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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 deficiency type I (LAD-I) is an autosomal recessive disease characterized by impaired leukocyte diapedesis to sites of infection. The disorder is caused by mutations in the ITGB2 (integrin beta-2) gene. Herein, we report the first series of Algerian patients with LAD-I. In this study, we enrolled twelve patients. All suffered from the severe form of the disease, with no significant delay in umbilical cord separation, except for two patients, however omphalitis was present in most cases. The analysis of the spectrum of mutations showed three different homozygous mutations, two were known mutations (missense mutation: c.533C˃T and nonsense mutation: c.562C > T) and one was novel nonsense mutation (c.1401C > A). Thus, the three mutations affect CD18 and are responsible for the severe form of the disease.

Resume L’embryologie permet de comprendre les anomalies du cordon qui touchent les vaisseaux sanguins, le canal omphalo-mesenterique et l’ouraque. Les mecanismes en jeu dans la chute du cordon et de la cicatrisation des plaies permettent de comprendre la pathologie de l’ombilic. La hernie du cordon est une forme mineure d’omphalocele. Un ecoulement peut etre du a une inflammation, une infection ou a une fistule digestive ou ouraquienne. Ces 2 types de reliquats peuvent avoir un aspect pseudo-tumoral. Omphalites et morbidite infectieuse du premier mois dependent de la qualite de l’hygiene de l’ombilic qui reste difficile a apprehender et doit s’adapter a l’environnement parental. Le traitement du granulome n’a pas fait ses preuves. Au-dela de 45 jours, la persistance du cordon fait rechercher une neutropenie ou un deficit de la phagocytose.

Summary Background Umbilical cord infection (omphalitis) is a risk factor for neonatal sepsis and mortality in low-resource settings where home deliveries are common. We aimed to assess the effect of umbilical-cord cleansing with 4% chlorhexidine (CHX) solution, with or without handwashing with antiseptic soap, on the incidence of omphalitis and neonatal mortality. Methods We did a two-by-two factorial, cluster-randomised trial in Dadu, a rural area of Sindh province, Pakistan. Clusters were defined as the population covered by a functional traditional birth attendant (TBA), and were randomly allocated to one of four groups (groups A to D) with a computer-generated random number sequence. Implementation and data collection teams were masked to allocation. Liveborn infants delivered by participating TBAs who received birth kits were eligible for enrolment in the study. One intervention comprised birth kits containing 4% CHX solution for application to the cord at birth by TBAs and once daily by family members for up to 14 days along with soap and educational messages promoting handwashing. One intervention was CHX solution only and another was handwashing only. Standard dry cord care was promoted in the control group. The primary outcomes were incidence of neonatal omphalitis and neonatal mortality. The trial is registered with ClinicalTrials.gov, number NCT00682006. Findings 187 clusters were randomly allocated to one of the four study groups. Of 9741 newborn babies delivered by participating TBAs, factorial analysis indicated a reduction in risk of omphalitis with CHX application (risk ratio [RR]=0·58, 95% CI 0·41–0·82; p=0·002) but no evidence of an effect of handwashing (RR=0·83, 0·61–1·13; p=0·24). We recorded strong evidence of a reduction in neonatal mortality in neonates who received CHX cleansing (RR=0·62, 95 % CI 0·45–0·85; p=0·003) but no evidence of an effect of handwashing promotion on neonatal mortality (RR=1·08, 0·79–1·48; p=0·62). We recorded no serious adverse events. Interpretation Application of 4% CHX to the umbilical cord was effective in reducing the risk of omphalitis and neonatal mortality in rural Pakistan. Provision of CHX in birth kits might be a useful strategy for the prevention of neonatal mortality in high-mortality settings. Funding The United States Agency for International Development.

n contrast to the vital role played by the umbilicus inutero, it has minimal physiologic importance afterbirth. It can be used as a convenient site for vascularaccess in newborns; neonatologists use umbilical arterialandumbilicalvenouscathetersfrequently.Theumbilicuscan be a portal for infection in newborns (omphalitis).Theumbilicusisfrequentlyusedasanentrysiteforlapa-roscopic procedures. Its psychological importancethroughout life has been observed in individuals whohave had surgical loss of their umbilicus.

