NEONATAL OMPHALITIS: PREVENTION, DIAGNOSIS, AND TREATMENT

Objective. To generalize the experience with the dry remaining umbilical stub management procedure recommended by the WHO and to analyze the efficiency of the prevention, diagnosis, and treatment of neonatal omphalitis. Material and methods. A population study — a retrospective analysis of 2527 case histories of the neonatal infants treated in the newborn and premature infant pathology unit (NPIPU) of a third-level obstetrical facility in the Central Federal District of the Russian Federation in 2006—2010 — was made. A total of 1833 case histories of patients with infectious and inflammatory diseases (sepsis, congenital and acquired pneumonia, omphalitis, rhinitis, conjunctivitis, vesiculosis, and enterocolitis) were selected using the elaborated audit model for the above neonatal diseases. The trend of infectious and inflammatory diseases, including omphalitis, in the structure of morbidity in the NPIPU patients and the frequency of antibacterial therapy were investigated. Results. The umbilical cord was clamped a minute after birth; a Kocher clamp was applied to the umbilical cord at a distance of 10 cm from the umbilical ring; another Kocher clamp was placed on the umbilical cord as close to the parturient’s external genitals as possible; the third clamp was put 2 cm outside from the first one; the umbilical portion between the f irst and third Kocher clamps was wiped with a 95% ethyl alcohol-soaked gauze ball and cut across with a sterile scissors. For secondary treatment of the umbilical cord, the investigators used a disposal plastic clamp that was applied to the remaining umbilical stub; the optimal distance from the belly skin to the clamp being 2—3 cm. Application of the clamp too close to the skin might cause skin roughness of the umbilical ring. After clamping, the remaining umbilical cord was cut off above the clamp, rubbed off blood, and treated with 95% alcohol. A plastic clamp was applied to the remaining umbilical stub after putting the baby to the breast for the first time. For declamping, the authors used special forceps that failed to injure the remaining umbilical stub and enabled, if required, vein catheterization. Thereafter the umbilical stump is subject to natural mummification and spontaneous detachment within 2 weeks. Final epithelization of an umbilical wound occurs within 3—4 weeks after birth. Daily examination of the umbilical stump reveals the steps of natural umbilical separation: the remaining umbilical stump dries, shrivels, becomes thicker and dark brown, and falls off. After the umbilical cord falls off, the bottom of the belly button is epithelized. If there is purulent discharge, the umbilical wound should be treated with 3% hydrogen peroxide and then 5% potassium permanganate or aqueous solutions of aniline dyes (1—2% aqueous brilliant green or 10% aqueous methylene blue) and thereafter covered with a 5—10% hypertonic saline dressing. Antiseptic ointments (levosin, levomicol, 5% syntomycin emulsion, bactroban, bepanthene plus) may be used during topical treatment. Phlegmonous omphalitis requires surgery, antibacterial therapy, and intravenous immunoglobulins A, M, and G (pentaglobin). The necrotic form needs surgical intervention (the necrotic tissues are excised to the border of the intact skin), massive antibiotic therapy, disintoxication therapy, and intravenous globulins. Conclusion. The proposed algorithm for the diagnosis and treatment of omphalitis has been introduced since 2009. The analysis of the pattern of infectious and inflammatory diseases notified in 2006—2011 has established a reduction in the proportion of omphalitis from 31.1 to 3.0% despite the fact that there were increases in the total number of infants admitted to the unit and in the proportion of premature neonates among all the children admitted to the unit in the past three years. Since 2009, the unit has been continuously auditing neonatal infectious and inflammatory diseases, allowing reductions in the hyperdiagnostic rate of infectious and inflammatory diseases and in the number of infants receiving antibacterial therapy.

umbilical cord, umbilical stump, umbilical wound, omphalitis, neonatal infant