Children with deep space neck infections: our experience with 178 children.

OBJECTIVE To identify clinical features associated with unsuccessful medical therapy in children with deep space neck infections (DSNIs). STUDY DESIGN Consecutive case series with chart review. SETTING Tertiary-care, academic children's hospital. SUBJECTS AND METHODS One hundred seventy-eight pediatric patients treated for retropharyngeal or parapharyngeal infections between July 1, 2007, and May 23, 2012. RESULTS Median age was 34.5 months (2.9 years; range, 2-142 months); two-thirds were male. Increased surgical drainage was found in children age ≤ 15 months (P = .002) and for abscesses >2.2 cm (P = .0001). Risk factors associated with increased likelihood of medical therapy failure included age ≤ 51 months, intensive care unit admission, and computed tomography findings consistent with abscess size >2.2 cm. Methicillin-resistant Staphylococcus aureus infections were found more often in younger children, with the highest incidence in those ≤ 15 months of age (P = .001). All children had resolution of infection. CONCLUSION Deep space neck infections in children can often be successfully managed with medical therapy alone, but life-threatening complications may occur. We recommend that young patients be managed cautiously.