Periumbilical necrotizing fasciitis in the newborn

 Periumbilical necrotizing fasciitis in the newborn

Neonatal necrotizing fasciitis is a rare complication of omphalitis.

Necrotizing fasciitis starts initially as periumbilical cellulitis and rapidly spreads to the subcutaneous tissues, with the overlying skin appearing edematous with purplish blue discoloration.

Necrotizing fasciitis may also present with bullae, crepitus and peau d’orange appearance.

Necrotizing fasciitis should be recognized early and treated aggressively by debridement, broad-spectrum antibiotics, and supportive care.

In addition to debridement of the involved abdominal wall, it is important to resect the umbilical vein, both umbilical arteries, and any urachal remnant that is present, as these may be involved in the necrotizing infection (even if they look normal).

Reported mortality rates are as high as 60 to 85 percent.

References:

1. Cilley R. Disorders of the umbilicus. In: Pediatric Surgery, Grosfeld J, O'Neill J, Coran A, Fonkalsrud E (Eds), Mosby Inc., Philadelphia 2006.
2. Pomeranz A. Anomalies, abnormalities, and care of the umbilicus. Pediatr Clin North Am 2004; 51:819.