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Background: Neonatal sepsis is a known leading cause of neonatal morbidity and mortality. Aim: To compare the efficacies of 96% methylated spirit and 4% chlorhexidine (CHX) gel in the treatment of umbilical stump of neonates. Method: This was a randomized, open labelled, parallel group trial of CHX gel and Methylated spirit for neonatal umbilical cord care in Jos, between 2/6/17 and 16/7/17. Inclusion criteria were term, newly born 0 to 6 hours old, with no known risk for sepsis and written informed parental consent. Eligible subjects were randomized to receive methylated spirit or 4% CHX gel. Outcome measures were cord separation time, omphalitis, neonatal sepsis and neonatal mortality by day 28. Results: A total sample of 51 of 58 met enrolment criteria. Thirtytwo (62.7%) where delivered in JUTH, 33(64.7%) were males with a mean birth weight of 3.7kg (CI 3.04 – 3.30). Mean cord separation times were 7.96 ± 4.07)days in the methylated spirit group vs 6.43 ± 3.13days in the CHX comparator group, (p=0.078). Omphalitis was0% vs2(8.3%) and NNS 2(7.4%)vs2(8.3%) in methylated spirit and CHX treatment groups respectively. There was 1(3.7%) mortality in the methylated spirit treatment group. Conclusion: Methylated spirit and 4% CHX gel have comparable umbilical stump treatment efficacy. Methylated spirit may be a safe alternative in clinical settings where topical 4% CHX gel is unavailable or unsafe.

Omphalitis, commonly caused by opportunistic bacteria has been significantly associated with morbidity and mortality in neonatal calves. Trueperella pyogenes is a commensal and opportunistic pathogen that can cause suppurative infection in farm animals. Our case involved a 10-day-old female Korean indigenous calf that presented with umbilical enlargement accompanied by a greenish-yellow purulent discharge and right forelimb lameness. The calf was diagnosed with failure of passive transfer at 24 h of age. Physical examination found hypothermia (38.1°C), tachycardia (110 beats/min), tachypnea (47 cycles/min), and open mouth breathing. Ultrasonography revealed hyperechoic pus in the 9th and 10th right intercostals, for which a liver abscess due to omphalophlebitis was suspected. After 3 days, the calf died. T. pyogenes was detected in the umbilical cord, lung, liver, kidney, intestine, mesenteric lymph node, urinary bladder, and bladder ligament. All genes related to the virulent factors (i.e., plo, cbpA, fimA, fimC, fimG, nanH, and nanP) were also identified, with plo and fimA being associated with pathogenicity. A final diagnosis of omphalitis was established based on the identification of virulent T. pyogenes and umbilical cord dilatation on ultrasonography. Antimicrobial susceptibility tests showed that the isolated T. pyogenes was susceptible to amoxicillin, ceftiofur, florfenicol, enrofloxacin, ofloxacin, and ciprofloxacin, suggesting the suitability of these antibiotics for treating T. pyogenes-induced omphalitis. Hence, accurate and rapid diagnosis of the involved bacteria and antimicrobial susceptibility patterns can help guide therapeutic decisions. Our case provides useful information that could aid large animal clinicians in the diagnosis and treatment of T. pyogenes-induced omphalitis. [ABSTRACT FROM AUTHOR]

Background: The Government of Kenya adopted the practice of 7.1% chlorhexidine digluconate (CHX) application for all newborns. However, challenges in implementation have arisen, as some counties in Kenya do not align with the underlying criteria for this recommendation. Therefore, we aimed to evaluate CHX adoption and associated factors in Kiambu County, Kenya. Methods: A cross-sectional survey was conducted among 434 caregivers attending their 6-week well-child clinics using multistage sampling. Descriptive statistics summarized sociodemographic data and CHX cord care uptake, while logistic regression analyzed associations between variables and CHX uptake. Results: The prevalence of use of CHX in Kiambu county was 41.0%. Twenty-two percent (22%) of the mothers were provided CHX post-delivery and 100% used it. Of the 78% who weren't provided CHX post-delivery, 39% were given prescriptions for CHX. The 61% who were not issued a prescription resorted to the use of surgical spirit (34.8%), dry cord care (9.2%) and saliva (3%). In public facilities, being married [AOR 0.19 (0.11–0.33)] and index use of CHX [AOR 0.17 (0.08–0.35)] were associated with non-adherence. Being employed [AOR 2.46 (1.26–4.77)] and delivering in hospital [COR 3.29 (1.69–7.08)] increased the likelihood of using CHX. Conclusion: Weak prescription and adherence to the CHX cord care policy in Kiambu county has led to women turning to alternative substances for cord care. Quality improvement strategies are necessary to enhance adherence to guidelines, such as refining county-specific recommendations for cord care and providing corresponding patient education, or issuing definitive prescriptions for CHX post-delivery.

