Sedation for children 2 to 5 years of age undergoing auditory brainstem response and auditory steady state responses recordings.

OBJECTIVE: To evaluate the feasibility, the duration and results of sedation by intrarectal pentobarbital and oral alimemazine for auditory brain stem responses (ABR) and auditory steady-state responses (ASSR) recordings in children aged 2 to 5 years. DESIGN: Prospective study. STUDY SAMPLE: 180 consecutive children aged 2 to 5 years, referred for language retardation and/or behavioral problems, who could not be tested by behavioral methods, underwent ABR and ASSR recordings. The children who did not spontaneously nap were sedated by intrarectal pentobarbital eventually potentiated by oral alimemazine. RESULTS: A spontaneous nap was obtained in only 23 cases, 72 children received only pentobarbital, and 85 received both pentobarbital and alimemazine. Even so, recording was impossible in 16 cases, and interrupted before completion of the ASSR recordings in 45 cases. Children went to sleep in average 64 min +/- 40. The average recording time for the ABR was 20 minutes, and for the ASSR 25 minutes. CONCLUSION: Sedation by pentobarbital, eventually completed by oral alimemazine, allows ABR and/or ASSR recordings in 89.8% of the children who did not nap in the recording room, and is therefore a good alternative to general anesthesia in these children.

Fusobacterium necrophorum middle ear infections in children and related complications: report of 25 cases and literature review.

BACKGROUND: Fusobacterium necrophorum is associated with Lemierre syndrome (pharyngitis with septic thrombosis of the internal jugular veins) but it can also be involved in other head and neck infections, including sinusitis, parotitis, dental infections, and otitis media. METHODS: This retrospective study analyzes a series of 25 pediatric cases of acute otitis media caused by F. necrophorum and treated in our institution between 1995 and 2006. RESULTS: We observed 3 clinical presentations: (1) uncomplicated otitis media (44%; n = 11); (2) acute mastoiditis (40%; n = 10); and (3) otogenic variant of Lemierre syndrome (16%; n = 4) associating acute mastoiditis, suppurative thrombophlebitis of the lateral and/or cavernous sinuses, meningitis syndrome, and sometimes distant septic metastasis or extensive osteolysis of the temporal bone. Sixty percent of these cases were diagnosed during the last 4 years of the study. Children less than 1 year of age were at increased risk for Lemierre syndrome. Broad range 16S rDNA polymerase chain reaction and sequencing were used to confirm the identification of F. necrophroum and to detect secondary sites of infection. All patients had favorable clinical outcome, but complicated cases (mastoiditis and otogenic variant of Lemierre syndrome) required prolonged hospital stays and duration of treatment. CONCLUSIONS: Based on bacteriologic investigation, we recommend systematic culture for anaerobes and that antibiotic treatment of F. necrophorum middle ear infections and subsequent complications includes coverage for anaerobic bacteria.