Localized Purulent-Inflammatory Diseases of Newborns

Umbilical cord infections (Omphalitis)

Omphalitis is a bacterial inflammation of the tissues of the umbilical region, occurring when normal epithelialization of the wound is delayed.

• Catarrhal form (simple omphalitis): This is the initial stage. It is characterized by hyperemia and infiltration of the umbilical ring. A scanty serospurulent exudate is released from the wound and accumulates under the forming bloody crusts. The child's general condition is stable, with no intoxication.
• Purulent omphalitis: The process progresses, and abundant purulent exudate appears. Edema and redness extend beyond the umbilical ring, involving the subcutaneous tissue. The umbilical vessels become inflamed (thrombophlebitis) and are palpable as thickened cords. Intoxication syndrome joins in: fever, lethargy, regurgitation, weight loss, and changes in the blood test. Deep complications (phlegmon, peritonitis) or umbilical sepsis are possible.
• Umbilical fungus: A specific complication associated with prolonged oozing. It appears as a mushroom-like overgrowth of granulation tissue at the base of the wound.

Treatment includes daily sanitization: cleansing with 3% hydrogen peroxide, drying with 70% ethanol, and treatment with 1–2% brilliant green. Topical agents (zinc hyaluronate, bacitracin + neomycin) are used. The fungus is cauterized with silver nitrate. Systemic antibiotics are prescribed only when there are systemic manifestations and a threat of generalization.

Pustular skin lesions

Skin infections vary from mild rashes to extremely life-threatening conditions for the newborn.

1. Vesiculopustulosis: A benign lesion. It localizes on the buttocks, thighs, and scalp. Small vesicles with transparent exudate become turbid (turning into pustules), then rupture after 2–3 days. Erosions and dry crusts form. No scars remain after the crusts fall off. It is treated with herbal baths (chamomile, celandine), mechanical removal of pustules with 70% ethanol, and mupirocin ointment.
2. Neonatal pemphigus:
3. Benign form: Blisters of 0.5–1 cm with serospurulent contents and a hyperemic rim. They localize on the lower abdomen, extremities, and in skin folds. After rupture, erosions form, but no crusts are formed. General well-being is not impaired.
4. Malignant form: Multiple flaccid blisters (phlyctenules) measuring 2–3 cm. Accompanied by severe intoxication, hyperthermia, and a high risk of sepsis.
5. Ritter's exfoliative dermatitis: The most severe septic variant. Caused by the exotoxic (exfoliatin) of Staphylococcus aureus, which detaches the epidermis. It begins with hyperemia and fissures in the folds, around the navel, and mouth. Erythema rapidly spreads over the entire body. Extensive erosive surfaces appear. The condition is extremely grave. Treatment of pemphigus and Ritter's disease includes systemic antibiotics, opening of lesions with mupirocin-based ointment application, and skin treatment with aniline dyes (Fucorcin).

Inflammation of the glands and conjunctiva

Pseudofurunculosis represents a staphylococcal inflammation of the excretory ducts of the sweat glands, leading to the destruction of the entire gland. Unlike a true furuncle (where the hair follicle is affected), here there is no dense necrotic core. The process begins with subcutaneous nodules that enlarge over 2–3 days (to the size of a walnut), turn red, and soften in the center (fluctuation). Surgical opening, wound discharge culture, and systemic antibiotic therapy are required.

Neonatal mastitis occurs secondarily against the background of physiological mastopathy. The process is unilateral (asymmetric). The mammary gland enlarges, and the paraareolar region becomes red. With purulent melting, fluctuation appears, and pus may discharge from the milk ducts. The main treatment is surgical (incision and adequate drainage) plus conservative anti-inflammatory therapy.

Neonatal conjunctivitis is most often associated with infection during passage through the birth canal. It manifests as marked edema, eyelid hyperemia, and the presence of purulent exudate. In the presence of abundant pus, microscopy and culture are mandatory. It is treated by rinsing the conjunctival cavity with a weak nitrofural solution and instilling antibiotics (20% sulfacetamide or eye ointments).

Class and exam questions

What else to study on this topic

• Mechanisms of infection generalization and development of umbilical sepsis
• Deep complications of omphalitis: anterior abdominal wall phlegmon and peritonitis
• Differential diagnosis of physiological mastopathy and purulent mastitis
• Specifics of exfoliatin production by hospital-acquired staphylococcal strains
• Laboratory signs of intoxication syndrome in the newborn's hemogram

Other topics in «Chapter 2. Neonatology»

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