具有生命危险的脐带发红
原作者： Joey Scollan，肖锋译 文章来源： 《中华急诊医学杂志》编辑部 发布日期：2014-05-19

Title: The Life-Threatening Red Umbilical Cord
题目：具有生命危险的脐带发红
Author 作者: Joey Scollan

Should you be concerned about erythema around the umbilical stump?你应该小心脐带残端发红吗？
Yes! 一定的！
Often parents will bring their neonate to the ED with concerns about the umbilical cord and it is just a simple granuloma or normal detachment. But is it omphalitis???
家长往往会带新生儿因担忧脐带到ED，它通常只是一个简单的肉芽肿或正常脱落。但它会是脐带炎吗？？？
Omphalitis incidence is low in developed countries, but that means it’s easier, and no less catastrophic, to miss!
脐带炎在发达国家的发生率低，但是这意味着它更容易出现而并不是没有危险的误诊！
Omphalitis is a superficial cellulitis of the umbilical cord, but 10-16% progress to necrotizing fasciitis of the abdominal wall!!!
脐带炎是脐带浅表蜂窝织炎，但10-16％会发展成腹壁坏死性筋膜炎！！
Always ADMIT and consider consulting surgery early in case of rapid progression…
一定要收入院并在病情迅速恶化前请外科会诊...
Most often polymicrobial and should be treated with:  
最常见的是多种微生物，应采取下列治疗：
Anti-staphylococcal PCN,  Vanc, & an Aminoglycoside
抗金黄色葡萄球菌青霉素， 万古霉素，和氨基糖苷类
Also consider adding Metronidazole or Clindamycin for anaerobic coverage
对厌氧菌，可考虑加甲硝唑或克林霉素
Anti-pseudomonal coverage if toxic
如病人中毒症状重，要用抗假单胞菌药
Should notice improvement within 12-24 hours, so if don’t or begin to observe
通常应该在12-24小时内改善，如果不好转，要开始观察
Fever 发烧
Induration 硬结
Peau d’orange tissue 桔皮样改变
Tenderness 压痛
Violaceous discoloration 变紫
Crepitace 捻发音
Increased erythema 红肿加重
Systemic signs of toxicity/shock 全身中毒反应或休克

CONSULT SURERY for concern of necrotizing fasciitis which has a mortality rate of close to 60%!!!
对任何怀疑坏死性筋膜盐的病人，要外科会诊，因其死亡率接近60％！！！
References 参考文献：
1. Pérez, David Vila, et al. "Prognostic Factors in Pediatric Sepsis Study, from the Spanish Society of Pediatric Intensive Care." The Pediatric Infectious Disease Journal (2013).
2. Sawin RS, Schaller RT, Tapper D. Early Recognition of Neonatal Abdominal Wall Necrotizing Fasciitis. American Journal of Surgery. May 1994; 167: 481 – 484.
3. Ulloa-Gutierrez R, Rodriguez-Calzada H, Quesada L, Arguello A. Is it Acute Omphalitis or Necrotizing Fasciitis? Report of Three Fatal Cases. Pediatric Emergency Care. Sept 2005; 21(9): 600 – 602.