Neonatal Acute Omphalitis and Congenital Urachal Anomalies

Abstract

Objectives − The objective of the study was to analyze clinical, laboratory and ultrasound imaging features of newborns with acute omphalitis (AO) and to define the most common congenital urachal anomalies that can present as neonatal AO and be diagnosed with umbilical ultrasound (US) imaging.

Patients and methods − The study included newborns aged up to 44 post- conceptional weeks with AO and congenital urachal anomalies (persistent patent urachus, urachal cyst, diverticulum and sinus).

Results − The study included 226 newborns, 132 (58.4%) male and 12 (5.3%) preterm. Their mean age was 9.7 days. The most frequent local signs of AO were umbilical discharge (151, 66.8%), periumbilical erythema (120, 53.1%) and periumbilical edema (64, 28.3%). The most frequently isolated bacteria, alone or in combination with other bacteria, was Staphylococcus aureus (120 newborns, 73.2%). Antibiotic treatment was needed in 148 (65.5%) newborns; most frequently intravenous flucloxacillin and gentamicin. US examination of the umbilical region was performed in 164 (72.6%) newborns with AO and congenital urachal anomalies were found in 96 (58.5%) newborns. The most frequent pathology was persistent patent urachus, found in 84 (87.5%) newborns.

Conclusions − AO, one of the most common infections in the neonatal period, could be causally related to congenital urachal anomalies, especially persistent patent urachus, in more than half of cases. US imaging of the umbilical region represents the diagnostic modality of choice for detecting underlying urachal pathology.