Background Omphalitis is considered a leading cause of sepsis among newborn infants and topical antiseptic cord care is usually recommended. In 2003, WHO recommended the use of dry cord care in settings where the risk of omphalitis and sepsis is low. In Palestine, recommendations on umbilical cord care are not clear; the 70% alcohol cord care method is still used as standard by many and the chlorhexidene method is virtually unknown. In this study we compared the alcohol and dry cord care methods among healthy newborns in two urban hospitals in the occupied Palestine territory. Methods A non-randomised controlled trial was conducted in the newborn nurseries of two tertiary hospitals in East Jerusalem and Hebron. Newborn infants born at 37 or more weeks' gestation between March and October, 2014, were enrolled. Infants with major congenital anomalies who were admitted to neonatal intensive care unit, required antibiotics at birth, or had a hospital stay of more than 72 h, were excluded. One group of parents was asked to clean the infant's stump with 70% alcohol, and the other group to use dry cord care, changing methods on a weekly basis. The study was approved by the ethics committees of both hospitals. Written consent was obtained from participating parents. Findings 692 newborn babies were enrolled to both treatment groups. 344 used dry cord care and 348 the alcohol cord care method. No infants developed cord infection. The mean time to separation of the umbilical cord was 7·03 days (SD 2·47) in the dry cord care group and 8·13 days (2·47) in the alcohol cord care group (p Interpretation Our findings suggest that dry cord care is safe, is associated with a reduced separation time, and can be recommended for use in our context. Neither method of cord care was associated with the development of omphalitis in any of the study participants. A limitation of our study was that randomisation was impossible in view of the work overload and limited human resources at our hospitals. Funding None.

Serratia species are known for the infections they cause in adult and neonatal intensive care patients. Little is known about colonization and infection in paediatric intensive care patients. This study aims to describe the type of infections in critically ill newborns, infants and children, caused by Serratia spp., to compare patients colonized by Serratia spp. to patients colonized with other micro-organisms, and to assess the importance of the respiratory and digestive tracts as reservoirs. To this end, all microbiological samples taken from patients in our paediatric surgical intensive care unit between January 1986 and November 1993 were retrieved from the hospital database and patient records reviewed. Serratia spp. were isolated 1356 times from 97 patients. Eighty-five infections were diagnosed in 40 patients. Infections of the respiratory tract occurred most frequently (n= 65), followed by septicaemia (13), urinary tract infections (3), omphalitis (2), meningitis (1) and conjunctivitis (1). Colonization by Serratia spp. was associated with yearly age at admission, long ICU stay and high mortality. Both the respiratory and digestive tracts were frequently colonized. Our findings do not support the contention that the digestive tract is more important as reservoir than the respiratory tract in neonates.

The authors report a prospective study of correlation between histopathological alterations of the placenta, risk factors and early-onset bacterial infections in 224 premature newborns. They used a mathematical model for evaluation and prediction of neonatal bacterial infection according to the localization in chorioamniotic tissues (chorioamniotic plate, amniotic membranes and umbilical cord) invaded by leukocytes. Septicemia, pneumonia or omphalitis were documented in 45 (20%) infected premature newborns and inflammatory lesions in the placenta were observed in all of them. In order of statistical significance, the most important variables for early-onset bacterial neonatal infection were invasion of the chorioamniotic plate, amniotic membranes and umbilical cord tissues by PMNL (P < 0.0000), premature rupture of membranes (P < 0.0000), birthweight lower than 1500 g (P < 0.0000), gestational age under 34 weeks (P < 0.0001), foul smell (P < 0.0038), no antibiotics before delivery (P < 0.0066) and intrapartum fever (P < 0.0087). By logistic stepwise multiple regression analysis, invasion of fetal chorioamniotic plate and of amniotic membranes by leukocytes were the only statistically significant variables. The probability of neonatal infection in premature newborns, when polymorphonuclear neutrophils were present in chorioamniotic plate and in amniotic membranes, was 62.5%, while the probability was 0.5% when these tissues were normal. These data suggest that histological chorioamnionitis has to be considered as an important risk factor for early-onset infection in premature newborns.

