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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.

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 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: 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.

Abstract 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. Trial registration Systematic Review Registration: CRD42018109280.

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

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.

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.

Introduction: Neonatal neutropenia is often secondary to sepsis, low birth weight, pregnancy-induced maternal hypertension, and other conditions. Case Report: We report a case of asymptomatic isoimmune neutropenia in a pair of preterm twins. Genotyping confirmed that the mother was negative for HNA-1a, 1b, and 1c, consistent with an FcγRIIIb deficiency. The father was 1(a+b+c–) and the neonates were 1(a–b+c–). A strongly positive result was observed in the granulocyte immunofluorescence test against paternal neutrophils (IgG antibodies). IgG anti-CD16b isoantibodies were detected in the mother’s breast milk. Neutropenia resolved after 28 days without requiring any specific treatments. Discussion: Even though neonatal alloimmune neutropenia (NAN) is usually benign and self-limiting, some patients pre­sent with delayed separation of the umbilical cord, mild skin infections, omphalitis, or severe infections like pneumonia, sepsis, and meningitis. Thus, it is important to rule out NAN in case of neonatal neutropenia.

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.

Infectious diseases of the joints, ears, and umbilicus are common diseases of the calf. Many different infectious agents can play a role in disease at these different anatomic sites. Combinations of these diseases often present in the same population of calves, and the problem can often be traced back to inappropriate colostrum management practices. This review provides an overview of septic arthritis, otitis, and navel ill in calves as well as a brief discussion on colostrum management practices., American Association of Bovine Practitioners Proceedings of the Annual Conference, 2020 Recent Graduate Proceedings

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.

Umbilical cord care can be a stressful practice for parents. Complications of cord care can increase neonatal morbidity and mortality. The extracts of Arnica montana (AM) have been reported to possess antibacterial, anti-inflammatory, antifungal, and immunomodulatory activities. We aim to demonstrate the efficacy of AM on cord detachment and parents’ stress level induced by cord medication in healthy full-term newborns. We enrolled full-term infants with a birth weight ≥ 2500 g in healthy conditions. Cord stumps of infants in the PRE-group were cleaned and dried, while cord stumps of infants in the POST-group were cleaned, dried, and medicated with a natural topic dermo-protective powder containing AM. After discharge, we interviewed parents on the stump status during follow-up visits in a pediatric office at 7 and 14 days of life, or by phone calls after follow-up visits. Long-rank test showed that time of cord separation of newborns in the PRE-group was significantly higher compared to that in the POST-group (p < 0.001). Parents of newborns in the PRE-group were significantly more stressed during cord medication compared to parents in the POST-group (2.0 (1.2 to 2.1) vs 1.0 (0.8 to 1.3), p = 0.011). Multivariate analysis showed a significantly linear relation with group assignment for cord separation (p < 0.001) and parents’ stress during the medication (p = 0.033).Conclusion: The use of a natural topic dermo-protective powder containing AM reduces the time of cord separation, improves parents’ stress level, and reduces the risk of complications. What is Known:• Cord stump care can be a stressful practice for parents.• Antiseptic treatment recommended for cord care could be associated with side effects such as burning and sensitization. What is New:• The medication of cord stump with a natural topic dermo-protective powder containing Arnica montana reduces time of cord detachment and of complication such as redness’, bleeding, or secretions.• The use of Arnica montana for cord medication may have a positive impact on the family, reducing parents’ stress, and the use of other medications.

