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Major complications of omphalitis in neonates and infants
Emmanuel A Ameh1, Paul T Nmadu
1Paediatric Surgery Unit, Department of Surgery, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria. ameh@abu.edu.ng
Insights
Omphalitis in infants can lead to severe surgical complications like evisceration and necrotizing fasciitis. Prompt recognition and treatment are crucial for improving outcomes and reducing mortality in these neonates.
Area of Science:
- Pediatric Surgery
- Neonatal Infections
- Infectious Diseases
Background:
- Omphalitis is a frequent neonatal infection in developing nations.
- Complications of omphalitis often necessitate surgical intervention.
- This study examines severe omphalitis complications in infants.
Purpose of the Study:
- To review major surgical complications arising from omphalitis in neonates and infants.
- To analyze the clinical presentation, management, and outcomes of these complications.
- To emphasize the importance of early diagnosis and treatment.
Main Methods:
- Retrospective review of 19 neonates and infants treated for major omphalitis complications.
- Data collected included patient demographics, clinical presentation, causative organisms, treatments, and outcomes.
- Analysis of surgical interventions and antibiotic therapy.
Main Results:
- Common complications included spontaneous small bowel evisceration (26%), necrotizing fasciitis (26%), peritonitis (16%), and hepatic abscesses (11%).
- Surgical management involved repair, debridement, drainage, and lavage.
- One patient died from peritonitis; no deaths occurred from necrotizing fasciitis.
Conclusions:
- Severe surgical complications from omphalitis pose significant risks to neonates and infants.
- Early recognition and prompt, aggressive treatment are essential for favorable outcomes.
- Effective management strategies can reduce morbidity and mortality associated with omphalitis complications.
Abstract:
Omphalitis is a common problem in developing countries, and a wide range of complications requiring surgery may occur. We conducted a retrospective review of 19 neonates and infants treated for major complications of omphalitis: 13 boys and 6 girls aged 5-75 days (median 33 days). Five (26%) patients presented with spontaneous evisceration of small bowel through the umbilical cicatrix, resulting in intestinal gangrene in 1. Necrotizing fasciitis (NF) occurred in 5 (26%) patients involving mainly the scrotum, and in 2 involving the penis as well. Three (16%) patients had peritonitis, resulting in intra-abdominal abscesses in 2. Three (16%) had superficial abscesses, 2 (11%) had hepatic abscesses resulting in extensive destruction of the left lobe in 1, and 1 (5%) developed an adhesive intestinal obstruction. Although Staphylococcus aureus was the most commonly cultured organism, many cultures were sterile due to the use of antibiotics before presentation. Treatments consisted of repair of the umbilical cicatrix for evisceration (and intestinal resection for gangrene), radical debridement for NF, drainage and lavage for peritonitis, drainage of superficial abscesses, and lysis of adhesions. Broad-spectrum antibiotics were also given. No patient developed tetanus. One patient died from peritonitis. There was no death from NF. As serious complications may result from omphalitis in neonates and infants, with high morbidity and possible mortality, early recognition and prompt treatment are necessary for a good outcome.