Group A sterptococcal sepsis and osteomyelitis of the skull in a neonate with cephalohematoma: a case report

Infected cephalohematoma may lead to osteomyelitis of the skull in a neonate. It is a rare entity which is difficult to diagnose clinically. A case report of skull osteomyelitis is presented. A 33 day old girl of African origin born by ventouse extraction came with breathing difficulty, high grade fever up to 104 F, excessive crying and poor feeding for the previous 4 days. The mother noted a scalp swelling present since birth which gradually increased in size over the last 10 days and was discharging pus. Examination showed an irritable baby with tachycardia, tachypnea and fever of 102 F. Oxygen saturation was 92% in room air. There was a large scalp swelling 6x4 cm in size on right parietal area. It was tense, indurated and tender to touch with three pus discharging lesions. Anterior fontanelle was soft and not bulging. Rest of the examination was normal. Initial investigations and chest x-ray were normal. Skull Xray showed erosion of the parietal bone proximal to the soft tissue swelling. Empirical intravenous antibiotics included ceftazidime, cloxacillin and amikacin. Blood culture done at admission revealed Group A Streptococcus after 48 hours. A localized pus swab and aspiration fluid from cephalohematoma revealed serous aspirate that was culture negative. The baby improved clinically with resolution of cephalohematoma after 10 days. She received intravenous cloxacillin for 3 weeks. She was followed up in clinic and had remained well since discharge. Neonates can develop skull osteomyelitis. Group A streptococcus may be implicated along with other microorganisms. Skull x-rays are suggestive whereas CT scan is diagnostic. Prompt antibiotics and surgical drainage will have successful outcome

Do cardiotocographic changes alone determine fetal outcome?

To compare fetal outcome in fetal distress on CTG with clear liquor versus CTG changes of fetal distress with meconium stained liquor. A cross sectional study. The Department of Obstetrics and Gynecology Islamic International Medical Complex. September2004 to December 2005[16 month]. During the study period 111 patients delivered in which fetal distress was diagnosed clinically and on cardiotocography [CTG]. Vaginal delivery [spontaneous or instrumental] was accomplished in 17 [15%] patients while the rest of 94 [85%] patients underwent emergency caesarean section for fetal distress. Irrespective of the mode of delivery, the patients were divided into two Groups; Group A and Group B. Group A comprised of those patients who had fetal distress on CTG with clear liquor and Group B included those patients who had fetal distress on CTG along with meconium staining of liquor. There were 67 patients in Group A and 44 patients in Group B. Out of the 94 patients who underwent caesarean section, 57 patients were operated for fetal distress on CTG with clear liquor and 37 patients had CTG changes with meconium staining of liquor. CTG changes noted included loss of beat to beat variability, tachycardia, bradycardia and decelerations. Demographic details noted were maternal age, parity, fetal weight and mode of delivery. Main outcome measures noted were CTG, Apgar score at 1 and 5 minutes, baby resuscitation measures and neonatal complications. The main outcome measures were expressedas numbers and percentages. Mean maternal age in Group A and Group B was 26.10 years and 25.57 years respectively Mean gestational age was 38 weeks in Group A and 39 weeks in Group B. Birth weight was 3.2 kg and 3.1 kg in Group A and Group B respectively. Main outcome measures showed more variable and late decelerations, [23% vs 8%] more babies with lower apgar scores [18% vs 6%] and more neonatal complications in Group B. There were two neonatal deaths in Group B. Meconium staining with CTG changes is a more significant sign of fetal distress than CTG changes alone