This case series reminds the pediatrician of the occasional pathophysiological association of neonatal infection of umbilical vessels and the kidneys. The report consists of the cases of 3 term infants with apparent rapidly progressive “sepsis” syndrome who had fatal outcome. Blood cultures were negative. At autopsy, the umbilicus of each infant appeared normal grossly by external examination, but each had microscopic evidence of infection in subcutaneous tissue extending to the subperitoneal area in 1 infant or infection of the umbilical artery or vein extending inferiorly. All had focal suppurative pyelonephritis.
The pathologist author speculates that there was contiguous spread of infection along periumbilical lymphatic vessels to the deep inguinal and iliac lymph nodes and then ascending infection via lymphatic vessels with subsequent seeding of the kidneys.
It also is noteworthy that these 3 infants had ABO incompatibility, jaundice, and clinical and pathologic evidence of kernicterus, with maximum serum bilirubin levels less than 20 mg/mL in 2 of the 3 infants. Potentiation of kernicterus by concurrent infection was well established in the decade after this report.
Section of Infectious Diseases, St. Christopher's Hospital for Children, Philadelphia, Pennsylvania
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