Physiologic Irritation Mimicking Bacterial Omphalitis

This neonate was seen in consultation when brought to the emergency department because of staff concern about bacterial omphalitis. The baby had been feeding well and sleeping through the night.

Key point: This notably mild degree of erythema and periumbilical swelling represents a physiologic irritation, and will resolve when the cord remnant sloughs. True bacterial omphalitits, and the more deadly necrotizing fasciitis, is so painful that the baby will neither feed nor sleep appropriately. Even light palpation will elicit immediate crying from the associated pain in omphalitis and periumbilical necrotizing fasciitis.

Treatment: No treatment is required.

Note: A clinical feature that denotes more severe, deep tissue polymicrobial infection is a deep dusky hue to outright periumbilical purpura.