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Acute Otitis Media in the first two months of life: characteristics and diagnostic difficulties.
  1. Yackov Berkun (berkun{at}
  1. Safra Children's Hospital, Sheba Medical Center, Tel-Hashomer, Israel, Israel
    1. Ran Nir-Paz (ran.nirpaz{at}
    1. Department of Clinical Microbiology and Infectious Diseases, Hadassah Hebrew University Medical Cent, Israel
      1. Anat Ben Ami (anatbenami{at}
      1. Department of Pediatrics, Bikur Cholim Hospital, Israel
        1. Aharon Klar (aklar{at}
        1. Department of Pediatrics, Bikur Cholim Hospital, Israel
          1. Elimelech Deutsch (edeutsch{at}
          1. Department of Otorhinolaryngology, Bikur Cholim Hospital, Israel
            1. Haggit Hurvitz (hhurvitz{at}
            1. Department of Pediatrics, Bikur Cholim Hospital, Israel


              Objective: To assess the clinical and laboratory features of AOM in infants younger than 2 months, to look for factors predicting bacterial otitis, and to evaluate the accuracy of AOM diagnosis among pediatricians.

              Methods: The study population comprised a cohort of 277 hospitalized infants up to 61 days old that were treated for the first episode of AOM at the pediatric department. We reviewed their medical records and analyzed the demographic, clinical and laboratory data, and the diagnosis made by both pediatricians and otolaryngologists.

              Results: Presenting symptoms were mainly respiratory (70.0%) and fever (62.5%). The most common pathogens were Streptococcus pneumoniae and Haemophilus Influenzae. Gram-negative bacilli grew in 10.5% of the infants. Multivariate analysis revealed that AOM in the 2nd month of life was associated with male gender, concurrent bronchiolitis and diarrhea. Although high leukocyte count was associated with bacterial pathogen, more than 70% of the patients with positive culture had normal WBC counts. The pediatrician diagnosed only 45% of the patients subsequently diagnosed with AOM by an otolaryngologist.

              Conclusions: The absence of predictors for bacterial infection in more than 70% of bacterial AOM suggests that empiric antibiotic treatment should be advised for the young infants with AOM even when afebrile and with normal laboratory profile. A low diagnostic rate of AOM by the pediatrician emphasizes the need for improvement in examination skills and instrumentation to allow a thorough ear evaluation in this very young age.

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