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Brook I. Overview of anaerobic infections in children and their treatment. J Infect Chemother 2024; 30:1104-1113. [PMID: 39029623 DOI: 10.1016/j.jiac.2024.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Revised: 05/30/2024] [Accepted: 07/14/2024] [Indexed: 07/21/2024]
Abstract
Anaerobic bacteria can cause many infections in children. Because they predominant in the normal human skin and mucous membranes bacterial flora, they are often associated with bacterial infections that originate from these sites. They are difficult to isolate from infectious sites, and are frequently missed. Anaerobic infections can occur in all body sites, including the central nervous system, oral cavity, head and neck, chest, abdomen, pelvis, skin, and soft tissues. Anaerobes colonize the newborn after birth and have been isolated in several types of neonatal infections. These include cellulitis of the site of fetal monitoring, neonatal aspiration pneumonia, bacteremia, conjunctivitis, omphalitis, and infant botulism. Management of anaerobic infection is challenging because of the slow growth of these bacteria, by their polymicrobial nature and by the growing antimicrobial resistance of anaerobic. Antimicrobial therapy may be the only treatment required, and may also be an adjunct to a surgical approach. Polymicrobial aerobic-anaerobic infection generally requires delivering antimicrobial therapy effective against all pathogens. The antibiotics with the greatest activity against anaerobes include carbapenems, beta-lactam/beta-lactamase inhibitor combinations, metronidazole, and chloramphenicol. Antimicrobial resistance is growing among anaerobic bacteria. The major increased in resistance have been reported with clindamycin, cephamycins, and moxifloxacin against Bacteroides fragilis group and related strains. Resistance patterns vary between different geographic areas and medical facilities.
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Affiliation(s)
- Itzhak Brook
- Georgetown University School of Medicine, Washington DC, USA.
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Sato J, Yotani N, Shoji K, Mori T, Fujino A, Hikosaka M, Kubota M, Ishiguro A. Necrotizing fasciitis following rapidly deteriorating neonatal omphalitis with good initial presentation. IDCases 2023; 32:e01750. [PMID: 37063783 PMCID: PMC10091041 DOI: 10.1016/j.idcr.2023.e01750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 03/20/2023] [Accepted: 03/28/2023] [Indexed: 03/31/2023] Open
Abstract
Neonatal omphalitis is a postpartum infection of periumbilical superficial soft tissues that usually has a good prognosis in developed countries. In rare cases, it could progress to periumbilical necrotizing fasciitis (NF), which is an infection of the deep soft tissues, including muscle fascia, and has a high mortality rate. However, the signs and timing of developing NF secondary to omphalitis are unclear. We encountered a neonatal case of NF following omphalitis. In the initial days of the clinical course, general symptoms and condition of the patient were good, and abdominal physical findings were mild; however, the patient rapidly developed NF. The patient was successfully treated by emergent surgical debridement, broad-spectrum antibiotics, and intensive care. To determine the area of blood perfusion, we intravenously injected indocyanine green by intraoperative angiography, and then extensively removed necrotic and hypoperfused tissues. In neonatal omphalitis, the deterioration can suddenly occur despite good initial conditions; intensive monitoring should be required during the first few days of the clinical course.
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Affiliation(s)
- Jin Sato
- National Center for Child Health and Development (NCCHD), Department of General Pediatrics and Interdisciplinary Medicine, 2-10-1 Okura, Setagaya-ku, Tokyo 157-8535, Japan
- NCCHD, Center for Postgraduate Education and Training, 2-10-1 Okura, Setagaya-ku, Tokyo 157-8535, Japan
| | - Nobuyuki Yotani
- NCCHD, Center for Postgraduate Education and Training, 2-10-1 Okura, Setagaya-ku, Tokyo 157-8535, Japan
- NCCHD, Division of Palliative Medicine, 2-10-1 Okura, Setagaya-ku, Tokyo 157-8535, Japan
- Correspondence to: Division of Palliative Medicine, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo 157-8535, Japan.