Background: Bacterial Omphalitis has been reported as a significant cause of mortalities in newly hatched broiler chicks. Aim: This study aimed at assessment of the occurrence of omphalitis among broiler chicken in Gharbia governorate in Egypt. In addition, the bacteria associated with the occurrence of omphalitis in broiler chicken were also investigated and characterized. Methods: For this purpose, forty-three farms in that area were surveyed. The comparative levels of omphalitis caused by Escherichia coli (E. coli), Salmonella spp., and Staphylococcus aureus (S. aureus) were screened in 129 chicks. The drug resistance to eight commonly used antimicrobials in the Egyptian poultry farms was screened using the disk diffusion method. Results: The overall incidence rate of omphalitis was 37.21%. In birds with omphalitis, the co-prevalence of S. aureus, Salmonella spp., and E. coli was 87.5%. When compared to healthy flocks, broiler chicks with omphalitis caused by Salmonella spp., Escherichia coli, and S. aureus had a greater mortality rate in the first week of life. However, there were no significant differences in the mortality cases caused by these pathogens. Eighty-seven percent of the cases of omphalitis were linked to E. coli, and seventy-five percent to Salmonella spp. and S. aureus. From the yolk sac of broiler chicks with omphalitis, E. coli, Salmonella spp., and S. aureus were isolated at rates of 87.5%, 62.5%, and 45.8%, respectively. The isolates of E. coli and Salmonella spp. exhibited great sensitivity to Gentamycin and Tetracycline, however the strongest drug resistance was observed towards Cefpodoxime, Sulphamethoxazole & trimethoprim, Ampicillin, and Amoxycillin & Clavulanic acid. The recovered isolates of S. aureus showed susceptibility to chloramphenicol (72.37%), oxytetracycline (81.82%), and erythromycin (81.82%). However, every S. aureus isolate that was found resistant to amoxycillin and clavulanic acid, penicillin G and oxacillin. The existence of blaTEM, blaSHV, and blaCTX-M genes has been proposed as the genetic cause of β-lactam antibiotic resistance in Salmonella spp. and E. coli. MecA and blaZ, however, were found in every strain of S. aureus. Conclusion: The frequency of omphalitis and its-associated mortalities was comparatively high in Gharbia governorate. More efforts should be done to adopt strict hygienic standards for controlling and preventing such disease and this will consequently lead to minimizing the use of antimicrobials in poultry farms. [Open Vet J 2024; 14(1.000): 284-291]

Background: Bacterial Omphalitis has been reported as a significant cause of mortalities in newly hatched broiler chicks. Aim: This study aimed to assess the occurrence of omphalitis among broiler chickens in Gharbia governorate in Egypt. In addition, the bacteria associated with the occurrence of omphalitis in broiler chickens were also investigated and characterized. Methods: For this purpose, 43 farms in that area were surveyed. The comparative levels of omphalitis caused by Escherichia coli (E. coli), Salmonella spp., and Staphylococcus aureus (S. aureus) were screened in 129 chicks. The drug resistance to eight commonly used antimicrobials in Egyptian poultry farms was screened using the disk diffusion method. Results: The overall incidence rate of omphalitis was 37.21%. In birds with omphalitis, the co-prevalence of S. aureus, Salmonella spp., and E. coli was 87.5%. When compared to healthy flocks, broiler chicks with omphalitis caused by Salmonella spp., E. coli, and S. aureus had a greater mortality rate in the first week of life. However, there were no significant differences in the mortality cases caused by these pathogens. Eighty-seven percent of the cases of omphalitis were linked to E. coli and 75% to Salmonella spp. and S. aureus. From the yolk sac of broiler chicks with omphalitis, E. coli, Salmonella spp., and S. aureus were isolated at rates of 87.5%, 62.5%, and 45.8%, respectively. The isolates of E. coli and Salmonella spp. exhibited great sensitivity to gentamycin and Tetracycline; however, the strongest drug resistance was observed toward cefpodoxime, sulphamethoxazole and trimethoprim, ampicillin, and amoxycillin and clavulanic acid. The recovered isolates of S. aureus showed susceptibility to chloramphenicol (72.37%), oxytetracycline (81.82%), and erythromycin (81.82%). However, every S. aureus isolate that was found resistant to amoxycillin and clavulanic acid, penicillin G and oxacillin. of blaTEM, blaSHV, and blaCTX-M genes has been proposed as the genetic cause of β-lactam antibiotic resistance in Salmonella spp. and E. coli. MecA and blaZ; however, were found in every strain of S. aureus. Conclusion: The frequency of omphalitis and its associated mortalities was comparatively high in Gharbia governorate. More efforts should be made to adopt strict hygienic standards for controlling and preventing such disease and this will consequently lead to minimizing the use of antimicrobials in poultry farms. [ABSTRACT FROM AUTHOR]

