Background Subcutaneous lidocaine injection and topical EMLA cream are both used to control lumbar puncture (LP) pain; however, local analgesia usage is not standardized. Methods We conducted a prospective, single-blinded, randomized-controlled crossover trial comparing the two modalities in reducing LP pain. Pediatric patients requiring serial LPs were randomly assigned to receive EMLA cream or lidocaine injection prior to LP. On the subsequent LP, analgesia was defaulted to the other agent. Pain was assessed using the Wong-Baker FACES Pain Rating Scale pre-procedure: 30 to 60 minutes post-LP, and 24 hours post-procedure. Results Ten patients were included in the analysis (median age: 5.5 years). Pain ratings at 1 and 24 hours post-LP did not differ between the two strategies (p = 0.79). No adverse local reactions were reported for either agent. Conclusion Accordingly, both lidocaine and EMLA cream provided effective LP pain control.

BackgroundThe rate of Haemophilus influenzae type b (HIB) infections has decreased dramatically since the use of HIB vaccines in infants and children. The current prevalence of invasive HIB infections and those due to non-type b H. influenzae is not fully known. The objective was to describe the cases of all invasive H. influenzae infections and describe the spectrum and severity of clinical disease.MethodsRetrospective study of all hospitalized patients with culture-proven invasive Haemophilus influenzae infections at Nationwide Children’s Hospital, Columbus, Ohio, from 2009 to 2018. The electronic health records were reviewed for pertinent demographic, clinical, laboratory data, and outcomes.ResultsThere were a total of 59 culture-proven H. influenzae infections of which 12 were excluded due to insufficient patient data. The remaining 47 patients (32 [68%] male; 30 [64%] white, 8 [17%] African-American) and their culture results are provided in Table:Haemophilus influenzae Infections in 47 Patients: Culture ResultsType a N = 1 (%)Type bN = 3(%)Encapsulated non-b N = 11(%)Not typeableN = 30(%)Not typedN = 2(%)TotalN = 47(%)<6 months0007(23)1(50)8(17)≥6–12 months1(100)2(67)7(64)7(23)017(36)>1–5 years01(33)4(36)6(20)1(50)12(25)>5–8 years0008(26)08(17)>8–17 years000000≥18 years0002(6)02(4)Blood only1(100)1(33)4(36)27(90)2(100)35(75)CSF only01(33)0001(2)Both Blood and CSF01(33)5(45)006(13)Both CSF and Peritoneal Fluid0001(3)01(2)Both Blood and Synovial Fluid002(18)002(4)Both Blood and Eye Discharge0002(6)02(4)Virus Coinfection1(100)3(100)3(27)14(46)1(50)22(47)Bacteria Coinfection01(33)05(16)2(100)8(17)Death0001(3)01(2)There were 14 (30%) patients with pneumonia and bacteremia, 6 (13%) with meningitis and bacteremia, 2 (4%) with only meningitis, 1 (2%) with bacteremia/meningitis and septic hip, 2 (4%) septic arthritis with bacteremia, 1 (2%) with periorbital cellulitis and bacteremia, and 21 (45%) with only bacteremia. Of the 3 cases of H. influenzae type b, 2 had not been vaccinated while 1 received only 1 dose of HIB vaccine.ConclusionInvasive H. influenzae infections were associated with substantial morbidity and a 2% case-fatality rate.Disclosures All authors: No reported disclosures.

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