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Antecedentes: la persistencia del uraco es una patología poco frecuente. Su diagnóstico y tratamiento oportuno puede impactar en el pronóstico. Reporte de caso: recién nacido a término de 8 días, antecedente de quiste de cordón umbilical, que consulta por cuadro onfalitis, se inició manejo antimicrobiano, se realizó ecografía abdominal evidenciándose imagen compatible con persistencia del uraco. Fue llevada a cirugía con adecuada evolución clínica y completó cubrimiento antibiótico para Klebsiella pneumoniae y Staphylococcus aureus de manera favorable. Conclusión: La persistencia del uraco es una patología poco frecuente que requiere un manejo multidisciplinar para iniciar un tratamiento de manera oportuna. Los quistes de cordón umbilical y la onfalitis están asociados a la persistencia del uraco.

Umbilical cord stump infection (omphalitis) is a risk factor for neonatal sepsis and death. We assessed the incidence of omphalitis, described the bacteriological and antibiotic-resistance profile of potentially pathogenic bacteria isolated from the umbilical cord stump of omphalitis cases, and evaluated whether bacteria present in the birth canal during birth predicted omphalitis. We enrolled 769 neonates at birth at three primary healthcare facilities and followed them for 28 days with scheduled visits on days 3, 7, 14, and 28. Cox regression models were used to estimate the rates of omphalitis associated with potential risk factors. Sixty-five (8.5%) neonates developed omphalitis, with an estimated incidence of 0.095 cases per 28 child-days (95% CI 0.073, 0.12). Potentially pathogenic bacteria were isolated from the cord stump area of 41 (63.1%) of the 65 neonates with omphalitis, and the most commonly isolated species were Escherichia coli (n = 18), Klebsiella pneumoniae (n = 10), Citrobacter freundii (n = 5), and Enterobacter spp. (n = 4). The Enterobacteriaceace isolates were resistant to gentamicin (10.5%, 4/38), ampicillin (86.8%, 33/38), and ceftriaxone (13.2%, 5/38). Delayed initiation of breastfeeding was associated with an increased risk of omphalitis (aHR 3.1; 95% CI 1.3, 7.3); however, vaginal colonization with potentially pathogenic bacteria did not predict omphalitis.

Background: Umbilical cord stump is a budding point for bacterial colonization subsequently leading to sepsis that contributes to high neonatal morbidity and mortality, if not properly managed. Antiseptic care can significantly reduce omphalitis and ultimately improve newborn survival. Objective of this study was to see the efficacy of 4% chlorhexidine use to prevent umbilical cord infection in neonates.Subjects and methods: It was a comparative analytical study conducted in Neonatal unit, Sir Ganga Ram Hospital (SGRH) Lahore from July, 2016 till January, 2017. One hundred neonates were enrolled and randomized into two equal group by simple random method (50 each). In one group, nothing was applied to cord while in chlorhexidine group, 4% chlorhexidine gel was applied on umbilicus and around it, once daily for 7 days or till cord detached whichever came early. First application was done by a nurse followed by duly trained mother/caregiver. The signs of omphalitis (redness, pus or localized oedema) were observed and recorded for each neonate in both groups. Chi square test was used to see the difference in omphalitis in these groups with p˂ 0.05 considered as statistically significant result.Results: Out of 100 neonates, 29 (58%) and 23 (46%) males while 21 (42%) and 27 (54%) females neonates belonged to dry care and chlorhexidine group respectively. Nineteen (38%) neonates with dry cord had omphalitis compared to only 5 (10%) in chlorhexidine group (p 0.001). Neonates with chlorhexidine application showed prolonged mean cord separation time (7.9±1.5 days) compared to dry care (6.1±1.8 days). Conclusion: The use of 4% Chlorhexidine was effective to lower omphalitis compared to neonates with dry cord care.

Umbilical lesions (omphalitis, onfalaoflebitis, omphaloarteritis, uracus fistula and hernia umbilicalis), which cause significant economic losses in ruminants, are quite common. In this study, abscess foci developed in various organs and tissues belonging to approximately 15 days old lamb that died in a sheep herd were macroscopically observed. In the necropsy evaluation, it was found that inflammation and abscess starting from the umbilical cord spread to the liver and peritoneum. According to the results of the examination, a diagnosis of onphalaophlebitis was made and the results were discussed.

Background. Newborn infections remain a major cause of morbidity and mortality among neonates in low-income countries. Clinical diagnosis for omphalitis in such settings is possible but this does not depict the microbiological characteristics of the involved organisms, and clinicians have often prescribed empirical antibiotics in neonates with omphalitis, despite an increasing burden of antibiotic resistance. Methods. A hospital-based cross-sectional study was conducted to evaluate the bacteriology and antibiotic susceptibility patterns among neonates diagnosed with omphalitis at the special care baby unit (SCBU) of Kampala International University-Teaching Hospital (KIU-TH), western Uganda from March to June 2019. Sixty-five (65) neonates with a clinical diagnosis of omphalitis were consecutively recruited in the study. Cord swabs were taken under sterile (aseptic) precautions from all neonates, and antibiotic susceptibility tests performed using the Kirby Bauer disk diffusion technique with commercially available antibiotics disks of ampicillin, cloxacillin, gentamicin, amikacin, cefotaxime, ceftriaxone, vancomycin, and imipenem on Mueller Hinton agar plates. The data was analyzed using STATA version 13.0, frequencies and proportions used to describe the variables. Results. Fifty-five, 55 (84.6%), neonates with suspected omphalitis had positive cord swab culture. Staphylococcal aureus (58.2%) was the commonest cause of omphalitis followed by Neisseria spp (16.4%), E. coli 6 (10.9%), Proteus spp (5.5%), Klebsiella spp (3.6%), Citrobacter spp (3.6%), and Haemophilus spp (1.8%) in decreasing frequency. Isolates were resistant to ampicillin (87.7%), gentamicin (54.4%), and cloxacillin (34.4%), the drugs recommended for use in neonates with suspected omphalitis. Conclusions. Staphylococcal aureus is still the predominant cause of omphalitis among neonates. There was high resistance to the commonly used antibiotics in the treatment of omphalitis among newborns. This study reemphasizes that clinicians should do cord swabbing for both culture and susceptibility tests among newborns with suspected omphalitis before initiation of antibiotics.