A 30-year-old male presented to the Emergency Department, over sequential visits, with abdominal complaints. The patient’s presenting history and physical examination were mistakenly diagnosed variously as gastroenteritis, omphalitis, and appendicitis. Ultimately, the diagnosis of urachal fistula was made at surgery. This case is discussed in light of prior published experiences with this disease entity.

A prospective cohort study was undertaken to determine calf-level factors that affected calf health status between birth and 6 months of age. A convenience sample of approximately 3300 female Holstein calves born in 1991 on two large Florida dairy farms was used for the study. Data collected on each calf at birth included farm of origin, weight, height at the pelvis, birth date, and serum total protein (a measure of colostral immunoglobulin absorption). Birth season was dichotomized into summer and winter using meteorological data collected by University of Florida Agricultural Research Stations. Health data including date of initial treatment and number of treatments were collected for the diseases diarrhea, omphalitis, septicemia and pneumonia. All calves were followed for 6 months. Cumulative incidences of mortality and occurrence of diarrhea, omphalitis, septicemia and pneumonia were 0.12, 0.35, 0.11, 0.24 and 0.21, respectively. Serum total protein (TP) was a significant risk factor for mortality. The association of TP and mortality was quadratic and showed a dramatic decrease in mortality as TP increased from 4.0 to 5.0 g/dl, a small improvement from 5.0 to 6.0 g/dl and virtually no improvement in mortality rates as TP increased over 6.0 g/dl. The hazard mortality ratio was constant from birth to six months, indicating that the increased risk of mortality associated with low levels of TP was evident through six months of age. No interactions between TP, farm, season, or birth weight were found in these analyses. Serum total protein concentration was a significant risk factor for the occurrences, age of onset and severity of septicemia and pneumonia. The association between TP and septicemia was linear and an interaction with birth season was found. The association between TP and pneumonia was quadratic, and in contrast to the TP-and-septicemia relationship, the morbidity hazard ratio for pneumonia was not constant over the time measured; that is, colostral immunity protected the calf from developing pneumonia early in life, but this effect disappeared as the calf got older. Total protein was not a significant risk factor for diarrhea or omphalitis.

Necrotizing fasciitis (NF) of the abdominal wall occurring in newborns is associated with a 50% mortality rate. Improved survival requires early diagnosis followed by aggressive surgical débridement. During a 10-year period, we treated 7 infants who developed NF. During the same period, 32 infants were admitted with omphalitis that did not progress to NF. The patients with omphalitis and those with NF were compared. Tachycardia, abnormal white blood cell counts, induration, and violaceous skin discoloration were seen exclusively in the NF patients. Polymicrobial infections were documented in 28% of the omphalitis patients and 86% of the NF patients. All omphalitis patients survived, whereas 5 of 7 (71%) NF patients died. Adjuvant hyperbaric oxygen therapy was used for 4 infants with NF, 2 of whom survived (50%). NF is a highly morbid disease, that can be distinguished from other infant abdominal wall infections by the skin changes, white blood cell counts, heart rate, and microbiologic results. Prompt diagnosis of NF improves survival when combined with aggressive surgical débridement.

The neutropenia often seen in infants of hypertensive mothers (IHMs) at12 hours of age has been associated with nosocomial infection in the first 18 days of life. To assess maternal hypertension as an independent factor for nosocomial infection, we compared 101 low birth weight (or = 2.00 kg) IHMs to a concurrent birth weight-matched group of infants of normotensive mothers (INMs). Infants without differential leukocyte counts at12 hours of age were excluded, leaving 93 IHMs and 98 INMs. The incidence of neutropenia at12 hours among IHMs was not significantly different from that among INMs (42/92 (45%) vs 37/98 (38%)). Nosocomial infection was more frequent in neutropenic IHMs than in neutropenic INMs (12/42 vs 2/37; p = 0.007). Infection in IHMs included omphalitis (2 infants), pneumonia (4), and sepsis with or without meningitis (6); INMs had cellulitis (1) and sepsis (1). The underlying mechanism(s) for this predisposition remains to be elucidated, although limited data suggest that neutropenia may be more severe and prolonged among IHMs.