Background: Ongoing high neonatal mortality rates (NMRs) represent a global challenge. In 2021, of the 5 million deaths reported worldwide for children under five years of age, 47% were newborns. Pakistan has one of the five highest national NMRs in the world, with an estimated 39 neonatal deaths per 1,000 live births. Reducing newborn deaths requires sustainable, evidence-based, and cost-effective interventions that can be integrated within existing community healthcare infrastructure across regions with high NMR. Methods: This pragmatic, community-based, parallel-arm, open-label, cluster randomized controlled trial aims to estimate the effect of Lady Health Workers (LHWs) providing an integrated newborn care kit (iNCK) with educational instructions to pregnant women in their third trimester, compared to the local standard of care in Gilgit-Baltistan, Pakistan, on neonatal mortality and other newborn and maternal health outcomes. The iNCK contains a clean birth kit, 4% chlorhexidine topical gel, sunflower oil emollient, a ThermoSpot™ temperature monitoring sticker, a fleece blanket, a click-to-heat reusable warmer, three 200 μg misoprostol tablets, and a pictorial instruction guide and diary. LHWs are also provided with a handheld scale to weigh the newborn. The primary study outcome is neonatal mortality, defined as a newborn death in the first 28 days of life. Discussion: This study will generate policy-relevant knowledge on the effectiveness of integrating evidence-based maternal and newborn interventions and delivering them directly to pregnant women via existing community health infrastructure, for reducing neonatal mortality and morbidity, in a remote, mountainous area with a high NMR. Trial registration: NCT04798833, March 15, 2021. [ABSTRACT FROM AUTHOR]

Copyright of Chinese Journal of Contemporary Pediatrics is the property of Xiangya Medical Periodical Press and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Simple Summary: In calves, omphalitis is an infection of one or all the umbilical structures. It is the third most frequent disease in newborn calves. The objective of this longitudinal clinical trial was to assess the association between omphalitis and the failure of passive immunity transfer. Twenty-two cow–calf operations in central France were visited twice weekly from November 2020 to March 2021. Female (n = 463) and male (n = 501) beef calves were health scored twice: between 1 and 9 days old during the first visit and between 8 and 16 days old during the second visit. Omphalitis was defined as an enlarged umbilicus (greater than 20 mm) or pain response or an umbilical stump discharge or ultrasonographic abnormalities. During the first visit, a blood sample was collected for serum measurement of the total solids percentage (TS-%Brix) and total protein (TP). Three hundred and eleven calves (32.3%) developed omphalitis. The failure of passive immunity transfer was defined as serum %Brix < 8.1 or TP < 5.1 g/dL. No statistical association between the prevalence of omphalitis and the failure of passive immunity transfer was observed. In cow–calf systems, farm-level management factors (calving difficulty, hygiene of housing, and umbilical disinfection) seem to have more influence on the risk of this disease. Omphalitis is the third most frequent disease in newborn calves after neonatal diarrhea and bovine respiratory disease (BRD), but limited data on the prevalence and risk factors are available in the literature. Failure of passive immunity transfer (FPIT) is recognized as a major risk factor for diseases and mortality in calves. However, the association between omphalitis and FPIT remains poorly described. To assess this association, 964 suckler beef calves from 22 farms were included in a longitudinal cohort study for 5 months. Each calf was examined twice (mean ages: 4.4 and 11.1 days old) to diagnose omphalitis through clinical examination and ultrasonographic evaluation (USE) if necessary. Measurements of the total solids percentage (TS-%Brix) and total protein (TP) were performed on the serum during the first visit to evaluate the calves' passive immunity status. FPIT (fair and poor) was defined as serum %Brix < 8.1 or TP < 5.1 g/dL; among calves with omphalitis, 14% had FPIT and among calves without omphalitis 12% had FPIT. The omphalitis prevalence was 32.3% in calves without any other disease (overall prevalence of 30.9%). No statistical association between the prevalence of omphalitis and FPIT was observed. Further research is needed to identify the risk factors and promote the prevention measures for omphalitis in cow–calf systems, such as calving difficulty, hygiene of housing, and navel disinfection. [ABSTRACT FROM AUTHOR]

Introduction: A newly cut neonatal umbilical stump is a potential portal of pathogen entry leading to omphalitis. Neonatal sepsis can complicate omphalitis, but good cord care practices can reduce this risk. Objective: The objective of this study was to assess umbilical cord care practices in tertiary-, secondary- and primary-level healthcare facilities in Jos, Nigeria. Methods: A multi-centre, cross-sectional study of 284 mothers of infants aged 3–6 weeks old attending immunisation clinics in the three‑level healthcare facilities using multistage sampling technique between April and September 2019. Data were analysed using SPSS version 23.0. Pearson’s Chi‑squared test was used to compare categorical variables. Adjusted odds ratios (AORs) and 95% confidence interval (CI) were used as point and interval estimates, respectively. P ˂ 0.05 was adjudged to be statistically significant. Results: The mean age of the mothers and infants was 25 ± 6 years and 5 ± 1 week, respectively. Only 2.2% of mothers used chlorhexidine (CHX) gel for cord care. Mothers showed good knowledge but poor practice of cord care. A significant positive relationship was observed between quality of cord care practices and level of healthcare facility (χ² = 15.213; df = 2; P ˂ 0.001). Good cord care practices were predicted by mothers’ age 30–46 (AOR = 3.6; CI: 1.4–9.1) and good knowledge of cord care (AOR = 4.7; 95% CI: 2.2–9.9). Conclusions: The study has highlighted the good knowledge but poor practices of cord care by mothers and the need to scale up the uptake of CHX gel in Jos. Mother’s age and good knowledge of cord care are predictors of good cord care practices. [ABSTRACT FROM AUTHOR]

