Methicillin-resistant Staphylococcus aureus as a cause of extensive retropharyngeal abscess in two infants

We report 2 cases of extensive methicillin-resistant Staphylococcus aureus (MRSA) retropharyngeal abscesses in young infants. In 1 case, the abscess was associated with a reactive thrombosis of the jugular vein. Based on the existing literature and the rapid emergence of MRSA skin and soft tissue infections, it is possible that similar severe infections will occur with increasing frequency in young infants.     

婴幼儿硬膜下积液的外科治疗

目的 评价硬膜下积液—腹腔分流术(内引流术)和持续外引流术对治疗各种原因引起的顽固性硬膜下积液的疗效。方法 57例硬膜下积液患儿包括外伤性24例、化脓性脑膜炎2l例、原发性ll例、Sturge-Weber征l例。根据积液性质，25例行外引流术，其中5例积液增多改内引流术；32例直接行内引流术。结果 25例外引流患儿中20例CT征象和临床症状好转，5例改行内引流其中4例好转，l例症状无改善，CT显示脑萎缩；32例直接行内引流者，l例出现转流管阻塞经再通术后好转，余患儿临床症状好转，共计26例治愈予拔管。内引流治愈率70％，总有效率97％。结论 内引流术手术创伤小，疗效满意，对非感染性和非血性硬膜下积液，可作为首选方法，对有内引流术指征患儿则行外引流术。     

Determination of hydrogen in expiratory air of premature infants in suspected necrotizing enterocolitis]

BACKGROUND: Breath hydrogen (H2) analysis has been recommended for the differential diagnosis between necrotizing enterocolitis and transient feeding intolerance. METHODS: We performed 360 breath H2 analyses in 32 unselected premature babies by use of an electrochemical method. RESULTS: All babies on oral feedings excreted H2. The concentration of H2 in expired air was extremely variable and often high even in well premature babies. Antibiotic medication (other than penicillin G alone) inhibited breath hydrogen excretion. CONCLUSIONS: Breath hydrogen analysis can be used as a diagnostic tool for necrotizing enterocolitis if performed in a symptomatic child on oral feedings prior to the initiation of antibiotic therapy.     

Magnetic resonance evaluation of disease of the soft tissues in children

Magnetic resonance imaging was a sensitive modality for identifying pathology in the soft tissues of 32 children, and it consistently showed more abnormality than CT. Magnetic resonance images are not histology specific, but with careful attention to the location of the abnormality, to the definition of the margins, and to the evaluation of involvement of adjacent muscle, bone, subcutaneous fat, and skin, the correct diagnosis can be strongly predicted in most cases. The ability of magnetic resonance to image in multiple planes aids in the evaluation of the extent of lesions and their relationship to adjacent structures. With magnetic resonance imaging, one can accurately predict the extent of abnormality, and there is great potential for the study of disease of soft tissues.     

Usefulness of short-term urine collection in the nutritional monitoring of low birthweight infants

To establish adequacy of urine collection times shorter than 24 h in the metabolic monitoring of low birthweight infants, we collected urine for 24 h in 39 LBW infants during the third and fourth week of life. All urine voidings over the 24-h period were separately collected, the volume of each sampling and the time of voiding were recorded, and 20% of the volume was removed for pooling. All individual and pooled samples were analysed for total nitrogen, urea and ammonia, a-amino nitrogen, creatinine, sodium, potassium, calcium and phosphorus, and for each compound the ratio to 1 mol creatinine was established. Individual sample results were“pooled”to obtain 3-, 6- and 12-h period excretion and than related to the 24-h excretion as measured in the pooled 24-h sample. As the volume of urine obtained in any 6-h collecting period depended on the time of sampling (06:00–12:00 h, 17.5 ± 3.1% of total; 12:00-18:00 h, 31.6 ± 5.1% of total; 18:00-24:00 h, 25.6 ± 3.1% of total; and 0:00-06:00 h, 25.3 ± 2.9% of total), calculations were based on samples obtained from 18:00 to 06:00 h. The correlation between results of 3- and 24 h-collection periods was weakest, while results of the 6-h collection correlated highly with the total daily excretion (r= between 0.82 and 0.93 for the different compounds) and the correlation was only slightly better when the 12-h collection period was considered. The correlation between the mean molar substrate/creatinine ratio of all individual samples of a 24-h collecting period and the and total daily excretion of the respective substrate was weaker (r= between 0.46 and 0.76 for the different compounds) than the correlation between the results of a 6-h collecting period and the daily excretion is not as stable than in later life. The data indicate that 6-h urine sampling may be sufficient for metabolic monitoring of LBW infants. By contrast, urinary substrate/ creatinine ratios are not good markers of the daily excretions of the respective substrate during the first weeks of life.     

