UMBILICAL INFECTION

UMBILICAL INFECTION

 Umbilical infections, which can progress to systemic infections and may lead to spesis, occur primarily in the newborn because of the following predisposing factors:
 

1. Immediately following birth, the umbilicus becomes colonized with a diverse flora of microorganisms. Staphylococcal species and other Gram-positive cocci are present within hours, and enteric organisms follow shortly thereafter.
2. Devitalized tissues of the umbilical cord stump provide an excellent growth medium for bacteria.
3. The thrombosed blood vessels within the umbilical cord stump provide an entry for microorganisms into the bloodstream of the neonates, potentially leading to sepsis.

References

1. Rotimi VO, Duerden BI. The development of the bacterial flora in normal neonates. J Med Microbiol 1981; 14:51.
2. Harnden A, Lennon D. Serious suppurative group A streptococcal infections in previously well children. Pediatr Infect Dis J 1988; 7:714.

UMBILICAL GRANULOMA

UMBILICAL GRANULOMA

 After the separation of the cord, granulation tissue may persist at the base as a small mass. The tissue, usually light pink in color, is composed of fibroblasts and capillaries and is typically 1 to 10 mm in diameter.  

Persistent serous or serosanguinous drainage around the umbilicus may be suggestive of an umbilical granuloma.

Umbilical granuloma must be differentiated from umbilical polyps and from granuloma secondary to a patent urachus, both of which do not respond to silver nitrate cauterization.

Conventional treatment of umbilical granulomas includes cauterization with silver nitrate.
Generally, only a few applications of silver nitrate are required for successful treatment.
 

Caution should be exercised in applying silver nitrate because of the risk of chemical burns or temporary discoloration of the surrounding skin.

DELAYED SEPARATION OF UMBILICAL CORD

DELAYED SEPARATION OF UMBILICAL CORD

There is no standard definition of delayed cord separation, probably due to the variations seen in normal cord separation.
Separation of the cord beyond 3-4 weeks of age is generally considered to be significantly delayed.

Conditions that are associated with delayed separation of the umbilical cord include:

1.    Prematurity
2.   low birthweight,
3.   administration of topical antimicrobial agents: Topical antimicrobials and/or isopropyl alcohol are usually applied after delivery. Studies have shown longer time to separation of the cord with use of antiseptic topical agents such as chlorhexidine, 70% alcohol, and triple dye.
4.  systemic antibiotics for neonatal infections
5.  delivery by cesarean route
6.   infections
7.    immune disorders including leukocyte adhesion deficiency type 1 &3
8.    omphalomesenteric and urachal remnants 
9.    infants with delayed cord separation and presentation of omphalitis or skin infections should be investigated for immunologic disorders, including leukocyte adhesion deficiency.
10.    Factor 13 deficiency.
11.  Hypothyrodism
    

Investigations:

SEPARATION OF UMBILICAL CORD

SEPARATION OF UMBILICAL CORD

The mechanism of cord separation is not fully understood.

After the umbilical cord is cut and clamped, cord separation is thought to be initiated by thrombosis and contraction of the umbilical vessels. 

This is followed by granulocyte- and phagocyte-mediated necrosis, collagenous degeneration, and infarction of the cord tissue.
 

EMBRYONIC DEVELOPMENT OF THE UMBILICAL CORD

 EMBRYONIC DEVELOPMENT OF THE UMBILICAL CORD

At 3 weeks’ gestation, the developing embryo is connected to the chorion by a connective stalk, which contains the developing umbilical vessels and allantois. The primitive gut develops from the yolk sac and is connected, along with vitelline vessels, to the extracoelomic part via the vitelline duct.

As the embryo grows, the amniotic cavity expands, drawing the connective stalk and vitelline duct together with proteoglycan-rich Wharton jelly to form the primitive umbilical cord.

By the 9th week of gestation, the vitelline duct involutes, whereas the allantois obliterates by the 5th month into the urachus, a fibrous structure that connects the urinary bladder to the umbilicus, to leave behind the umbilical cord composed of 2 umbilical arteries and a single umbilical vein supported by Wharton jelly.

Failure of obliteration of allantois and/or the omphalomesenteric duct (OMD) or vessels either completely or partially can lead to congenital disorders of the umbilical cord.

- Lung Function Abnormalities in Bronchial Asthma.

Lung Function Abnormalities in Bronchial Asthma.

Spirometry (in clinic):

• Airflow limitation
• Low FEV1 (relative to percentage of predicted norms)
• FEV1:FVC ratio< 0.80

Bronchodilator response (to inhaled β-agonist):
o Improvement in FEV1 ≥12% and ≥200 mL
Exercise challenge: Worsening in FEV1 ≥15%
Daily peak flow or FEV1 monitoring: day to day and/or A.M.-to-P.M .variation ≥20%.

Ibrahim Samaha

- Understanding Bronchial Asthma Triggers.

 Understanding Bronchial Asthma Triggers.

1. Allergens: 

• Allergen exposures in sensitized individuals can initiate airways inflammation and hypersensitivity to other irritant exposures, and are strongly linked to disease severity and persistence. 
• Consequently, eliminating the offending allergen(s) can lead to resolution of asthma symptoms and can sometimes cure asthma.