Copyright of Firat Universitesi Saglik Bilimleri Veteriner Dergisi is the property of Firat Universitesiu, Saglik Bilimleri Enstitusu and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: A newly cut neonatal umbilical stump is a potential portal of pathogen entry leading to omphalitis. Neonatal sepsis can complicate omphalitis, but good cord care practices can reduce this risk. Objective: The objective of this study was to assess umbilical cord care practices in tertiary-, secondary- and primary-level healthcare facilities in Jos, Nigeria. Methods: A multi-centre, cross-sectional study of 284 mothers of infants aged 3–6 weeks old attending immunisation clinics in the three-level healthcare facilities using multistage sampling technique between April and September 2019. Data were analysed using SPSS version 23.0. Pearson's Chi-squared test was used to compare categorical variables. Adjusted odds ratios (AORs) and 95% confidence interval (CI) were used as point and interval estimates, respectively. P < 0.05 was adjudged to be statistically significant. Results: The mean age of the mothers and infants was 25 ± 6 years and 5 ± 1 week, respectively. Only 2.2% of mothers used chlorhexidine (CHX) gel for cord care. Mothers showed good knowledge but poor practice of cord care. A significant positive relationship was observed between quality of cord care practices and level of healthcare facility (χ2 = 15.213; df = 2; P < 0.001). Good cord care practices were predicted by mothers' age 30–46 (AOR = 3.6; CI: 1.4–9.1) and good knowledge of cord care (AOR = 4.7; 95% CI: 2.2–9.9). Conclusions: The study has highlighted the good knowledge but poor practices of cord care by mothers and the need to scale up the uptake of CHX gel in Jos. Mother's age and good knowledge of cord care are predictors of good cord care practices.

This study was undertaken to evaluate the use of photobiomodulation and photodynamic therapy as an auxiliary method for umbilical healing in calves, aiming at preventing omphalitis. Thirty newborn cattle that underwent treatment for umbilical lesion were evaluated. The animals were divided into three treatment groups, as follows: G1 - conventional treatment; G2 - conventional treatment + laser irradiation; and G3 - conventional treatment + photosensitizer and laser irradiation. Applications were performed only once and clinical evaluation was carried out throughout the experimental period until complete healing. The obtained data were analyzed using the Scott-Knott Test for mean comparison. The G2 animals performed better than G1 since D3, with complete healing by D15, whereas G3 showed better healing effectiveness from D3, compared with G1, and stood out relative to G2 at D12, when complete healing occurred. The G1 calves were healed at D21. As regards healing speed, after treatment, G3 had a 1.12 cm reduction in wound size when measured at D3, whereas G2 animals had it reduced by 0.89 cm and G1 by 0.5 cm, with statistical differences between these values (P<0.05). This study allows us to conclude that photobiomodulation and photodynamic therapy had positive effects in accelerating umbilical healing in calves, when compared with the control group. Between the treatments, aPDT showed better results than photobiomodulation, as it advanced total healing by three days. [ABSTRACT FROM AUTHOR]

ABSTRACT: The objective of this randomized clinical trial was to evaluate the effectiveness of a single application of 7% iodine tincture-based umbilical dip for preventing infection of the external umbilical structures in dairy calves. Five dairy farms in southern Ontario were visited twice weekly from September 2020 through June 2021. Female (n = 244) and male (n = 40) Holstein calves were randomly assigned at birth to receive either a 7% iodine tincture-based umbilical dip (n = 140) or no treatment (n = 144). Calves in the 7% iodine tincture umbilical dip group had the product administered once by the producer shortly after birth. For each newborn calf, the experimental group, calving difficulty, volume and timing of colostrum administration, time of birth, calving pen cleanliness, and the dam ID were recorded. Calf body weight was recorded during the first visit after birth, and a blood sample was collected for measurement of serum IgG concentration. Calves were health scored twice weekly from enrollment until approximately 30 d of age for assessment of external umbilical infection, joint inflammation, respiratory disease, and diarrhea. The primary outcome of the study was external umbilical infection, which was defined as an enlarged umbilicus with pain, heat, or a malodorous discharge. Calves were also weighed at 30 and 60 d to determine average daily gain. Serum IgG concentration and birth weight did not differ significantly between groups. Twenty-nine calves (20%) in the umbilical dip group developed an external umbilical infections, compared with 31 calves (22%) in the control group. A mixed logistic regression model, accounting for farm as a random effect, showed no effect of treatment on the incidence of an external umbilical infection. However, for every additional hour that calves received colostrum after birth, the odds of developing an external umbilical infection increased during the first month of life (odds ratio = 1.15; 95% confidence interval: 1.04–1.26). Additionally, treatment had no effect on respiratory disease, joint inflammation, diarrhea, average daily gain, or mortality, compared with the untreated control. These findings suggest that administering a single application of 7% iodine tincture dip to the umbilicus around the time of birth may not be effective for preventing external umbilical infections. Farm-level management factors, including colostrum management, appear to have more influence on risk of this disease.