| | - Kensuke Shoji
- NCCHD, Division of Infectious Diseases, Department of Medical Subspecialties, 2-10-1 Okura, Setagaya-ku, Tokyo 157-8535, Japan
| | - Teizaburo Mori
- NCCHD, Division of Surgery, Department of Surgical Subspecialties, 2-10-1 Okura, Setagaya-ku, Tokyo 157-8535, Japan
| | - Akihiro Fujino
- NCCHD, Division of Surgery, Department of Surgical Subspecialties, 2-10-1 Okura, Setagaya-ku, Tokyo 157-8535, Japan
| | - Makoto Hikosaka
- NCCHD, Division of Plastic Surgery, Department of Surgical Subspecialties, 2-10-1 Okura, Setagaya-ku, Tokyo 157-8535, Japan
| | - Mitsuru Kubota
- National Center for Child Health and Development (NCCHD), Department of General Pediatrics and Interdisciplinary Medicine, 2-10-1 Okura, Setagaya-ku, Tokyo 157-8535, Japan
| | - Akira Ishiguro
- NCCHD, Center for Postgraduate Education and Training, 2-10-1 Okura, Setagaya-ku, Tokyo 157-8535, Japan
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Hester G, King E, Nickel A, Smedshammer S, Wageman K. Omphalitis Hospitalizations at a US Children's Hospital. Hosp Pediatr 2022; 12:e423-e427. [PMID: 36353854 DOI: 10.1542/hpeds.2022-006623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To describe demographics, presentation, resource use, and outcomes of patients diagnosed with omphalitis. METHODS This was a retrospective descriptive study of infants with omphalitis at a children's hospital system between January 2006 and December 2020. Presentation, resource use, and outcomes (omphalitis complications [eg, necrotizing fasciitis], 30-day related cause revisit, and death) were described. RESULTS Ninety-one patients had a primary or secondary International Classification of Diseases, Ninth or 10th Revision, code for omphalitis. Seventy-eight patients were included in analysis (47 with omphalitis as primary reason for admission). Patients with omphalitis as the primary reason for admission presented with rash (44 of 47, 93.6%), fussiness/irritability (19 of 47, 40.4%), and fever (6 of 47, 12.8%). C-reactive protein was minimally elevated, with a median of 0.4 mg/dL (interquartile range 0.29-0.85).Among all patients, blood cultures were positive in 3 (3 of 78, 3.8%) and most had positive wound cultures (70 of 78, 89.7%), with primarily gram-positive organisms. Median duration of intravenous antibiotics was 5 days (interquartile range 3-7). No patients had complications of omphalitis or death. Five patients (5 of 78, 6.4%) had a 30-day revisit for a related cause. CONCLUSIONS We found variation in presentation and management of patients with omphalitis at our tertiary children's hospital system. Wound cultures, but not blood tests, were helpful in guiding management in the majority of cases. There were no complications of omphalitis or deaths.
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Affiliation(s)
| | - Erin King
- Children's Minnesota, Minneapolis, Minnesota
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Kaplan RL, Cruz AT, Freedman SB, Smith K, Freeman J, Lane RD, Michelson KA, Marble RD, Middelberg LK, Bergmann KR, McAneney C, Noorbakhsh KA, Pruitt C, Shah N, Badaki-Makun O, Schnadower D, Thompson AD, Blackstone MM, Abramo TJ, Srivastava G, Avva U, Samuels-Kalow M, Morientes O, Kannikeswaran N, Chaudhari PP, Strutt J, Vance C, Haines E, Khanna K, Gerard J, Bajaj L. Omphalitis and Concurrent Serious Bacterial Infection. Pediatrics 2022; 149:186812. [PMID: 35441224 DOI: 10.1542/peds.2021-054189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/25/2022] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Describe the clinical presentation, prevalence of concurrent serious bacterial infection (SBI), and outcomes among infants with omphalitis. METHODS Within the Pediatric Emergency Medicine Collaborative Research Committee, 28 sites reviewed records of infants ≤90 days of age with omphalitis seen in the emergency department from January 1, 2008, to December 31, 2017. Demographic, clinical, laboratory, treatment, and outcome data were summarized. RESULTS Among 566 infants (median age 16 days), 537 (95%) were well-appearing, 64 (11%) had fever at home or in the emergency department, and 143 (25%) had reported fussiness or poor feeding. Blood, urine, and cerebrospinal fluid cultures were collected in 472 (83%), 326 (58%), and 222 (39%) infants, respectively. Pathogens grew in 1.1% (95% confidence interval [CI], 0.3%-2.5%) of blood, 0.9% (95% CI, 0.2%-2.7%) of urine, and 0.9% (95% CI, 0.1%-3.2%) of cerebrospinal fluid cultures. Cultures from the site of infection were obtained in 320 (57%) infants, with 85% (95% CI, 80%-88%) growing a pathogen, most commonly methicillin-sensitive Staphylococcus aureus (62%), followed by methicillin-resistant Staphylococcus aureus (11%) and Escherichia coli (10%). Four hundred ninety-eight (88%) were hospitalized, 81 (16%) to an ICU. Twelve (2.1% [95% CI, 1.1%-3.7%]) had sepsis or shock, and 2 (0.4% [95% CI, 0.0%-1.3%]) had severe cellulitis or necrotizing soft tissue infection. There was 1 death. Serious complications occurred only in infants aged <28 days. CONCLUSIONS In this multicenter cohort, mild, localized disease was typical of omphalitis. SBI and adverse outcomes were uncommon. Depending on age, routine testing for SBI is likely unnecessary in most afebrile, well-appearing infants with omphalitis.