Myasis is the infestation by fly larvae (Diptera) in live vertebrates including humans. Myasis has been reported most commonly in tropical and subtropical areas around the world with poor sanitation and presence of cattle. Neonatal umbilical myiasis is an important cause of death in bovines and produces major economic losses in the livestock industry. However, its presentation in humans is rare, with a few cases reported worldwide. Moreover, umbilical myasis can be life-treating due to the risk of larvae migration to deeper tissues of the abdomen, omphalitis, and sepsis. We describe the case of a 7-day-old infant admitted to the hospital due to umbilical cord myiasis. In total, 55 larvae were removed from the wound and identified as Cochliomyia hominivorax. The patient recovered satisfactorily after treatment with ivermectin and amoxicillin. A literature search was performed in Pubmed, Medline, Lilacs and Google Scholar, with 64 cases of myasis by C. hominivorax being reviewed. Oral cavity, wounds, scalp and natural orifices are the main affected anatomical areas. Risk factors include the extremes of age, male sex, poor hygiene, alcohol and drug use, cancer, and mental disability. Programs for human myiasis prevention and surveillance are needed in neotropical areas where living conditions make it difficult to implement control strategies.

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.

Objective: To report the educational experience with pregnant women considering the recovery of collective memory inherited from the care for the umbilical cord stump provided by grandmothers. Method: This case study was based on collective memory and resulted from a workshop with 20 pregnant women from a Basic Health Unit in a city in the inland of Bahia. Results: The study showed that pregnant women’s grandmothers are significant in the stump care process because they transmit their memories pervaded by beliefs, myths and superstitions that, although should be respected by nurses and other health professionals, can sometimes contribute to the occurrence of omphalitis and neonatal tetanus. Final considerations: The results indicated the need for raising awareness and education of all persons involved in this care, especially grandmothers, so that they can reflect on the risks and damage that certain empirical knowledge can cause to the health of the umbilical cord.

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

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.

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.

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.

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 care of the umbilical cord until its detachment still remains controversial. The latest updated recommendations by the World Health Organisation advocate dry cord care in those countries with adequate obstetric care and low neonatal mortality rate. In recent years, new studies and reviews attribute some benefit to applying chlorhexidine on the umbilical stump. An analysis is presented here of the available evidence and results in the advisability of still recommending the dry cord care in the newborns in our setting. Resumen: El cuidado del cordón umbilical hasta su desprendimiento continúa siendo motivo de controversia en la actualidad. La Organización Mundial de la Salud recomienda en su última revisión realizar la cura en seco en países con cuidados obstétricos adecuados y una tasa baja de mortalidad neonatal. Por otro lado, en los últimos años han surgido nuevos estudios y revisiones que atribuyen un beneficio a aplicar clorhexidina tópica en el muñón. El presente documento analiza la evidencia disponible y concluye en la conveniencia de continuar recomendando la cura en seco en los nacimientos de nuestro entorno.

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 compare the effectiveness of 10% povidone iodine to that of 70% alcohol in umbilical cord care of newborn infants. Methods This open label clinical trial was conducted in Pirngadi Hospital, Medan from July to September 2003. Newborn infants who fulfilled inclusion criteria were randomly allocated to umbilical cord care using 10% povidone iodine or 70% alcohol. The main outcome measures were omphalitis prevalence, microorganism colonization, and time to umbilical cord separation. Culture of the umbilical cord swab was taken in the first 48-72 hours after birth. The umbilical cord was observed daily during hospitalization and every other day after discharge until cord separation. Statistical analysis was done using chi-square test and independent t-test. Results There were 54 infants in the povidone iodine group and 52 infants in the alcohol group. Omphalitis was absent in both groups. Fourteen percent of subjects in the povidone iodine group showed no microorganism growth, compared to 7% in the alcohol group. Staphylococcus aureus colonization was found in 10% of subjects in the povidone iodine group and 23% of subjects in the alcohol group. The prevalence of Escherichia coli colonization was 41% and 47% in the povidone iodine and alcohol groups, respectively. There was no statistically significant difference between both groups in bacterial colonization (P=0.135). Mean time to umbilical cord separation was 6.44 days in the povidone iodine group and 6.13 days in the alcohol group (P=0.431). Conclusion These results suggest that 10% povidone iodine and 70% alcohol are equally effective in umbilical cord care of newborn infants [Pediatr Indones 2005;45:198-202].

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

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.

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.

Objective The objective of this study was to explore the umbilical cord separation time, predictors, and healing complications from birth until the newborn was one month old. Design A quantitative longitudinal observational analytical study by stratified random sample was adopted. Setting Public health system hospitals in southern Spain and at newborns’ homes. Participants Between April 2016 and December 2017, the study included 106 neonates born after 35–42 weeks of gestation whose umbilical cord was cured with water and soap and dried later as well as newborns without umbilical canalisation whose mothers enjoyed a low-risk pregnancy. Methods The data collection procedure comprised two blocks: from birth to the time of separation of the umbilical cord and from cord separation to the first month of life of the newborn. Umbilical cord separation time was measured in minutes; socio-demographic and clinical characteristics were measured by means of questionnaires, and the external diameter of the umbilical cord was measured using an electronic stainless-steel calliper and trailing roller. Results The mean umbilical separation time: 6.61 days (±2.33, IC 95%:6.16–7.05). Incidence of omphalitis was 3.7%; granuloma was 8.6%. Separation time predictors were wetting recurrence, birth weight, intrapartum antibiotics, birth season, and Apgar < 9 (R2 = 0.439 F: 15.361, p

The umbilical cord, a vital conduit between the placenta and the fetus, loses much of its significance after birth. However, newborns can often present with various abnormalities of the umbilicus, such as benign granulomas or more serious lesions due to persistent remnants, many of which can change the normal course of cord separation and may be associated with significant morbidities if left unrecognized and uncorrected. Although not uncommon, sanguineous drainage from the umbilical stump can be quite alarming to new parents. Parental counseling regarding normal umbilical cord changes, as well as abnormal findings, such as discharge and skin changes, are important for the recognition and timely treatment of potentially significant umbilical cord disorders.

A stark contrast exists between the physiologic importance of the umbilicus during development and after birth. During development, the umbilical cord functions as a channel allowing blood flow between the placenta and fetus; it also serves an important role in the development of the intestine and the urinary system. After birth, once the umbilical cord falls off, no evidence of these connections should be present, except the umbilical scar, as landmark of the previously exist cord. Nevertheless, umbilical disorders are frequently encountered in paediatric surgery. It has been estimated that 30% of births have some type of umbilical cord finding. These disorders range from the very common umbilical hernia to infections such as omphalitis, which can be life-threatening, and from simple straightforward anatomy like granuloma to complicated and sophisticated malformations, like vitellointestinal and urachal anomalies. Most patients with umbilical problems present with a mass or drainage from the umbilicus. An understanding of the anatomy and embryology of the abdominal wall and umbilicus is important to identify and properly treat common as well as rare umbilical conditions.

A stark contrast exists between the physiologic importance of the umbilicus during development and after birth. During development, the umbilical cord functions as a channel allowing blood flow between the placenta and fetus; it also serves an important role in the development of the intestine and the urinary system. After birth, once the umbilical cord falls off, no evidence of these connections should be present, except the umbilical scar, as landmark of the previously exist cord. Nevertheless, umbilical disorders are frequently encountered in paediatric surgery. It has been estimated that 30% of births have some type of umbilical cord finding. These disorders range from the very common umbilical hernia to infections such as omphalitis, which can be life-threatening, and from simple straightforward anatomy like granuloma to complicated and sophisticated malformations, like vitellointestinal and urachal anomalies. Most patients with umbilical problems present with a mass or drainage from the umbilicus. An understanding of the anatomy and embryology of the abdominal wall and umbilicus is important to identify and properly treat common as well as rare complicated conditions.

