802 MY Baek, et al. • Needle aspiration as therapeutic management for suppurative cervical lymphadenitis in children Materials and methods Data were collected on children diagnosed with suppurative cervical lymphadenitis at Pusan National University Hospital from January 1998 to June 2008 who underwent needle aspiration. They were referred for a drainage procedure because they needed to require open surgical drainage. We studied 38 children with suppurative cervical lymphadenitis that required open surgical drainage as management of infected lymph nodes. The aspiration procedure was done using 18 or 21 gauge needle under US guide. After a local anesthetic ointment (EMLA®, Astra, Södertälje, Sweden) was applied for 1 hour before the aspiration in all patients, aspiration was performed until there was no return in the 5 mL syringe. In noncooperative patients, a conscious sedation with midazolam (0.05-0.1 mg/kg) was done with oxygen monitoring throughout the procedure. The aspirated specimen was sent for microbiologic culture study to the microbiology laboratory. For the clinical database, we retrospectively collected demo- graphic details, clinical characteristics, laboratory data, presentation of involved lymph nodes, and culture of aspirated f luid. We excluded anatomical anomalies, immunologic abnormality, BCG lymphadenitis, and TB lymphadenitis. Statistical analysis was performed using Student’s t-test and chi-square analysis. Results 1. Demographic characteristics Thirty-eight children underwent needle aspiration for treatment with suppurative cervical lymphadenitis that required surgical drainage (Table 1). There were 15 males and 23 females. Mean age was 2.6±2.5 years (range: 0.1-10.0 years). The patient population was representative of a wide range of age groups, including 11 Table 1. Demographic and Clinical Characteristics of 38 Patients Characteristics Sex, n (%) Male Female Age (yr) (Mean±SD) Clinical manifestations, n (%) Tenderness Fever Redness Heating sensation Laboratory finding White blood cell count (/µL) C reactive protein (mg/dL) Duration of prior antibiotics treatment (days) Duration of antibiotics treatment (days) Duration of hospitalization (days) 15 (39.5) 23 (60.5) 2.6±2.5 30 (78.9) 27 (71.0) 21 (55.3) 20 (52.6) 19,500±7,265 6.35±6.97 4.8±2.7 21.6±13.9 13.7±9.4 children from age 0 to 1 years, 16 children from 1 to 4 years, 10 children from 4 to 8 years, 1 child > 8 years of age. Patients typically present with a clinical manifestation of tenderness (78.9%), fever (71.0%), redness (55.3%) and heating sensation (52.6%). Average WBC count and C reactive protein was 19,500±7,265/ µL (range: 7,600-37,440/µL) and 6.35±6.97 mg/dL (range: 0.22- 26.8 mg/dL). There was no statistical difference between patients who presented high white blood count and C reactive protein, and those with low counts concerning the characteristic of lymph nodes. All of the 38 patients received one or two antibiotic medications before needle aspiration. Twenty-three patients received one antibiotic treatment and fifteen patients received two antibiotic treatments. The antibiotics administered before needle aspiration included nafcillin (16 cases), cefazolin (9 cases), nafcillin and cefotaxime (3 cases), ampicillin/sulbactam and cefotaxime (3 cases), cefazolin and clindamycin (3 cases), nafcillin and clindamycin (2 cases), ampicillin/sulbactam and clindamycin (2 cases). Mean duration of antibiotics before needle aspiration was 4.8±2.7 days and mean total duration of antibiotics treatment was 21.6±13.9 days. Mean duration of hospitalization was 13.7±9.4 days (range: 5-59 days). 2. Characteristics of lymph nodes The most common site of infected lymph nodes is the submandibular lymph node. Thirty-two patients (84.2%) presented submandibular lymph nodes, two patients with submental lymph node, each patient with retropharyngeal, preauricular, paravertebral and multiple lymph nodes (Table 2). Twenty-nine (90.6%) of 32 patients with submandibular lymph node were unilaterally involved lymph nodes. The mean size of involved lymph nodes is 6.2±2.9 cm2 (range: 2.1-15.0 cm2). The size of submandibular lymph nodes ranged from 2.1 to 12.0 cm2 (mean 5.8 cm2). The size of abscess pocket ranged from 1.0 to 4.0 cm2 (mean 1.9 cm2). The amount of fluid aspirated for any 1 case ranged from 0.3 to 6.0 mL (mean 1.7 mL). Thirty-four (89.5%) lymph nodes were firm in consistency at the time of needle aspiration. Hospitalization duration was Table 2. Characteristics of Infected Lymph Nodes Location Right submandibular 15 (39.5) Left submandibular 14 (36.8) Both submandibular 3 ( 7.9) Submental 2 ( 5.3) Others* 4 (10.5) Size (cm2) (range) 6.2±2.9 (2.1-15.0) Consistency, firm 34 (89.5) *Retropharyngeal 1, Preauricular 1, Paravertebral 1, Multiple 1 n (%)