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Affiliation(s)
- Ron L Kaplan
- Department of Pediatrics, University of Washington School of Medicine, Seattle Children's Hospital, Seattle, Washington
| | - Andrea T Cruz
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Stephen B Freedman
- Departments of Pediatrics and Emergency Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Kathleen Smith
- Department of Pediatrics, Rady Children's Hospital San Diego, San Diego, California
| | - Julia Freeman
- Department of Pediatrics, Children's Hospital Colorado/University of Colorado School of Medicine, Aurora, Colorado
| | - Roni D Lane
- Department of Pediatrics, University of Utah, Primary Children's Hospital, Salt Lake City, Utah
| | - Kenneth A Michelson
- Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Richard D Marble
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Leah K Middelberg
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Kelly R Bergmann
- Department of Pediatric Emergency Medicine, Children's Minnesota, Minneapolis, Minnesota
| | - Constance McAneney
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Kathleen A Noorbakhsh
- Department of Pediatrics, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Christopher Pruitt
- Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina
| | - Nipam Shah
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama
| | | | - David Schnadower
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
| | - Amy D Thompson
- Department of Pediatrics, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware
| | - Mercedes M Blackstone
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Thomas J Abramo
- Pediatric Emergency Medicine Associates, Children's Hospital of Atlanta, Atlanta, Georgia
| | | | - Usha Avva
- Department of Pediatrics, Joseph M Sanzari Children's Hospital, Hackensack Meridian Health, Hackensack, New Jersey
| | | | - Oihane Morientes
- Pediatric Emergency Department, Cruces University Hospital, Bilbao, Spain
| | - Nirupama Kannikeswaran
- Department of Pediatrics, Central Michigan University, Children's Hospital of Michigan, Detroit, Michigan
| | - Pradip P Chaudhari
- Department of Pediatrics, University of Southern California, Children's Hospital Los Angeles, Los Angeles, California
| | - Jonathan Strutt
- Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota
| | - Cheryl Vance
- Departments of Emergency Medicine and Pediatrics, University of California, Davis School of Medicine, Sacramento, California
| | - Elizabeth Haines
- Ronald O. Perelman Department of Emergency Medicine/NYU Langone Health, New York, New York
| | - Kajal Khanna
- Department of Emergency Medicine, Stanford University, Stanford, California
| | - James Gerard
- Department of Pediatrics, Saint Louis University School of Medicine, St. Louise, Missouri
| | - Lalit Bajaj
- Department of Pediatrics, Children's Hospital Colorado/University of Colorado School of Medicine, Aurora, Colorado
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López-Medina MD, López-Araque AB, Linares-Abad M, López-Medina IM. Umbilical cord separation time, predictors and healing complications in newborns with dry care. PLoS One 2020; 15:e0227209. [PMID: 31923218 PMCID: PMC6953818 DOI: 10.1371/journal.pone.0227209] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 12/14/2019] [Indexed: 11/19/2022] Open
Abstract
Objective The objective of this study was to explore the umbilical cord separation time, predictors, and healing complications from birth until the newborn was one month old. Design A quantitative longitudinal observational analytical study by stratified random sample was adopted. Setting Public health system hospitals in southern Spain and at newborns’ homes. Participants Between April 2016 and December 2017, the study included 106 neonates born after 35–42 weeks of gestation whose umbilical cord was cured with water and soap and dried later as well as newborns without umbilical canalisation whose mothers enjoyed a low-risk pregnancy. Methods The data collection procedure comprised two blocks: from birth to the time of separation of the umbilical cord and from cord separation to the first month of life of the newborn. Umbilical cord separation time was measured in minutes; socio-demographic and clinical characteristics were measured by means of questionnaires, and the external diameter of the umbilical cord was measured using an electronic stainless-steel calliper and trailing roller. Results The mean umbilical separation time: 6.61 days (±2.33, IC 95%:6.16–7.05). Incidence of omphalitis was 3.7%; granuloma was 8.6%. Separation time predictors were wetting recurrence, birth weight, intrapartum antibiotics, birth season, and Apgar < 9 (R2 = 0.439 F: 15.361, p <0.01). Conclusion The findings support the World Health Organization recommendations: dry umbilical cord cares is a safe practice that soon detaches the umbilical cord, taking into account the factors studied that will vary the length of time until the umbilical cord is separated.
