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Subject:
From:
Nancy Holtzman <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Fri, 1 Mar 2002 21:03:55 -0500
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A study published today in Pediatrics discussed a previously healthy full
term breastfed baby who had abrupt inconsolable crying, after workup was
found to have Group B Strep (GBS) and retropharyngeal cellulitis. I found
this study interesting and something to file in the back of the brain since
we someday might encounter a baby with lethargy, feeding difficulties, and
swelling of the jaw, throat or neck area.  Although this presentation of
late-onset GBS is fairly rare,  retropharyngeal infection is more likely
(perhaps due to trauma) when a newborn has been deep-suctioned or used
C-PAP, and that, unfortunately, is not so rare.

Here is the portion I thought might be useful to read:

The clinical manifestations of GBS infection vary according to the age of
the infant. Early-onset disease most commonly manifests as sepsis,
meningitis, and pneumonia, all of which frequently present with respiratory
signs such as tachypnea and grunting as an initial clinical finding. The
dominant presentations of late-onset GBS disease are meningitis,
bacteremia, and bone and joint infection. Clinical signs in these infants
are almost always nonspecific and include fever, irritability, poor
feeding, and lethargy.3

A less common clinical manifestation is cellulitis. These infants present
with symptoms similar to those seen in other forms of late-onset infection
and also have swelling and erythema of the involved site. The submandibular
and parotid areas are the most frequently involved sites, and, in one
report, several infants are described as having enlarged lymph nodes
associated with the infection. The majority of reported cases have GBS
bacteremia at the time of presentation

Initial clinical signs commonly reported in young infants with
retropharyngeal abscess or cellulitis are typically respiratory distress,
poor feeding, and submandibular swelling. Several of the infants were also
described as being irritable and having a hoarse, weak cry. Lateral
radiographs of the neck, when obtained, consistently revealed widening of
the retropharyngeal space. Similar to our patient, many of the neonates
initially were afebrile. The total leukocyte count was variable among the
cases described, which is not unusual, as total leukocyte counts have been
shown to be poor predictors of infection in young infants.19

An infant with acute, unexplained crying and a negative initial physical
examination must always be evaluated until the cause is determined and
serious conditions are ruled out. A thorough examination should be
performed to identify signs of infection, trauma, corneal abrasion,
intestinal malrotation, testicular torsion, incarcerated hernia, and hair
tourniquet. The extremities should be palpated for possible fractures and
observed for signs of unusual posturing or decreased motion, and
radiographic examination, including skeletal survey, should be considered.
Finally, as illustrated in this case, consider occult soft tissue
infections; in the case of retropharyngeal abscess or cellulites, cervical
spine radiographs should be obtained if indicated.

The entire study can be found at:
http://www.pediatrics.org/cgi/content/full/109/3/e51

Nancy Holtzman RN BSN IBCLC
Great Beginnings New Mothers Groups
Boston Breastfeeds!
West Roxbury MA
mailto:[log in to unmask]

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