Evaluating the specificity of a new type of urine collection bag for infants

ObjectiveFor diagnosing urinary tract infection (UTI) in infants, the urine collection bag is a common sampling method. It has several advantages versus other methods but a high risk of contamination makes culture results difficult to evaluate. Previous studies report a specificity ranging from 14% to 84%. The objective of this study was to evaluate the specificity of a new type of urine collection bag.MethodUrine samples were collected from healthy infants with a new type of collection bag. As the urine is expected to be sterile, any bacterial growth would be considered a contamination.ResultsForty-four samples were included: 40 samples showed <10,000 cfu/ml of mixed growth or no growth at all, three samples showed <10,000 cfu/ml of single-strain growth and one sample showed >10,000 < 100,000 cfu/ml of single-strain growth. No samples showed any growth >100,000 cfu/ml.ConclusionAccording to Kass criteria, 97.7% of the samples would exclude a UTI and 2.3% would be considered inconclusive. None of the samples had a contamination level that, falsely, would be interpreted as positive. Further studies will be valuable as a specificity of 97.7% suggests that this collection device could give the clinician a non-invasive option for diagnosing UTI in infants.     

Asymmetric growth of the lateral cerebral ventricle in infants with posthemorrhagic ventricular dilation

Lateral cerebral ventricular volume in 36 preterm infants with or without an intraventricular hemorrhage, and with or without posthemorrhagic hydrocephalus, was measured longitudinally and compared with the ventricular index measurements of the same ventricles. A poor correlation was found (r2 = 0.67). To determine a reason for this poor relationship, we analyzed the volumes of the regions of the ventricles by a segmental volume analysis. The occipital region of the lateral cerebral ventricle enlarged at a much faster rate (1.904 +/- 0.477 ml/day) than either the anterior region (0.546 +/- 0.253 ml/day; p less than 0.01) or the middle region (-0.209 +/- 0.334 ml/day; p less than 0.01) in infants with posthemorrhagic hydrocephalus. The rate of growth of the middle region of the lateral cerebral ventricles was the same for all infants. Linear indexes, such as the ventricular index and the lateral ventricular ratio, do not allow for accurate serial estimates of ventricular size in posthemorrhagic hydrocephalus because of asymmetric growth of the lateral cerebral ventricle. We conclude that sequential volume measurements are more useful than ventricular index measurements to follow ventricular size sequentially in infants with posthemorrhagic hydrocephalus.     

Common lumps and bumps of the head and neck in infants and children

The majority of lesions in the neck of children will prove to be benign and of congenital origin arising from such structures as the thyroglossal duct and the branchial clefts in addition to hemangiomas and lymphangiomas. However, it is essential that lymphadenopathy be proven infectious and any asymptomatic lymph node enlargement must be considered Hodgkin's disease until proven otherwise. The occasional neuroblastoma or rhabdomyosarcoma presenting in the neck can usually be identified as solid by sonography, leading to early investigation and biopsy. Because of the abundance of important structures that course through the neck, surgery should be conducted in an operating suite with sophisticated, modern anesthetic techniques and with a surgeon experienced in dealing with the full array of lesions that occur.     

Measurement of the growth of the lateral ventricles in preterm infants with real-time ultrasound.

Real-time ultrasound was used to make exact measurements from the lateral wall of the body of the lateral ventricle to the falx (the ventricular index) in 273 infants of varying gestational ages. The measurement performed in an axial plane through the temporoparietal bone correlated closely with an actual measurement made in coronal plane in 50 infants. A cross-sectional centile chart was drawn up of the normal range for this measurement from 27 to 42 weeks'' postmenstrual age. A further chart showing the rate of change of the ventricular index allowed growth of the ventricles to be assessed in a longitudinal manner. Use of these charts permits early detection of hydrocephalus or dilated ventricles secondary to cerebral atrophy.