Umbilical Cord Infection in Newborns

Umbilical cord is responsible for providing essential nutrients and oxygen supply to the developing fetus in the mother's womb. The utility of birth cord is only till the baby is inside the mother's womb. After delivery, the baby no longer requires it, hence, is snipped off. Gradually, the cord dries out, turns black and gets detached from the newborn. But in some cases, the umbilical cord stump develops infection which requires medical intervention. The incidence of omphalitis or umbilical cord infection in newborns ranges between 0.2-0.7% in industrialized nations with good medical facilities. It affects premature babies more than full-term neonates and is not dependent on the sex of the baby. However, male babies may be more prone to it than female babies. The main cause behind omphalitis is a mixture of anaerobic and aerobic microorganisms.

Umbilical Cord Infection

Associated Symptoms

• Fever
• Pus secretion
• Foul-smelling discharge
• Bleeding from the umbilical area
• Redness and swelling around the cord

Diagnostic Procedures

Lab Tests
Specimens are collected from the infected area and are tested to determine the presence of aerobic and anaerobic microorganisms. A blood culture is also obtained to perform diagnostic tests. Complete Blood Count (CBC) is obtained to check for the presence of neutrophilia, neutropenia, and thrombocytopenia in acute cord infections. Tests like peripheral blood smear, fibrinogen split products, prothrombin time, fibrinogen, and activated partial thromboplastin time are conducted for neonates suspected to have disseminated intravascular coagulation and sepsis.

Imaging Tests
Studies like ultrasonography, CT scan, and radiography of the abdomen are conducted to reveal fascial involvement and intra-abdominal wall gas. CT scan and ultrasonography are two imaging techniques which help in detecting anatomic abnormalities in the baby, if present.

Treatment Provided

Antimicrobial Therapy
Doctors prescribe antistaphylococcal penicillin and an aminoglycoside antibiotic to treat this infection. The drugs are given through parenteral administration to cover Gram-positive and Gram-negative microorganisms. Aggressive treatment approach is used for cases with myonecrosis, wherein anaerobic coverage becomes important. Topical application of bacitracin and other antimicrobials are also suggested along with parenteral treatment, although, its effectiveness is not yet proven.

Additional Care
Extreme care is essential to support survival of the newborn. Infants should be admitted in hospitals which can support cardiopulmonary function and provide supplementary oxygen and ventilation. Provision to administer vasoactive agents and/or fluids must be available to control hypotension.

After treating the newborn with antimicrobial therapy, careful monitoring is required. If the redness around the umbilical cord stump reduces within one day after treatment, it means the baby is responding well to the treatment. If any improvement is not observed within the set time period, it may indicate progression of disease in the baby which would require additional therapeutic treatments.

Surgical Procedures
Surgery is carried out on affected tissue or muscle to manage conditions like myonecrosis and necrotizing fasciitis. Surgery is carried out as early as possible to prevent further tissue damage due to spread of necrosis. Doctors may need to carry out many surgeries for complete removal of damaged tissue.

Preventive Measures

• Keep the stump clean by simply washing it with soap and water, and then dry it using an absorbent soft towel. Change nappies immediately to maintain dryness.
• Do not bathe the infant till the umbilical cord stump falls off. Till then, it is safe to give sponge bath to the baby.
• Let the cord dry out completely and fall off on its own. Do not try to detach it from the baby's body even if it is slightly attached.
• Fold the diaper to avoid covering of the umbilical cord stump.
• Encourage early and regular breastfeeding so that the baby develops antibodies to fight against infection-causing microorganisms.

Umbilical cord usually comes out with the baby during delivery. In some cases, the baby has umbilical cord around the neck at birth and this is considered dangerous by parents. However, this event is observed in almost one-third of births and is not a reason to worry. The cord is snipped off carefully and is removed from the baby's neck. Omphalitis occurs only when parents fail to take proper care of the umbilical stump. Therefore, parent education about cord care should be carried out so that they are capable enough of taking care of their baby's cord and protect it from developing acute or chronic umbilical infection.