title: Mediastinitis in infants from deep neck space infections.
abstract: OBJECTIVE
  To describe mediastinitis in infants.
  
  
  METHODS
  Case series.
  
  
  METHODS
  Tertiary-care, academic, pediatric hospital.
  
  
  METHODS
  Four infants managed during eight months.
  
  
  RESULTS
  Patients were eight months (two patients), nine months, and 18 months old. They had retropharyngeal phlegmons and were started on clindamycin/cephalosporin. Interval imaging scans revealed abscess formation with mediastinal extension. All retropharyngeal abscesses were drained; three patients required video-assisted thoracoscopic debridement. Methicillin-resistant Staphylococcus aureus (two patients) and methicillin-sensitive Staphylococcus aureus (two patients) were cultured. Peak white blood cell counts were 15,000, 18,400, 30,200, and 44,900. The patients survived without long-term morbidity.
  
  
  CONCLUSIONS
  In infants with pediatric deep neck space infections, increased vigilance should be maintained for progression to mediastinal extension. Optimal management includes imaging of the neck and chest as indicated, broad-spectrum antibiotic coverage, and aggressive surgery as warranted to clear the neck space infections with appropriate surgical consultants to manage the mediastinal process. Despite high morbidity and mortality in adult mediastinitis, infant mediastinitis may be a different disease process as all patients survived without sequelae.
authors.affiliation: Division of Otolaryngology, Children's National Medical Center, The George Washington University Medical Center, Washington, DC 20010, USA. rshah@cnmc.org
authors.forename: Rahul K
authors.initials: RK
authors.lastname: Shah
authors.forename: Robert
authors.initials: R
authors.lastname: Chun
authors.forename: Sukgi S
authors.initials: SS
authors.lastname: Choi
mesh_terms: D000038:Abscess / Q000150:complications* / Q000000981:diagnostic imaging / Q000628:therapy; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D004322:Drainage; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008480:Mediastinitis / Q000000981:diagnostic imaging / Q000382:microbiology* / Q000628:therapy; D009333:Neck / Q000000981:diagnostic imaging; D013203:Staphylococcal Infections / Q000150:complications* / Q000000981:diagnostic imaging / Q000628:therapy; D013211:Staphylococcus aureus; D014057:Tomography, X-Ray Computed
chemical_list: D000900:Anti-Bacterial Agents