The main concerns about neonates’ umbilical stump are delay in its falling, umbilical cord infections and bleeding. Optimal umbilical cord care is therefore an important issue for both nurseries’ staff and neonates’ caregivers. Many investigators have explored the optimal cord care treatment. Among current umbilical cord care options, topical application of chlorhexidine decreases omphalitis and neonatal mortality, both in primary and community care settings in developing countries; whereas dry cord care has proved to be adequate in hospital settings, in developed countries. We here report our experience on arnica/echinacea powder, a safe method of treating the umbilical cord in developed countries. Clinical Practice Article Scurati-Manzoni et al.; JSRR, 5(6): 435-440, 2015; Article no.JSRR.2015.110 436

1. Shobhan Sivathanu, MD* 2. Sowmya Sampath, MD* 3. Indhumathi Sridhar, MD* 1. *ESIC Medical College and Post Graduate Institute of Medical Sciences and Research, Chennai, India A 7-month-old girl, who is the first child born to second-degree consanguineous parents, presents with a large, nonhealing ulcer (Fig 1) over the scalp of 3 weeks’ duration. She has been having fever, vomiting, and loose stools for the past week. A review of the past medical history reveals 2 previous hospitalizations for the treatment of omphalitis: first as a neonate and the second time as a 2-month-old infant. The repeated episodes of omphalitis were attributed to a patent urachus (Fig 2) detected at that time. The infant had also developed skin lesions on 3 occasions between ages 2 and 5 months, diagnosed as atopic dermatitis, seborrheic dermatitis, and irritant contact dermatitis, at 3 different medical centers. She was also treated for acute suppurative otitis media at age 5 months. Figure 1. Nonhealing ulcer on the scalp. Figure 2. Omphalitis. On physical examination, the infant is febrile and pale. She weighs 5.7 kg (

Introduction: Omphalitis and umbilical cord separation time contributing to the number of morbidity and mortality in infants. There are various ways of cord care, but there was no significant difference in prevent of infection and cord separation time. Breast milk contains anti-infective and antiinflammatory factors that can be used for cord care. WHO recommends to develop it. The purpose of this study was to analyze the effect of topical breastmilk model on the incidence of omphalitis and separation time of the umbilical cord to the newborn.Methods: The study design was a quasy experimental. The subjects of this study were 30 newborns obtained by consecutive sampling in Rumah Sakit Ibu dan Anak Kendangsari Surabaya May–June 2012. The samples were divided into 2 groups (topical breastmilk and open dry treatment), each group consists of 15 newborns. Data were analyzed using chi-square and independent t-test with a signifi cance level ofα≤0.05.Results: There was no difference in the incidence of omphalitis in the use of topical breastmilk model compared to open dry treatment (p=0.33). However, there are significant differences in the average of cord separation time between topical breastmilk model and open dry treatment (p=0.020).Conclusion: Model of cord care with topical breastmilk lowers the risk of omphalitis and accelerate the cord separation time compared to open dry treatment. Using breastmilk as cord care are safe, effective and efficient.

Background Yearly, nearly all the estimated worldwide 2.7 million neonatal deaths occur in low- and middle-income countries. Infections, including those affecting the umbilical cord (omphalitis), are a significant factor in approximately a third of these deaths. In fact, the odds of all-cause mortality are 46% higher among neonates with omphalitis than in those without. Five large randomized controlled trials in Asia and Sub-Saharan Africa (SSA) have examined the effect of multiple cord stump applications with 4% chlorhexidine (CHX) for at least 7 days on the risk of omphalitis and neonatal death. These studies, all community-based, show that multiple CHX applications reduced the risk of omphalitis. Of these trials, only one study from South Asia (the Bangladeshi study) and none from Africa examined the effect of a single application of CHX as soon as possible after birth. In this Bangladeshi trial, CHX led to a reduction in the risk of mild-moderate omphalitis and neonatal death. It is important, in an African setting, to explore the effect of a single application among health-facility births. A single application is programmatically much simpler to implement than daily applications for 7 days. Therefore, our study compares umbilical cord cleansing with a single application of 4% CHX at birth with dry cord care among Ugandan babies born in health facilities, on the risk of omphalitis and severe neonatal illness. Methods The CHX study is a facility-based, individually randomized controlled trial that will be conducted among 4760 newborns in Uganda. The primary outcomes are severe illness and omphalitis during the neonatal period. Analysis will be by intention-to-treat. Discussion This study will provide novel evidence, from a Sub-Saharan African setting, of the effect of umbilical cord cleansing with a single application of 4% CHX at birth and identify modifiable risk factors for omphalitis. Trial registration ClinicalTrials.gov, identifier: NCT02606565. Registered on 12 November 2015. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-2050-0) contains supplementary material, which is available to authorized users.

