Brief Reports
December 1, 1999 4 minutes read
Brief Reports
Frequency of Serious Infections in Infants Younger than 8 Weeks with Otitis Media
Source: Nozicka CA, et al. Otitis media in infants aged 0-8 weeks: Frequency of associated serious bacterial disease. Pediatr Emerg Care 1999;15:252-254.
Nozicka and associates at the children’s hospital of Wisconsin emergency department (ED) in Milwaukee studied 40 nontoxic-appearing small infants with otitis media (OM) confirmed by a pediatric otolaryngologist using a binocular operating microscope. Thirty-eight percent (15/40) had rectal temperatures equal to or greater than 38°C. All infants had typanocentesis with middle ear fluid (MEF) culture and complete sepsis evaluation including complete blood count (CBC), blood culture, catheter urine culture, and lumbar puncture with cerebrospinal fluid (CSF) culture. All infants were treated with parenteral ampicillin and either gentamicin or cefotaxime and admitted to the hospital.
Bacterial pathogens were recovered from the MEF in 25/40 (62.5%) infants and 15 infants had negative cultures of the MEF. All infants who were afebrile on admission to the ED had negative blood, urine, and CSF cultures. Only two of 15 febrile infants had positive cultures from sites other than the MEF.
Nozicka et al conclude that previously healthy, non-toxic-appearing, afebrile, nontoxic infants aged 2-8 weeks of age with OM infrequently have an associated serious bacterial infection and the oral antibiotic therapy with close follow-up may be a reasonable therapeutic option. However, infants younger than 2 months of age with OM who are febrile and toxic and who have signs of systemic illness require a full septic workup and consideration of parenteral antibiotic therapy. —lmb
Neonates with proven otitis media:
a. frequently have bacterial pathogens cultured from MEF.
b. frequently have bacterial pathogens cultured from other sites than the MEF.
c. have other positive bacterial cultures more frequently if they are febrile/toxic.
d. should always be hospitalized for a septic workup and parenteral antibiotics.
Breath-Holding Spells and Iron Deficiency
Source: Mocan H, et al. Breath holding spells in 91 children and response to treatment with iron. Arch Dis Child 1999;81: 261-262.
Breath-holding spells are a frequent complaint in pediatric practice. They are clinical episodes based upon history given by the family as well as direct observation of the spells. Spells are usually defined as stopping of the child’s breathing during expiration after a deep inspiration during crying. Spells are classified as cyanotic, pallid, and mixed according to the color of the patient’s skin during the spell. It has been estimated that as many as 27% of otherwise healthy children experience breath-holding spells.1 The cause of breath-holding spells has not been defined2; however, an association with iron deficiency anemia has been suggested and reports have described correction of these spells coincident with iron medication.3
Mocan and associates from Turkey studied 91 children, 6-31 months of age, with typical breath-holding spells. Studies of iron status included hemoglobin, mean cell volume (MCV) serum iron, and total iron-binding capacity. Other studies included blood sugar serum calcium, ECG, EEG, and skull x-rays. Sixty-three patients with breath-holding spells had concomitant iron deficiency anemia and were treated with oral iron, 6 mg/kg/d for three months. The remaining 28 patients were not treated. Frequency of the spells were assessed. Fifty percent (32/68) patients treated with iron had complete cessation of spells and another 33.3% (21/68) had partial remissions, with at least a 50% decrease in the frequency of spells. In contrast, only 6/28 (21%) of the non-iron-deficient, nontreated patients had complete or partial improvement during three months of observation. Mocan et al acknowledge that they did not measure serum ferritin levels in these children, and it is possible that some of their "non-iron-deficient" children may have had a degree of iron deficiency.
Breath-holding spells are most frequent in children of the same age group in which iron deficiency is most prevalent. It would seem prudent that children experiencing repetitive breath-holding spells should be studied for iron deficiency and given appropriate therapy for this when present. One might consider a short course of empiric iron therapy even without blood studies. Mocan et al conclude that anticonvulsants are not the treatment of choice for breath-holding spells in infancy. —hap
References
1. Bridge EM, et al. Breath holding spells; their relationship to syncope, convulsions and other phenomena. J Pediatr 1943;23:539-561.
2. Dimaro FJ, et al. Pallid breath holding spells; evaluation of the autonomic nervous system. Clin Pediatr 1990;29:17-24.
3. Daoud AS, et al. Effectiveness of iron therapy on breath-holding spells. J Pediatr 1997;130:547-550.
Breath-holding spells of infancy:
a. can be diagnosed by appropriate laboratory studies and EEG.
b. are characterized by a cessation of breathing during inspiration.
c. are usually diagnosed by the family history coupled with direct observation when possible.
d. do not usually repond to iron therapy and often require anticonvulsant therapy.
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