Background Infections contribute to 30% of the 2.5 million neonatal deaths that occur globally every year. A newly cut umbilical cord can be a pathway for bacteria to enter the vulnerable neonate and cause neonatal sepsis. Most infections are preventable with evidenced-based cord care. Objective To assess postnatal mothers’ knowledge and practice of umbilical cord care in the Kibungo Hospital catchment area in Rwanda. Methodology A descriptive cross-sectional study design and purposive sampling strategy was used to recruit 224 postnatal mothers. Data were collected using a structured questionnaire. Descriptive and inferential statistics were used to analyze data. Results A third of mothers (33%) had adequate knowledge, and a half (54%) had good umbilical cord care practice. The majority (70%) reported dry cord care practice, though many applied substances including Vaseline (23%) and Movit ointment (15%). There was a negative correlation between knowledge of cord care and substance applied to cord (R2=0.224, p=0.001), and days applied (R2=0.167, p=0.012). Conclusion The study population had low cord care knowledge. Health care providers need to educate mothers on the practice of allowing the cord to dry naturally, and discourage the use of harmful substances that delay cord separation and increase risk of sepsis and subsequent neonatal mortality. Rwanda J Med Health Sci 2020;3(2):167-180

Background: Omphalitis is a neonatal infection resulting from unhygienic care of the umbilical cord.In 2014, the World Health Organization issued a new recommendation; the application Of daily Chlorhexidine gel to the umbilical stump. The aim of this study was to determine cord care practices common amongst mothers in Makurdi Local Government area of Benue State in North Central Nigeria. Methodology: The study was a cross-sectional study carried out at the well-baby Immunization Clinic of the Benue State University Teaching hospital (BSUTH) and the Immunization Clinic at the Epidemiology unit of the Benue State Ministry of Health both in Makurdi Local Government area of Benue State from April to July 2018.Subjects were mothers presenting with their babies at these clinics during the study period. Information was collected using a structured intervieweradministered questionnaire. Results: Three hundred and ninetyeight mother-infant pairs participated in this study. Of the infants the males were 205 (51.5%) while the females were 193 (48.5%); they were aged 1-16 days with mean age of 4.29±2.37 days. Two hundred and seventy-two (68.3%) mothers had their babies’ cords cleaned with methylated spirit alone while 11 (2.8%) cleaned with methylated spirit and another substance. The commonest substance applied to cord after cleaning was Vaseline 58(14.6%). Conclusion: The use of methylated spirit for cord care is high among mothers in Makurdi, the uptake of Chlorhexidine as recommended by WHO is significantly very low and this calls for more concerted efforts in educating mothers about the use of Chlorhexidine for cord care. Key words: Chlorhexidine, Cord care, Mothers, Newborn, Practices

Background; Omphalitis (umbilical cord infection) among new-borns is common and a major cause of neonatal deaths in developing countries. Annually, about 4 million neonatal deaths occur around the world. Of these, >30% are caused by infections that mainly from umbilical cord. Cord care practices may directly contribute neonatal infections, largely contributing tothis was part data from a larger randomized trial among 540 participant’s neonatal deaths. Cord infections are more prevalent in developing countries because of the high rates of poverty and unhygienic practices. Objective: To determine the predictors of omphalitis among neonates in Nakuru County Hospital, Kenya. Methodology This was part data from a larger randomized trial among 540 participants. Findings: The prevalence of Omphalitis was 23.1. Babies whose mothers’ did not wash hands when eating had 2.14 times risk of developing cord infection compared to those babies whose mothers’ indicated otherwise [AOR=2.14; 95%CI=1.28 - 3.57; p=0.004]. Likewise, babies whose mothers’ never folded diapers backwards were twice likely over those who did to develop cord infection [AOR=1.88; 95%CI=1.03 - 3.44; p=0.039]. Babies whose mothers’ stayed in different rooms had 7.35 times risk of developing cord infection [AOR=7.35; 95%CI=3.40 - 15.91; p

Background: Umbilical cord infection (omphalitis) is a major cause of neonatal mortality and morbidity in a developing country like Nepal. Detached umbilical stump is an important colonizing site for different types of bacteria and it also provides direct access to bloodstream. Hence, inadequate cord care may lead to omphalitis as well as neonatal sepsis. Objectives: This study aims to compare two different cord care regimens (dry cord care versus chlorhexidine cord care) on their cord separation time and the incidence of omphalitis. Methodology: This is a comparative observational study conducted at the Neonatal unit of Kathmandu Medical College over a three months period (August 2019 to October 2019). All newborn babies born between 37 to 42 weeks of gestation were enrolled. Randomization for dry cord care and chlorhexidine cord care group was done via computer generated numbers. Statistical package for social sciences 19 version was used for statistical analysis. Results: Among 514 term babies, 256 babies were included in the dry cord care group while 258 babies were enrolled in the chlorhexidine cord care group. The two groups had similar baseline characteristics. The mean cord separation time in the dry cord care group was 7.70±1.2 days (range 3-15 days), whereas in the chlorhexidine group, it was 7.77±1.4 days (range 4-18 days). Conclusion: There was no significant difference between the cord separation times in dry and chlorhexidine cord care regimens. Both dry cord care and chlorhexidine cord care regimens were found to be safe and effective.

Lotus birth, or umbilical nonseverance, is the practice wherein the umbilical cord is not separated from the placenta after birth, but allowed instead to dry and fall off on its own. Lotus birth may result in neonatal omphalitis. This article describes the history and rationale for lotus birth as well as the etiology, incidence, clinical presentation, and management of neonatal omphalitis. Recommendations for educating families how to perform lotus birth safely are presented. Additionally, signs and symptoms that warrant newborn assessment and treatment are reviewed.

Background Omphalitis is an important contributor to neonatal mortality in Kenya. Chlorhexidine digluconate 7.1 % w/w (CHX; equivalent to 4 % w/w chlorhexidine) was identified as a life-saving commodity for newborn cord care by the United Nations and is included on World Health Organization and Kenyan Essential Medicines Lists. This pilot study assessed the potential resource savings and breakeven price of implementing CHX for neonatal umbilical cord care versus dry cord care (DCC) in Kenya. Methods We employed a cost-consequence model in a Kenyan birth cohort. Firstly, the number of omphalitis cases and cases avoided by healthcare sector were estimated. Incidence rates and treatment effect inputs were calculated from a Cochrane meta-analysis of randomised clinical trials (RCTs) (base case) and 2 other RCTs. Economic outcomes associated with omphalitis cases avoided were determined, including direct, indirect and total cost of care associated with omphalitis, resource use (outpatient visits and bed days) and societal impact (caregiver workdays lost). Costs and other inputs were sourced from literature and supplemented by expert clinical opinion/informed inputs, making necessary assumptions. Results The model estimated that, over 1 year, ~ 23,000 omphalitis cases per 500,000 births could be avoided through CHX application versus DCC, circumventing ~ 13,000 outpatient visits, ~ 43,000 bed days and preserving ~ 114,000 workdays. CHX was associated with annual direct cost savings of ~ 590,000 US dollars (USD) versus DCC (not including drug-acquisition cost), increasing to ~ 2.5 million USD after including indirect costs (productivity, notional salary loss). The most-influential model parameter was relative risk of omphalitis with CHX versus DCC. Breakeven analysis identified a budget-neutral price for CHX use of 1.18 USD/course when accounting for direct cost savings only, and 5.43 USD/course when including indirect cost savings. The estimated breakeven price was robust to parameter input changes. DCC does not necessarily represent standard of care in Kenya; other, potentially harmful, approaches may be used, meaning cost savings may be understated. Conclusions Estimated healthcare cost savings and potential health benefits provide compelling evidence to implement CHX for umbilical cord care in Kenya. We encourage comprehensive data collection to make future models and estimates of impacts of upscaling CHX use more robust.

