Necrotizing fasciitis: A serious complication of omphalitis in neonates

Samuel, Madan; Freeman, N.V.; Vaishnav, Avirat; Sajwany, Mohammed Jaffer; Nayar, Madhavan

doi:10.1016/0022-3468(94)90133-3

Cited by 45 publications

(22 citation statements)

References 6 publications

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“…Umbilical catheterization was associated with only 2(3.1%) cases of Omphalitis and was not significant factor in this study. The presenting physical findings are shown in Table [2]. In the first Omphalitis category, there were no symptoms or local signs.…”

Section: Resultsmentioning

confidence: 99%

“…The disease may spread to include the complete wall of the abdomen. It can give rise to a number of complications, such as necrotizing fasciitis, systemic disease, and myonecrosis [1][2][3]. Necrotic tissue of the umbilical cord is an excellent medium for bacterial growth and become rapidly colonized by bacteria from the maternal genital tract and from the environment soon after birth [4].The umbilical vessels in a necrotic infected cord provide microbial pathogens direct access to the blood stream [5].…”

Section: Introductionmentioning

confidence: 99%

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Neonatal Omphalitis in Iraq

Jasim¹

2013

IOSR-JAC

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Neonatal Omphalitis in Iraq

Jasim¹

2013

IOSR-JAC

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“…On hospitalization in the NICU at only 24 hours of life, our patient already had signs of cellulite in the left leg, which rapidly compromised all the tissular planes. Samuel et al 9 reported 14 cases, with only 2 survivors, and emphasized the fact that the patients initially appear to be responding, but rapid deterioration in the general state occurs, and death follows within 72 hours. The most frequent causal agent of neonatal necrotizing fasciitis is Staphylococcus aureus, observed in two-thirds of all cases and is related to the presence of omphalitis and mastitis 3,8 .…”

Section: Discussionmentioning

confidence: 99%

Necrotizing fasciitis in a newborn infant: a case report

et al. 2001

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We report the case of a one-day-old newborn infant, female, birth weight 1900 g, gestational age 36 weeks presenting with necrotizing fasciitis caused by E. coli and Morganella morganii. The newborn was allowed to fall into the toilet bowl during a domestic delivery. The initial lesion was observed at 24 hours of life on the left leg at the site of the venipuncture for the administration of hypertonic glucose solution. Despite early treatment, a rapid progression occurred resulting in a fatal outcome. We call attention to the risk presented by this serious complication in newborns with a contaminated delivery, and highlight the site of the lesion and causal agents. Necrotizing fasciitis occurs predominantly in adult patients. The initiating site is usually a local trauma or a surgical wound. In children, the disease is not common; however, frequently the clinical course is fatal 1 . The mortality rate among pediatric patients ranges from 10% to 60% 2 . During the neonatal period, the occurrence of necrotizing fasciitis is rare and is generally associated with other infections, such as omphalitis and mammary infection 3 . Mortality is high, reaching over 70%, even with precocious diagnosis and treatment 4 . These aspects of the disease's behavior demonstrate the importance of bearing in mind the predisposing factors and rigorous vigilance needed to treat the at-risk newborn. This case report describes our experience with a newborn with necrotizing fasciitis that followed a massive contamination during the delivery. CASE REPORTThe patient was a one-day-old girl, with a birth weight of 1900 g and a gestational age 36 weeks. The mother was 29 years old, and this was her second gestation without prenatal care. The birth took place at home, and the newborn was allowed to fall into the toilet bowl during delivery; the umbilical cord was severed with domestic scissors. Shortly after birth, the newborn was taken to the hospital where she received her first medical care and intravenous penicillin and amikacin therapy. At 90 minutes of life, she presented with hypoglycemia, necessitating intravenous infusion of 10% glucose. At 24 hours of life, hyperemia and edema of the left leg were observed at the site of the venipuncture and infiltration of intravenous solution. The clinical course was marked by a rapid deterioration of the lesion's appearance and extension. The infant was transferred to the Neonatal Intensive Care Unit (NICU) of the Children's Institute because of her worsening clinical course. On admission, she was in a poor general state, groaning, with decreased peripheral perfusion, an axillary temperature of 36°C, tachycardia (160 beats/min), tachypnea (88 breaths/min), abdominal distention, her

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“…Multiple studies, either from older literature in the United States or more contemporary from abroad, have investigated omphalitis and necrotizing fasciitis in the newborn. 31,32 These show that infants presenting with omphalitis have a lower mortality and morbidity than those with necrotizing fasciitis. In our study, we had 2 patients with omphalitis, both were afebrile and neither had a coexisting CSI.…”

Section: Other Infectionsmentioning

confidence: 99%

Evaluation, management, and outcome of focal bacterial infections (FBIs) in nontoxic infants under two months of age

Vidwan

Geis

2010

Journal of Hospital Medicine

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BACKGROUND:Well‐appearing young infants with focal bacterial infections present to the emergency department (ED) and are often admitted for a sepsis evaluation of blood, urine, and spinal fluid. However, the risk of concomitant systemic infections (CSI) in this population is not well reported, specifically comparing febrile to afebrile infants. We hypothesized that afebrile, well‐appearing infants under two months of age with a defined focal bacterial infection on exam have a very low risk of CSI.METHODS:This retrospective study was conducted at an urban, academic, tertiary care pediatric hospital ED on patients seen from January 2000‐December 2005. Eligible infants were less than 60 days of age, well‐appearing on exam, and with normal‐for‐age vital signs who presented with a focal bacterial infection on exam. Exclusion criteria included immunodeficiency, indwelling catheter, previous admission for bacterial infection, or current use of systemic antibiotics. Main study outcome was risk of CSI in febrile and afebrile groups.RESULTS:One hundred ninety seven patients were included in the study population. Of these, 39 were febrile and 158 were afebrile. Four patients had a documented CSI: one case of S. pneumoniae bacteremia and three cases of E. coli urinary tract infection. Of these 4 infants, 3 were febrile (7.7% CSI risk) and 1 was afebrile (0.6%). Febrile infants had a significantly higher risk of CSI (OR 13.1, 95% CI 1.3, 129.5).CONCLUSIONS:CSI is very uncommon in afebrile, well‐appearing infants under 60 days of age with a focal bacterial infection. Journal of Hospital Medicine 2010;5:76–82. © 2010 Society of Hospital Medicine.

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Necrotizing fasciitis: A serious complication of omphalitis in neonates

Cited by 45 publications

References 6 publications

Neonatal Omphalitis in Iraq

Neonatal Omphalitis in Iraq

Necrotizing fasciitis in a newborn infant: a case report

Evaluation, management, and outcome of focal bacterial infections (FBIs) in nontoxic infants under two months of age

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