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Affiliation(s)
- María Dolores López-Medina
- Department of Nursing, Faculty of Health Sciences, Universidad de Jaén, Jaén, Spain
- San José Health Center, Northern Jaén Sanitary District, Linares, Jaén, Spain
- * E-mail:
| | | | - Manuel Linares-Abad
- Department of Nursing, Faculty of Health Sciences, Universidad de Jaén, Jaén, Spain
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Rellinger EJ, Craig BT, Craig-Owens LD, Pacheco MC, Chung DH, Danko ME. Clostridium sordellii necrotizing omphalitis: A case report and literature review. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2016. [DOI: 10.1016/j.epsc.2016.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Ortega J, Daft B, Assis RA, Kinde H, Anthenill L, Odani J, Uzal FA. Infection of Internal Umbilical Remnant in Foals by Clostridium sordellii. Vet Pathol 2016; 44:269-75. [PMID: 17491067 DOI: 10.1354/vp.44-3-269] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Omphalitis and the resulting septicemia contribute to perinatal mortality in several animal species. In foals, the most important causes of omphalitis are Escherichia coli and Streptococcus zooepidemicus. However to date, no information has been published about the role of Clostridium sordellii in these infections. In this paper, we describe 8 cases of perinatal mortality in foals associated with internal umbilical remnant infection by C. sordellii. The foals studied were between 12 and 21 days old at the time of death, and various breeds were represented in the group. Five of the foals were male and 3 were female. The diagnosis was established on the basis of the detection of C. sordellii by 3 methods (culture, fluorescent antibody test, and immunohistochemistry) and on gross and histopathologic findings. All foals had acute peritonitis, and the internal umbilical remnant was thickened by edema, hemorrhage, and fibrosis. A moderate amount of serosanguinous fluid with fibrin strands was present in the pericardial sac and pleural cavity. Histopathologically, the urachus and umbilical arterial walls were thickened by edema and exhibited hemorrhage, fibrin, and leukocytic infiltration. Gram-positive bacterial rods were observed in subepithelial areas of the urachus, the adventicia of umbilical arteries, and interstitium of the internal umbilical remnant. On the basis of these findings, we suggest that C. sordellii should be considered in the differential diagnosis for infections of the internal umbilical remnant in foals.
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Affiliation(s)
- J Ortega
- Departamento de Atención Sanitaria, Salud Pública y Sanidad Animal, Facultad de Ciencias Experimentales y de la Salud, Universidad Cardenal Herrera-CEU, Valencia, Spain.
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Abstract
Necrotizing fasciitis is an uncommon but life-threatening infection in the pediatric population. It is rarely reported in neonates. In these rare cases, the reported origin of infection was the umbilical cord stump, infection due to circumcision, and similar lesions. We hereby report a 3-week-old neonate sustaining necrotizing fasciitis without detectable origin of infection. We describe the clinical course of her illness, the diagnostic process, and eventual surgical intervention. We discuss the importance of awareness to this potentially lethal infectious disease and the need for urgent use of certain imaging modalities and aggressive surgical approach.
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Tazi F, Ahsaini M, Khalouk A, Mellas S, Stuurman-Wieringa RE, Elfassi MJ, Farih MH. Abscess of urachal remnants presenting with acute abdomen: a case series. J Med Case Rep 2012; 6:226. [PMID: 22846644 PMCID: PMC3459711 DOI: 10.1186/1752-1947-6-226] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2011] [Accepted: 05/22/2012] [Indexed: 11/20/2022] Open
Abstract
Introduction Urachal diseases are rare and may develop from a congenital anomaly in which a persistent or partial reopening of the fetal communication between the bladder and the umbilicus persists. The most frequently reported urachal anomalies in adults are infected urachal cyst and urachal carcinoma. The diagnosis of this entity is not always easy because of the rarity of these diseases and the atypical symptoms at presentation. Imaging techniques, such as ultrasonography and computed tomography have a significant role in recognizing the presence of urachus-derived lesions. Cases presentations Case presentation 1: A 25-year-old Arab-Berber man presented with a 10-day history of progressive lower abdominal pain accompanied by fever, vomiting, and low urinary tract symptoms to our emergency department. Laboratory data revealed leucocytosis. The diagnosis of an acute peritonitis was made initially. Abdominal ultrasonography revealed a hypoechoic tract from the umbilicus to the abdominal wall, and the diagnosis was rectified (infected urachal remnants). The patient was initially treated with intravenous antibiotics in combination with a percutaneous drainage. Afterwards an extraperitoneal excision of the urachal remnant including a cuff of bladder was performed. The histological analysis did not reveal a tumor of the urachal remnant. Follow-up examinations a few months later showed no abnormality. Case presentation 2: A 35-year-old Arab-Berber man, without prior medical history with one week of abdominal pain, nausea and vomiting, associated with fever but without lower urinary tract symptoms visited our emergency department. Laboratory data revealed leucocytosis. Abdominal ultrasonography was not conclusive. Computed tomography of the abdomen was the key to the investigation and the diagnosis of an abscess of urachal remnants was made. The patient underwent the same choice of medical-surgical treatment as previously described for case one, with a good follow-up result. Case presentation 3: A 22-year-old Arab-Berber man, with no relevant past medical history, presented to our emergency department because of suspected acute surgical abdomen. Physical examination revealed umbilical discharge with erythema and a tender umbilical mass. Abdominal ultrasonography and computed tomography scan confirmed the diagnosis of infected urachal sinus. Initial management was intravenous antibiotics associated with a percutaneous drainage with a good post-operative result, but a few days later, he was readmitted with the same complaint and the decision was made for surgical treatment consisting of excision of the infected urachal sinus. The clinical course was uneventful. Histological examination did not reveal any signs of malignancy. Conclusions We describe our clinical observations and an analysis of the existing literature to present the various clinical, radiological, pathological and therapeutic aspects of an abscess of urachal remnants. To the best of our knowledge, this manuscript is an original case report because this atypical presentation is rarely reported in the literature and only a few cases have been described.