We examined 17 infants under age 1 year with inguinal bacterial lymphadenitis; 8 had a prior episode of omphalitis or an umbilical procedure, and one-third were afebrile and initially received the misdiagnosis of incarcerated hernia. Our findings suggested a possible association between inguinal bacterial lymphadenitis in infants and umbilical problems.

Objective: To describe the factors that affect the incubation of fertile eggs of Creole hens (Gallus gallus domesticus) at Mezquital Valley, Hidalgo, Mexico. Design/Methodology/Approach: 448 eggs of Creole hens were incubated in a Casser model 7622 incubator, in which the number of infertile and fertile eggs was evaluated; within the number of fertile eggs, the number of dead embryos was determined; due to dehydration or damage caused by fungi and bacteria. From the live hatched chickens, those that died due to omphalitis were recorded. Results: 272 of 448 incubated eggs were fertile; 119 of them hatched and 153 were dead embryos. While 176 were infertile. Among the dead embryos, 84 of dehydration, 69 due to fungal and bacterial infection and 11 live hatched chicks due to omphalitis. Limitations/implications: The literature review found little information on factors affecting the hatching of fertile Creole chicken eggs in backyard flocks. Findings/conclusions: Infection by fungi and bacteria increase embryonic mortality, while omphalitis increases mortality during the first days of life of the backyard Creole chickens. High storage temperature in the nest or incubator causes embryo dehydration.

Introduction: Severe omphalitis in adults is rare and can be caused by both congenital and acquired etiologies. We are reporting an impacted self-foreign-body in omphalitis case induced by accumulated keratin fragments.Case: A 28-year-old overweight male presented with a 3-day history of persistent purulent umbilical discharge with a remittent fever a few days before, constant abdominal tenderness with edema and erythema around navel area. There were no other GIT-related symptoms. He was given oral antibiotics, which showed no improvement. Upon surgery, we examined deep umbilical cavity without urachal connection to the navel. From the umbilical cavity scooped out multiple polypoid umbolith debris. Histopathologic examination revealed pyogenic granuloma with numerous keratin fragments without any foreign bodies.Conclusion: An impacted and infected self-foreign-body may be a cause of omphalitis in adults and could lead to severe and wide-spread infection if left untreated.

Objectives: To compare umbilical cord separation time and incidence of omphalitis in newborns receiving three different umbilical cord care techniques: topical breast milk, open dry, and closed dry techniques. Methods: This study was conducted during the period of June-August 2018 on consecutively selected 120 newborns aged 0 days up to 2 days after the release of the umbilical cord. Subjects were divided into three groups based on the umbilical cord care technique used with 40 subjects in each group. Omphalitis incidence was analyzed. Results: Umbilical cord separation was found to be significantly faster in topical breast milk group (2 days faster than in the open dry technique group and four days faster than in the closed dry technique group) with p

In this study, it was aimed to determine the effects of enteritis, pneumonia and omphalitis on oxidative/antioxidant balance in the calves. In total, 27 calves with neonatal disease and 10 healthy calves (control) were used. The sick calves were divided into 3 groups according to localization of infection, omphalitis (n = 10), pneumonia (n = 8) and enteritis (n = 9). Blood samples of the calves were taken from jugular vein for analysis. Blood in tubes without anticoagulant was centrifuged at 5000 rpm for 5 min following clotting, and the sera were removed and stored at -80°C until analyzed. Serum malondialdehyde and nitric oxide levels of all groups were significantly higher, while glutathione, glutathione peroxidase, catalase and superoxide dismutase levels were significantly lower compared to the control group. As a conclusion, diarrhea, pneumonia and omphalitis are caused by oxidative damage in the calves, and antioxidant treatment may be beneficial in the treatment of these diseases.

Umbilical cord nonseverance (UCNS) is the practice of leaving the umbilical cord attached to the placenta after delivery. Limited case reports exist revealing adverse outcomes of UCNS. We report a case of neonatal omphalitis associated with Escherichia coli bacteremia and urinary tract infection after UCNS.

Background Umbilical cord infection (omphalitis) is a major cause of neonatal mortality and morbidity in developing country like Nepal. Detached umbilical stump is an important colonizing site for different types of bacteria and it also provides direct access to blood stream. Inadequate cord care may lead to omphalitis as well as neonatal sepsis. This study compares 2 cord care regimens. Objectives General: To compare two different cord care regimens (dry cord care vs chlorhexidine) Specific: • To evaluate the cord separation time in both regimens. • To find out the incidence of omphalitis Methods Comparative observational study carried out in over a three month period of August 2019 to October 2019 in a tertiary hospital after receiving ethical clearance. Study population consisted of healthy neonates born between 37 -42 weeks. Consent was taken from parents. Babies admitted to NICU, with any umbilical disorders or requiring umbilical catheterization were excluded. Babies were randomized in two groups dry cord care (group I) and chlorhexidine care (group II) via computer generated numbers. In group I after delivery, umbilical cord was kept dry and nothing was applied. In group II 4% chlorhexidine gluconate gel was applied once on the umbilical cord immediately after cutting. In both the groups parents were counseled to avoid unhygienic cord care practices. Sample size : 280 Personal data of the mother and the newborn’s were recorded. A questionnaire was administered on regular neonatal follow up at well baby clinic or by phone on 15 days of life. 256 babies enrolled in group I as 24 babies did not follow up and 258 babies were enrolled in group II as 22 babies were lost to follow up. Results 730 babies were delivered over three months period and 514 babies were enrolled. Among them 313 (60%) males. Mean birth weight - 3057±443 grams, mean gestational age - 38.63±1.0 weeks, Mean maternal age - 27.2 years. The key clinical and epidemiologic features of the two study groups are shown in table 1. Both groups were comparable. mean cord separation time in dry cord care group was 7.70±1.2 days, and in chlorhexidine group it was 7.77±1.4 days. There was no significant difference between these two regimens. None of the newborns developed umbilical sepsis. Conclusions There was no significant difference between the cord separation times in both cord care regimens. Both dry cord care and chlorhexidine cord care regimens were found to be safe and effective.