Omphalitis, an infection caused by various bacteria entering the exposed umbilicus or bloodstream, significantly contributes to chick mortality within the first week post-hatch, often due to suboptimal hygiene practices during hatching. This study aimed to characterise the effects of omphalitis on day-old chicks (DOCs) by examining the anatomical and pathological changes. Necropsies were performed on four DOCs at Poultry Breeding Development Center Jatiwangi, Majalengka, West Java, Indonesia. Observations revealed that the infected chicks had small body sizes, dull feathers, enlarged yolk sacs, and unhealed umbilici. Anatomical pathology revealed abdominal distension, necrotic yolk stalks, and greenish, foul-smelling yolk sacs. [ABSTRACT FROM AUTHOR]

Neonatal omphalitis is a postpartum infection of periumbilical superficial soft tissues that usually has a good prognosis in developed countries. In rare cases, it could progress to periumbilical necrotizing fasciitis (NF), which is an infection of the deep soft tissues, including muscle fascia, and has a high mortality rate. However, the signs and timing of developing NF secondary to omphalitis are unclear. We encountered a neonatal case of NF following omphalitis. In the initial days of the clinical course, general symptoms and condition of the patient were good, and abdominal physical findings were mild; however, the patient rapidly developed NF. The patient was successfully treated by emergent surgical debridement, broad-spectrum antibiotics, and intensive care. To determine the area of blood perfusion, we intravenously injected indocyanine green by intraoperative angiography, and then extensively removed necrotic and hypoperfused tissues. In neonatal omphalitis, the deterioration can suddenly occur despite good initial conditions; intensive monitoring should be required during the first few days of the clinical course.

Omphalitis is an inflammation of the umbilicus and is seldom diagnosed in adults. It is even rarer when it results from an infection of the urachus, an embryological remnant that connects the umbilicus to the dome of the bladder. Patients with omphalitis present with erythema, edema, tenderness, and purulent discharge form the umbilical stump. Workup includes ultrasonography and CT scan of the abdomen and pelvis. Management consists of antibiotics and incision and drainage of the umbilical abscess, followed by surgical resection of the urachal remnant. In this article, we report a case of omphalitis complicated by umbilical abscess in a 20-year-old female with a urachal remnant.

Umbilical discharge is a commonly encountered problem in infants, with common causes being omphalitis and umbilical granuloma. Unusual causes of persistent umbilical discharge are remnants of the omphalomesenteric duct and the urachus. Heterotopic or ectopic tissues at the umbilicus are rare events that cause umbilical discharge and these mandate a surgical intervention. Gastric heterotopia at the umbilical region is such an unusual entity causing persistent discharge and chemical dermatitis around the region, which needs surgical intervention. We hereby report a rare case of gastric heterotopia of the umbilicus in an 8-month-old male baby. [ABSTRACT FROM AUTHOR]

Abstract 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.

Good calf health is crucial for a successfully operating farm business and animal welfare on dairy farms. To evaluate calf health on farms and to identify potential problem areas, benchmarking tools can be used by farmers, herd managers, veterinarians, and other advisory persons in the field. However, for calves, benchmarking tools are not yet widely established in practice. This study provides hands-on application for on-farm benchmarking of calf health. Reference values were generated from a large dataset of the “PraeRi” study, including 730 dairy farms with a total of 13,658 examined preweaned dairy calves. At herd level, omphalitis (O, median 15.9%) was the most common disorder, followed by diarrhea (D, 15.4%) and respiratory disease (RD, 2.9%). Abnormal weight bearing (AWB) was rarely detected (median, 0.0%). Calves with symptoms of more than one disorder at the same time (multimorbidity, M) were observed with a prevalence of 2.3%. The enrolled farms varied in herd size, farm operating systems, and management practices and thus represented a wide diversity in dairy farming, enabling a comparison with similar managed farms in Germany and beyond. To ensure comparability of the data in practice, the reference values were calculated for the whole data set, clustered according to farm size (1–40 dairy cows (n = 130), 41–60 dairy cows (n = 99), 61–120 dairy cows (n = 180), 121–240 dairy cows (n = 119) and farms with more than 240 dairy cows (n = 138), farm operating systems (conventional (n = 666), organic (n = 64)) and month of the year of the farm visit. There was a slight tendency for smaller farms to have a lower prevalence of disorders. A statistically significant herd-size effect was detected for RD (p = 0.008) and D (p < 0.001). For practical application of these reference values, tables, diagrams, and an Excel® (Microsoft®) based calf health calculator were developed as tools for on-farm benchmarking (https://doi.org/10.6084/m9.figshare.c.6172753). In addition, this study provides a detailed description of the colostrum, feeding and housing management of preweaned calves in German dairy farms of different herd sizes and farm type (e.g., conventional and organic).

