Antibiotics for Pediatric Neck Abscess: A Systematic Review

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Ankyloglossia: Effects of Frenulotomy on Breastfeeding Dyads Eliav Gov-Ari, MD (presenter) OBJECTIVE: 1) To review the efficacy and safety of in-office frenulotomy on infants with ankyloglossia and breastfeeding difficulties. 2) To identify specific outcome variables which may be affected by frenultomy. METHOD: This retrospective chart review and survey studied infant-mother dyads who presented to a pediatric otolaryngology clinic with breastfeeding difficulties and whose infants were found to have ankyloglossia. All infants underwent inoffice frenulotomy and were immediately evaluated for improvement in breastfeeding. A telephone survey was then conducted, which identified specific improvement in several variables, including latch, nipple pain, and infant weight gain. These variables were then subjected to statistical analysis with determination of 95% confidence intervals. RESULTS: Fifty-two percent of mothers reported immediate improvement in latching (p ⬍ 0.0001). Forty-four percent reported improvement in nipple pain within days (p ⬍ 0.0001), and sixty-five percent experienced improvement in infant weight gain (p ⬍0.05). Complications included minor bleeding in two patients, and pain lasting more than one hour in one patient. Seventy percent (n⫽19) of the dyads treated were referred by a lactation consultant, twenty-nine percent (n⫽7) by a pediatrician and less than one percent (n⫽1) by a family practitioner. CONCLUSION: Office based frenulotomy is a safe procedure which leads to improvement in infant latch and decreased nipple pain within days. These outcomes likely influence the continuation and overall length of breastfeeding, and do affect infant weight gain. In our studied population, provider awareness of frenulotomy as a possible solution for breastfeeding difficulties was greatest among lactation consultants.

Antibiotics for Pediatric Neck Abscess: A Systematic Review Peter Carbone, MD (presenter); Gregory Capra, MD; Matthew Brigger, MD, MPH OBJECTIVE: To evaluate the current evidence regarding the safety and efficacy of medical management for deep neck abscesses in children. METHOD: An a priori protocol defining inclusion and exclusion criteria was developed to identify all articles addressing medical therapy of pediatric deep neck abscesses that presented details regarding diagnostic criteria, specifics of medical therapy and definitions of failure. The search was conducted between 16-28 February, 2010, and included electronic databases to identify candidate articles as well as a manual crosscheck of references. The level of evidence was assessed and data extracted by three authors independently. Data were pooled using a random effects model due to significant study heterogeneity. RESULTS: Eleven articles met inclusion criteria. The overall level of evidence was grade C. There was significant heterogeneity among the studies (I2⫽98.8%; p⬍.001). However, each article uniformly presented cases suggesting that medical therapy may be a viable alternative to surgical drainage in some patients. The pooled success rate of medical therapy in avoiding surgical drainage in children with deep neck infections was 0.751 (95%CI: 0.578, 0.923). In studies documenting clearly defined medical therapy protocols and abscesses diagnosed by computed tomography, pooled data analysis demonstrated a success rate of .949 (95%CI: 0.848,1.0). Subgroup analysis by duration of intravenous antibiotic trial greater than 48 hours demonstrated a pooled success rate of 0.868 (95%CI: 0.722,1.0). CONCLUSION: The current literature suggests medical management is a safe alternative to surgical drainage of deep neck abscesses in children. However, the level of evidence lacks strength and therefore further investigation is warranted. Cigarette Smoke Inhibits Adenoid Ciliary Beat Stimulation Ling-Feng Wang, MD (presenter); Steven Andreoli, MD; Ryan Mulligan, MS; David White, MD; Rodney Schlosser, MD OBJECTIVE: Environmental tobacco smoke exposure in children increases the incidence of upper respiratory infections, chronic sinusitis, and chronic otitis media. This study intends to determine the effects of in vitro exogenous smoke exposure on dynamic ciliary beat frequency (CBF) in pediatric adenoid explants. METHOD: Ten children undergoing adenoidectomy at a tertiary care pediatric hospital for obstructive sleep apnea and adenotonsillar hypertrophy were enrolled in this study. Adenoids were surgically removed using curettage. Tissue was

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standard deviation). There was a slight male predilection (52%). The majority of victims were less than 5 years of age (60%), with the highest incidence occurring in 3-year-olds (16%). Incidence decreased with increasing age. The vast majority (88%) of the dogs were familiar to the children. The most common breeds included mixed breeds (16%), Labrador retrievers (16%), and terriers (10%). Repair in the operating room was required in 67 (12%) patients. Consultation services were called for 128 (24%) patients, with otolaryngology, ophthalmology, and plastic surgery being the most common. Inpatient treatment was required in 129 (24%) patients. CONCLUSION: We report the epidemiological data on the largest series of pediatric dog facial dog bites. Children younger than 5 years are at high risk for being bitten in the face by a familiar dog. Consultation services are frequently utilized in the management of these injuries, as is hospitalization.