Background: Neonatal mastitis and omphalitis are uncommon but potentially serious infections in neonates. Clinical findings may range from localized soft tissue infection to more invasive necrotizing local infection or systemic illness with other concurrent serious bacterial infections. Modern literature on these diseases is scant, and there is very little evidence available to guide evaluation and treatment decisions. Objective: Describe the clinical presentation, prevalence of concurrent serious bacterial infection (SBI), and outcomes among infants with neonatal mastitis and omphalitis. Design/Methods: Utilizing the framework of the Pediatric Emergency Medicine Collaborative …

Aim We aimed to determine the current factors affecting the development of omphalitis in our region. Materials and methods This prospective case-control study included term and late preterm newborns admitted to the newborn outpatient clinic or paediatric emergency service between 2014 and 2015. One hundred newborns with omphalitis and age-matched 100 newborns as a control group were included. The perinatal, postnatal, and sociocultural characteristics of newborns were evaluated and the factors that could influence the development of omphalitis were determined. Results Younger maternal age and primiparity, lower maternal education, and lower maternal hand washing habits were the significant risk factors of omphalitis development. Using non-cotton clothes were the most important risk factor amongst all factors as it increases the omphalitis risk up to 13 times. The frequency of omphalitis was significantly higher in warm months when microorganisms were able to colonise and reproduce compared with the colder months. Conclusion Results suggested that community-based interventions promoting the improvement of neonatal care should emphasise simple and low-cost interventions such as hand washing habit of mothers, caring for the umbilical cord, and using cotton clothes for babies. This study also confirms the safety of dry cord care at the time of birth and afterwards. However, broadscale multicentric studies are needed to protect against omphalitis.

On the commercial level, the poultry industry strives to find new techniques to combat bird's infection. During the first week, mortality rate increases in birds because of several bacterial infections of about ten bacterial species, especially colisepticemia. This affects the flock production, uniformity, and suitability for slaughter because of chronic infections. Escherichia coli (E. coli) causes various disease syndromes in poultry, including yolk sac infection (omphalitis), respiratory tract infection, and septicemia. The E. coli infections in the neonatal poultry are being characterized by septicemia. The acute septicemia may cause death, while the subacute form could be characterized through pericarditis, airsacculitis, and perihepatitis. Many E. coli isolates are commonly isolated from commercial broiler chickens as serogroups O1, O2, and O78. Although prophylactic antibiotics were used to control mortality associated with bacterial infections of neonatal poultry in the past, the commercial poultry industry is searching for alternatives. This is because of the consumer's demand for reduced antibiotic-resistant bacteria. Despite the vast and rapid development in vaccine technologies against common chicken infectious diseases, no antibiotic alternatives are commercially available to prevent bacterial infections of neonatal chicks. Recent research confirmed the utility of probiotics to improve the health of neonatal poultry. However, probiotics were not efficacious to minimize death and clinical signs associated with neonatal chicks' bacterial infections. This review focuses on the causes of the increased mortality in broiler chicks during the first week of age and the methods used to minimize death.

There are conflicting results from large randomized controlled trials in different populations regarding the effectiveness of topical application of 4% chlorhexidine to the umbilical stump of newborn infants at reducing neonatal mortality. Meta-analysis and systematic review of trials performed in South Asia and Europe support 4% chlorhexidine application to reduce neonatal mortality, whereas trials performed in Sub-Saharan Africa do not. The aim of this review is to determine the effectiveness of 4% chlorhexidine application to the umbilical stump of newborn infants born in lower income countries in order to reduce neonatal mortality when compared with usual cord care. Our search strategy included randomized trials published between January1st 2000 and September 4th, 2018, that compared 4% chlorhexidine with usual cord care (“dry cord care”). The outcome variable of interest was neonatal mortality. Pooled relative risks (RR) with 95% confidence intervals (CIs) using a random-effects model were calculated. Nine trials were included, from six countries: Zambia, Tanzania, Bangladesh, Nepal, India and Pakistan, with a total of 257,153 participants. Five studies (N = 119,833) reported neonatal mortality. There was a 21% reduction in neonatal mortality among with 4% chlorhexidine application: pooled RR (95% CI) 0.79 (0.69–0.90), P = 0.0005. The incidence of omphalitis was decreased by 35% with 4% chlorhexidine (6 studies, N = 108,263): pooled RR (95% CI) 0.65 (0.56–0.75), P = 0.00001. Chlorhexidine application delayed the umbilical cord separation time (4 studies, N = 28,917): mean difference (95% CI) 2.71 (2.63–2.78) days. In conclusion, this systematic review found that topical application of 4% chlorhexidine to the umbilical cord stump of newborn infants in lower income countries significantly reduces the incidence of neonatal mortality. Chlorhexidine also reduces the incidence of omphalitis, but prolongs umbilical cord separation time. Systematic Review Registration: CRD42018109280 .

La onfalitis corresponde a una de las principales causas de mortalidad neonatal en países en vías de desarrollo. Se define como el proceso infeccioso asociado al muñón umbilical, tejido circundante y estructuras adyacentes. Actualmente el manejo adecuado del cordón umbilical permanece controversial, sin embargo, la Organización Mundial de la Salud sugiere el manejo en seco del cordón umbilical en situaciones de bajo riesgo social y el empleo de antisépticos en poblaciones con alta mortalidad neonatal y prevalencia de partos caseros. Tras el diagnóstico, el manejo oportuno consiste en la pronta instauración de antibioticoterapia parenteral con el fin de mitigar posibles eventos adversos.

A variety of congenital and acquired umbilical disorders present to the pediatric surgeon, including umbilical hernia, granulomas, polyps, omphalomesenteric duct, and urachal remnants. The burden of some of these conditions on children in Africa is significant. This chapter discusses the pathology, clinical presentation, and the management of selected such umbilical conditions.

Southern right whales Eubalaena australis (SRW) use the southern coast of Brazil as a wintering and calving ground. Other than anthropogenic threats, there is limited knowledge on health and disease aspects for this species. We report the gross and microscopic findings and microbiological identification of streptococcal septicemia in a SRW calf. Main gross findings included fibrinosuppurative omphalitis and urachocystitis, suppurative cystitis, valvular endocarditis and myocarditis, embolic pneumonia, suppurative myositis and osteoarthritis, and lymphadenomegaly. Histological examination confirmed the above inflammatory processes and indicated disseminated Gram-positive coccoid septicemia. PCR analysis, based on the 16S rRNA gene from bacteria isolated on blood agar, identified Streptococcus dysgalactiae. Pathologic and microbiologic analysis indicated that β-hemolytic S. dysgalactiae septicemia, presumably initiated as ascending omphalic infection, was responsible for stranding and death in this individual. These results further confirm pathogenicity of streptococci in cetaceans and add to the limited health and disease related pathology knowledge for this species.

Background: Leukocyte adhesion deficiency (LAD) syndromes are primary immunodeficiency disorders caused by defects in adhesion molecules on leukocytes resulting in impaired migration into tissues. Common cutaneous manifestations of LAD include bacterial infections, omphalitis with delayed separation of the umbilical cord, impaired pus formation and poor wound healing. LAD is associated with significant morbidity and mortality, making early diagnosis and management integral in the care of these patients. Methods: Molecular testing and flow cytometry for expression of CD18 were performed on 2 siblings presenting with cutaneous lesions including pyoderma gangrenosum (PG). Results: We describe 2 siblings with a novel homozygous mutation in ITGB2 (c.2070del, p.Asp690Glufs*25) resulting in an atypical presentation of LAD-I with PG. Conclusion: LAD should be considered in patients presenting with unexplained PG, even in the absence of significant infections or umbilical cord complications. Statement of novelty: To the best of our knowledge, we describe a novel homozygous mutation in ITGB2 (c.2070del, p.Asp690Glufs*25) resulting in LAD-I. Patients with LAD-I may present with unexplained PG and may lack classic symptoms including umbilical cord complications.