Omphalitis is the third most frequent disease in newborn calves after neonatal diarrhea and bovine respiratory disease (BRD), but limited data on the prevalence and risk factors are available in the literature. Failure of passive immunity transfer (FPIT) is recognized as a major risk factor for diseases and mortality in calves. However, the association between omphalitis and FPIT remains poorly described. To assess this association, 964 suckler beef calves from 22 farms were included in a longitudinal cohort study for 5 months. Each calf was examined twice (mean ages: 4.4 and 11.1 days old) to diagnose omphalitis through clinical examination and ultrasonographic evaluation (USE) if necessary. Measurements of the total solids percentage (TS-%Brix) and total protein (TP) were performed on the serum during the first visit to evaluate the calves’ passive immunity status. FPIT (fair and poor) was defined as serum %Brix < 8.1 or TP < 5.1 g/dL; among calves with omphalitis, 14% had FPIT and among calves without omphalitis 12% had FPIT. The omphalitis prevalence was 32.3% in calves without any other disease (overall prevalence of 30.9%). No statistical association between the prevalence of omphalitis and FPIT was observed. Further research is needed to identify the risk factors and promote the prevention measures for omphalitis in cow–calf systems, such as calving difficulty, hygiene of housing, and navel disinfection.

Objectives: To study the impact of applying topical Chlorhexidine compared with Methylated spirit on umbilical cord sloughing time in neonates. Study Design: Quasi-experimental study. Place and Duration of Study: Paediatric Department, KRL Hospital, Islamabad Pakistan from Oct 2018 to Mar 2019. Methodology: A total of 100 neonates were enrolled in each Group, i.e., Chlorhexidine and Methylated spirit. After taking informed consent from the parents, the treatment was applied twice daily for five days. Parents had telephonic interviews about the signs of umbilical cord infection on day two following enrollment in the study, and then babies were examined for signs of omphalitis during each hospital visit on days-7, 14 and 21. Umbilical cord sloughing time was noted. Results: Both Groups were independent (statistically insignificant) with respect to neonatal birth weight, gestational age, neonatal sex, mode of delivery and type of feed with p-values of 0.258 and 0.17, 0.066, 0.304 and 0.143, respectively. The result showed that the mean rank of cord sloughing time with the Methylated spirit was significantly less than Chlorhexidine, with the p-value of 0.001. Conclusion: Based on our results, we concluded that the application of Methylated spirit on the umbilical cord shortens the sloughing time compared to Chlorhexidine, but both treatments have comparable efficacy in preventing omphalitis. [ABSTRACT FROM AUTHOR]

The objective of this randomized clinical trial was to evaluate the effectiveness of a single application of 7% iodine tincture-based umbilical dip for preventing infection of the external umbilical structures in dairy calves. Five dairy farms in southern Ontario were visited twice weekly from September 2020 through June 2021. Female (n = 244) and male (n = 40) Holstein calves were randomly assigned at birth to receive either a 7% iodine tincture-based umbilical dip (n = 140) or no treatment (n = 144). Calves in the 7% iodine tincture umbilical dip group had the product administered once by the producer shortly after birth. For each newborn calf, the experimental group, calving difficulty, volume and timing of colostrum administration, time of birth, calving pen cleanliness, and the dam ID were recorded. Calf body weight was recorded during the first visit after birth, and a blood sample was collected for measurement of serum IgG concentration. Calves were health scored twice weekly from enrollment until approximately 30 d of age for assessment of external umbilical infection, joint inflammation, respiratory disease, and diarrhea. The primary outcome of the study was external umbilical infection, which was defined as an enlarged umbilicus with pain, heat, or a malodorous discharge. Calves were also weighed at 30 and 60 d to determine average daily gain. Serum IgG concentration and birth weight did not differ significantly between groups. Twenty-nine calves (20%) in the umbilical dip group developed an external umbilical infections, compared with 31 calves (22%) in the control group. A mixed logistic regression model, accounting for farm as a random effect, showed no effect of treatment on the incidence of an external umbilical infection. However, for every additional hour that calves received colostrum after birth, the odds of developing an external umbilical infection increased during the first month of life (odds ratio = 1.15; 95% confidence interval: 1.04–1.26). Additionally, treatment had no effect on respiratory disease, joint inflammation, diarrhea, average daily gain, or mortality, compared with the untreated control. These findings suggest that administering a single application of 7% iodine tincture dip to the umbilicus around the time of birth may not be effective for preventing external umbilical infections. Farm-level management factors, including colostrum management, appear to have more influence on risk of this disease. [ABSTRACT FROM AUTHOR]