BACKGROUND AND OBJECTIVES: In developed countries, where omphalitis has become rare and related mortality nil, benefits of antiseptic use in umbilical cord care have not been demonstrated. We aimed to assess the noninferiority of dry care compared with antiseptics in France where antiseptic use is widespread. METHODS: We conducted a noninferiority, cluster-randomized, 2-period crossover trial, in 6 French university maternity units including all infants born after 36 weeks’ gestation. Maternity units were randomly assigned to provide either their usual antiseptic care or a dry care umbilical cord method for a 4-month period, and then units switched to the alternate cord cleansing method for a 4-month period. The primary outcome was neonatal omphalitis, adjudicated by an independent blinded committee based on all available photographs, clinical, and bacteriological data. We used a noninferiority margin of 0.4%. Analysis was performed per protocol and by intention to treat. RESULTS: Among 8698 participants, omphalitis occurred in 3 of 4293 (0.07%) newborns in the dry care group and in none of the 4404 newborns in the antiseptic care group (crude difference: 0.07; 95% confidence interval: –0.03 to 0.21). Late neonatal infection, parental appreciation of difficulty in care, and time to separation of the cord were not significantly different between the 2 groups. CONCLUSIONS: Dry cord was noninferior to the use of antiseptics in preventing omphalitis in full-term newborns in a developed country. Antiseptic use in umbilical cord care is therefore unnecessary, constraining, and expensive in high-income countries and may be replaced by dry care.

Urachal sinus is rare congenital urachal anomaly in adults develops from incomplete obliteration of fetal urachus. Usually incidental finding and remain asymptomatic unless a complication occurs. Complications includes infection, abscess, calculus, gas formation, intraperitoneal rupture, peritonitis and malignant transformation. High index of clinical suspicion is required when patient presents with pain abdomen, infraumbilical mass or umbilical discharge. Infected urachal sinus remains a diagnostic challenge due to its rare incidence and variable clinical presentations. We report a case in 37 year old female patient of infected urachal sinus presenting as infraumbilical mass, umbilical discharge and local tenderness. Two months back presented with fever, lower abdominal pain of unknown origin. Clinical suspicion of abdominal wall abscess or omphalitis were made. In our case ultrasonography and magnetic resonance imaging confirmed this rare entity. Brief discussion were made on clinical presentation, differential diagnosis, radiological findings and management options in order to prevent further complications, recurrence and malignant transformation.

A total of 130 diseased and dead broiler chicks of 1-10 days of age obtained from different sources were examined; yolk sac samples from these chicks were cultured and the bacteria were isolated and identified on biochemical tests. Unabsorbed yolk sac was observed in 48 (36.9%) chicks associated with signs of septicemia in many cases. These unabsorbed yolk sac exhibit signs of moderate to mild inflammation indicating that the cause of death is the consequences of the infection rather than it's direct effect. The recovered 12 Salmonella isolates were: S. enteritidis 5(41.6%), S.virchow 3(25%), S.typhimurium 2(16.6%), S.heidelberg 1 (8.3%), S. kentucky 1(8.3%). Thickness of yolk sac wall and the fibroses may be the cause of un absorption of yolk, Sever changes were seen in the liver, heart, intestine and yolk sac represented by congestion, inflammatory cells infiltration.