Omphalitis or yolk sac infection (YSI) and colibacillosis are the most common infectious diseases that lead to high rates of early chick mortalities (ECMs) in young chicks. Out of numerous microbial causes, avian pathogenic Escherichia coli (APEC) or extraintestinal pathogenic E. coli infections are considered the most common cause of these conditions. YSI causes deterioration and decomposition of yolk, leading to deficiency of necessary nutrients and maternal antibodies, retarded growth, poor carcass quality, and increased susceptibility to other infections, including omphalitis, colibacillosis, and respiratory tract infection. Presently, in ovo injection of antibiotics, heavy culling, or after hatch use of antibiotics is practiced to manage ECM. However, increased antibiotic resistance and emergence of "super bugs" associated with use or misuse of antibiotics in the animal industry have raised serious concerns. These concerns urgently require a focus on host-driven nonantibiotic approaches for stimulation of protective antimicrobial immunity. Using an experimental YSI model in newborn chicks, we evaluated the prophylactic potential of three in ovo-administered innate immune stimulants and immune adjuvants for protection from ECM due to YSI. Our data have shown80%, 65%, and 60% survival with in ovo use of cytosine-phosphodiester-guanine (CpG) oligodeoxynucleotides (ODN), polyinosinic:polycytidylic acid, and polyphosphazene, respectively. In conclusion, data from these studies suggest that in ovo administration of CpG ODN may serve as a potential candidate for replacement of antibiotics for the prevention and control of ECM due to YSI in young chicks.

Background: Chlorhexidine cleansing of the cord can reduce neonatal mortality among newborns. Objective: The aim of study was to determine the effect of cord cleansing with chlorhexidine in reduction of umbilical infection among newborns in hospital settings. Methodology: This randomized controlled trial was carried out between April 2013 to July 2014 and 510 newborns were randomly assigned within a tertiary level hospital in Bangladesh to receive 1 of 3 cord care regimens single cord cleansing with 4% chlorhexidine(Group-1), multiple cord cleansing with 4% chlorhexidine (Group-2) and clean and dry cord care (Group-3 : control). Results: The risk of umbilical cord infection (omphalitis) was significantly reduced in both the single (Relative risk [RR] 0.15 [95% CI] 0.008-0.93) and multiple chlorhexidine cleansing group (RR 0.37 [95% CI] 0.04- 0.99) compared to the dry cord care group. The risk of omphalitis was not significantly different between multiple and single chlorhexidine cleansing group (RR 3.14 [0.13-76.54]). Conclusion: Chlorhexidine significantly reduce the risk of umbilical infection in both single and multiple cord cleansing neonates. Bangladesh Journal of Infectious Diseases 2017;4(2):35-39

Objective Omphalitis, or umbilical cord infection, is an important cause of newborn morbidity and mortality in low-resource settings. We tested an algorithm that task-shifts omphalitis diagnosis to community-level workers in sub-Saharan Africa. Methods Community-based field monitors and Zambian paediatricians independently evaluated newborns presenting to health facilities in Southern Zambia using a signs and symptoms checklist. Responses were compared against the paediatrician's gold standard clinical diagnosis. Results Of 1009 newborns enrolled, 6.2% presented with omphalitis per the gold standard clinical diagnosis. Paediatricians' signs and symptoms with the highest sensitivity were presence of pus (79.4%), redness at the base (50.8%) and newborn flinching when cord was palpated (33.3%). The field monitor's signs and symptoms answers had low correlation with paediatrician's answers; all signs and symptoms assessed had sensitivity Conclusion Despite extensive training, field monitors could not consistently identify signs and symptoms associated with omphalitis in the sub-Saharan African setting.

Made available in DSpace on 2018-12-11T17:20:08Z (GMT). No. of bitstreams: 0 Previous issue date: 2018-02-01. Added 1 bitstream(s) on 2019-10-09T18:31:43Z : No. of bitstreams: 1 S0100-736X2018000200256.pdf: 707527 bytes, checksum: 2aa803b125d2fc7de67ca11d28350bab (MD5) The aim of this study was to measure serum immunoglobulin concentrations of Nellore cattle produced by in vitro fertilization (IVF) with umbilical diseases and to evaluate surgical excision as a method of treatment. Sixteen cattle with ages ranging from 1 to 15 months, males and females, affected by umbilical diseases were enrolled in the study. Blood samples were collected for cell counts and the determination of immunoglobulin concentrations by electrophoresis and zinc sulphate turbidimetry (ZST). Four calves were presented with umbilical herniation, two with an umbilical herniation associated with a persistent urachus, two with an umbilical herniation with a persistent urachus and omphaloarteritis, three with an umbilical herniation and an urachal diverticulum, three with a persistent urachus, one with an urachal diverticulum, and one with omphalitis. The blood cell counts pre- and post-surgical revealed differences in cell volume and the number of leukocytes. The immunoglobulin values measured by electrophoresis values were below normal in most animals, whereas the ZST showed normal levels in most of them. Most of the calves affected by umbilical diseases and produced by IVF presented hypoglobulinaemia. Correlations between umbilical diseases, failure of passive transfer of immunity and IVF could not be demonstrated. Departamento de Cirurgia e Anestesiologia Veterinária Faculdade de Medicina Veterinária e Zootecnia (FMVZ) Universidade Estadual Paulista (Unesp), Rua Prof. Doutor Walter Mauricio Correa s/n, Cx. Postal 560 Departamento de Clínica Cirurgia e Reprodução Animal Faculdade de Medicina Veterinária de Araçatuba (FMVA) Unesp, Rua Clóvis Pestana 793 Departamento de Apoio Produção e Saúde Animal FMVA-Unesp, Rua Clóvis Pestana 793 Departamento de Clínicas Veterinárias Centro de Ciências Agrárias (CCA) Universidade Estadual de Londrina (UEL) Campus Universitário, Cx. Postal 10.011 Mestrando FMVZ-Unesp, Rua Prof. Doutor Walter Mauricio Correa s/n, Cx. Postal 560 Faculdade de Medicina Veterinária e Zootecnia FAMEZ Universidade Federal do Mato Grosso do Sul (UFMS), Av. Senador Felinto Müller 2443 Iniciação Científica FMVA-Unesp, Rua Clóvis Pestana 793 Departamento de Cirurgia e Anestesiologia Veterinária Faculdade de Medicina Veterinária e Zootecnia (FMVZ) Universidade Estadual Paulista (Unesp), Rua Prof. Doutor Walter Mauricio Correa s/n, Cx. Postal 560 Departamento de Clínica Cirurgia e Reprodução Animal Faculdade de Medicina Veterinária de Araçatuba (FMVA) Unesp, Rua Clóvis Pestana 793 Departamento de Apoio Produção e Saúde Animal FMVA-Unesp, Rua Clóvis Pestana 793 Mestrando FMVZ-Unesp, Rua Prof. Doutor Walter Mauricio Correa s/n, Cx. Postal 560 Iniciação Científica FMVA-Unesp, Rua Clóvis Pestana 793

Neonatal alloimmune neutropenia (NAIN, NAIN or NIN) is a neutrophil blood group antagonism, analogous to hemolytic disease of the fetus and newborn (HDFN) and fetal/neonatal alloimmune thrombocytopenia (FNAIT). A limited number of prospective screening studies showed that granulocyte-specific antibodies were detectable in 0.35-1.1% of random postnatal maternal samples and that the incidence of NAIN was below 0.1%. Symptoms vary from none to mild skin infections, omphalitis or more severe infections like pneumonia, sepsis, and meningitis. Treatment of neonatal infection with antibiotics and granulocyte-colony stimulating factor is advised.

