OMPHALITIS

OMPHALITIS

 Def : Infection of the umbilicus and/or surrounding tissues.
Incidence : approximately 1 in 1,000 infants in developed countries where aseptic delivery and hygienic dry cord care are practiced.

The risk factors associated with the development of omphalitis include:

• prolonged rupture of membranes
• maternal infection
• nonsterile delivery practices
• home delivery
• umbilical catheterization
• low birth weight
• improper cord care or cultural practices of cord care (such as application of cow dung, charcoal dust, or products such as cooking oil and baby powder to the cord stump, and lotus births)
• delayed cord separation
• immunologic conditions such as defects in leukocyte adhesion, neutrophil or natural killer lymphocyte function, and interferon production.

Clinical features:
Mild discharge from the umbilical stump in the absence of inflammatory signs may be a normal occurrence, even when accompanied by some odor.

Unhealthy, discolored, and craggy-appearing umbilical stump; purulent drainage; periumbilical erythema; and induration.

Umbilical stump bleeding may occur with omphalitis because the infection delays thrombosis of the umbilical vessels.

Systemic signs, including lethargy, fever, irritability, temperature instability and poor feeding are suggestive of more severe infection or complication. The most common complication of omphalitis is sepsis.

Other complications include septic umbilical arteritis, portal vein thrombosis, liver abscess, peritonitis, intestinal gangrene, small bowel evisceration, necrotizing fasciitis, and death (Mortality rate is estimated between 7 and 15 percent)
 

Omphalitis is a polymicrobial infection. Historically, the predominant pathogens included Staphylococcus aureus, Streptococcus pyogenes, and Gram-negative bacteria such as Escherichia coli, Klebsiella pneumoniae, and Proteus mirabilis. However, with the routine use of antistaphylococcal cord care regimens, Gram-negative infections of the umbilicus have increased . In addition, anaerobic bacteria such as Bacteroides fragilis, Clostridium perfringens, and Clostridium tetani can contribute to umbilical infections, especially in infants born to mothers with chorioamnionitis . In these infants, foul smelling umbilical drainage is a typical finding.

- Edwards syndrome and Patau syndrome

 

Trsiomy 18 and Trisomy 13

Trisomy 13 (Patau syndrome)	Trisomy 18 (Edwards syndrome)
1/ 14000 ( female = male)	1/8000 ( female > male)	incidence
Severe MR		neurological
Hypo or hypertonia Holoprosencephaly (single hemisphere with single ventricle)	Hypertonia
Microcephaly		head
Sloping forehead Scalp defects	Prominent occiput
Micrognathia, dysplastic Low set ears		face
Midline Cleft lip and palate
Eye anomalies (cataract, coloboma, micropthalmia (small eye) and corneal opacities) Closely-spaced eyes, single central eye (cyclopia)	Small palpebral fissure
polydactaly	Clenched fist Rocker bottom clinodactyly,  overlapping fingers (second and fifth overlap third and fourth)	extremities
Cardiac (88%),: VSD or PPA	Cardiac (99%):  vsd , pda	Associated malformations
renal
Pre & post-natal growth retardation		growth
Some 50% of babies die in the first month and most of the rest in the first year. Survival beyond early infancy is rare and associated with profound learning disability.	Only 5% lives > 1year and associated with profound learning disability. Most babies die in the first year of life.	Life expectancy
confirmed by chromosome analysis. Many affected fetuses are detected by ultrasound scan during the second trimester of pregnancy and diagnosis can be confirmed antenatally by amniocentesis and chromosome analysis.  Can also be diagnosed on non-invasive prenatal testing (NIPT).		diagnosis
Recurrence risk is low, except when the trisomy is due to a balanced chromosome rearrangement in one of the parents.		Recurrence risk

Patterns of Intrauterine Growth Restriction.

 Patterns of Intrauterine Growth Restriction.

1.  Symmetric or non-symmetric:

	Symmetric	Non-symmetric
Onset	Early	Late
Incidence	less common ≈ 30% of FGR cases	more common ≈ 70%–80% of cases
Pattern of retardation	Symmetric, Infants have reductions in all organ systems with the body, head, and length proportionally affected.	Asymmetric, Infants have disproportionate growth restriction in which head circumference is preserved, length is somewhat affected but may be spared, and weight is compromised to a greater degree. The weight deficit is principally due to a reduction in fat deposition, particularly during the 3rd trimester of pregnancy. The disproportion is due to the redistribution of blood flow during fetal development with preferential perfusion of the brain, heart and adrenal glands at the expense of the kidney, GIT and liver, limbs and SC tissues.
	Reduction in cell number.	Reduction of cell size.
Head size	Decreased	Normal
Ponderal index	Normal	Decreased
Catch up growth	Less	More
Genetic growth potential	Not attainable	Attainable
Amniotic fluid	typically accompanied by normal amniotic fluid volume but may be accompanied by polyhydramnios if there is reduced fetal swallowing of amniotic fluid, e.g. trisomy 21 or GIT anomalies.	often oligohydramnios, which is a result of chronic stress on the fetus and reduced urine production.
Causes	usually is caused by intrinsic factors such as congenital   infections or chromosomal abnormalities, maternal drug and alcohol abuse or a chronic medical condition or malnutrition.	usually is caused by Extrinsic factors such as   disorders of the placenta or from maternal problems e.g uteroplacental dysfunction secondary to maternal pre-eclampsia, multiple pregnancy, maternal smoking or may be idiopathic.
Prognosis	poor prognosis, these infants are more likely to remain small permanently, decreased nutrient supply early in development can restrict growth of all organs.	good prognosis, these infants rapidly put on weight after birth.