Neonatal Surgical Infection

8/13/2019 Neonatal Surgical Infection

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Neonatal surgical infection


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Overview

The problem of management of suppurativeinfections is one of the longest standing in the

history of pediatric surgery. Widespread use of

anti-bacterial madication and consequentmicrobial resistance to these medications has

lead to changes in the type and characteristics of

infecting microbes. Important aspects of the

study of this problem includes early diagnosis

with etiopathogenetic treatment and prevention

of these infections in childhood.


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Infection

,

Burnes,pancreonecrosis

()

Systemic inflammatoryRespound syndrome

(SIRS)

Massivebleeding

Trauma

Infection

,


()


(SIRS)

Massivebleeding

Trauma

Infection

,


()


(SIRS)

Massivebleeding

Trauma


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Neonatal phlegmon

Neonatal phlegmon-acute soft-tissue

infections in childhood. Types: simple, toxic

and septicopyemic. Etiology: most common-Staphylococcus

epidermidis

Typical localizations: lumbar area, back,

anterior and lateral superficies of the thorax

Local symptoms: pain, local rise in

temperature, hyperemia, swelling.


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Neonatal phlegmon


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Neonatal phlegmon


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Neonatal phlegmon-surgical

treatment


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Adyponecrosis


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Erysipelas


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Neonatal mastitis

Neonatal mastitis is a local bacterial infectionduring the first mounth (first weeks) of life

Causative organisms. Staphylococcal organisms

(S.epidermidis,S.aures)

The male:female ratio is 1:1 Physiological enlargement of mammalian glands

is a prepodisposatary factor for the development

of the disease

General symptoms Local symptoms (tenderness, swelling,

hyperemia, local rise in temperature, fluctuation)


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Neonatal mastitis


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Neonatal mastitis.Surgical

management


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Special features of conservative treatment of

neonates with acute suppurative infections

1. Anti-bacterial therapy.

2. Intensive infusive therapy of hemostatic dysbalance

(IV and IM administration of drugs)3. Passsive and active immunization

4. Symptomatic treatment

5. Desensitization and hormonal therapy6. Administration of physiotherapeutic procedures

(compresses, warm baths, ultraviolet therapy)

7. Hyperbaric oxygen therapy.


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Special features of surgical methods ofmanagement of acute suppurative

infections in childhood

Operative aproach (wide excision of the infection site)

Drainage

Collection of pus for culture Special features of surgical management of neonatal

phlegmont (multiple cuts in the zone of the lesion includingthe border with healthy tissue and frequent dressing every 6 -8 hours)

Special features of surgical management of neonatal mastitisdepending on clinical type

Peculiarities of placement and removal of sutures


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Acute hematogenous

osteomyelitis

Acute hematogenous osteomyelitis(AHO)-bacterial

infections of bones with subsequent involving of the

surrounding soft-tissue

Antacedent infections -Immunological disbalance -

widesread by way of bloodstream -hematogenous

abscess in the marrow cavity

The most common pathogen culture is Staphyloccus

aureus

The male: female ratio is 3:2

The most common involving long tubular bones


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Causative agents of the acute

hematogenous osteomyelitis

Age group Most common organisms

Newborns (younger than 4 month)S. aureus,Enterobacterspecies, and group

Aand BStreptococcusspecies

Children (aged 4 mo to 4 year)

S. aureus, group AStreptococcusspecies,

Haemophilus influenzae, andEnterobacter

species

Children, adolescents (aged 4 y to adult)S. aureus(80%), group AStreptococcusspecies,H. influenzae, andEnterobacter

