Omphalitis is the medical term for a severe infection of the umbilical cord stump. In the United States, omphalitis is very rare, thanks to infection control procedures in hospitals and routine standards of umbilical cord care.

Yet, these nasty infections do happen in about 1 in 200 newborns.[1] Read on to find out who's at risk and why prompt medical attention is so important.

What causes omphalitis?

The main cause of omphalitis is exposure to any bacteria during delivery, when the umbilical cord is cut after birth or a few days later at home.

Here are some of the main bacteria-causing infections to keep in mind:

  • Strep
  • Staph
  • Gram negative bacteria

Though tetanus can sometimes lead to omphalitis, it rarely causes the condition in the United States. Infants with neonatal tetanus are likely to get the cord infection from unsanitary delivery and cord care practices.[2]

Proper home care after delivery can lower the risk of omphalitis, so follow your pediatrician's guidance carefully.

Who is at risk for omphalitis?

Omphalitis strikes in the days and early weeks following delivery, and it's rarely seen outside of the neonatal period.

There are some things that can make a newborn more susceptible, including:

  • Birth outside the United States or a home birth (in low-resource countries, the risk of omphalitis is up to 8 percent of infants born in hospitals and as high as 22 percent of infants born at home)
  • Preterm birth
  • Septic delivery
  • Low birth weight
  • Umbilical catheterization
  • Chorioamnionitis (a bacterial infection of the amniotic membranes and fluid that surround and protect your baby)
  • Prolonged rupture of the membranes

If your baby has omphalitis, you will most likely notice the telltale signs of infection (like pus and redness) three to five days after birth in a preemie, and five to nine days afterwards in a full-term baby.

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What are the signs of omphalitis?

Keep a careful eye on your little one's belly button, checking for inflammation and discoloration around the umbilical cord area during your baby's first few weeks of life.

Here are omphalitis signs and symptoms to watch for:

  • Pus or a fluid-filled lump on or near the umbilical cord stump
  • Red skin spreading from around the navel
  • Abdominal swelling
  • Cloudy foul-smelling discharge from the infected region
  • Fever (do not give your baby any fever medicine without approval from the pediatrician)
  • Bleeding around the umbilical cord stump
  • Irritability, lethargy and decreased activity

Since any of these symptoms can occur early on or late in the infection, it's important to see your pediatrician right away if you suspect a problem. 

Sepsis is the most common complication from omphalitis and can progress to something much more serious and harmful, which is why early detection and treatment of omphalitis is so crucial.

How is omphalitis diagnosed?

In most cases, the doctors can diagnose omphalitis simply by sight when examining the baby, in person or from a photograph.

How is omphalitis treated?

If you suspect that your baby has developed an umbilical cord infection, call your pediatrician as soon as possible.

The standard treatment for omphalitis is hospitalization for a few days to monitor your little one and administer antibiotics that fight the bacteria, including gram negative bacteria, though surgery may be needed in some more serious cases.

As long as you remain alert and act quickly, though, your new arrival should bounce back without complications.

How can you prevent omphalitis?

Both the American Academy of Pediatrics (AAP) and the American College of Obstetricians Gynecologists (ACOG) advise dry cord care (aka keeping the stump clean and dry without using alcohol as an antiseptic or ointments), and it's now common practice in American hospitals. 

Other prevention strategies include:

  • Washing hands with clean water and soap before delivery and before cutting and tying the cord
  • Laying the newborn on a clean surface and cutting the cord with a sterile instrument
  • Using a clean tie or clamp on the cord
  • An immunization for tetanus during pregnancy

Note: Some cultures have traditional practices of applying ash, oil, dirt or other substances to the umbilical cord, all of which can increase the baby's risk of infection and omphalitis. 

So, remember, keep your baby's belly button clean, dry and exposed to air.[3] If you see any oozing, gently clean it away with a wet cotton swab and dry it carefully (though it's normal for a baby's belly button to ooze a little bit after the cord falls off). Do not use rubbing alcohol. 

Always talk with your pediatrician if you have any questions or concerns about your baby's umbilical cord. Thanks to telemedicine, a quick photo is often all your doctor will need to check for omphalitis.