Pediatric Deep Neck Infections: Does Age Matter?

Pediatric deep neck infections (DNIs) pose diagnostic and therapeutic challenges due to their varied presentation across age groups. Current management strategies lack age-specific guidelines despite known anatomical and clinical differences. Our study aims to evaluate age-related variations in clinical presentation, imaging use, treatment approach and outcomes in pediatric DNIs, and to assess potential implications for modifying existing management algorithms.

This retrospective study analyzed 268 pediatric patients diagnosed with retropharyngeal or parapharyngeal infections between 2009 and 2020 at a tertiary pediatric center. Patients were stratified into 3 age groups: <1 year, 1-6 years and >6 years. Clinical features, imaging modality, treatment and outcomes were compared across age groups. Multivariate logistic regression was used to identify predictors for surgical drainage and prolonged hospitalization.

Retropharyngeal infections were predominant in children under 6, while parapharyngeal infections were more common in those over 6. The clinical presentation varied significantly by age, with infants more likely to present with nonspecific symptoms and older children presenting with localized signs. Computed tomography scan performance was the strongest predictor for surgical drainage ( P < 0.001). However, age did not significantly influence the surgical intervention rate or hospitalization length. The overall rate of surgical drainage was low (7.8%).

Pediatric DNIs exhibit distinct age-related patterns in presentation and infection site, though outcomes remain consistent across groups. These findings support the need for age-specific clinical algorithms, particularly regarding diagnostic imaging and thresholds for intervention, to optimize care and reduce unnecessary procedures in young children.