Umbilical Cord Infection in Newborns: Symptoms, Causes & Treatment

What Is an Umbilical Cord Infection?

An umbilical cord infection, medically known as omphalitis, is a bacterial infection of the umbilical stump and surrounding tissue in newborns. It occurs when bacteria enter the healing cord stump, causing redness, swelling, discharge, and potentially life-threatening complications if left untreated. Omphalitis affects approximately 0.7% of newborns in developed countries and up to 8% in developing regions.

When a baby is born, the umbilical cord that connected them to the placenta is clamped and cut, leaving a small stump attached to the newborn's belly button. This stump contains no nerve endings, so the baby does not feel pain from it. Over the following days and weeks, the stump dries out, changes color from yellowish-green to brown or black, and eventually falls off naturally, leaving behind what we know as the navel or belly button.

The umbilical stump is essentially an open wound that is healing, which makes it vulnerable to bacterial contamination. In most cases, with proper care and hygiene, the stump heals without any problems. However, when bacteria manage to colonize and multiply in this area, an infection can develop. The bacteria that most commonly cause umbilical infections include Staphylococcus aureus, Streptococcus species, and Escherichia coli, although many different types of bacteria can be responsible.

The reason umbilical cord infections are taken so seriously is that the blood vessels in the umbilical stump connect directly to the newborn's circulatory system. This means that bacteria can potentially spread from a localized infection into the bloodstream, causing a systemic infection known as neonatal sepsis. Newborns have immature immune systems that are not yet fully capable of fighting off infections, making them particularly vulnerable to serious complications.

Why Does Omphalitis Occur?

The umbilical stump provides an ideal environment for bacterial growth if not properly cared for. The stump contains tissue that is slowly dying and separating from the body, which creates organic matter that bacteria can feed on. Additionally, the moist, warm environment close to the baby's skin can promote bacterial multiplication if the area is not kept clean and dry.

Several factors increase the risk of developing an umbilical cord infection. Premature babies and those with low birth weight have less developed immune systems and thinner skin, making them more susceptible to infections. Babies born after prolonged rupture of membranes (when the mother's water breaks long before delivery) may have been exposed to bacteria before birth. Home births without proper sterile technique, application of traditional substances to the cord stump, and unhygienic handling practices all increase the risk of contamination.

How Common Is Umbilical Cord Infection?

The incidence of omphalitis varies significantly depending on the healthcare setting and hygiene practices. In developed countries with good access to healthcare and proper cord care practices, omphalitis occurs in approximately 0.7% of newborns. However, in developing regions where access to clean birthing facilities and proper cord care may be limited, the incidence can be as high as 8% or more. Historically, before the advent of modern antiseptic practices and antibiotics, omphalitis was a major cause of newborn death.

What Are the Symptoms of Umbilical Cord Infection?

The main symptoms of an umbilical cord infection include redness and swelling around the navel, yellow or foul-smelling discharge from the cord stump, warmth in the umbilical area, and in severe cases, fever, lethargy, poor feeding, and grayish or discolored skin. Early recognition of these symptoms is critical for preventing serious complications.

Recognizing the symptoms of an umbilical cord infection early can make the difference between a simple treatment and a serious medical emergency. The symptoms can range from mild local signs that respond well to treatment, to severe systemic illness that requires hospitalization. Understanding what to look for can help parents seek appropriate care at the right time.

The first signs of infection typically appear in the area immediately around the umbilical stump. Parents may notice that the skin surrounding the belly button looks different than it did before - it may appear red, swollen, or puffy. The area may feel warm to the touch, which indicates inflammation. These early signs are the body's natural response to bacterial invasion and should prompt parents to contact their healthcare provider.

As the infection progresses, more obvious signs develop. Discharge from the umbilical area is a key indicator. While a small amount of clear or slightly blood-tinged fluid can be normal, especially as the stump is separating, discharge that is yellow, green, or thick like pus indicates infection. Perhaps the most distinctive sign is a foul or unpleasant odor coming from the umbilical area. Healthy cord stumps have little to no smell, so a bad odor is a clear warning sign that bacteria are present and multiplying.

