Neonatal surgical infection

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Neonatal surgical infection
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• Overview
• The problem of management of suppurative
  infections is one of the longest standing in the
  history of pediatric surgery. Widespread use of
  anti-bacterial madication and consequent
  microbial 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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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 infection
  during the first mounth (first weeks) of life
• Causative organisms. Staphylococcal organisms
  (S.epidermidis,S.aures)
• The malefemale ratio is 11
• 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 therapy
• 6. Administration of physiotherapeutic procedures
  (compresses, warm baths, ultraviolet therapy)
• 7. Hyperbaric oxygen therapy.

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• Special features of surgical methods of
  management 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 including the border with healthy
  tissue and frequent dressing every 6 - 8 hours)
• Special features of surgical management of
  neonatal mastitis depending 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 32
• The most common involving long tubular bones

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Cause acute hematogenous osteomyelitis
Age group Most common organisms
Newborns (younger than 4 month) S. aureus, Enterobacter species, and group A and B Streptococcus species
Children (aged 4 mo to 4 year) S. aureus, group A Streptococcus species, Haemophilus influenzae, and Enterobacter species
Children, adolescents (aged 4 y to adult) S. aureus (80), group A Streptococcus species, H. influenzae, and Enterobacter species
Adult S. aureus and occasionally Enterobacter or Streptococcus species
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• In general, microorganisms may infect bone
  through one or more of three basic methods via
  the bloodstream, contiguously from local areas of
  infection (as in cellulitis), or penetrating
  trauma, including iatrogenic causes such as joint
  replacements or internal fixation of fractures or
  root-canaled teeth. Once the bone is infected,
  leukocytes enter the infected area, and, in their
  attempt to engulf the infectious organisms,
  release enzymes that lyse the bone.

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• Pus spreads into the bone's blood vessels,
  impairing their flow, and areas of devitalized
  infected bone, known as sequestra, form the basis
  of a 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) type
• Septico-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 localization
• Epiphyseal
• 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 the
  periosteum is loosely attached to the surface of
  the bone

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Acute hematogeneous osteomyelitis

• 10-14 days after the onsetlytic areas

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Linear periostitis and maculosus 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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• 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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Albuminous osteomyelitis
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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 AHOShades reduction
traction
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Immobilization-wide diapering as a prophylactic
management of acquired dislocation of the hip
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Further complication of AHOvarus deformation and
limb contraction
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Thank you for attention !!!