Omphalitis is primarily a disease of the neonate and is characterized by tenderness, erythema, and induration of the umbilicus and surrounding tissues. Early on, patients may only have superficial cellulitis but, if untreated, this can progress to involve the entire abdominal wall. Patients may also have purulent drainage or be bleeding from the umbilical cord stump. Foul-smelling discharge should raise the suspicion of anaerobic infection. Systemic symptoms such as lethargy, poor feeding, fever, and irritability suggest sepsis and portend a worse prognosis. If there is a rapid progression of abdominal wall erythema or gas in the surrounding tissues, necrotizing fasciitis should be considered, and acute surgical consultation is needed