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Affiliation(s)
- Fadl Tazi
- Department of Urology, Hospital University Center Hassan II, Fez, 30000 Morocco.
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Reddy K, Kogan S, Glick SA. Procedures and drugs in pediatric dermatology: Iatrogenic risks and situations of concern. Clin Dermatol 2011; 29:633-43. [DOI: 10.1016/j.clindermatol.2011.08.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Pandey A, Gangopadhyay AN, Sharma SP, Kumar V, Gopal SC, Gupta DK. Surgical considerations in pediatric necrotizing fasciitis. J Indian Assoc Pediatr Surg 2011; 14:19-23. [PMID: 20177439 PMCID: PMC2809457 DOI: 10.4103/0971-9261.54816] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Necrotizing fasciitis (NF) is a serious infection of soft tissues. This paper presents experience with pediatric NF and suitability of conservative surgery in its management. MATERIALS AND METHODS In this retrospective study, 70 patients of NF were managed during the study period of eight years. The study was divided into two time periods- first period (June 1998 to June 2001- group 1) and second period (June 2001 to June 2006- group 2). The parameters studied were age, sex, site of involvement and treatment. The treatment included intravenous antibiotics, supportive therapy and either aggressive (group 1) or conservative surgery (group 2). RESULTS Age of presentation ranged from 10 days to 11 years. Male to female ratio was 1.69:1. Back was the commonest site to be involved. Culture reports were polymicrobial in 70% with predominance of Staphylococcus species. Predisposing factors included malnourishment, boils, scratch injury, intravenous cannulation and injections. Conservative surgery had better outcome in terms of hospital stay, complications and cost of treatment. CONCLUSION NF is a serious and disease which requires immediate and all out attention. Early diagnosis, aggressive supportive treatment and conservative surgery improve survival.
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Affiliation(s)
- A Pandey
- Department of Pediatric Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi - 221 005, U.P. India
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Tsoraides SS, Pearl RH, Stanfill AB, Wallace LJ, Vegunta RK. Incision and loop drainage: a minimally invasive technique for subcutaneous abscess management in children. J Pediatr Surg 2010; 45:606-9. [PMID: 20223328 DOI: 10.1016/j.jpedsurg.2009.06.013] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2009] [Revised: 06/05/2009] [Accepted: 06/05/2009] [Indexed: 11/19/2022]
Abstract
PURPOSE The aim of the study was to evaluate outcomes after a minimally invasive approach to pediatric subcutaneous abscess management as a replacement for wide exposure, debridement, and repetitive packing. METHODS A retrospective study was performed of all children who underwent incision and loop drainage for subcutaneous abscesses between January 2002 and October 2007 at our institution. TECHNIQUE Two mini incisions, 4-5 mm each, were made on the abscess, as far apart as possible. Abscess was probed, and pus was drained. Abscess was irrigated with normal saline; a loop drain was passed through one incision, brought out through the other, and tied to itself. An absorbent dressing was applied over the loop and changed regularly. RESULTS One hundred fifteen patients underwent drainage procedures as described; 5 patients had multiple abscesses. Mean values (range) are as follows: age, 4.25 years (19 days to 20.5 years); duration of symptoms, 7.8 days (1-42 days); length of hospital stay, 3 days (1-39 days); duration of procedure, 10.8 minutes (4-43 minutes); drain duration, 10.4 days (3-24 days); and number of postoperative visits, 1.8 (1-17). Bacterial culture data were available for 101 patients. Of these, 50% had methicillin-resistant Staphylococcus aureus, 26% had methicillin-sensitive Staphylococcus aureus, and 9% streptococcal species. Of the 115 patients, 5 had pilonidal abscesses, 1 required reoperation for persistent drainage, and 1 had a planned staged excision. Of the remaining 110 patients, 6 (5.5%) required reoperation-4 with loop drains and 2 with incision and packing with complete healing. CONCLUSION The use of loop drains proved safe and effective in the treatment of subcutaneous abscesses in children. Eliminating the need for repetitive and cumbersome wound packing simplifies postoperative wound care. Furthermore, there is an expected cost savings with this technique given the decreased need for wound care materials and professional postoperative home health services. We recommend this minimally invasive technique as the treatment of choice for subcutaneous abscesses in children and consider it the standard of care in our facility.
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Affiliation(s)
- Steven S Tsoraides
- Department of Surgery, University of Illinois College of Medicine at Peoria, Peoria, IL 61603, USA
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Pandey A, Gangopadhyay AN, Upadhyaya VD. Necrotising fasciitis in children and neonates: current concepts. J Wound Care 2008; 17:5-10. [PMID: 18210950 DOI: 10.12968/jowc.2008.17.1.27914] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
While the incidence is very low, necrotising fasciitis in neonates and children is a potentially life-threatening infection that requires rapid diagnosis and treatment. This review describes its aetiology, symptoms, clinical feature and treatment.