Umbilical inflammatory conditions may result from a variety of congenital and acquired abnormalities, some of which may be life threatening. An understanding of the developmental anatomy of the umbilicus provides a basis for formulating an approach to both evaluation and treatment of these conditions. A case report is presented.

Necrotizing fasciitis occurs when the inflammation (cellulitis) spreads beyond the umbilicus to include the subcutaneous tissue and underlying fascia. Presently, omphalitis is relatively uncommon because of aseptic delivery techniques and antimicrobial therapy. One hundred three neonates aged 7 to 28 days, with varying degrees of omphalitis, were treated on an outpatient or inpatient basis between 1989 and mid-1993. The neonates were full-term and weighed at least 2.5 kg. Patients with necrotizing fasciitis initially appear deceptively well, which results in less-than-optimum treatment at the outset, followed by a rapid and fulminating downhill course, in turn resulting in death within 24 to 72 hours. Early recognition of the condition, with aggressive resuscitation, appropriate antibiotics, and early surgery are necessary to salvage this high-risk group. The risk factors that may predict the development of necrotizing fasciitis and its early detection are discussed.

Most cases of umbilical pilonidal sinus present as recurrent omphalitis with pain, suppuration and bleeding, or even as an umbilical mass. Pilonidal sinus typically affects young, hirsute men, often with poor personal hygiene. Obesity and sweating are other factors that facilitate hair entry in the epidermis. 1 The literature does not refer to depilation as a risk factor for the development of umbilical pilonidal sinus, possibly because the interest in depilation among men is a fairly recent development. In our patient, fragments of hair cut from the chest and abdomen very likely settled within the navel, resulting in the formation of the pilonidal sinus. Diagnosis is clinical and based on the detection of hairs nesting deep within the navel. Pathology reveals a foreignbody granuloma, with an epitheliumlined tract leading to an area of fibrosis and granulation tissue enveloping the hair fragments. This entity should be included in the differential diagnosis of umbilical lesions, such as, for example, epidermal cysts, umbilical hernias, pyogenic granulomas, endometriosis, omphalomesenteric duct remnants, urachal anomalies, and metastatic tumors. 2 Most patients are cured by conservative treatment involving the extraction of the hair fragments and other debris from the cavity and, if necessary, the administration of oral antibiotics. 3,4 Omphalectomy should only be resorted to for difficult-to-treat cases. In order to avoid the possibility of recurrence, navel reconstruction is not recommended, it being preferable to allow the surgical wound to heal by second intention.

Summary Aerobic and anaerobic cultures were obtained from 23 newborns with omphalitis. Aerobes were isolated from 20 specimens (87 per cent). In six cases (26 per cent) they were mixed with anaerobes, and in 14 cases (61 per cent) they were the only isolates. Anaerobes alone were recovered in three instances (13 per cent). There were 47 aerobic isolates (2·1 per specimen). These included 11 Group B beta hemolytic streptococci, nine Esch. coli , six Staph. aureus , five Group D streptococci and four Proteus mirabilis . There were 22 anaerobic isolates (0·9 per specimen). They included seven B. fragilis group, four anaerobic Gram-positive cocci and two Clostridium perfringens . Beta lactamase production was detected in 13 isolates, recovered from 12 patients. The above findings demonstrate the polymicrobial aerobic and anaerobic aetiology of neonatal omphalitis.

Six neonates are described with a gangrenous omphalitis, a disease not reported for many years. They had many features in common including previous good health. In two, the disease was preceded by the application of tobacco ash to the umbilical stump. Clinically there was gangrene of the umbilicus with a blood-stained discharge and extensive cellulitis radiating into the abdominal wall. Despite aggressive therapy including excision of the affected area, the systemic effects of the local disease progressed rapidly until all of the first five infants who presented, died. Microbiologically there was a polybacterial infection involving a wide variety of organisms particularly E coli and Clostridia species. There appeared to be an appropriate response by the infants to an acute bacterial infection, and two patients investigated showed no evidence of cellular or humoral immunodeficiency. The pathology was an infection causing local tissue necrosis with a vasculitis and microabscess formation, which involved adjacent structures by direct extension. The severe systemic symptoms were attributable to an endotoxemia or exotoxemia. The evolution of therapy for gangreneous omphalitis in the newborn, successful in the sixth patient, is discussed.

