Antimicrobial Prophylaxis in Neonates and Children Undergoing Dental, Maxillo-Facial or Ear-Nose-Throat (ENT) Surgery: A RAND/UCLA Appropriateness Method Consensus Study

Abstract

Surgical site infections (SSIs) represent a potential complication in surgical procedures, mainly because clean/contaminated surgery involves organs that are normally colonized by bacteria. Dental, maxillo-facial and ear-nose-throat (ENT) surgeries are among those that carry a risk of SSIs because the mouth and the first respiratory tracts are normally colonized by a bacterial flora. The aim of this consensus document was to provide clinicians with recommendations on surgical antimicrobial prophylaxis in neonates (<28 days of chronological age) and pediatric patients (within the age range of 29 days–18 years) undergoing dental, maxillo-facial or ENT surgical procedures. These included: (1) dental surgery; (2) maxilla-facial surgery following trauma with fracture; (3) temporo-mandibular surgery; (4) cleft palate and cleft lip repair; (5) ear surgery; (6) endoscopic paranasal cavity surgery and septoplasty; (7) clean head and neck surgery; (8) clean/contaminated head and neck surgery and (9) tonsillectomy and adenoidectomy. Due to the lack of pediatric data for the majority of dental, maxillo-facial and ENT surgeries and the fact that the recommendations for adults are currently used, there is a need for ad hoc studies to be rapidly planned for the most deficient areas. This seems even more urgent for interventions such as those involving the first airways since the different composition of the respiratory microbiota in children compared to adults implies the possibility that surgical antibiotic prophylaxis schemes that are ideal for adults may not be equally effective in children.

Prophylactic Antibiotics After Cleft Lip and Palate Reconstruction: A Review From a Global Health Perspective

“…Regarding clean-contaminated head and neck procedures, the American Association of Plastic Surgeons acknowledges minimal evidence that antibiotic prophylaxis reduces SSI but recommends a one-time preoperative dose of antibiotics and no postoperative use. Rigotti et al used the Research and Development Corporation and University of California-Los Angeles appropriateness method to develop consensus statements on the use of prophylactic antibiotic use in CL/P surgery [ 9 ]. They recommended that neonates or pediatric patients undergoing cleft operations receive a perioperative dose of ampicillin/sulbactam of 50 mg/kg.…”

Characterization and functional prediction of the dental plaque microbiome in patients with alveolar clefts

“…Oral, nasal, pharyngeal, and ear fissures, as well as bodily fluids, secretions, and excretions, are all potential sites for diseases (Lee et al, 2021;Rigotti et al, 2022). According to research, maintaining the stability of microbiota is of the utmost importance to prevent dysbiosis (Zaura et al, 2014), which may cause disorders such as dental caries or periodontitis to develop from healthy conditions.…”

Prevention of Surgical Site Infections in Neonates and Children: Non-Pharmacological Measures of Prevention

“…This document describes the current knowledge on risk factors for SSIs in neonates and children undergoing surgery and has the purpose of providing guidance to health care professionals for the prevention of SSIs in this population. Our aim is to consider the possible non-pharmacological measures that can be adopted to prevent SSIs, except the use of antibiotics, for which we refer to the specific papers of the Peri-Operative Prophylaxis in Neonatal and Paediatric Age (POP-NeoPed) Study Group [ 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 ]. To our knowledge, this is the first study to provide recommendations based on a careful review of the available scientific evidence for the non-pharmacological prevention of SSIs in neonates and children.…”