The main objective of the study was to identify early risk factors associated with the development of umbilical outpouchings (UOs) in pigs. Secondly, to describe 1) the nature of UOs, 2) the age when UOs become visible, and 3) at which age UOs spontaneously may regress and disappear. A longitudinal study following pigs (n=3031) from birth to slaughter was carried out in two commercial Danish herds. In total, 8 % (n=255) of the pigs developed an UO between birth and death (spontaneous, euthanasia or slaughter). The odds for developing an UO was significantly lower for males than females (OR, 0.7; 95% CL, 0.5-0.9). Pigs born immature (OR, 3.4; 95% CL, 1.3-8.2) or observed with: 1) clinical sign of omphalitis (OR, 1.8; 95% CL, 1.1-2.8), 2) a elongated moist umbilical cord at birth (OR, 5.1; 95% CL, 2.6-9.8) or 3) a healed or healing protruding umbilicus in the second week after birth (OR, 1.9; 95% CL, 1.4-2.6) were associated with significant higher odds of developing an UO. No significant association (p-value >0.05) was found between the development of UOs and sow parity, litter size, birth weight and length of the umbilical cord. The nature of the UOs were mainly due to umbilical herniation and/or formation of abscesses or fibrosis. The majority of UOs became visible within the first 10 weeks of age (80%, n=234). Spontaneous regression of the UOs occurred in 14% (n=36) of the pigs; 83% (n=30) disappeared between the 4th and 14th week. Identifying piglets with high odds of developing UOs makes it possible to identify to which pig special attention should be paid during the daily management.

Leukocyte adhesion defect I is a rare disorder (1:1,000,000) caused by diminished expression of CD-18 β2 integrins on leukocytes leading to abnormal adhesion, migration, and chemotaxis. Clinical manifestations include delayed separation of umbilical cord, omphalitis, recurrent severe infections, impaired wound healing, persistent oral ulcers, and severe periodontitis in primary and permanent dentition. A 5-year-old girl, second-born child to parents with consanguinity, presented with pain and mobility of lower teeth. There was history of recurrent infections and multiple hospital admissions with CD18 level-3% and frame shift mutation in ITGB2, on 21q22.3. There were scars on hands and feet. Oral examination revealed multiple missing teeth and periodontitis in primary dentition. Oral prophylaxis and palliative treatments were performed with periodic follow-ups. Interdisciplinary care is ubiquitous for patients with immune deficiencies. Early consultation with pediatric dentists and exploration of medical history is essential for diagnosis and treatment of rare diseases.

The present study was conducted to determine the prevalence of broiler and layer diseases at Gazipur sadar upazilla veterinary hospital in Bangladesh. A total of 296 either dead or sick birds were considered for the present study. Diagnosis of different diseases was made on the basis of history, owner’s complains, age of birds, presenting signs, clinical and necropsy examination findings. The prevalence of diseases was recorded in broiler (n=189) 63.9% and layer (n=107) 36.1%. In broiler the prevalence of Colibacillosis (33.4%) was higher followed by Omphalitis (23.8%), Infectious Bursal Disease-IBD (15.3%), Newcastle disease-ND (9.0%), mixed infection (7.4%), Gout (5.3%) and Coccidiosis (5.8%). In case of layer highest prevalence was recorded in Salmonellosis (19.6%). while other diseases were Collibacilosis (15.9%), Mycoplasmosis (12.1%), ND (10.3%), IBD (8.4), Mareks (9.3%), mixed infection (8.4%), Fowl Cholera (4.7%) and Mycotoxicosis (4.7%). The present findings will help poultry researchers and practitioner to know the present status of infectious diseases of commercial chickens in the study area and also help to establish flock based control strategy.Asian J. Med. Biol. Res. June 2017, 3(2): 290-293

The present work evaluated the effects of LED light irradiation on the healing of the navels of neonatal dairy calves. Fifty-seven neonatal calves were divided into two groups. Animals had their umbilical stumps immersed in 10% iodine tincture for 60 s, and this process was repeated every 24 h for three consecutive days. The 29 animals in the first group did not receive LED therapy. The 28 animals in the second group received LED light irradiation at 640 nm with 300 mW power, 46.8 J/cm2 energy density, 60 s irradiation time, and 0.385 cm2 spot size. The animals were irradiated at four points (46.8 J/cm2 per point) evenly distributed around the insertion site of the umbilical stump every 24 h for three consecutive days. Irradiation with LED light was applied before the umbilical stumps were immersed in the iodine solution. The time after birth at which the umbilical stump fell off of each calf was noted. The umbilical stumps of all animals fell off by the 25th day of age. After the umbilical stump fell off, the healing of the remnant wound was followed up to the 30th day after birth. The area of the wound was measured on the 15th, 20th, and 25th day after birth using digital photographs and computer-assisted area measurements. A two-tailed unpaired t test was applied to analyze the falling off the umbilical stump, whereas a Kruskal-Wallis one-way ANOVA test with a Dunn's multiple comparison test was used for the wound size evolution. GraphPad Prisma 5.0® and GraphPad StatMate 2.00® were used for the statistical analysis. The results revealed that phototherapy hastened the falling off the umbilical stump, accelerated navel healing, and reduced the mortality rate in newborn calves. Therefore, this study introduced a preventive and adjuvant after birth treatment that proved to be effective in reducing the incidences of omphalitis and newborn mortality.

Aim. Investigation of the features of epidemiological characteristics of infectious morbidity associated with medical care registered in newborns in maternity care facilities of the Republic of Tatarstan. Methods. Retrospective epidemiological study of the morbidity of infections associated with medical care registered in newborns in the Republic of Tatarstan was performed. Epidemiological analysis was carried out using the forms of Federal statistical observation №2 of the Federal Service for Surveillance on Consumer Rights Protection and Human Wellbeing «The information about the infectious and parasitic diseases» (section «Hospital-acquired infections»). Results. Based on the received materials epidemiological analysis of the dynamics of hospital-acquired infectious morbidity in newborns for the period from 2009 to 2015 was performed. Unidirectional trend of infectious morbidity associated with medical care and of various nosological forms was revealed. Downward trend with a negative morbidity growth rate was identified for neonatal pneumonia, osteomyelitis, pyoderma, impetigo, mastitis, panaritium and paronychia of newborns, omphalitis, phlebitis of the umbilical vein and neonatal conjunctivitis. Neonatal morbidity of hospital-acquired otitis media did not changed from the baseline. Prevalent nosological forms of infections associated with medical care among newborns were pyoderma, impetigo, mastitis, panaritium, paronychia (33.6%) and pneumonia (29.5%). Conclusion. The average morbidity of infections associated with medical care in newborns in the Republic of Tatarstan for the period from 2009 to 2015 was 13.0 per 1000 newborns; negative dynamics of the morbidity with negative morbidity growth rate in newborns during this period was revealed (-42.3%).