Objectives - The aim of the study was to retrospectively evaluate the clinical and laboratory data in neonates treated for acute omphalitis at the time of admission at the University Hospital of Split. Patients and Methods - All neonates treated for acute omphalitis from January 1st 2015 to December 31st 2019 were included in this study. Results - There were 97 neonates included, of whom 58 (59.79%) were males. The median age at admission was 7 days. The most common clinical sign was periumbilical redness in 70 (72.16%), followed by umbilical discharge in 49 (50.52%) neonates. In 62 (63.92%) neonates bacteria were isolated from the umbilical stump swab. The most common microorganism isolated was methicilin-sensitive Staphylococcus aureus (MSSA) in 21 (33.87%) neonates followed by Klebsiella pneumoniae in 15 (24.19%), and Escherichia coli in 14 (22.58%) cases. Antibiotics were given to all neonates. In all neonates treatment and clinical course were uneventful, without mortality. Conclusion - Neonatal omphalitis was not a frequent cause of hospitalization in the entire group of hospitalized patients at the Department of Pediatrics of the University Hospital of Split (0.75%). Acute omphalitis had a mild clinical course and redness of the periumbilical area, together with the presence of umbilical cord discharge, predominated in the clinical presentation. It is necessary to educate the population and medical staff continuously on the importance of maintaining newborn hygiene and proper umbilical cord care. [ABSTRACT FROM AUTHOR]

The objective of this scoping review was to describe and characterize the existing literature regarding umbilical health and identify gaps in knowledge. Six databases were searched for studies examining umbilical health in an intensively raised cattle population. There were 4249 articles initially identified; from these, 723 full text articles were then screened, with 150 articles included in the review. Studies were conducted in the USA (n = 41), Brazil (n = 24), Canada (n = 13), UK (n = 10), and 37 additional countries. Seventeen were classified as descriptive, 24 were clinical trials, and 109 were analytical observational studies. Umbilical outcomes evaluated in descriptive studies were infection (n = 11), parasitic infection (n = 5), and hernias (n = 2). Of the clinical trials, only one examined treatment of navel infections; the remainder evaluated preventative management factors for navel health outcomes (including infections (n = 17), myiasis (n = 3), measurements (n = 5), hernias (n = 1), and edema (n = 1)). Analytical observational studies examined risk factors for umbilical health (n = 60) and umbilical health as a risk factor (n = 60). Studies examining risk factors for umbilical health included navel health outcomes of infections (n = 28; 11 of which were not further defined), hernias (n = 8), scoring the navel sheath/flap size (n = 16), myiasis (n = 2), and measurements (n = 6). Studies examining umbilical health as a risk factor defined these risk factors as infection (n = 39; of which 13 were not further defined), hernias (n = 8; of which 4 were not further defined), navel dipping (n = 12), navel/sheath scores as part of conformation classification for breeding (n = 2), measurements (n = 3), and umbilical cord drying times (n = 2). This review highlights the areas in need of future umbilical health research such as clinical trials evaluating the efficacy of different treatments for umbilical infection. It also emphasizes the importance for future studies to clearly define umbilical health outcomes of interest, and consider standardization of these measures, including time at risk. [ABSTRACT FROM AUTHOR]

Omphalitis is the third most common cause for diseases and infections in newborn calves. Its risk factors are well described in dairy production, but data in beef production is limited. To identify and quantify the risk factors of omphalitis in cow-calf operations with seasonal indoor calving period. Nine hundred sixty-four calves included from 22 cow–calf operations in central France were included. A prospective cohort study involved data collection during two visits for each calf. Simple and multivariable logistic regression analyses evaluated the association between omphalitis and the variables. Among 964 included calves, 311 (32.3%) calves had an omphalitis. Accounting for farms' random effect, risk factors for omphalitis highlighted by the univariable analysis were: absence of navel disinfection (odds ratio (OR) = 2.3, [1.45–3.04]), wetness of bedding calving area (OR = 1.8–2.1, [0.78–2.83]-[0.63–3.57]), cleanliness of calves' pen (OR =1.6–2.8, [1.22–2.27]-[2.02–3.84]), wetness of calves' pen bedding (OR = 1.7–3.2, [1.12–2.06]-[3.08–3.84]), calf weight at birth >50 kg (OR = 2.0–5.0, [1.02–2.38]-[1.51–11.1]), umbilical cord length <3 cm (OR = 2.2–2.3, [1.53–3.11]-[1.24–4.38]), and sex (male vs female) (OR = 2.6, [2.08–3.69]). The multivariable analysis, accounting for farms' random effect, showed that the absence of navel disinfection (OR= 2.2, [1.44–3.09]), wetness of bedding calving area (OR = 1.9–2.4, [0.55–2.83]-[0.59–3.28]), calf weight at birth >50 kg (OR = 1.9–2.6, [1.03–2.56]-[1.43–12.5]) and sex (male vs female) (OR =2.4, [2.09–3.49]) were risk factors for omphalitis. These observations may help identify animals at early risk (>50 kg, male, short umbilical cord) and pay particular attention to the wetness of bedding and cleanliness of housing. This study highlights the importance of calving-pen bedding, calf characteristics and navel disinfection. [ABSTRACT FROM AUTHOR]