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Affiliation(s)
- A Pandey
- Institute of Medical Sciences, Banaras Hindu University,Varanasi, India
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15
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Gangopadhyay AN, Pandey A, Upadhyay VD, Sharma SP, Gupta DK, Kumar V. Neonatal necrotising fasciitis--Varanasi experience. Int Wound J 2007; 5:108-12. [PMID: 18081783 DOI: 10.1111/j.1742-481x.2007.00350.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Neonatal necrotising fasciitis (NNF) is a rare and fatal disorder. Successful outcome depends on timely intervention. This paper presents single-centre experience of presentation, management and outcome of the condition. Fifteen patients of NNF were managed during the study period of 5 years. Parameters studied were age, sex, site of involvement and treatment. Treatment included intravenous (i.v.) antibiotics and conservative surgery. Age of presentation was 10-28 days. Male to female ratio was 2:1. Neck and scalp were the commonest site (53.3%). Culture reports were unimicrobial in 66% with predominance of Staphylococcus species. Predisposing factors included rural environment (100%), malnourishment (60%), boils (40%) and scratch injury (13%). Forty per cent had idiopathic NNF. Wound healing was by secondary intention in 46.6% and skin grafting in 53.3%. Overall survival was 80%, while the premature had poorer outcome. NNF is a serious disorder. Early treatment with i.v. antibiotics and supportive measures followed by debridement improves survival.
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Affiliation(s)
- Ajay Narayan Gangopadhyay
- Department of Pediatric Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi 221005, Uttar Pradesh, India
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von Laer Tschudin L, Laffitte E, Baudraz-Rosselet F, Dushi G, Hohlfeld J, de Buys Roessingh AS. Tinea capitis: no incision nor excision. J Pediatr Surg 2007; 42:E33-6. [PMID: 17706485 DOI: 10.1016/j.jpedsurg.2007.05.046] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Tinea capitis is a fungal infection of the scalp and hair shaft that mainly affects prepubescent children. Its clinical aspects range from a mild noninflammatory infection resembling seborrheic dermatitis to a highly inflammatory swelling reaction (kerion). We report the cases of 2 children who underwent surgical treatment of their kerions under general anesthesia. One lesion had been incised and the other excised. This inappropriate treatment made conservative treatment after surgery more difficult. We recommend that abscesslike lesions on the scalps of children be carefully investigated by surgeons and dermatologists to determine whether they are the result of a dermatophytic infection in order that the appropriate conservative treatment can be initiated.
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Affiliation(s)
- Laetitia von Laer Tschudin
- Department of Pediatric Surgery, University Hospital Center of the Canton of Vaud (CHUV), 1011 Lausanne-CHUV, Switzerland
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17
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Zilm PS, Rogers AH. Co-adhesion and biofilm formation by Fusobacterium nucleatum in response to growth pH. Anaerobe 2007; 13:146-52. [PMID: 17540586 DOI: 10.1016/j.anaerobe.2007.04.005] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2006] [Revised: 04/04/2007] [Accepted: 04/05/2007] [Indexed: 12/23/2022]
Abstract
Fusobacterium nucleatum is a Gram-negative anaerobic organism considered to play an important role in the progression of periodontal disease and is commonly found in clinical infections of other body sites. Apart from its metabolic versatility, its cell-surface properties enable it to attach to epithelial cells, collagen, gingival epithelial cells and other bacterial genera, but not with other Fusobacteria. The development of periodontitis is associated with a rise in pH in the gingival sulcus to around 8.5, and this is thought to occur by the catabolism of proteins supplied by gingival crevicular fluid. F. nucleatum is commonly isolated from diseased sites and has also been shown to survive in root canal systems at pH 9.0 after Ca(OH)(2) treatment. In order to survive hostile environmental conditions, such as nutrient deprivation and fluctuating temperature and pH, bacteria form biofilms, which are usually made up of multi-species co-aggregates. We have grown F. nucleatum in a chemostat at a growth rate consistent with that of oral bacteria in vivo and report that, at a growth pH of 8.2, F. nucleatum co-adheres and forms a homogeneous biofilm. Cell-surface hydrophobicity was determined in planktonic and co-adhering cells to characterise the interfacial interactions associated with the response to pH. Cell-surface hydrophobicity was found to increase at pH 8.2 and this was also associated with a decrease in the levels of intracellular polyglucose (IP) and an observed change in the bacterial cell morphology. To our knowledge, these results represent the first study in which F. nucleatum has been shown to co-adhere and form a biofilm, which may be important in the organism's persistence during the transition from health to disease in vivo.
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Affiliation(s)
- Peter S Zilm
- Oral Microbiology Laboratory, Dental School, The University of Adelaide, Adelaide, South Australia.
