Omphalitis

OMPHALITIS (omphalitis), inflammation of the skin and subcutaneous tissue in the area of the navel, is always caused by infection of this area. The latter can occur not only at the moment of cutting and tying the umbilical cord, but even more frequently in the following days, especially at the time of its separation and healing. Negligent care, lack of asepsis, and a contaminated external environment are conditions that favor infection. The causative agents of infection are diverse, but staphylococci and streptococci are most commonly encountered. Symptoms. Usually on the 2nd or even 3rd week of life, redness, swelling, and infiltration appear around the navel. At this time, the umbilical cord has often already fallen off, the umbilical wound may still be discharging and moist, or sometimes it appears completely healed. The area of the navel protrudes conically, the skin is tense, shiny, and covered with dilated veins. The child is restless, cries on touch, and holds its legs tightly pressed to the abdomen to reduce tension of the abdominal wall. Breathing becomes of the costal type. Depending on the extent and depth of the process and whether it takes on a septic character, general symptoms develop—elevation of temperature, loss of appetite, vomiting, and depression. The course depends on the virulence of the infection and the resistance of the body. In severe cases, the process spreads further over the surface and into the depth, can cause gangrene of the navel, extend to the peritoneum and umbilical vessels, and end in peritonitis and sepsis. The basis of prevention is the strictest asepsis in relation to the umbilical cord. Extreme caution must be observed not only at the moment of delivery but also at all subsequent times. The first bath, if one is given, should be in boiled water; in the following days, bathing should not take place, but should begin only a day after the umbilical cord has fallen off. According to some observations, infection of the umbilical cord occurs significantly more frequently in children who are bathed than in those who are not. The umbilical dressing should cover the umbilical cord well and not shift, so as not to expose it to the risk of contamination. Treatment. When symptoms have already developed, the remainder of the umbilical cord is removed, if it still remains, then the wound is washed with 3% hydrogen peroxide, coated with 3-5% silver nitrate, warm compresses are applied—alcoholic, from 10% aluminum acetate or 2% soda. In the formation of an abscess or phlegmon—early and wide incisions along a probe with the application of a wet absorbent dressing. In all cases, breastfeeding is an important factor for the success of treatment; cardiac remedies are indicated; and in the presence of sepsis—early hemotherapy.

^t« Chebotarevskaya. OMPHALO-MESENTERICAE ARTERIAE (aa. omphalo-mesaraicae), vitelline-umbilical, vitelline-intestinal or vitelline arteries, representing two paired small arterial vessels of the embryo, closely related to the circulation in the yolk sac (vesicle). The o.-m. a. arise from both dorsal aortas, exit from the embryo in the posterior third of its body, then enter the outer layer of the yolk sac and branch throughout the vascular field (see Area vasculosa). Small vessels at the edge of the vascular field end in a closed vessel, the so-called venous sinus, from which venous blood flows to the embryo through two large vitelline veins. The latter extend from front to back and empty into the so-called venous sinus of the heart. The combination of the two vitelline arteries and veins constitutes the vitelline circulatory system. In humans, the significance of this circulation is small; it reaches particular development in birds. The rudiments of the vitelline vascular system appear at very early stages of development: in a chick on the 3rd, in a rabbit on the 8-9th day. The vitelline circulation increases rapidly in area and caliber of vessels, reaching its maximum at relatively early stages of embryonic development. With the further growth of the latter, the increasing need for O₂ and the depletion of yolk reserves, the vitelline circulation becomes insufficient, and its vessels lose their significance. The left vitelline artery disappears, the right one, from which the intestinal vessels are formed, remains and transforms into the a. mesenterica superior. The vitelline veins, in connection with the appearance of the liver, participate in the formation of the primary portal circulatory system and subsequently form the portal vein of the liver.