Local Symptoms of Omphalitis

• Redness around the navel: The skin surrounding the umbilical stump becomes pink, red, or inflamed, often spreading beyond the immediate area of the stump
• Swelling: The area around the belly button appears puffy, raised, or distended compared to the surrounding skin
• Warmth: The umbilical area feels warmer than the rest of the baby's skin when touched
• Discharge: Yellow, green, or pus-like fluid coming from the cord stump or surrounding tissue
• Foul odor: An unpleasant, sometimes putrid smell emanating from the umbilical area
• Tenderness: The baby may cry or show discomfort when the umbilical area is touched
• Delayed cord separation: The stump may take longer than usual to fall off

Signs of Serious Infection Requiring Emergency Care

If the infection spreads beyond the local area into the bloodstream, the baby may develop systemic symptoms that indicate a more serious condition. These warning signs require immediate emergency medical attention, as they may indicate the development of neonatal sepsis or other life-threatening complications.

The progression from local infection to systemic illness can happen rapidly in newborns. Their immature immune systems mean that what starts as a localized infection can spread through the bloodstream within hours. This is why any signs of umbilical infection should be taken seriously and evaluated by a healthcare professional promptly.

When Should You Seek Medical Care?

Seek immediate medical care if you notice redness spreading around your baby's navel, foul-smelling or yellow discharge from the umbilical stump, fever, lethargy, poor feeding, or any combination of these symptoms. When in doubt, it is always better to have your baby evaluated by a healthcare professional.

As a parent, it can sometimes be challenging to determine whether the changes you see in your baby's umbilical area are normal or concerning. Understanding when to seek medical care is crucial for ensuring your baby receives prompt treatment if an infection is present. The general rule is: when in doubt, seek medical advice. It is always better to have a healthcare professional evaluate your baby and determine that everything is normal than to delay care for a genuine infection.

There are different levels of urgency depending on the symptoms you observe. Some situations require immediate emergency care, while others warrant a same-day visit to your pediatrician or healthcare provider. Recognizing which category your baby's symptoms fall into can help you respond appropriately.

Emergency Situations - Call Emergency Services or Go to the Emergency Room

Certain combinations of symptoms indicate that the infection may have spread or that your baby is becoming seriously ill. In these situations, do not wait for a regular appointment - seek emergency medical care immediately:

• Your baby has a fever above 38°C (100.4°F) or an unusually low temperature
• Your baby is unusually sleepy, difficult to wake, or unresponsive
• Your baby refuses to feed or is feeding much less than normal
• Your baby's skin looks grayish, pale, or mottled
• Your baby is breathing rapidly or seems to be struggling to breathe
• There is spreading redness extending well beyond the umbilical area
• You notice blistering or breakdown of the skin around the navel

Urgent - Contact Your Healthcare Provider Same Day

These symptoms suggest a localized infection that needs prompt evaluation and likely treatment, but may not require emergency room care:

• Redness, swelling, or warmth around the umbilical stump
• Yellow, green, or pus-like discharge from the navel area
• A foul or unpleasant odor from the umbilical stump
• Your baby seems more fussy or irritable than usual
• The umbilical area appears to be bleeding more than just minor spotting

Routine Consultation - Schedule an Appointment

Some situations are not emergencies but still warrant professional advice:

• The cord stump hasn't fallen off after 3-4 weeks
• You notice a small amount of persistent moisture around the navel after the cord falls off
• There is a small pink bump (granuloma) at the base of the umbilical area after the cord separates
• You have questions about proper cord care or are unsure if what you see is normal

How Can You Prevent Umbilical Cord Infection?

Preventing umbilical cord infection involves keeping the cord stump clean and dry, practicing good hand hygiene before touching the baby, allowing air to circulate around the stump, and letting it fall off naturally without pulling or covering with tight clothing. These simple measures significantly reduce the risk of infection.

The good news is that most umbilical cord infections are preventable with proper cord care practices. The World Health Organization and pediatric associations worldwide have developed evidence-based guidelines for umbilical cord care that have been shown to significantly reduce the incidence of omphalitis. By following these simple steps, parents can help ensure their baby's umbilical stump heals safely.

The primary principles of cord care are cleanliness, dryness, and minimal interference. The cord stump is a natural process of tissue separation and healing, and in most cases, the best thing parents can do is keep the area clean and dry while allowing nature to take its course. Excessive handling, application of substances, or attempts to hasten the process can actually increase the risk of infection.

