Clinical analysis of 6 cases of orbital cellulitis in neonates and literature review / 中华实用儿科临床杂志

ABSTRACT

Objective:To investigate the clinical characteristics and treatment of orbital cellulitis in neonates.Methods:Clinical data of 6 neonates with orbital cellulitis were retrospectively analyzed.Newborn orbital cellulitis cases were searched in PubMed, Web of Science, CNKI, Wanfang and VIP databases from the establishment of the database to July 1, 2019, and then relevant literature was reviewed.Results:(1)There were 4 males and 2 females.Five patients had fever.White blood cell(WBC), C-reactive protein(CRP) and procalcitonin(PCT) were significantly increased in 5 cases.Three cases were caused by the spread of infection of surrounding tissues, 2 cases were caused by bacteremia, and 1 case was suspected of vertical transmission from mother to child.Two cases of blood culture and 2 cases of purulent culture were positive.Microbial culture results were all staphylococcus aureus(SA). Four patients were treated with Ceftriaxone + Ampicillin and 2 cases with Ceftriaxone + Linezolid.Abscess incision and drainage were performed in 1 patient.All 6 cases were cured.(2)A total of 13 articles were retrieved, which reported 15 cases of neonatal orbital cellulitis were reported.Together with this 6 cases, 21 cases were analyzed.Periorbital swelling and fever were the main manifestations, and some children presented with simple fever or refuse milk and moan as the first symptom.WBC was significantly increased in most cases.The positive bacterial cultures of 19 cases all contained SA.Nineteen cases were treated with two or more antibiotics.According to the drug sensitivity test results, Vancomycin was used in 8 of the 12 foreign cases, and the third-generation cephalosporin combined with Ampicillin or Linezolid was mainly used in the domestic cases.Abscess incision and drainage were performed in 12 cases.Nineteen cases were cured, 1 case was left with spastic paralysis of limbs, and 1 case died.Conclusions:Orbital cellulitis is rare in the neonatal period, mainly due to the spread of periorbital tissue infection, bacteremia and vertical maternal and infant infection.It is sensitive to oral wiping.Invasive operations increase the risk of infection.The onset of the disease is insidious and ra-pid, and the diagnosis may be delayed in the neonatal period due to the lack of typical symptoms.SA is the chief pathogen.Antibiotics including staphylococci and streptococci should be used for treatment, and drug combination is often required.Incision and drainage should be performed timely for abscess formation.Early diagnosis, rational use of antibio-tics and prompt surgical treatment are necessary conditions for cure.Most of the patients have good prognosis, while the patients with cavernous sinus thrombosis have poor prognosis.