TY - JOUR
T1 - Omphalitis and Concurrent Serious Bacterial Infection
AU - Kaplan, Ron L.
AU - Cruz, Andrea T.
AU - Freedman, Stephen B.
AU - Smith, Kathleen
AU - Freeman, Julia
AU - Lane, Roni D.
AU - Michelson, Kenneth A.
AU - Marble, Richard D.
AU - Middelberg, Leah K.
AU - Bergmann, Kelly R.
AU - McAneney, Constance
AU - Noorbakhsh, Kathleen A.
AU - Pruitt, Christopher
AU - Shah, Nipam
AU - Badaki-Makun, Oluwakemi
AU - Schnadower, David
AU - Thompson, Amy D.
AU - Blackstone, Mercedes M.
AU - Abramo, Thomas J.
AU - Srivastava, Geetanjali
AU - Avva, Usha
AU - Samuels-Kalow, Margaret
AU - Morientes, Oihane
AU - Kannikeswaran, Nirupama
AU - Chaudhari, Pradip P.
AU - Strutt, Jonathan
AU - Vance, Cheryl
AU - Haines, Elizabeth
AU - Khanna, Kajal
AU - Gerard, James
AU - Bajaj, Lalit
N1 - Publisher Copyright:
Copyright © 2022 by the American Academy of Pediatrics.
PY - 2022/5/1
Y1 - 2022/5/1
N2 - OBJECTIVE: Describe the clinical presentation, prevalence of concurrent serious bacterial ab infection (SBI), and outcomes among infants with omphalitis. METHODS: Within the Pediatric Emergency Medicine Collaborative Research Committee, 28 sites reviewed records of infants #90 days of age with omphalitis seen in the emergency department from January 1, 2008, to December 31, 2017. Demographic, clinical, laboratory, treatment, and outcome data were summarized. RESULTS: Among 566 infants (median age 16 days), 537 (95%) were well-appearing, 64 (11%) had fever at home or in the emergency department, and 143 (25%) had reported fussiness or poor feeding. Blood, urine, and cerebrospinal fluid cultures were collected in 472 (83%), 326 (58%), and 222 (39%) infants, respectively. Pathogens grew in 1.1% (95% confidence interval [CI], 0.3%–2.5%) of blood, 0.9% (95% CI, 0.2%–2.7%) of urine, and 0.9% (95% CI, 0.1%–3.2%) of cerebrospinal fluid cultures. Cultures from the site of infection were obtained in 320 (57%) infants, with 85% (95% CI, 80%–88%) growing a pathogen, most commonly methicillin-sensitive Staphylococcus aureus (62%), followed by methicillin-resistant Staphylococcus aureus (11%) and Escherichia coli (10%). Four hundred ninety-eight (88%) were hospitalized, 81 (16%) to an ICU. Twelve (2.1% [95% CI, 1.1%–3.7%]) had sepsis or shock, and 2 (0.4% [95% CI, 0.0%–1.3%]) had severe cellulitis or necrotizing soft tissue infection. There was 1 death. Serious complications occurred only in infants aged <28 days. CONCLUSIONS: In this multicenter cohort, mild, localized disease was typical of omphalitis. SBI and adverse outcomes were uncommon. Depending on age, routine testing for SBI is likely unnecessary in most afebrile, well-appearing infants with omphalitis.
AB - OBJECTIVE: Describe the clinical presentation, prevalence of concurrent serious bacterial ab infection (SBI), and outcomes among infants with omphalitis. METHODS: Within the Pediatric Emergency Medicine Collaborative Research Committee, 28 sites reviewed records of infants #90 days of age with omphalitis seen in the emergency department from January 1, 2008, to December 31, 2017. Demographic, clinical, laboratory, treatment, and outcome data were summarized. RESULTS: Among 566 infants (median age 16 days), 537 (95%) were well-appearing, 64 (11%) had fever at home or in the emergency department, and 143 (25%) had reported fussiness or poor feeding. Blood, urine, and cerebrospinal fluid cultures were collected in 472 (83%), 326 (58%), and 222 (39%) infants, respectively. Pathogens grew in 1.1% (95% confidence interval [CI], 0.3%–2.5%) of blood, 0.9% (95% CI, 0.2%–2.7%) of urine, and 0.9% (95% CI, 0.1%–3.2%) of cerebrospinal fluid cultures. Cultures from the site of infection were obtained in 320 (57%) infants, with 85% (95% CI, 80%–88%) growing a pathogen, most commonly methicillin-sensitive Staphylococcus aureus (62%), followed by methicillin-resistant Staphylococcus aureus (11%) and Escherichia coli (10%). Four hundred ninety-eight (88%) were hospitalized, 81 (16%) to an ICU. Twelve (2.1% [95% CI, 1.1%–3.7%]) had sepsis or shock, and 2 (0.4% [95% CI, 0.0%–1.3%]) had severe cellulitis or necrotizing soft tissue infection. There was 1 death. Serious complications occurred only in infants aged <28 days. CONCLUSIONS: In this multicenter cohort, mild, localized disease was typical of omphalitis. SBI and adverse outcomes were uncommon. Depending on age, routine testing for SBI is likely unnecessary in most afebrile, well-appearing infants with omphalitis.
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U2 - 10.1542/peds.2021-054189
DO - 10.1542/peds.2021-054189
M3 - Article
C2 - 35441224
AN - SCOPUS:85129781115
SN - 0031-4005
VL - 149
JO - Pediatrics
JF - Pediatrics
IS - 5
M1 - e2021054189
ER -