Three outbreaks of colibacillosis have occurred in chicks during the quarantine period after importation to Japan. All three were derived from three different countries without epidemiologic relevance. Some birds from each infected flock were examined pathologically and bacteriologically. The characteristic histologic finding common to all three cases was severe bacterial meningitis in the central nervous system. Pericarditis, perihepatitis, and omphalitis with bacterial colonies were also observed. The bacterial colonies observed histologically were immunohistochemically positive for Escherichia coli antigens. Escherichia coli was isolated from the organ samples from each outbreak. At least two E. coli isolates were serotyped as O18 and O161, which differed from the popular serotypes in Japan. These results suggest that avian pathogenic E. coli of uncommon serotypes can be imported from outside countries by infected chicks. Colibacillosis should be included in the differential diagnosis when meningitis is histologically observed in chicks.

A total of two hundred diseased Saso chicks with omphalitis were examined (1400 samples) for the isolation of E. colifrom different organs (liver, caecum, spleen, heart, lung, yolk sac and cloacal swab). Results showed that 64 cases werepositive with an incidence of 32%. Fifty isolates (25%) of E. coli were recovered from chicks could be sero-grouped in19 O groups with the most predominant serotype was O91 20 % (10 out of 50 isolates), O26 10% (5 strains out of 50) O788% (4 strains out of 50), and 7 strains untypable E. coli 14%. Among E. Coli O groups were found to be resistant toAmoxicillin 93.02% followed by Tetracycline 74.42%, Enrofloxacin 46.51%, Erythromycin 30.32%, Ciprofloxacin27.91%, Norofloxacin and Streptomycin 20.93% and Gentamycin 6.98%. While they were found to be sensitive forGentamycin, Streptomycin, Ciprofloxacin, Tetracycline, Erythromycin, Norofloxacin, Enrofloxacin, and Amoxicillin asthe following: 88.37%, 46. 51%, 34.89%, 23.26%, 18.60%, 9.30%, 9.30% and 6.98%, respectively. The incidence rateof eaeA gene of E. coli was 15.79%. Quaternnary ammonium compound (qacEΔ1) gene also was detected in E. coli withincidence rate 63.16%.

Introduction: There is still some uncertainty on cord care practices all around the world, especially in developing countries. The aim of our study was to investigate the effects of six different umbilical cord care practices on the rate of colonization and cord separation time. Methodology: A total of 516 newborns were randomly allocated to the following six umbilical cord care groups: group 1 received dry care; groups 2–4 received a single application of 70% alcohol, 4% chlorhexidine, or povidon-iodine in the delivery room, respectively, which were discontinued thereafter; groups 5 and 6 received a single application of 70% alcohol or 4% chlorhexidine, respectively, starting in the delivery room and continuing every six hours until discharge. Umbilical cords were examined on the second and third days and between the fifth and seventh day for signs of omphalitis. Swab cultures were taken on the second or third day from all cases. Results: Cord separation time (median [interquartile range]) was the shortest for group 1 (7 [6–7] days) and the longest for group 3 (10 [7–12] days) and group 6 (10 [8–12] days) (p < 0.001). The cord colonization in the swab cultures was significantly lower in groups 3 and 6 (p < 0.001). Omphalitis was detected in eight (1.5%) patients among the study population, and there was no significant difference between the groups. Conclusions: Our study showed that chlorhexidine application was the most effective agent in decreasing colonization, though it increased cord separation time significantly in both groups.

Omphalitis in domestic animals being considered as commonest ailment after birth, are in general, poorly reported for its uneventful recovery. Several previously reported cases endeavoured to highlight involvement of pathogenic organism in progression of the condition with little elaboration to pathologic changes occurred. Moreover, description of omphalitis in buffalo calf was never been attempted. Therefore this report intends to elaborate the pathology noted around umbilical zone in a buffalo calf possibly arisen to infectious etiology with special reference to complicated involvement of urachus, eventual haemoperitoneum and striking acute vascular changes of multi-systemic organs. Intriguingly, this report also attempted to review few recent cases of omphalitis seen in different animals along with their paramount etiologic causes.

Omphalitis is a rare infection in our countries. Streptoccus pyogenes is one of the most frequently encountered germs. Complications are rare but include septicemia and necrotizing fasciitis with a high mortality rate. The case reported in this article is that of an 11 days old infant with pyogenic streptococcal omphalitis who developed cellulitis of left food. An intravenous antibiotic treatment allowed complete resolution of the symptoms. The article is the opportunity to review of the risk factors of this affection, its complications and treatments.L’omphalite est une infection rare dans nos pays. Le streptocoque pyogène est un des germes les plus fréquemment rencontrés. Les complications sont rares mais incluent les septicémies et la fasciite nécrosante avec un taux important de mortalité. Le cas rapporté dans cet article est celui d’un nourrisson de 11 jours présentant une omphalite à Streptocoque pyogène ayant développé une cellulite du pied gauche. Un traitement antibiotique intraveineux a permis une résolution complète des symptômes. Cet article est l’occasion d’une revue des facteurs de risques de cette affection, de ses complications et traitements.

Necrotizing soft tissue infections are a serious medical emergency that involve necrosis within the soft tissue space including the dermis, subcutaneous tissue, superficial fascia, deep fascia, and muscle. Inciting factors include recent varicella infection, omphalitis, trauma, intramuscular injections, perianal trauma, and surgery. Unlike adult cases, children presenting with necrotizing soft tissue infections are more likely to be immunocompetent and without underlying chronic illnesses. Although rare in children, familiarity with the clinical manifestations of necrotizing soft tissue infections is essential for early diagnosis and surgical debridement, as significant mortality is associated with advanced disease.

