333 - The incidence of Urachal Remnants in Infants with Omphalitis

Poster Number: 333
Publication Number: 333.214

Natasha Cordero, RUMC, Rockaway, NJ, United States; Catherine A. McDonough, Richmond University Medical Center, Staten Island, NY, United States; Shahnaz Akhter, Richmond University Medical Center, Staten Island, NY, United States; Melissa Grageda, Richmond University Medical Center, Staten Island, NY, United States; Kevin McDonough, Richmond University Medical Center, Staten Island, NY, United States

Background: Omphalitis is a rare infectious cellulitis involving the umbilical stump. It affects primarily the infants with risk factors, such as prematurity, umbilical catheterization and septic delivery. Omphalitis may rarely result from an infection of patent urachal remnants, a congenital urachal anomaly with an incidence of 1 in 5000 – 8000 live births. 
 

Objective:
We aimed to determine the incidence of urachal remnants in neonates with omphalitis.

Design/Methods:
A retrospective chart review was performed in an academic community hospital to determine the occurrence of urachal remnants in infants with omphalitis. Inclusion criteria were: age < 90 days, diagnosis of omphalitis, and hospital visit from November 1, 2017 to June 30, 2020. Data collected were: gestational age, sex, umbilical culture results, and approaches to diagnosis and management (i.e., topical and/or systemic agents, surgical intervention) in both outpatient and inpatient settings. Presence of urachal remnants was determined by a positive ultrasound result, or direct identification by a surgeon.

Results: Forty-six infants were included. Fifty percent were full term infants, and 59% were males. Umbilical cultures were obtained in all patients. The most common organism was Staphylococcus aureus. Most infants were managed as outpatients (74%, n=34/46), and treated with topical agents. Twelve patients were admitted for intravenous antibiotics. Ultrasonography was performed in 15 infants, and urachal remnants identified in 33% (n=5).  Surgical consultation was obtained in 20% (n=9), and 67% (n=6) underwent procedures (i.e., incision and drainage, surgical excision, chemical cautery). Three patients (20%) with negative ultrasound results were found to have urachal remnants confirmed by direct identification and excision of the surgeon.   31 infants did not have a sonogram performed.  Ultimately, urachal remnants were diagnosed in 53%. Conclusion(s):
In fifteen infants with omphalitis, urachal remnants were ultimately diagnosed in 53% by ultrasonography or direct identification by the surgeon. Larger, prospective studies of omphalitis and urachal remnants in infants may provide insight towards the clinical significance and utility of universal screening for urachal remnants via ultrasonography.

 

Table 1. Approach to Diagnosis and ManagementA7D19C6B-BA72-4BDE-A404-B9F9BDBFA86F.jpeg
Table 2. Ultrasonography resultsAA58AF30-791B-4812-8F8F-19D3A2A5AD0A_4_5005_c.jpegUrachal remnants were identified in 33% via ultrasonography, and an additional 20% by direct visualization of the surgeon.