Infected neonatal cephalohematomas caused by anaerobic bacteria.
OBJECTIVE
To present the microbiological and clinical features of six children with infected cephalohematomas (IC) caused by anaerobic bacteria.


METHODS
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.


CONCLUSIONS
This study highlights the polymicrobial nature and potential importance of anaerobic bacteria in IC in newborns.
Brook
Itzhak
I
Department of Pediatrics, Georgetown University School of Medicine, Washington, DC, USA. ib6@georgetown.edu
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001421:Bacteria, Anaerobic / Q000302:isolation & purification*; D001424:Bacterial Infections / Q000175:diagnosis / Q000382:microbiology* / Q000628:therapy; D015984:Causality; D002543:Cerebral Hemorrhage / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D004322:Drainage / Q000379:methods; D005260:Female; D005334:Fever / Q000209:etiology; D006406:Hematoma / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D006801:Humans; D007231:Infant, Newborn; D007964:Leukocytosis / Q000209:etiology; D008297:Male; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents