Mediastinitis in infants from deep neck space infections.
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.
Shah
Rahul K
RK
Division of Otolaryngology, Children's National Medical Center, The George Washington University Medical Center, Washington, DC 20010, USA. rshah@cnmc.org
Chun
Robert
R
Choi
Sukgi S
SS
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
D000900:Anti-Bacterial Agents