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Abstract:
Suppurative middle ear effusions (MEE) have been shown to occur commonly in neonates. In spite of this, otoscopy is not routinely performed on septic infants in the neonatal intensive care unit (ICU). This is clinically significant since unrecognized suppurative MEE may act as a focus for dissemination of bacteria into the circulation and/or central nervous system (CNS). We have completed a prospective study in an attempt to define the prevalence, bacteriology, and response to therapy of MEE in neonates. To facilitate this, the normal micro-otsocopic appearance of the newborn TM was established by systematically examining 50 normal infants under 24 hours old. MEE was present in 30% of 125 consecutively examined infants in the neonatal ICU. Bacteriologic data are drawn from tympanocentesis performed on 34 neonates. Nasotracheal intubation of longer than seven days is highly associated with suppurative MEE. Suppurative MEE in the neonatal ICU is often refactory to treatment and may require prolonged therapy and repeated tympanocentesis.
Insights
Suppurative middle ear effusions (MEE) are common in neonates, yet often missed in intensive care units. Early detection is crucial to prevent serious complications like sepsis and meningitis.
Area of Science:
- Neonatal Medicine
- Otolaryngology
- Infectious Disease
Background:
- Suppurative middle ear effusions (MEE) are frequently observed in neonates.
- Otoscopy is not routinely performed on septic infants in neonatal intensive care units (ICUs).
- Unrecognized MEE can lead to bacterial dissemination into the bloodstream or central nervous system (CNS).
Purpose of the Study:
- To determine the prevalence of MEE in neonates.
- To identify the bacteriology of MEE in this population.
- To assess the response to therapy for MEE in neonates.
Main Methods:
- Established normal micro-otoscopic appearance of the tympanic membrane (TM) in 50 healthy newborns.
- Conducted a prospective study of 125 infants in the neonatal ICU.
- Performed tympanocentesis on 34 neonates for bacteriologic analysis.
Main Results:
- MEE was present in 30% of infants in the neonatal ICU.
- Nasotracheal intubation exceeding seven days showed a strong association with suppurative MEE.
- Suppurative MEE in neonates often proved refractory to treatment, necessitating prolonged therapy and repeated tympanocentesis.
Conclusions:
- Suppurative MEE is a significant concern in neonatal ICUs.
- Routine otoscopy in septic neonates is warranted.
- Effective treatment strategies for neonatal MEE require further investigation due to treatment refractoriness.