Cephalhematomas are usually uncomplicated and of little clinical importance. When infection occurs, osteomyelitis of the underlying bone may ensue. The progression of clinical and roentgenographic events in our patient represent an instance of infected cephalhematoma associated with neonatal sepsis and complicated by osteomyelitis.Treatment with antibiotics alone did not eradicate the infection. Recovery followed adequate treatment by incision and drainage in addition to appropriate antibiotic therapy for four weeks.Cephal hematoma, a common form of neonatal injury, generally re¬ ceives little medical attention beyond observations for anemia, hyper¬ bilirubinemia, and fracture. Os¬ teomyelitis associated with infected cephalhematoma is not a frequent oc¬ currence. This report describes a newborn with bacteremia who developed an in¬ fected cephalhematoma and osteomy¬ elitis of the underlying parietal bone. Report of a CaseAfter a full-term gestation, a white girl, weighing 3.4 kg, was delivered to a healthy gravida-4, para-3, abortus-1, type-O, RHnegative mother on Nov 17, 1971. The anti-RH titer was 1:64 five days prior to deliv¬ ery. Low forceps were used to effect delivery after an uncomplicated labor. The Ap¬ gar score was 8 at one minute and 10 at five minutes.The placenta was large and edematous, and the cord was stained with meconium.Results of the initial physical examination revealed a vigorous infant with an edema¬ tous occiput and mild hepatosplenomegaly.The total cord bilirubin level was 5.0 mg/100 ml with a direct fraction of 1.1 mg/100 ml. Initial hemoglobin level was 10.0 gm/100 ml, and the leukocyte count was 25,500/cu mm with many nucleated red blood cells (RBC) and pronormoblasts. The infant's blood type was 0, RH-positive, and the direct Coombs test was posi¬ tive with anti-C and anit-D eluted from the cells. Phototherapy was begun immedi¬ ately, since parental religious preference precluded the use of blood products in treatment.During the first three hours of life, the total serum bilirubin level rose at the rate of 1 mg/hr. At nine hours, the hemoglobin level was 9.8 gm/100 ml, and the total serum bilirubin level was stable at 8.3 mg/100 ml with a direct fraction of 0.8 mg/100 ml. Physical examination at this time revealed splenomegaly and moderate pallor. A polyethylene catheter was in¬ serted into the umbilical vein to insure ad¬ equate hydration.During the next three days, the infant developed progressive anemia associated with decreased activity and vigor. During the fifth day of life, she was noted to have a small, left-parietal cephalhematoma. The overlying skin was intact. Abdominal dis¬ tension, irritability, and inactivity were present. The liver edge was felt at the um¬ bilicus, and tachycardia and tachypnea were prominent. The hemoglobin level was 2.8 gm/100 ml, and the hematocrit reading was 12%. After obtaining legal consulta¬ tion and court action, 95 ml of freshpacked, type-O, RH-negative blood cells were infused. Since the clinical condition and physical examination indicated ...

Indirect immunofluorescence was applied to achieve the rapid diagnosis of enteroviral meningitis within hours of receipt of the specimen. Cerebrospinal fluid (CSF) leukocytes from 40 patients were studied by a method adapted to utilize combination antiserum pools in conjunction with indirect immunofluorescence, and results were compared to those of conventional isolation and serological techniques. When virus was isolated from the CSF (17 patients), there was general agreement with the virus identified by immunofluorescence staining of CSF leukocytes. The advantages of immunofluorescence were particularly striking in 19 patients from whom virus could not be isolated from the CSF and in 4 patients from whom virus could not even be isolated from the throat or rectum. By immunofluorescence, virus was detected in 20 of 21 of these patients. Overall, the rapid immunofluorescence findings were confirmed by the slower conventional methods in 32 of 33 cases. Economy of both time and materials was made practicable by use of the LBM combination antiserum pools, which allow 42 antigenic types to be identified in a single set of 8 simultaneous tests.

\s=b\A full-term infant of an appropriate size for gestational age was found to have meningitis due to Lancefield group B \ g = b \ \ x = r e q -\ hemolytic streptococci at 8 weeks of age. On admission, the baby had bulging tympanic membranes Lancefield group B \g=b\-hemolyticstreptococci were isolated from aspirate of the middle ear, supporting the importance of otitis media in the pathogenesis of late-onset Lancefield group B \g=b\-hemolyticstreptococcal meningitis.