Essential Cord Care Practices

Keep the stump clean: If the cord stump becomes soiled or dirty, gently clean around the base using plain water and a cotton swab or clean, soft cloth. In some settings, healthcare providers may recommend using chlorhexidine solution, particularly in areas where the risk of infection is higher. After cleaning, make sure to dry the area thoroughly with a dry cotton swab or cloth.

Keep the stump dry: Moisture promotes bacterial growth, so keeping the umbilical area dry is essential. Fold the front of your baby's diaper down below the cord stump so that it doesn't cover or rub against the stump. This also prevents urine from reaching the cord area. Choose loose-fitting clothing that allows air to circulate around the umbilical area rather than tight clothing that traps moisture.

Practice good hand hygiene: Always wash your hands thoroughly with soap and water before and after touching your baby's umbilical cord area. Anyone else who will be handling the baby should do the same. This simple practice prevents the transfer of bacteria from hands to the vulnerable cord stump.

Let it fall off naturally: The cord stump will separate on its own when it is ready, typically within 7-21 days. Never try to pull, twist, or hurry the separation of the stump, even if it looks like it is hanging by a thread. Premature removal can cause bleeding and increase infection risk.

Sponge baths until the cord falls off: Many healthcare providers recommend giving your baby sponge baths rather than tub baths until the cord stump has fallen off and the area has healed. This helps keep the umbilical area from being submerged in water. If the area does get wet, dry it thoroughly afterward.

What to Avoid

• Do not apply traditional substances: Some cultures have traditions of applying various substances (herbs, ash, animal dung, oils) to the cord stump. These practices significantly increase the risk of infection and should be avoided
• Do not cover with bandages or tight clothing: The stump needs air circulation to dry properly. Covering it can trap moisture and bacteria
• Do not use alcohol: While alcohol was previously recommended for cord care, current evidence shows it is not necessary and may actually delay cord separation
• Do not pull on the stump: Even if it appears loose or is hanging by a small piece, let it fall off naturally
• Do not ignore warning signs: If you notice any signs of infection, seek medical care promptly

How Is Umbilical Cord Infection Treated?

Treatment for umbilical cord infection depends on the severity. Mild infections may be treated with topical antiseptics like chlorhexidine. Moderate infections typically require oral antibiotics. Severe infections or those with signs of systemic spread require hospitalization and intravenous antibiotics. Early treatment is essential to prevent serious complications.

The treatment approach for umbilical cord infection varies based on how severe the infection is and whether it has remained localized or begun to spread. Healthcare providers will assess the extent of the infection, look for signs of systemic illness, and determine the most appropriate treatment plan. The key to successful treatment is prompt intervention before the infection can spread.

When parents notice the first signs of umbilical infection and seek early medical attention, treatment is usually straightforward and the baby recovers quickly. However, if infection is allowed to progress, more intensive treatment including hospitalization may be necessary. This is why recognizing the warning signs and seeking timely care is so important.

Mild Infections

For very mild infections where there is minimal redness and no signs of discharge or systemic illness, the healthcare provider may recommend enhanced local care. This might include careful cleaning of the area with antiseptic solutions such as chlorhexidine, which is available from pharmacies. The provider will show you how to properly clean and care for the area at home and will schedule follow-up to ensure the infection is resolving.

Parents will be given clear instructions on what signs to watch for that might indicate the infection is worsening. If home treatment does not result in improvement within 24-48 hours, or if symptoms worsen at any time, parents should return for reevaluation. Mild infections that respond to local treatment typically resolve within a few days with proper care.

Moderate Infections

When the infection shows more significant signs - such as spreading redness, discharge, or odor - but the baby does not have signs of systemic illness, oral antibiotics are typically prescribed. The antibiotic chosen will be effective against the bacteria most commonly responsible for umbilical infections, including Staphylococcus aureus and Streptococcus species.

Parents will need to administer the antibiotic as prescribed, completing the full course even if the infection appears to improve before the medication is finished. The healthcare provider will schedule a follow-up visit to confirm that the infection is responding to treatment. If there is no improvement or if the baby develops new symptoms, parents should seek care immediately rather than waiting for the scheduled follow-up.

