Omphalitis

What is omphalitis?

Omphalitis is an infection in the soft tissues of your baby’s umbilical cord stump and surrounding areas. Your baby’s umbilical cord stump is the short piece of their umbilical cord that remains when a healthcare provider snips the cord after birth.

The stump should naturally and painlessly fall off by the time your baby is about three weeks old. Rarely, bacteria can infect the stump before it falls off, causing omphalitis. This is a serious infection that can lead to complications without prompt treatment.

Signs of omphalitis appear around the base of the stump and include redness or discoloration, hardened skin and yellowish discharge. These signs typically appear within the first week or two after birth.

If you think your baby may have an umbilical cord infection, or if their umbilical stump looks normal but hasn’t fallen off after three weeks, call your pediatrician. They’ll evaluate the situation and provide care, if needed, to help your baby’s belly button area heal and develop as it should.

How common is an infected umbilical cord?

Experts estimate omphalitis affects less than 1% of babies in high-income countries like the U.S. But it affects up to 6% of babies in low- and middle-income countries.

What are the signs and symptoms of an infected umbilical stump?

Omphalitis symptoms include:

• Red or discolored skin around your baby’s umbilical stump.
• Skin that feels thick or hard around the stump.
• Fluid (discharge) that leaks from the stump. It may look yellowish in color and/or smell bad.
• Tenderness to the touch. Your baby may cry when you touch their umbilical stump or the skin around it.

Some babies may also:

• Be fussy or irritable.
• Be overly sleepy or lethargic.
• Have a fever.

These may be signs that the infection has spread to other areas of your baby’s body.

Call your pediatrician right away if your newborn has any signs or symptoms of omphalitis. You should also call if your baby has a fever, even if they don’t have any other symptoms. Their provider will check for signs of infection. Due to how quickly omphalitis and other infections can progress in newborns, your child may be referred directly to the ER or hospital for urgent evaluation and treatment.

Normal vs. infected umbilical cord

Normally, your baby’s umbilical stump should dry up and fall off by the time they’re about 3 weeks old. During this time, the stump will get smaller and change in color from yellowish-green to brown to black. It will then fall off, leaving just the small mark of a belly button. The skin around the stump should be the same color as the rest of your baby’s skin (no redness or discoloration).

An infected umbilical stump looks different. You’ll see redness or discoloration around the base of the stump. Fluid (possibly with a foul smell) may leak from the stump. These things shouldn’t normally happen as the stump prepares to fall off.

What causes omphalitis?

Omphalitis is a bacterial infection, which means bacteria are the specific type of germ responsible. The most common culprit is Staphylococcus aureus.

What are the risk factors for omphalitis?

Factors that may raise your baby’s risk of developing omphalitis include:

• Leaking of amniotic fluid before labor begins (premature rupture of membranes).
• Prolonged labor.
• Use of umbilical catheters (long tubes placed in the umbilical cord) to manage critical illness in a newborn.
• Infection in the birthing parent.
• Home birth.
• Lack of proper umbilical cord hygiene.
• Low birth weight.
• Nonseverance of the umbilical cord from the placenta at birth (lotus birth).

What are the complications of this condition?

Complications of omphalitis are rare in the U.S. but can include:

• Bloodstream infection (bacteremia).
• Extreme and widespread inflammation (sepsis).
• Severe, rapidly spreading bacterial infection (necrotizing fasciitis).
• Inflammation of the membrane lining the inside of the belly (peritonitis).

These conditions are very serious and can quickly turn into a medical emergency. Call your pediatrician or seek care if you suspect your baby has one of these conditions.

How is omphalitis diagnosed?

Healthcare providers diagnose omphalitis by doing a thorough physical exam. This includes:

• Checking your baby’s vital signs.
• Evaluating their breathing.
• Looking at the umbilical stump for signs of omphalitis and other conditions.

Depending on what they find during the exam, your baby’s provider may order bacteria culture tests. This involves taking a sample of any drainage from the umbilical stump. Providers may also look at the blood and urine to see if the infection has spread elsewhere or to look for other causes of illness.

Your baby may also need an imaging test called an ultrasound to identify or rule out problems affecting the area between their umbilical stump and bladder (urachal abnormalities).

What is the treatment for an umbilical cord infection?

Antibiotics can effectively treat omphalitis. These medications clear up bacterial infections and lower the risk of complications. Most babies will require a short hospital stay to receive intravenous (IV) antibiotics to ensure the infection is treated quickly. Your baby’s healthcare provider will explain what’s needed, which type of antibiotics they recommend and how long your baby will need to take them.

A small number of babies need a surgical procedure to manage omphalitis complications. This may involve making a small incision to clean out damaged and infected tissues. 

Can omphalitis be prevented?

Healthcare providers take precautions to prevent omphalitis and other infections in newborns. For example, they follow strict cleanliness standards (aseptic techniques) during labor and delivery, and they use sterilized scissors to cut your baby’s umbilical cord. Providers also keep the umbilical stump clean and tell parents how to care for it at home.

But infections can still happen, especially in babies at higher risk. Recognizing signs of an infection early and seeking care can help your baby recover without any lasting effects. Be sure to follow your provider’s guidance on how to care for your baby’s umbilical stump. Don’t hesitate to ask if you aren’t sure you understand. Your provider will be happy to help you understand what to do to prevent your baby from having a serious medical issue.

What can I expect if my baby has omphalitis?

Your baby’s healthcare provider is the best person to ask about what you can expect going forward. They know your baby’s medical history and the unique details of their current situation.

In general, babies in the U.S. recover well from omphalitis. It’s usually an uncomplicated infection that goes away with antibiotics. Most babies don’t experience long-term health issues from an infected umbilical cord.

When should I seek medical care for my baby?

Call a healthcare provider if your baby:

• Has any signs or symptoms of omphalitis.
• Has a fever over 100.4 degrees Fahrenheit (38 degrees Celsius), even without any other symptoms.
• Still has their umbilical stump three weeks after birth.
• Has continued bleeding or fluid oozing from their umbilical stump.