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Scalp abscesses following fetal blood sampling or monitoring
344
Letters to the Editor
of vision and he was ascertained in a school for blind children 10 years after the operation.
G. R. Fraser, M.D., Ph.D. Professor of Human Genetics University o[ Leiden Leiden, Holland REFERENCE
The Journal o[ Pediatrics August 1971
REFERENCES
1. Balfour, H. H., Jr., Block, S. H., Bowe, E. T., and James, L. S.: Complications of fetal blood sampling, Amer. J. Obstet. Gynec. 107: 288, 1970. 2. Kubli, F., Berg, D., K6hnlein, G., Hiiter, J., and Bretz, D.: Microanalysis of foetal blood: A critical study of the method, German Med. Monthly 12: 315, 1967.
1. Fraser, G. R., and Friedmann, A. I.: The causes of blindness in childhood. A study of 776 children with severe visual handicaps, Baltimore, 1967, Johns Hopkins Press.
3'call ) abscesses f o l l o w i n g f e t a l blood s a m p l i n g or m o n i t o r i n g To the Editor: In their recent article "Scalp abscess: A rare complication of fetal monitoring" (J. PEDIAT. 78: 533, 1971), Cordero and Hon report 7 infants who developed scalp abscesses associated with clipping of an electrocardiograph electrode onto the scalp. Since only 3 of these 7 infants had undergone scalp punctures for fetal blood sampling, the authors concluded that fetal scalp sampling did "not seem to be causally related to the abscesses." We wish to emphasize that scalp abscesses may be secondary to fetal blood sampling. We have previously reported 3 infants who developed large scalp abscesses associated with fetal blood sampling incisions? Of interest is that in the one instance E. coli was isolated from the infant's scalp abscess and from the mother's infected cesarean section wound. Kubli and associates 2 have also noted localized infections following fetal blood sampling procedures. Although the incidence of infection following scalp sampling is low (3/678 in our series), we urge that strict aseptic technic be employed in fetal blood sampling. We also suggest that pediatricians examine the scalp area of such babies carefully, so that when the rare abscess does occur it can be treated promptly.
Henry H. Bal[our, Jr., M.D. University of Minnesota Medical School Minneapolis, Minn. 55455 E. T. Bowe, M.D. L. Stanley James, M.D. Columbia-Presbyterian Medical Center New York, N. Y. 10032
H o h e r intravenous p u m p To the Editor: I would like to communicate to the readers of the JOURNAL a recent problem encountered with the use of the Holter intravenous pump. The pump accomplishes the task of intravenous administration of fluids by the action of a roller mechanism on a flexible plastic pump chamber. Luer connectors inserted into the ends of soft plastic pump chambers allow connections with standard intravenous systems. A very small but potentially dangerous rupture of the pump chamber occurred when the hard surfaced Luer connector was inserted into the soft pump chamber. This was not noticed initially, the pump was turned on, and intravenous fluid was administered. An alert ward nurse on her rounds noticed that air was being sucked into the pump chamber through the small rupture in the chamber wall. As a result of this rupture it was estimated that 2 89 c.c. of air was pumped into the child. Fortunately this amount of air did not produce any complications. This situation, however, could have proved fatal had it not been discovered in time. The Extracorporeal Medical Specialties Inc., Mount Laurel, N. J., was informed of this problem. They suggested that care be taken when the Luer connectors were inserted into the pump chambers. They are now marketing a completely assembled disposable pump chamber complete with Luer connectors. This will eliminate the need for manipulation of the pump chambers during the assembly, and therefore should eliminate as much as possible the potential for rupture of the pump chambers. However, as I understand the information from Extracorporeal Medical Specialties, the pump chamber material will be the same as previously
Letters to the Editor
of vision and he was ascertained in a school for blind children 10 years after the operation.
G. R. Fraser, M.D., Ph.D. Professor of Human Genetics University o[ Leiden Leiden, Holland REFERENCE
The Journal o[ Pediatrics August 1971
REFERENCES
1. Balfour, H. H., Jr., Block, S. H., Bowe, E. T., and James, L. S.: Complications of fetal blood sampling, Amer. J. Obstet. Gynec. 107: 288, 1970. 2. Kubli, F., Berg, D., K6hnlein, G., Hiiter, J., and Bretz, D.: Microanalysis of foetal blood: A critical study of the method, German Med. Monthly 12: 315, 1967.
1. Fraser, G. R., and Friedmann, A. I.: The causes of blindness in childhood. A study of 776 children with severe visual handicaps, Baltimore, 1967, Johns Hopkins Press.
3'call ) abscesses f o l l o w i n g f e t a l blood s a m p l i n g or m o n i t o r i n g To the Editor: In their recent article "Scalp abscess: A rare complication of fetal monitoring" (J. PEDIAT. 78: 533, 1971), Cordero and Hon report 7 infants who developed scalp abscesses associated with clipping of an electrocardiograph electrode onto the scalp. Since only 3 of these 7 infants had undergone scalp punctures for fetal blood sampling, the authors concluded that fetal scalp sampling did "not seem to be causally related to the abscesses." We wish to emphasize that scalp abscesses may be secondary to fetal blood sampling. We have previously reported 3 infants who developed large scalp abscesses associated with fetal blood sampling incisions? Of interest is that in the one instance E. coli was isolated from the infant's scalp abscess and from the mother's infected cesarean section wound. Kubli and associates 2 have also noted localized infections following fetal blood sampling procedures. Although the incidence of infection following scalp sampling is low (3/678 in our series), we urge that strict aseptic technic be employed in fetal blood sampling. We also suggest that pediatricians examine the scalp area of such babies carefully, so that when the rare abscess does occur it can be treated promptly.
Henry H. Bal[our, Jr., M.D. University of Minnesota Medical School Minneapolis, Minn. 55455 E. T. Bowe, M.D. L. Stanley James, M.D. Columbia-Presbyterian Medical Center New York, N. Y. 10032
H o h e r intravenous p u m p To the Editor: I would like to communicate to the readers of the JOURNAL a recent problem encountered with the use of the Holter intravenous pump. The pump accomplishes the task of intravenous administration of fluids by the action of a roller mechanism on a flexible plastic pump chamber. Luer connectors inserted into the ends of soft plastic pump chambers allow connections with standard intravenous systems. A very small but potentially dangerous rupture of the pump chamber occurred when the hard surfaced Luer connector was inserted into the soft pump chamber. This was not noticed initially, the pump was turned on, and intravenous fluid was administered. An alert ward nurse on her rounds noticed that air was being sucked into the pump chamber through the small rupture in the chamber wall. As a result of this rupture it was estimated that 2 89 c.c. of air was pumped into the child. Fortunately this amount of air did not produce any complications. This situation, however, could have proved fatal had it not been discovered in time. The Extracorporeal Medical Specialties Inc., Mount Laurel, N. J., was informed of this problem. They suggested that care be taken when the Luer connectors were inserted into the pump chambers. They are now marketing a completely assembled disposable pump chamber complete with Luer connectors. This will eliminate the need for manipulation of the pump chambers during the assembly, and therefore should eliminate as much as possible the potential for rupture of the pump chambers. However, as I understand the information from Extracorporeal Medical Specialties, the pump chamber material will be the same as previously