Severe Infections

Babies with severe umbilical infections or any signs of systemic illness (fever, lethargy, poor feeding, skin color changes) require hospitalization for intravenous antibiotic treatment. This allows for close monitoring of the baby's condition and ensures that high doses of antibiotics are delivered directly into the bloodstream where they can most effectively fight the infection.

In the hospital, the baby will be monitored for signs of improvement or deterioration. Blood tests may be performed to check for the presence of bacteria in the bloodstream and to monitor the body's response to infection. The length of hospital stay depends on how quickly the baby responds to treatment, but most babies with uncomplicated omphalitis respond well to intravenous antibiotics within a few days.

What Complications Can Occur?

If left untreated, umbilical cord infection can lead to serious complications including neonatal sepsis (bloodstream infection), peritonitis (abdominal infection), necrotizing fasciitis (rapidly spreading soft tissue infection), and in severe cases, death. Early recognition and prompt treatment are essential to prevent these life-threatening complications.

While most umbilical cord infections, when caught early and treated appropriately, resolve without any lasting problems, it is important for parents to understand the potential complications that can occur if infection is not treated promptly. This understanding underscores why early recognition of symptoms and seeking timely medical care is so critical.

The umbilical area has direct vascular connections to the baby's bloodstream through the remnants of the umbilical blood vessels. This anatomical feature, while essential during fetal development, means that bacteria from an umbilical infection can potentially enter the circulation and spread throughout the body. Newborns are particularly vulnerable because their immune systems are still developing and may not be able to contain the infection effectively.

Neonatal Sepsis

Neonatal sepsis is the most serious complication of umbilical cord infection. It occurs when bacteria from the infected umbilical area enter the bloodstream and cause a systemic infection. Sepsis in newborns is a medical emergency that requires immediate intensive care. Signs include high or low body temperature, rapid breathing, poor feeding, lethargy, and changes in skin color. Without prompt treatment, sepsis can lead to organ failure and death.

Peritonitis

Because the umbilical area is located on the abdomen, infection can sometimes spread into the abdominal cavity, causing peritonitis. This is an infection of the peritoneum, the membrane lining the abdominal cavity and covering the abdominal organs. Peritonitis causes severe abdominal pain and distension, fever, and rapid deterioration of the baby's condition. It requires emergency treatment with antibiotics and may need surgical intervention.

Necrotizing Fasciitis

In rare cases, umbilical infection can lead to necrotizing fasciitis, a rapidly spreading infection of the soft tissue beneath the skin. This is sometimes called "flesh-eating" disease because the bacteria produce toxins that destroy tissue. Necrotizing fasciitis spreads very quickly and requires emergency surgical treatment to remove the infected tissue, along with intensive antibiotic therapy.

Other Potential Complications

• Abscess formation: A pocket of pus may form around the umbilical area that requires drainage
• Meningitis: In severe cases, bacteria can spread to the membranes surrounding the brain and spinal cord
• Osteomyelitis: Infection can spread to the bones, particularly the hip joints in newborns
• Delayed umbilical healing: Even after the infection is treated, the umbilical area may take longer to heal completely

The key message is that these serious complications are largely preventable. By practicing proper cord care, recognizing the early signs of infection, and seeking prompt medical attention when symptoms appear, parents can help ensure their baby's umbilical stump heals safely without complications.

What Is the Prognosis for Umbilical Cord Infection?

With prompt recognition and appropriate treatment, the vast majority of umbilical cord infections resolve completely without any long-term effects. Babies treated early for uncomplicated omphalitis typically recover within days. Even babies with more severe infections who receive timely care generally make full recoveries.

The prognosis for umbilical cord infection is generally excellent when the infection is identified early and treated appropriately. Most cases of omphalitis are mild to moderate and respond well to antibiotic treatment, with babies recovering completely within a few days to a week. The umbilical area heals normally, and there are typically no lasting effects from the infection.

Even babies who develop more severe infections requiring hospitalization usually recover fully with proper treatment. Modern neonatal care, including effective antibiotics and close monitoring, means that the serious complications of umbilical infection are relatively rare in settings with good access to healthcare. The key factor in outcome is time - the sooner the infection is recognized and treated, the better the prognosis.

After recovery from an umbilical infection, parents can expect the navel area to heal normally. There may be some residual redness or slight scarring in the area initially, but this typically fades over time. The baby's belly button will develop normally, and there are generally no long-term health consequences from a treated umbilical cord infection.