FROM the standpoint of avian pathology, some recent observations indicate that the condition of infection and inflammation of the navel of baby chicks (omphalitis) has not been accorded the importance it warrants. This situation seems particularly obvious in view of the recent report by Volkmar (1929) on omphalitis in baby chicks and turkeys, which includes references to omphalitis in chicks described by Antoine and Hebrant (1913), and by Rasberger (1928), and in recognition of several outbreaks from different sources encountered quite recently at the Kansas Station. Perhaps many cases of the disease have gone unrecognized although its occurrence in incubator hatched chicks may mean that it is of significance only under certain environmental conditions which prevail during incubation, hatching, and brooding by the more modern methods. H istory The first serious outbreak of omphalitis in chicks, recognized at the Kansas Station, occurred in February, 1929, and since that time another serious . . .

OMPHALITIS, or navel infection in baby chicks and poults, has been an increasing problem over the years. Volkmar (1929) described the syndrome of omphalitis and concluded that the increased bacterial content of the air in the incubator at hatching time was the major factor in the production of the disease. Diagnostic laboratories throughout the country have isolated from chicks with omphalitis or sometimes termed “mushy chick,” “filth” organisms such as Escherichia coli, staphylococci spp., streptococci spp. pseudomonasspp., and proteolytic anaerobic bacteria. Williams and Daines (1942) found that within 72 hours after hatching, losses ran as high as 30 percent and the causative agent was Staphylococcus aureus. Recent work by Pathak et al. (1960) indicated that from 146 chicks with unabsorbed egg yolks they isolated Escherichia, Aerobacter, Klebsiella and Proteus. They stressed the importance of disinfection of eggs, incubators, brooders and other equipment concerned with chick raising. Very little work has…

FOUR plane loads of baby chicks totalling 135,000 plus the usual extras have have been shipped from Idlewild Airport near New York City to Cairo, Egypt. These chicks were established in brooding plants for a three-week period before distribution to various poultry raisers. Day to day shifts in mortality rates during the brooding period made it desirable to make post mortem and bacteriological studies. The diagnosis of omphalitis and analysis of incidence data may be useful in planning for future air shipments. SHIPMENT CONDITIONS DURING FLIGHT All incubators from some dozen hatcheries were set to hatch approximately 24 hours before previously announced flight time from Idlewild Airport. The first load of 31,169 chicks in March took 33¼ hours from departure at Idlewild to arrival in Cairo, with four stops enroute. Temperature recordings, which were made a four points inside the plane, varied from 52° to 71°. Difficulty was encountered in …

A 6-year study of bacteria isolated from swabs taken from clinically apparent infections of the stump of the umbilical cord showed an overall infection rate of 0.7% (200/27,107), with a preponderance of Gram-negative organisms as compared with Gram-positive organisms (171/118), an excess which was statistically significant. When the data were broken down into premature and non-premature nurseries, the incidence of infection in the former was 2.08% (84/4028) and in the later 0.5% (116/23,079), a highly significant statistical difference. Most of the organisms isolated from the premature nurseries were Gram negative (83/120) and this finding too was statistically highly significant.

A simplified technique for the repair of gastroschisis without the need to excise the umbilicus or make a fascial incision has been developed. First, the abdominal wall is stretched and the viscera are reduced. Next, the skin and subcutaneous tissue are elevated from the fascia for 1.5 cm around the defect and the fascia is closed transversely with interrupted sutures. The skin is also closed transversely. The umbilical stump is left intact. Eight of nine consecutive patients with gastroschisis were able to undergo repair by this technique. The average hospital stay was 35.6 days. There were no cases of omphalitis or cellulitis of the abdominal wall, but one child has a small umbilical hernia. All have a near normal-appearing umbilicus. This simpler technique for the repair of gastroschisis is quicker and less traumatic, and gives a better cosmetic result than the conventional method.