species

AdultS. aureusand occasionallyEnterobacteror

Streptococcusspecies
http://en.wikipedia.org/wiki/Staphylococcus_aureushttp://en.wikipedia.org/wiki/Enterobacterhttp://en.wikipedia.org/wiki/Group_A_streptococcal_infectionhttp://en.wikipedia.org/wiki/Group_A_streptococcal_infectionhttp://en.wikipedia.org/wiki/Group_B_streptococcal_infectionhttp://en.wikipedia.org/wiki/Staphylococcus_aureushttp://en.wikipedia.org/wiki/Group_A_streptococcal_infectionhttp://en.wikipedia.org/wiki/Haemophilus_influenzaehttp://en.wikipedia.org/wiki/Enterobacterhttp://en.wikipedia.org/wiki/Staphylococcus_aureushttp://en.wikipedia.org/wiki/Group_A_streptococcal_infectionhttp://en.wikipedia.org/wiki/Haemophilus_influenzaehttp://en.wikipedia.org/wiki/Enterobacterhttp://en.wikipedia.org/wiki/Staphylococcus_aureushttp://en.wikipedia.org/wiki/Enterobacterhttp://en.wikipedia.org/wiki/Streptococcushttp://en.wikipedia.org/wiki/Streptococcushttp://en.wikipedia.org/wiki/Enterobacterhttp://en.wikipedia.org/wiki/Staphylococcus_aureushttp://en.wikipedia.org/wiki/Staphylococcus_aureushttp://en.wikipedia.org/wiki/Enterobacterhttp://en.wikipedia.org/wiki/Haemophilus_influenzaehttp://en.wikipedia.org/wiki/Haemophilus_influenzaehttp://en.wikipedia.org/wiki/Group_A_streptococcal_infectionhttp://en.wikipedia.org/wiki/Staphylococcus_aureushttp://en.wikipedia.org/wiki/Staphylococcus_aureushttp://en.wikipedia.org/wiki/Enterobacterhttp://en.wikipedia.org/wiki/Haemophilus_influenzaehttp://en.wikipedia.org/wiki/Haemophilus_influenzaehttp://en.wikipedia.org/wiki/Haemophilus_influenzaehttp://en.wikipedia.org/wiki/Group_A_streptococcal_infectionhttp://en.wikipedia.org/wiki/Staphylococcus_aureushttp://en.wikipedia.org/wiki/Staphylococcus_aureushttp://en.wikipedia.org/wiki/Group_B_streptococcal_infectionhttp://en.wikipedia.org/wiki/Group_A_streptococcal_infectionhttp://en.wikipedia.org/wiki/Group_A_streptococcal_infectionhttp://en.wikipedia.org/wiki/Enterobacterhttp://en.wikipedia.org/wiki/Staphylococcus_aureushttp://en.wikipedia.org/wiki/Staphylococcus_aureus


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In general, microorganisms may infect bone

through one or more of three basic methods:

via the bloodstream, contiguously fromlocal areas of infection (as in cellulitis), or

penetrating trauma, including iatrogenic

causes such as joint replacements or internalfixation of fractures or root-canaled teeth.

Once the bone is infected, leukocytes enter

the infected area, and, in their attempt toengulf the infectious organisms, release

enzymes that lyse the bone.


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Pus spreads into the bone's bloodvessels, impairing their flow, and

areas of devitalized infected bone,

known assequestra, form the basis ofa chronic infection. Often, the body

will try to create new bone around the

area of necrosis. The resulting new

bone is often called an involucrum.


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Peculiarity dissemination

inflammatory process.


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On histologic examination, these areas of

necrotic bone are the basis for

distinguishing between acute osteomyelitis

and chronic osteomyelitis. Osteomyelitis is

an infective process which encompasses

all of the bone (osseous) components,

including the bone marrow. When it is

chronic it can lead to bone sclerosis and

deformity.


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Classification of AHO by clinical

pictures:

Toxic (adynamic) typeSeptico-pyemic type

Local


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Pathogenetic stages of AHO

Bone marrow phlegmon

Periosteal abscess

Soft tissue phlegmone

Dermal fistula


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Classification of AHO by

localizationEpiphyseal

Metaphyseal

Diaphyseal

Metadiaphyseal

Pelvic

Other localization


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In infants, the infection can spread

to the joint and cause arthritis. In

children, large subperiosteal

abscesses can form because theperiosteum is loosely attached to

the surface of the bone


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Acute hematogeneous osteomyelitis

10-14 days after the

onset:lytic areas

Linear periostitis and


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Linear periostitis andmaculosus osteoporosis


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Periostitis and destruction bone


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Pathologic fracture tibia on

background destruction bone


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Chronic osteomyelitis with

sequestrum


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Computed tomogram.


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Differential diagnosis

Bone tuberculosis.

Inflammation diseases soft tissues.

Articular syndrome for systemic

diseases.

Benign lesions of the bone.Malignant tumor of the bone.


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intervention, surgical

procedure


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Atypical forms of osteomyelitis

Brodies abscess

Albuminous osteomyelitis

Sclerosing osteomyelitis

Antibiotic osteomyelitis


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Cronical osteomyelitis

Typical radiograph

of Brodies abscess



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Sclerosing osteomyelitis


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Neonatal acute osteomyelitis.


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X-ray findings of neonatal acute

hematogenous osteomyelitis


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Treatment of neonatal AHO:Shades

reduction traction

I bili ti id di i


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Immobilization-wide diapering as a

prophylactic management of

acquired dislocation of the hip


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Further complication of AHO:varus

deformation and limb contraction


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Thank you for attention !!!

Neonatal Surgical Infection

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