphalitis in newborn infants is a bacterial inflammation of the umbilical stump remaining after transection of the umbilical cord and the surrounding tissue of the abdominal wall.

The complication of umbilical healing is often due to mixed infections with different types of bacteria that are part of the normal human bacterial flora. The skin types Staphylococcus aureus and Streptococcus and the intestinal bacteria Escherichia coli, Klebsiella pneumoniae and Proteus mirabilis are frequently involved in navel infections.

causes

Since the umbilical stump is still an open wound for several weeks after delivery, it is relatively easy for germs to enter, possibly triggering a navel infection. The germs usually come from the mother and get to the navel during delivery or in the following days.

The infant's immature immune system often can not 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, his body has hardly any experience with bacteria. Risk factors for an inflammation of the navel are a low birth weight, other infectious diseases such as pneumonia or existing sepsis, immune deficiency and poor general condition.

In normal weight, healthy infants, abnormally long births and previous complications such as placental infections are among the risk factors. An umbilical cord catheter used during neonatal treatment also increases the risk of developing a navel infection.

Symptoms, complaints & signs

An umbilical infection usually occurs immediately after birth. The disease can be recognized by the greasy purulent, usually reddened navel, which is 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.

The umbilicus can cause bleeding and swelling. As the infection progresses, the navel bulges forward and assumes a reddish-white color. When pus has formed, a cyst also develops. This can break up and lead to a carryover of the pathogens into the blood, which can lead to complications such as superinfections and sepsis.

Possible consequences of a navel infection are also peritonitis, abscesses in the gastrointestinal tract and bacterial thrombosis. In severe cases, liver abscesses or inflammations of the heart's lining are formed. Omphalitis is a life-threatening disease and, if left untreated, can lead to the death of the infant.

The 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 symptoms usually clear quickly.

Diagnosis & History

Even if slight redness and minor bleeding may be normal side effects of the umbilical healing: signs of an umbilical infection should be examined in any case, the pediatrician. The diagnosis of the umbilical infection is made by examining the navel.

Redness, bloody or purulent discharge, swelling, heat and protrusion of the navel are common symptoms of an incipient navel infection. In the advanced stage of navel inflammation, an extreme protrusion of the navel is often observed. Fever, accelerated heartbeat, low blood pressure and apathy occur.

Left untreated, the infection can rapidly enter the bloodstream, leading to sepsis and life-threatening bacterial infections of the organs. Peritonitis, liver abscesses, bacterial thromboses (vein occlusions) and endocarditis (inflammation of the heart's lining) can be extremely dangerous consequences of a navel infection.

complications

The umbilical infection is a life-threatening disease. For this reason, a treatment must be done in any case, because it usually does not come to a self-healing. In the worst case, the baby can die due to the umbilical infection. However, considering the standard of hygiene, death can be avoided.

At the belly button it comes with the affected one usually to strong redness or swelling. A secretion can also escape from the navel. The infection continues to spread throughout the body, usually causing a fever and an increased heart rate. Low blood pressure and respiratory problems can also occur due to the umbilical infection. Furthermore, it comes without treatment to damage to the liver and peritonitis.

Those affected can also develop heart disease and die from it. In most cases, relatives and parents also suffer from psychological distress or depression. The treatment of the umbilical infection usually takes place with the help of antibiotics and leads relatively quickly to a success. There are no complications.

When should you go to the doctor?

The risk group of an umbilical infection includes infants. Therefore, especially parents or guardians should initiate a visit to the doctor with the offspring in case of complaints or irregularities. If it comes to a strange and striking behavior of the newborn, a clarification by a doctor is recommended. Tearfulness, apathy or apathy are signs of an existing discrepancy. If food intake is denied, body temperature rises, or anxiety sets in, the infant needs medical help.

Sleep disorders, optical changes in the navel, bleeding or swelling require consultation with a physician. Redness of the skin at the navel or open wounds need medical treatment. If the symptoms increase in size or intensity, a doctor's visit is required as soon as possible. In severe cases, a sepsis and thus a life-threatening condition for the child threatens.

Under poor hygienic conditions, the premature death of the baby can occur without medical treatment. A prolonged fatigue and a malaise of the infant should be presented to a doctor. If the child hardly reacts to social interactions or other sensory stimuli of the environment, these are signs of an existing irregularity. The observations should be discussed with a doctor to clarify the cause and prepare a treatment plan to relieve the symptoms.