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18
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Zilm PS, Bagley CJ, Rogers AH, Milne IR, Gully NJ. The proteomic profile of Fusobacterium nucleatum is regulated by growth pH. MICROBIOLOGY-SGM 2007; 153:148-59. [PMID: 17185543 DOI: 10.1099/mic.0.2006/001040-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Fusobacterium nucleatum is a saccharolytic Gram-negative anaerobic organism believed to play an important role in the microbial succession associated with the development of periodontal disease. Its genome contains niche-specific genes shared with the other inhabitants of dental plaque, which may help to explain its ability to survive and grow in the changing environmental conditions experienced in the gingival sulcus during the transition from health to disease. The pH of the gingival sulcus increases during the development of periodontitis and this is thought to occur by the metabolism of nutrients supplied by gingival crevicular fluid. In comparison with other plaque inhabitants, F. nucleatum has the greatest ability to neutralize acidic environments. The differential expression of soluble cytoplasmic proteins induced by acidic (pH 6.4) or basic (pH 7.4 and 7.8) conditions, during long-term anaerobic growth in a chemostat, was identified by two-dimensional gel electrophoresis and image analysis software. Twenty-two proteins, found to have altered expression in response to external pH, were identified by tryptic digestion and mass spectrometry. Eight differentially expressed proteins associated with increased energy (ATP) production via the 2-oxoglutarate and Embden-Meyerhof pathways appeared to be directed towards either cellular biosynthesis or the maintenance of internal homeostasis. Overall, these results represent the first proteomic investigation of F. nucleatum and the identification of gene products which may be important in the organism's persistence during the transition from health to disease in vivo.
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Affiliation(s)
- Peter S Zilm
- Oral Microbiology Laboratory, Dental School, The University of Adelaide, Adelaide, Australia.
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19
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Dauger S, Benhayoun M, Touzot F, Bonnard A. Images in neonatal medicine. Abdominal cellulitis due to Escherichia coli in a two month old premature newborn. Arch Dis Child Fetal Neonatal Ed 2006; 91:F442. [PMID: 17056840 PMCID: PMC2672754 DOI: 10.1136/adc.2006.094201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- S Dauger
- Pediatric Intensive Care Unit, Hôpital Robert Debré, Université Paris VII-Denis Diderot, Paris, France.
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20
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Vayalumkal JV, Jadavji T. Children hospitalized with skin and soft tissue infections: a guide to antibacterial selection and treatment. Paediatr Drugs 2006; 8:99-111. [PMID: 16608371 DOI: 10.2165/00148581-200608020-00003] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Skin and soft tissue infections in children are an important cause for hospitalization. A thorough history and physical examination can provide clues to the pathogens involved. Collection of purulent discharge from lesions should be completed prior to initiating antimicrobial therapy, and results of bacteriologic studies (Gram stain and culture) should guide therapeutic decisions. The main pathogens involved in these infections are Staphylococcus aureus and group A beta-hemolytic streptococci, but enteric organisms also play a role especially in nosocomial infections. Increasing antibacterial resistance is becoming a major problem in the treatment of these infections worldwide. Specifically, the rise of methicillin-resistant S. aureus and glycopeptide-resistant S. aureus pose challenges for the future. Infections of the skin and soft tissues can be broadly classified based on the extent of tissue involvement. Superficial infections such as erysipelas, cellulitis, bullous impetigo, bite infections, and periorbital cellulitis may require hospitalization and parenteral antibacterials. Deeper infections such as orbital cellulitis, necrotizing fasciitis, and pyomyositis require surgical intervention as well as parenteral antibacterial therapy. Surgery plays a key role in the treatment of abscesses and for the debridement of necrotic tissue in deep infections. Intravenous immunoglobulin, as an adjunctive therapy, can be helpful in treating necrotizing fasciitis. For most infections an antistaphylococcal beta-lactam antibacterial is first-line therapy. Third-generation cephalosporins and beta-lactam/beta-lactamase inhibitor antibacterials as well as clindamycin or metronidazole are often required to provide broad-spectrum coverage for polymicrobial infections.Special populations, such as immunocompromised children, those with an allergy to penicillins, and those that acquire infections in hospitals, require specific antibacterial strategies. These usually involve broader antimicrobial coverage with increased Gram-negative (including antipseudomonal) and anerobic coverage. In patients with a true allergy to penicillins, clindamycin and vancomycin play an important role in treating Gram-positive infections. Newer antibacterial agents, such as linezolid and quinupristin/dalfopristin, are increasingly being studied in children for the treatment of skin and soft tissue infections. These agents hold promise for the future especially in the treatment of highly resistant, Gram-positive organisms such as methicillin-resistant S. aureus, vancomycin-resistant S. aureus, and vancomycin-resistant enterococci.
