Robert D. Roghair, MD and Herman A. Hein, MD
Peer Review Status: Internally Peer Reviewed
Electronic fetal heart rate monitoring and instrumented deliveries are integral components of high risk obstetric management. Between 0.1% and 5.2% of infants develop an abscess at the site of scalp electrode placement, depending on factors including the duration of membrane rupture. Infections typically present as fluctuant or indurated masses 2-10 days following delivery.
The differential diagnosis includes the vesicular lesions that may be seen with Herpes simplex virus infection. Microbiology of scalp abscesses typically reflects polymicrobial contamination by recto-vaginal bacterial flora (predominantly Streptococcus sp, enteric gram negative rods, and occasionally anaerobes).
If the infant is clinically ill, both sepsis and meningitis are potential complications, and cultures should be obtained prior to incision, drainage and initiation of systemic antibiotics, including ampicillin and gentamicin.
If the infant is clinically well, the primary therapeutic modality is surgical incision and drainage, followed by local wound care. Antimicrobial therapy can be tailored to the sensitivities of the cultured organisms. Care givers must remain vigilant for signs of intracranial extension and consider neuroimaging if the infants condition warrants further evaluation. Parental instruction in wound care and local physician follow-up are critical components of successful management.
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- Brook I, Frazier EH. Microbiology of scalp abscess in newborns. Pediatr Infect Dis J 1992; 11:766-8.