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] *********************************************** The LACTNET mailing list is powered by L-Soft's renowned LISTSERV(R) list management software together with L-Soft's LSMTP(TM) mailer for lightning fast mail delivery. For more information, go to: http://www.lsoft.com/LISTSERV-powered.html