Umbilical granuloma is a common umbilical problem in infants. Although various modalities are available for the treatment of umbilical granulomas, the best method remains controversial. A seven week old infant presented with umbilical granuloma with features of omphalitis. We treated the omphalitis first to prevent local inflammation. On the following day, the umbilical granuloma was successfully cut off with a nylon suture thread. No residue of the granuloma was left behind and no signs of local inflammation appeared. Umbilical granuloma can be successfully removed with a nylon suture thread. Treatment for omphalitis before granuloma removal may be useful to prevent local inflammation. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Brevundimonas diminuta is rarely described in clinical specimens, never at the umbilical stump. Most of the reported cases are in patients with underlying pathologies. We must integrate this microorganism in the etiological agents of nosocomial infections, but much remains to be understood about its virulence. We present a case of umbilical stump infection (omphalitis) caused by B. diminuta, in a preterm and hypotrophic new-born and discuss the diagnosis of this bacterium and its role as responsible of nosocomial neonatal infections. [ABSTRACT FROM AUTHOR]

Omphalitis is an inflammation of the umbilicus and is seldom diagnosed in adults. It is even rarer when it results from an infection of the urachus, an embryological remnant that connects the umbilicus to the dome of the bladder. Patients with omphalitis present with erythema, edema, tenderness, and purulent discharge form the umbilical stump. Workup includes ultrasonography and CT scan of the abdomen and pelvis. Management consists of antibiotics and incision and drainage of the umbilical abscess, followed by surgical resection of the urachal remnant. In this article, we report a case of omphalitis complicated by umbilical abscess in a 20-year-old female with a urachal remnant. [ABSTRACT FROM AUTHOR]

The objective of this cross-sectional study was to determine the prevalence of disorders in preweaned calves in 3 regions in Germany, exemplary for structural diversity in dairy farming. A farm visit was performed on a single occasion on 731 dairy farms in the northern, eastern, and southern regions of Germany between December 2016 and July 2019. Farms differed in herd size, geographical location, and management. In the northern region, the farms had a median of 90 milking cows and were often run as full-time family businesses, partly with external workers. The eastern region tended to have larger farms (a median of 251 milking cows), which were often large-scale agricultural enterprises with employees. In the southern region, the farms had a median of 39 milking cows and were often traditional family businesses, some of these being part-time businesses. Clinical examinations were performed on 14,164 preweaned dairy calves (median 12 calves per farm) by trained veterinarians. A complete data set was available for 13,656 calves. Almost half (42.0%) of the evaluated calves were classified as being affected by at least 1 of the common calf disorders. Omphalitis (O, 20.9%; n = 2,876) and diarrhea (D, 18.5%; n = 2,670) were the most frequently recorded diagnoses, whereas respiratory diseases (RD) were observed to a lesser extent (8.7%; n = 1,100). A striking feature was the fact that 7.1% (n = 987) of the calves were affected by more than 1 disorder at the same time (multimorbidity, M). The following combinations of disorders were frequently observed: O and D (n = 596), O and RD (n = 164), and D and RD (n = 140). Disorders such as O and D, as well as M, were predominantly observed in calves aged 2 wk. A gradual increase in the frequency of RD was observed with age. For all disorders except RD, male calves were more often affected than females. Omphalitis was predominantly diagnosed in the summer months, whereas RD, D, and M were more common in the fall. We detected several statistically significant differences in the prevalence of clinical signs and disorders in preweaned dairy calves between the 3 exemplary regions. The prevalence of RD was higher in the south (10.8%) than in the north (8.2%) and east (7.4%). In the north (33.2%), O was observed more frequently than in the other regions (east: 18.9%; south: 10.5%), whereas D was found less frequently in the north (13.8%) than in the east (21.6%) and south (20.0%). [ABSTRACT FROM AUTHOR]

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

The objective of this scoping review was to describe and characterize the existing literature regarding umbilical health and identify gaps in knowledge. Six databases were searched for studies examining umbilical health in an intensively raised cattle population. There were 4249 articles initially identified; from these, 723 full text articles were then screened, with 150 articles included in the review. Studies were conducted in the USA (n = 41), Brazil (n = 24), Canada (n = 13), UK (n = 10), and 37 additional countries. Seventeen were classified as descriptive, 24 were clinical trials, and 109 were analytical observational studies. Umbilical outcomes evaluated in descriptive studies were infection (n = 11), parasitic infection (n = 5), and hernias (n = 2). Of the clinical trials, only one examined treatment of navel infections; the remainder evaluated preventative management factors for navel health outcomes (including infections (n = 17), myiasis (n = 3), measurements (n = 5), hernias (n = 1), and edema (n = 1)). Analytical observational studies examined risk factors for umbilical health (n = 60) and umbilical health as a risk factor (n = 60). Studies examining risk factors for umbilical health included navel health outcomes of infections (n = 28; 11 of which were not further defined), hernias (n = 8), scoring the navel sheath/flap size (n = 16), myiasis (n = 2), and measurements (n = 6). Studies examining umbilical health as a risk factor defined these risk factors as infection (n = 39; of which 13 were not further defined), hernias (n = 8; of which 4 were not further defined), navel dipping (n = 12), navel/sheath scores as part of conformation classification for breeding (n = 2), measurements (n = 3), and umbilical cord drying times (n = 2). This review highlights the areas in need of future umbilical health research such as clinical trials evaluating the efficacy of different treatments for umbilical infection. It also emphasizes the importance for future studies to clearly define umbilical health outcomes of interest, and consider standardization of these measures, including time at risk.