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A 4-day-old female neonate presented with a black necrotic lesion with circumferential ulceration and erythema located to the left of the umbilicus. ### Prenatal and Birth Histories ### Presentation The infant was admitted to the NICU. An umbilical venous catheter (UVC) was inserted with the use of betadine as the antimicrobial skin preparation and a thin hydrocolloid dressing (DuoDERM®, ConvaTec, Bridgewater, NJ) as a protective skin barrier to secure the UVC. The hydrocolloid dressing was located just left of the umbilicus and placed on intact abdominal skin. The infant was noted to have asymptomatic thrombocytopenia (platelet count 73,000/μL [73×109/L]) and neutropenia (absolute neutrophil count 700/μL [0.70×109/L]), which were attributed to maternal preeclampsia. The infant received 1 dose of granulocyte colony-stimulating factor (G-CSF, 10 μg/kg, subcutaneously) at 2 days of age. Prophylactic antibiotics were not indicated at the time of birth because there were no concerns for infection. The infant underwent extubation to receive nasal noninvasive ventilation within 24 hours of birth. …

BACKGROUND: Optimal management of neutropenic appendicitis (NA) in children undergoing cancer therapy remains undefined. Management strategies include upfront appendectomy or initial nonoperative management. We aimed to characterize the effect of management strategy on complications and length of stay (LOS) and describe implications for chemotherapy delay or alteration. METHODS: Sites from the Pediatric Surgery Oncology Research Collaborative performed a retrospective review of children with NA over a 6-year period. RESULTS: Sixty-six children, with a median age of 11 years (range 1–17), were identified with NA while undergoing cancer treatment. The most common cancer diagnoses were leukemia (62%) and brain tumor (12%). Upfront appendectomy was performed in 41% of patients; the remainder had initial nonoperative management. Rates of abscess or perforation at diagnosis were equivalent in the groups (30% vs 24%; P = .23). Of patients who had initial nonoperative management, 46% (17 of 37) underwent delayed appendectomy during the same hospitalization. Delayed appendectomy was due to failure of initial nonoperative management in 65% (n = 11) and count recovery in 35% (n = 6). Cancer therapy was delayed in 35% (n = 23). Initial nonoperative management was associated with a delay in cancer treatment (46% vs. 22%, P = .05) and longer LOS (29 vs 12 days; P = .01). Patients who had initial nonoperative management and delayed appendectomy had a higher rate of postoperative complications (P CONCLUSIONS: In pediatric patients with NA from oncologic treatment, upfront appendectomy resulted in lower complication rates, reduced LOS, and fewer alterations in chemotherapy regimens compared to initial nonoperative management.