SURGICAL AND ORTHOPEDIC ASPECTS OF INFECTIONS IN NEWLY BORN AND YOUNG INFANTS

Abstract

Trends in Infecting Organisms The relative frequency of various organisms recovered from superficial abscesses oven the years is shown in Table I. These data document the clinical impression that with the introduction of penicillin, the pneumococcus practically disappeared as a cause of abscesses; a gradual reduction of streptococcic infections occurred; and the staphylococcus emerged as the most common organism responsible for peripheral abscesses. Minor Infections Furunculosis and pyoderma have assumed importance with increased incidence of staphylococcic infections in nurseries. Breast abscesses are peculiar to infants 2 to 3 weeks of age, in whom they owe their origin to estrogenic hypertrophy of the breast. Incision and drainage is often necessary and should not be delayed when a 3-to 4-day course of antibiotic therapy fails to cause recovery. Paronychia, subungual abscess, and infected ingrown toenail are common, often slow to improve, and may be a source of septicemia. Infants who persist in pulling the feet up and down, while resting the stomach, will irritate the toes and cause ingrowing. Often the nail itself is slow to grow. Surgical excision, either a wedge or complete removal of the toenail, should not be done. The lateral mounds of granulation tissue can be removed by silver-nitrate cauterization and kept below the level of the nail by pressure with cotton and adhesive tape. Most important, the family must be cautioned against impatience. Actual abscesses must be drained. Pneumonitis and Empyema Pnemonitis and empyema in young infants have been occurring with increasing frequency in the past several years. Staphylococcic pneumonia with empyema in infants is not a new disease; even the nature of the disease has not altered. Since 1955, Staphylococcus aureus, coagulase positive, has become the most common responsible organism in the empyema complicating bacterial pneumonia in young infants.