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Affiliation(s)
- Joseph V Vayalumkal
- Department of Pediatrics, Division of Infectious Diseases, University of Calgary, Alberta Children's Hospital, Calgary, Alberta, Canada
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21
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Abstract
BACKGROUND Fetal scalp electrode monitoring is usually without complications, but on rare occasions it can serve as a portal of entry for organisms colonizing the maternal genital tract. CASE We present a case of neonatal necrotizing fasciitis of the scalp that was associated with intrapartum fetal scalp electrode monitoring. Skin cultures grew Group A Streptococcus M11 T nontypeable serotype, an unusual cause of neonatal necrotizing fasciitis. The neonate's mother had a concurrent perineal infection and the same Group A streptococcal serotype was cultured from maternal blood and vaginal swabs. CONCLUSION This case highlights the emergence of life-threatening Group A Streptococcus causing invasive disease in both infants and mothers and the need for careful monitoring of neonates who have had intrapartum electrode monitoring.
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Affiliation(s)
- Cecile Davey
- Department of Perinatal-Neonatal Medicine, University of Toronto/Hospital for Sick Children, Toronto, Ontario, Canada.
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22
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Abstract
OBJECTIVE To present the microbiological and clinical features of six children with infected cephalohematomas (IC) caused by anaerobic bacteria. DESIGN Presentation of a case series. RESULTS Polymicrobial infection was present in all instances, where the number of isolates varied from two to four. Two patients had anaerobes only and the other four had mixed flora of strict anaerobes and facultatives. There were 16 bacterial isolates (12 anaerobic, 4 aerobic). The anaerobic isolates were Peptostreptococcus spp. (5 isolates), Prevotella spp. (4), Bacteroides fragilis group (2), and Propionibacterium acnes (1). The aerobic isolates were E. coli (2), Staphylococcus aureus (1) and group B streptococci (1). Blood cultures were positive for three patients. The most common predisposing conditions were vacuum extraction and amnionitis (4 instances of each), instrumental delivery (3), electronic fetal monitoring (2), prolonged delivery (1), and premature rupture of membranes (1). All patients underwent drainage, and four also had surgical incision and drainage of the IC. Osteomyelitis developed in one instance and scalp abscess developed in two patients, both of whom had electronic fetal monitoring. All patients eventually recovered from infection after receiving parenteral and subsequent oral antibiotic therapy for a total of 14-38 days. CONCLUSION This study highlights the polymicrobial nature and potential importance of anaerobic bacteria in IC in newborns.
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Affiliation(s)
- Itzhak Brook
- Department of Pediatrics, Georgetown University School of Medicine, Washington, DC, USA.
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Ulloa-Gutierrez R, Rodríguez-Calzada H, Quesada L, Arguello A, Avila-Aguero ML. Is it acute omphalitis or necrotizing fasciitis? Report of three fatal cases. Pediatr Emerg Care 2005; 21:600-2. [PMID: 16160666 DOI: 10.1097/01.pec.0000177201.76031.c4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We describe 3 Costa Rican newborns that developed acute omphalitis, complicated with fulminant abdominal wall and genital necrotizing fasciitis. The emergency practitioner should be capable of distinguishing promptly between acute omphalitis and early necrotizing fasciitis. Prompt medical treatment and surgical debridement should be encouraged to decrease the high associated morbidity and mortality rates.
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Affiliation(s)
- Rolando Ulloa-Gutierrez
- Servicio de Infectología, Hospital Nacional de Niños de Costa Rica, Dr. Carlos Sáenz Herrera, San José, Costa Rica.
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Holt SC, Ebersole JL. Porphyromonas gingivalis, Treponema denticola, and Tannerella forsythia: the "red complex", a prototype polybacterial pathogenic consortium in periodontitis. Periodontol 2000 2005; 38:72-122. [PMID: 15853938 DOI: 10.1111/j.1600-0757.2005.00113.x] [Citation(s) in RCA: 629] [Impact Index Per Article: 33.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Affiliation(s)
- Stanley C Holt
- Department of Periodontology, The Forsyth Institute, Boston, MA, USA
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25
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Hsu CC, Liu YP, Lien WC, Lai TI, Chen WJ, Wang HP. Urachal abscess: a cause of adult abdominal pain that cannot be ignored. Am J Emerg Med 2005; 23:229-30. [PMID: 15765359 DOI: 10.1016/j.ajem.2004.03.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Chia-Chun Hsu
- Department of Emergency Medicine, National Taiwan University Hospital, College of Medicine, Taipei, Taiwan
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26
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Abstract
This article discusses various anomalies and abnormalities of the umbilical cord and issues related to cord care. The issue of screening newborns with an isolated single umbilical artery for renal abnormalities is addressed. The clinical presentation of infants with omphalomesenteric and urachal duct remants along with the more common umbilical granuloma is reviewed. All three of these abnormalities can present with a wet or draining cord. The need for umbilical cord treatment with antimicrobial/antiseptic agents versus dry cord care is discussed, as are serious infections that involve the cord.
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Affiliation(s)
- Albert Pomeranz
- Department of Pediatrics, Medical College of Wisconsin, Children's Hospital of Wisconsin, Downtown Health Center, 1020 North 12th Street, Milwaukee, WI 53233, USA.
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