Acute pediatric neck infections: Outcomes in a seven-year series

 Acute neck infections (ANIs) can occur at any age and are not uncommon in children [1].
 However, its incidence seems to be diminishing due to the development of antibiotics and
 improvement of health care in general [2]. These infections are known to spread along fascial
 planes and potential spaces of the neck. Infection in one space can easily spread to another
 space as well as to connecting regions, such as the mediastinum and along the vertebral
 spine [3]. Because of this complex anatomy of the head and neck and the subtle symptoms of
 the children, a high index of suspicion is necessary to prevent failures in diagnosis [4]. In
 paediatric ages the initial symptoms can range from upper respiratory tract symptoms, with or
 without fever, to decreased oral intake, neck pain, swelling of the cervical lymph nodes, and
 limitations in neck range of motion with or without trismus [5]. Because of their rapidly
 progressive nature, an assertive management is required to avoid delays in diagnosis and
 treatment that may lead to serious potential complications, including airway obstruction,
 jugular vein thrombosis, mediastinitis and sepsis [6]. Appropriate antibiotic therapy, surgical
 drainage and management of complications are the mainstays of treatment for ANIs [3].
 Some authors defend that an initial medical treatment with empiric intravenous antibiotic
 therapy should be tried, reserving surgery for those cases that fail to clinically improve or to
 secure a compromised airway [5,7]. Furthermore, the presence of airway obstruction and
 multiple abscess sites have been reported in association with severe infections and
 complicated clinical courses, which may lead to an undesired outcome [8].
 The purpose of this study was to analyse the epidemiology, clinical presentation, diagnostic
 clues and age of children with ANI to identify possible independent prognostic factors leading
 to complications and prolonged hospitalization.