Inadequate cord care in neonates is an important modifiable risk factor of cord stump infection, sepsis, and neonatal death, particularly in countries with limited resources. Dry cord care and alcohol 70% are commonly used in multiple developing countries. There is a need to investigate the efficacy and safety of both the cord care to achieve the best outcomes in neonates during this critical period of life. The objective of the study was to compare between dry cord care and topical application of alcohol 70% for cord care in newborn infants in terms of cord separation time (CST) as well as the incidence of omphalitis, sepsis, and neonatal mortality. The analysis was conducted up to April 2019 in MEDLINE, Cochrane Library, Embase, Scopus, and Google Scholar to include randomized clinical trials (RCTs) and quasi-experiments which investigated at least two infant groups receiving either dry cord care or alcohol 70%. Mean differences (MDs) and 95% confidence intervals (CIs) were used to analyze continuous data, while risk ratios (RRs) and 95% CIs were used to analyze dichotomous variables. A total of 13 articles were included (4967 infants, 50.35% females, six RCTs). Alcohol application was significantly associated with longer CST (MD = 1.93 days, 95% CI: 0.80, 3.06) with significant heterogeneity among studies (I2 = 97%) while no significant differences were found in the risk of omphalitis. On the other hand, dry cord care was associated with the risk of foul odor at the cord/surrounding tissues (RR = 0.49, 95% CI: 0.28, 0.85) and increased risk of E-coli colonization (RR = 0.75, 95% CI: 0.57, 0.98). Dry cord care is a simple and effective way to shorten CST, particularly in countries with limited resources. However, in light of the limitations of the included studies, future RCTs with higher methodological quality are warranted. The significant heterogeneity among studies is the limitations of the included studies.

The present work evaluated the effects of LED light therapy at 640 nm on healing the navels of newborns by using animal model. Fifty-seven neonatal calves were divided into two study groups. The members of the control group had the umbilical stump immersed in a solution of 10% tincture of iodine for 60 s, which was repeated every 24 h for three consecutive days. The members of the treated group received light doses of 7.2 J that were applied to four points evenly distributed around the insertion site of umbilical stump every 24 h for three consecutive days before the umbilical stumps were immersed in the iodine solution. The time, in days from birth, at which the umbilical stump fell off for each calf was noted. After the umbilical stump fell off, the remnant wound area was measured at different times after birth. Digital photographs with a dimensional reference were used for area measurements. The results showed that phototherapy hastened the fall-off of the umbilical stump, accelerated navel healing and reduced the mortality rate in newborn calves. We can anticipate that light treatment, as an afterbirth care, could also bring benefits to human neonates.

Objective To describe a laparoscopic technique for evaluating umbilical disorders in calves, including feasibility, visualization of umbilical structures, and related complications. Study Design Prospective clinical study. Animals Male calves (15 Holstein, 2 Montbeliard) with umbilical disorders (n=17). Methods Calves

We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) to evaluate the efficacy of chlorhexidine application to the umbilical cord in neonates. We searched MEDLINE and other electronic databases, and included all RCTs that evaluated the effect of single or multiple chlorhexidine cord applications on the neonatal mortality rate (NMR) and/or the incidence of systemic sepsis and omphalitis. A total of six RCTs—four community-based cluster RCTs and two hospital-based trials—were included in the review. Of the four cluster RCTs, three were conducted in South Asia in settings with high rates of home births (>92%) while the fourth, available only as an abstract, was conducted in Africa. Pooled analysis by the ‘intention-to-treat' principle showed a significant reduction in NMR after chlorhexidine application (four studies; relative risk (RR) 0.85; 95% confidence interval (CI) 0.76 to 0.95; fixed effects (FE) model). On subgroup analysis, only multiple applications showed a significant effect (four studies; RR 0.88; 95% CI 0.78 to 0.99) whereas a single application did not (one study; RR 0.86; 0.73 to 1.02). Similarly, only the community-based trials showed a significant reduction in NMR (three studies; RR 0.86; 95% CI 0.77 to 0.95), while the hospital-based study did not find any effect (RR 0.11; 0.01 to 2.03). Since all the studies were conducted in high-NMR settings (⩾30 per 1000 live births), we could not determine the effect in settings with low NMRs. Only one study—a hospital-based trial from India—reported the incidence of neonatal sepsis; it did not find a significant reduction in any sepsis (RR 0.67; 95% CI 0.35 to 1.28). Pooled analysis of community-based studies revealed significant reduction in the risk of omphalitis in infants who received the intervention (four studies; RR 0.71; 95% CI 0.62 to 0.81). The hospital-based trial had no instances of omphalitis in either of the two groups. Chlorhexidine application delayed the time to cord separation (four studies; mean difference 2.11 days; 95% CI 2.07 to 2.15; FE model). Chlorhexidine application to the cord reduces the risk of neonatal mortality and omphalitis in infants born at home in high-NMR settings. Routine chlorhexidine application, preferably daily for 7 to 10 days after birth, should therefore be recommended in these infants. Given the paucity of evidence, there is presently no justification for recommending this intervention in infants born in health facilities and/or low-NMR settings.

To describe clinical and flow cytometric immunophenotyping details of 26 patients of Leukocyte adhesion deficiency-I (LAD-I) along with molecular characterization of 7 patients. Diagnosis of LAD-I was suspected on the basis of clinical features, white blood cell count and absolute neutrophil counts and flow cytometric assessment of expression of CD18 and CD11(a, b, c) on leukocytes. Mutation analysis was performed using DNA PCR and conformation sensitive gel electrophoresis (CSGE) technique followed by sequencing. All the patients were symptomatic by the age of 6 mo, with history of recurrent bacterial infections involving skin, mucosa or umbilical cord (omphalitis) being the most frequent presenting symptoms. White blood cells (WBC) and absolute neutrophil counts (ANC) were markedly elevated, without any specific morphological findings. On flow cytometry, CD11a and CD11c showed moderate correlation with CD18 expression. Mutation analysis was performed in 7 patients and six different mutations (4 missense, 2 nonsense and 1 splice site) were identified, all of which were homozygous in nature. A presentation of repeated bacterial infections during infancy, especially omphalitis, with markedly elevated absolute neutrophil counts should trigger investigations for LAD-I including flow cytometric analysis of CD11/CD18 expression.

Background: Omphalitis (umbilical cord infection) among new-borns is common and a major cause of neonatal deaths in developing countries. Annually about 4 million neonatal deaths occur around the world; of these, more than 30% are caused by infections. Majority of these infections start as umbilical cord infection. Objective: The aim of the present study was to establish cord care practices associated with omphalitis among neonates aged 3-28 days at Pumwani Maternity Hospital, Kenya. Methodology: Cross-sectional descriptive study was employed among 178 mothers with neonates of 3-28 days. Participants were selected systematically and data was collected on new-born cord care practices. Omphalitis was defined as pus discharge, redness with or without pus and swelling of umbilical cord. Pearson’s chi-square test (P < 0.05) was performed to compare the significant discrepancies. Crude and adjusted odds ratios with corresponding 95% confidence interval were also used to determine the strength of association between omphalitis and cord care practices. Results: Among 178 neonates, 67 (37.6%) were diagnosed with omphalitis. In logistic regression analysis, the main predictors of omphalitis were initiation of breastfeeding after one hour of delivery [AOR = 2.47; 95%CI = 1.15 - 5.30; P < 0.05] compared to within one hour and application of saliva to the cord [AOR = 6.59; 95%CI = 2.02 - 21.46; P < 0.01] compared to dry cord. Conclusion: The prevalence of omphalitis among neonates was high. Health workers need to participate in educating the mothers to initiate breastfeeding within one hour and to avoid application of harmful cord care practices.