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Do Infants with Omphalitis Need a Full Sepsis Workup?

May 26, 2022

Written by Clay Smith

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Serious bacterial infection was rare in well appearing, afebrile infants with omphalitis, suggesting that routinely obtaining cultures may not be needed.

Why does this matter?
Omphalitis is infection around the umbilical cord stump and can lead to more serious infection, sepsis, even death. But this is rare. Do we need to do a full sepsis workup on all these infants?

Omphalitis – bad… but usually not too bad?
This was a multicenter retrospective study that identified 566 infants with omphalitis, median age of 16 days. Blood cultures were drawn in 472, of which 5 (1.1%) were positive. Urine cultures were done in 326, of which 3 (0.9%) were positive. CSF was obtained in 222, of which 2 (0.9%) were positive. 95% of infants were well appearing, and 11% were febrile. Sepsis or shock occurred in 12 infants (2.1%), all ≤21 days. One child died. Blood culture contaminants were 3 times as likely as true pathogens. The authors concluded that in well appearing, afebrile infants, workup for serious bacterial infection might not be warranted. Specifically, they said, “our study suggests that routinely obtaining CSF cultures may not be indicated in well-appearing, afebrile infants ≤21 days old with omphalitis.” However, they still recommended a blood culture in this age group.

Omphalitis and Concurrent Serious Bacterial Infection. Pediatrics. 2022 Apr 20;e2021054189. doi: 10.1542/peds.2021-054189. Online ahead of print.

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