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October 3, 1966

Septicemia in the Newborn

JAMA. 1966;198(1):90. doi:10.1001/jama.1966.03110140140047

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To the Editor:—  The editorial (197: 215, 1966) dealing with the increasing incidence of neonatal septicemia and meningitis due to Escherichia coli and other enteric organisms failed to mention one obvious source of infection.When attempting to insert a needle into the caudal canal of an obese patient with a fetal head deep in the pelvis, a less than expert anesthesiologist might, for example, be off less than 1 cm from the anatomical landmarks, yet perforate the sacrococcygeal ligament, rectum, vaginal wall, and the infant's scalp and enter the needle tip into the fontanelle or superior sagittal sinus.Needle puncture marks on newborn infant scalps and subcutaneous emphysema from air injection to test placement of the caudal needle have been observed.Paracervical and pudendal block injections conceivably carry a similar hazard of introducing enteric organisms into the fetal cranium and bloodstream prior to birth.