Omphalitis is inflammation of the navel or umbilical cord stump. It can affect both adults and children. In infants, it is caused by infection and should not be overlooked.

Omphalitis is a common pathology in infants. At birth, the umbilical cord is cut, but there is still a stump of a few centimeters, which will come off a few days later. In the meantime, the parents should clean it according to the recommendations of the midwives. It is important: the necrotic tissues of this cord remnant constitute the ideal site for bacterial proliferation, in particular for pathogenic bacteria such as Staphylococcus aureus, Streptococcus A and B or Enterobacteriaceae (Escherichia coli, etc.). 

If hygienic conditions are not good, these germs can infect the umbilicus (another name for the navel). The area around it then becomes red and hot, an erythema develops on the skin, pus may drip at the base of the cord. This should not be seen as a simple irritation, but talk to the pediatrician. If the doctor confirms the diagnosis, he will prescribe a local antibiotic treatment, in the form of an ointment, to stop the infection and prevent it from entering the body further. The umbilical vein, still connected to the infant’s bloodstream, indeed offers an ideal gateway to generalized infection (sepsis). Fortunately, this complication rarely happens (<1% of births): women now give birth in France under satisfactory aseptic conditions, and parents are more aware of the issue.

Omphalitis also exists in adults and older children. The risks of complications are less serious, because the navel has healed for a long time and is no longer directly connected to the bloodstream. The redness and itching can be explained by poor hygiene, favoring the development of bacteria or fungi in the folds of the navel, or by an incomplete regression of the ducts which connected, before birth, the intestine and the bladder to the placenta. . This little developmental error can show itself years later.

In the newborn

Infant omphalitis is favored by a number of factors:

• related to the conditions of childbirth : premature birth, prolonged period of rupture of the water bag, prolonged labor, maternal infection, umbilical catheter, home births in poorly sanitized conditions, etc. ;
• related to cord care after birth : lack of care, use of inappropriate products to clean the cord, poor hygiene of the hands and the environment in which the care is carried out, etc. ;
• related to the infant itself : omphalitis is more common in low birth weight infants. It can also reveal an abnormality of the immune system. Congenital leukemias, favoring neonatal infections, are manifested by a red plaque around the navel, warm and centered by an umbilicus oozing pus should suggest it. But they are rare (<1% of childhood leukemia)

In adults and children

The causes are different. It could be :

• a hygiene problem : the hollow of the navel is humid and warm, filled with sebum and dander, so it offers a perfect environment for the development of fungi. The flora that it shelters in general is protective, but it sometimes becomes disorganized and gives way to mycoses. This results in tissue inflammation and itching;
• a small development problem : before birth, a so-called omphalo-mesenteric duct connects the umbilical cord to the primitive intestine of the embryo. Likewise, the allantoic duct connects the cord to the bladder. These two structures must then disappear. But sometimes they do not regress, or not completely. There may then be a fistula, which is an abnormal connection between the navel and the organs. The situation is not common but, when it does occur, it is most often manifested by an oozing from the umbilicus or an umbilical cyst, but also, sometimes, by abdominal pain, urinary disorders or infectious signs such as omphalitis.

Omphalitis is inflammation of the area around the umbilicus. It turns red and hot. Sometimes it is accompanied by signs of infection (fever, pus, umbilical cord edema, abdominal pain, etc.). 

Complications are rare but they can be fatal in infants: necrotizing fasciitis when the infection sinks deeper into the skin and fat, thrombophlebitis of the umbilical vein or the portal vein when the infection causes the formation of a clot, or sepsis. By treating omphalitis before it gets out of hand, all of this is avoided.

The treatment of omphalitis in infants is often very simple: the application of an antibiotic ointment based on fusidic acid is often enough to reduce the infection. Parents should also continue to care for the cord until the stump falls off and the umbilicus heals. They will be reminded of the basic rules: 

• hand washing before and after treatment;
• do not put anything other than what has been prescribed on the umbilicus;
• fold the layer below the navel;
• cover it with clean, loose clothing, etc.

If signs of a more widespread infection have already appeared, however, intravenous antibiotic treatment will be necessary to prevent serious complications such as sepsis.

In adults, if it is a yeast infection, antimycotic ointment is effective. On the other hand, when omphalitis is related to the complete or incomplete persistence of the omphalomenteric duct or the allantoic duct after birth, the problem will have to be solved by a surgical intervention.