The efficacy of lumbar puncture in febrile early infants with urinary tract infection in pediatric emergency department

OBJECTIVE: This study was conducted to identify the characteristics of early infants with urinary tract infection (UTI) who visited the pediatric emergency department (PED) and to investigate the characteristics of patients with cerebrospinal fluid (CSF) pleocytosis and incidence of bacterial meningitis. METHODS: We retrospectively reviewed the records of UTI infants aged 31 to 90 days presenting at PED whom had lumbar puncture. From September 1, 2014 to August 31, 2017, a total of 225 infants were enrolled. RESULTS: Twenty three patients had CSF pleocytosis. Of these, two patients were positive for CSF enteroviral polymerase chain reaction, while none were positive for bacterial culture. We compared the characteristics of infants with CSF pleocystosis. There were not diffences in sex, vaccination before fever, general condition, peak body temperature, peripheral white blood cell, C-reactive protein, and procalcitonin between two groups. However, in patients with prematurity history, incidence of CSF pleocytosis was high. Four infants hot bacteremia, and organism of these patients was all Escherichia coli. All of them had negative CSF culture and normal CSF findings. CONCLUSION: No febrile early infants with UTI had bacterial meningitis. As a result, we must not do conventional test of CSF in patients with UTI.

Clinical Investigation of Neck Masses in Children

PURPOSE: Neck masses are frequently encountered in pediatric practice, and have various underlying diseases. If the underlying diseases of the neck mass are not confirmed by its clinical characteristics, it can be done by neck mass biopsy. To define the necessity and the appropriate time of neck mass biopsy is very difficult and also important. Therefore the authers have conducted this study to have aids in differential diagnosis of neck mass in children by analyzing the clinical manifestations of underlying diseases of neck mass. METHODS: The authors have reviewed 390 children under 15 years of age who visited and admitted with neck masses to Shinchon Severance Hospital between Jan. 1987 and Dec. 1994. In order to elucidate the nature and etiologic diseases of neck masses, we classify and analyze the neck masses by age and sex distribution, duration of symptoms and signs, size and consistencies and by site and number of neck masses, and finally by underlying diseases. RESULTS: 1)Of the overall sex distribution, male patients were more than female, the male to female ratio was 1.32 : 1(222:168). The most common age group was 2-5 years of age. The most common acompanying symptoms were upper respiratory tract infection symptoms, comprising 37.7 % of all, and the most common duration of symptoms and signs was within 3 months, comprising 65.6 % of all. 2)Of the underlying diseases of the neck masses, the largest proportions were inflammatory masses, which comprising 49.2 % of all cases, among these, nonspecific cervical lymphadenitis was most common(65.6 %). 3)We could also confirm the nonspecific cervical lymphadenitis by clinical manifestations, blood exams and neck ultrasonography except neck mass biopsy. 4)For the diagnosis of tuberculous lymphadenitis, the family history of tuberculosis, PPD skin test, and chest X- ray findings are almost helpful, but the neck mass biopsy was essential. 5)Malignant tumors were 24 cases, which comprise 6.2 % of all. CONCLUSIONS: For the appropriate differential diagnosis of neck masses in children, we should observe and describe accurately the clinical characteristics of the neck masses. On physical examination, if we can not rule out the possibility of tuberculous lymphadenitis or malignant tumors, the neck mass biopsy should be done immediately, but if it is likely the nonspecific cervical lymphadenitis, we must wait until the size of neck masses decrease or other symptoms disappear after empirical antibiotics therapy.