Delayed Presentation of Neonatal Omphalitis with Suspected Invasive Soft-Tissue Infection and Late-Onset Sepsis Following Non-Sterile Home Delivery: A Case Report.
Najma Abdifatah Mohamed, Hamdi Abdi Ali
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Case in brief
A 19-day-old girl presented with fever, poor feeding, abdominal distension, purulent umbilical discharge, periumbilical inflammation and necrotic-appearing tissue after a non-sterile home delivery and cord tying with non-sterile cloth. Her umbilical symptoms had been present for approximately two weeks, and her admission white blood cell count was 50 ×10 3 /µL. She received intravenous ampicillin, cefotaxime and vancomycin, supportive care and local wound management in the neonatal intensive care unit. She continued to deteriorate over five documented hospital days and subsequently died. Cultures and imaging findings were not reported, so the extent of deeper infection remained uncertain.
What made this case unusual
The report describes delayed omphalitis with necrotic-appearing tissue and clinical concern for invasive soft-tissue infection, but without microbiological or imaging confirmation; the depth and extent of infection could not be established.
Diagnostic / clinical pearl
In a neonate with omphalitis and necrotic-appearing tissue, consider possible invasive infection and reassess promptly if the clinical course worsens; cultures when feasible and surgical evaluation are important considerations.