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Risk factors and clinical and bacteriologic profile of neonates with omphalitis were studied during a 5-year period (January 1994 through December 1998).Prospective observational study in a Special Care Baby Unit of a regional referral hospital in Oman.Consecutive cases of neonatal omphalitis admitted at a regional special care baby unit during a 5-year period formed the study cohort; 207 cases of omphalitis among 11 260 births (9528 hospital births and 1732 home births) were studied.Proportional risk factors and clinical, bacteriologic and relevant investigational profiles and outcomes were studied in neonates with omphalitis. For the study purpose omphalitis was classified into four categories based on severity.The incidence of omphalitis was higher in home births (P < 0.001), in neonates with an intrapartum setup for sepsis (P < 0.05) and in low birth weight (weight <2500 grams) neonates (P < 0.05). Staphylococcus aureus was the most common pathogen isolated from umbilical swabs followed by Escherichia coli and Klebsiella spp. The incidence and severity of omphalitis showed a proportionate decline with reduction of home births during the 5-year study period.The spectrum and severity of neonatal omphalitis are on the decline in conformity with the decline in home births and septic deliveries besides general improvement in maternal and child health care delivery in Oman.