Treatment & Therapy

If the umbilical infection is present at a very early stage, local disinfecting measures can bring the inflammation to a standstill. Typically, an umbilical infection requires a hospital stay of about two weeks. A combination of antibiotics that combat the different types of bacteria involved is administered intravenously.

Penicillin is often supplemented by aminoglycosides and anti-anaerobic agents. Due to the continuous monitoring of life functions in the hospital, the course of the infection can be closely monitored. Possible complications are detected early and treated in good time.

In addition to antibiotic therapy, blood pressure stabilizing measures, ventilation and other steps to stabilize the general condition are often required. The possible complications of an umbilical infection include abscesses (encapsulated pus) or the death of skin and muscle tissue (necrosis) in the umbilical environment. In these cases surgical intervention to remove pus and necrotic tissue is urgently needed.

Outlook & Forecast

The prognosis for an umbilical infection is very favorable. However, complications of inflammation, if left untreated, lead to mortality rates of 7% to 15%. In about 4% of newborns who develop a localized form of omphalitis, dreaded sepsis often occurs. The death rate is still very high in such cases despite the advances of modern medicine today. In the case of sepsis, the mortality is 30% to 40% in normal-born children, whereas the mortality rate in premature babies is around 50% or more. This prognosis points to the very high demand for a timely diagnosis of the disease. Omphalitis is a pathology that can be well seen despite the rapid prevalence of inflammation. Therefore, it should also be able to be diagnosed by mothers of affected children on the basis of the visual assessment of the belly button.

The unforeseen diagnosis of the disease and the resulting delayed treatment of omphalitis often lead to disability or even death of affected children. Therefore, timely diagnosis and effective treatment are very important. Consequences and complications occur when the bacteria migrate to the umbilical cord, which is a direct access to blood flow. This leads to complications that significantly increase the risk of death.

prevention

Measures for navel hygiene can be effective against a navel infection. However, as a rule, the navel is much more relaxed today than in previous generations. For example, it is generally no longer recommended to cover or connect the navel, and bathing is no longer advised.

Silver powder or disinfectants are no longer part of normal umbilical care. It is important to keep the navel dry, airy, clean and free of urine and bowel movements. The umbilical stump should only be touched with washed hands. If it is necessary to clean the navel directly, it is recommended to use sterile water or alcohol-moistened compresses.

aftercare

As long as the umbilical infection is not completely healed, the diaper should be closed just below the navel in infants. Otherwise there is a risk that the navel will become infected again by excreta. Similarly, adults should wear the clothes as loosely as possible.

For a cover would significantly delay the drying and healing of the navel. If the navel is wet, sufferers should use some umbilical powder and keep the inflamed navel as dry as possible. Also, a special antibiotic navel powder can be used. There are also air permeable navel compresses that keep the navel dry.

The most important thing in the aftercare is that the navel remains dry and is especially protected against chafing. Creams or perfumed oils should never be used for post-operative care because they only irritate and soften sensitive skin. If you use a special powder for faster dehydration, you should carefully remove all powder residues once a day from the inflamed navel.

This is best done with the help of a sterile compress, which was previously soaked in diluted calendula essence. Any crusts should not be removed, otherwise there is the possibility of injuring the sensitive navel. If, despite careful follow-up, redness, moisture or even suppuration persist for a longer time, it is advisable to see a doctor.

You can do that yourself

If an umbilical infection has been identified, parents should first pay attention to strict child hygiene in order to prevent further spread of the inflammation. The doctor may prescribe appropriate ointment that parents can apply to the affected area.

Accompanying this is a close medical supervision important. The parents should consult the doctor closely and inform him of any complications. If the inflammation becomes stronger or if additional symptoms occur, for example, a fever or an increasing malaise, it is best to go to the doctor's office immediately. The other self-help measures focus on applying the antibiotic and antiseptic ointments according to the doctor's instructions. In addition, care should be taken that the child drinks enough liquid. If this is taken into account, a speedy recovery is expected.

Nevertheless, serious complications such as necrosis may develop in isolated cases. Then the child has to be treated surgically. After such an intervention, protection and bed warmth are important. In addition, the child should be examined for allergies so that there are no unforeseen complications when using analgesics and anti-inflammatories.

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