Neonatal surgical infection

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.

Infection

Burnes, , pancreonecrosis ss

Systemic inflammatory Respound syndrome

(SIRS) ()

Massive bleeding

Trauma

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.

Neonatal phlegmon

Neonatal phlegmon

Neonatal phlegmon-surgical treatment

Adyponecrosis

Erysipelas

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 male:female ratio is 1:1 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)

Neonatal mastitis

Neonatal mastitis.Surgical management

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.

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

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 3:2 The most common involving long tubular bones

Cause acute hematogenous osteomyelitis

Age group Newborns (younger than 4 month) Children (aged 4 mo to 4 year) Most common organisms S. aureus, Enterobacter species, and group A and B Streptococcus species S. aureus, group A Streptococcus species, Haemophilus influenzae, and Enterobacter species S. aureus (80%), group A Streptococcus species, H. influenzae, and Enterobacter species S. aureus and occasionally Enterobacter or Streptococcus species

Children, adolescents (aged 4 y to adult)

Adult

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.

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.

Peculiarity dissemination inflammatory process.

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.

Classification of AHO by clinical pictures:

Toxic

(adynamic) type Septico-pyemic type Local

Pathogenetic stages of AHO

Bone

marrow phlegmon Periosteal abscess Soft tissue phlegmone Dermal fistula

Classification of AHO by localization

Epiphyseal Metaphyseal Diaphyseal Metadiaphyseal Pelvic Other localization

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

Acute hematogeneous osteomyelitis

10-14 days after the onset:lytic areas

Linear periostitis and maculosus osteoporosis

Periostitis and destruction bone

Pathologic fracture tibia on background destruction bone

Chronic osteomyelitis with sequestrum

Computed tomogram.

 .
Bone tuberculosis. Inflammation diseases soft tissues. Articular

syndrome for systemic

diseases. Benign lesions of the bone. Malignant tumor of the bone.

intervention, surgical procedure

Atypical forms of osteomyelitis

Brodies

abscess Albuminous osteomyelitis Sclerosing osteomyelitis Antibiotic osteomyelitis

Cronical osteomyelitis
Typical

radiograph of Brodies abscess

Albuminous osteomyelitis

Sclerosing osteomyelitis

Neonatal acute osteomyelitis.

X-ray findings of neonatal acute hematogenous osteomyelitis

Treatment of neonatal AHO:Shades reduction traction

Immobilization-wide diapering as a prophylactic management of acquired dislocation of the hip

Further complication of AHO:varus deformation and limb contraction

Thank you for attention !!!