Ver el código de «Neonatal mastitis»

{{Peds top}} [[mastitis]] (also for adolescent patients)''
==Background==
*Uncommon soft-tissue infection of the breast tissue in children <2mo of age<ref name="Masoodi">Masoodi T, et al. Neonatal mastitis: a clinico-microbiological study. J Neonatal Surg. 2014;3(1):2. Published 2014 Jan 1</ref>
*More common in females than in males<ref name = "Masoodi" />
*More commonly unilateral than bilateral<ref name = "Masoodi" />
*Reported confirmed sources have included [[MSSA]] and [[MRSA]]<ref name = "Masoodi" />, and rarely [[acinetobacter]]<ref>Mohr EL, Berhane A, Zora JG, Suchdev PS. Acinetobacter baumannii neonatal mastitis: a case report. J Med Case Rep. 2014;8:318. Published 2014 Sep 25. doi:10.1186/1752-1947-8-318</ref>, e. coli<ref>Stetler H, et al. Neonatal mastitis due to Escherichia coli. J Pediatr. 1970;76(4):611-613. doi:10.1016/s0022-3476(70)80415-2</ref>, and [[proteus mirabilis]]<ref>McGuigan MA, et al. Neonatal mastitis due to Proteus mirabilis. Am J Dis Child. 1976;130(11):1296. doi:10.1001/archpedi.1976.02120120130028</ref>
*Reported sequelae have included [[brain abscess]]<ref>Manzar S. Brain abscess following mastitis in a 3-month-old infant. J Trop Pediatr. 2001;47(4):248-249. doi:10.1093/tropej/47.4.248</ref> and osteomyelitis<ref>Michael IM, et al. Osteomyelitis due to penicillin resistant staphylococci in infancy following suppurative mastitis. J Trop Pediatr. 1960; 6:19-21.</ref>

==Clinical Features==
[[File:NeonatalMastitis1.jpg|thumb|Right neonatal mastitis in a female infant]]
[[File:NeonatalMastitis2.jpg|thumb|Right neonatal mastitis in a female infant]]
* Presentation within 2 months of life with redness overlying the breast tissue and/or possibly purulent discharge from one, or rarely both, nipples. 
**The affected breast may be apparently tender to the touch on exam. 
**Palpable fluctuance suggestive of abscess may or may not be present.<ref name = "Masoodi" /><ref name = "Ruwaili">Al Ruwaili N, et al. Neonatal mastitis: controversies in management. J Clin Neonatol. 2012;1(4):207-210. doi:10.4103/2249-4847.105997</ref>
*Parents may also report other concurrent, but nonspecific concerns such as 
**Poor feeding
**Increased fussiness 
**Inconsolability 
**Subjective or measured [[fevers]]
**Lethargy

==Differential Diagnosis==
*[[Cellulitis]]
*[[Necrotizing soft tissue infections]]
*[[Pediatric fever of uncertain source]]
*[[Sepsis (peds)]]
*Physiologic breast hypertrophy (Neonatal Mastauxe/Giant Mastauxe)

{{Neonatal rashes DDX}}

==Evaluation==
===Febrile or Ill-Appearing===
*Serious bacterial infection (SBI) workup for [[pediatric fever of uncertain source]]<ref name = "Masoodi" /><ref name = "Ruwaili" /><ref name = "Shah">Shah A,et al. Neonatal Mastitis. In: Knoop KJ, Stack LB, Storrow AB, Thurman R. eds. The Atlas of Emergency Medicine, 5e. McGraw-Hill; 2021. Accessed October 02, 2025. https://accessmedicine.mhmedical.com/content.aspx?bookid=2969&sectionid=250460144</ref><ref name = "Kaplan">Kaplan RL, et al. Neonatal Mastitis and Concurrent Serious Bacterial Infection. Pediatrics. 2021;148(1):e2021051322. doi:10.1542/peds.2021-051322</ref>
**Neonatal Mastitis should not be relied upon as a diagnosis to exclude other SBI in the febrile or ill-appearing infant
*Consider [[Sepsis (peds)|sepsis]] alerts and bundles per local protocol

===Afebrile, Well-Appearing===
*Head-to-toe physical examination
**May have varying degrees of normal breast tissue hypertrophy bilaterally, but lack of breast tissue hypertrophy is not specific against the diagnosis.<ref>Raveenthiran V. Neonatal mastauxe (breast enlargement of the newborn). J Neonatal Surg. 2013;2(3):31. Published 2013 Jul 1.</ref>
*Laboratory workup to include
**Complete blood count
**Basic metabolic panel
**Consider [[blood cultures]]
**Consider sending swabs for local site cultures
***Catheterized urine sample and LP are not required <ref name = "Shah"/>

*Imaging
**[[Ultrasound: Soft tissue|POCUS]] assessment for abscess in the ER has not been studied
**Radiology ultrasounds may be ordered at consultant/admitting provider request or per local protocol, may help to identify abscess and guide surgical decision making

===Diagnosis===
*Clinical diagnosis which does not require imaging or microbiological confirmation to plan for disposition or begin treatment.<ref name = "Masoodi"/><ref name = "Kaplan"/>
*Other diagnoses, such as [[sepsis]], disseminated [[cellulitis]], or [[necrotizing fasciitis]] may be made concurrently and should be managed appropriately.

==Management==
*Inpatient (most)
**IV [[Nafcillin]] (first choice)<ref name = "Masoodi"/><ref name = "Kaplan"/>
***Antibiosis should focus on anti-staphylococcal coverage with consideration given for local [[MRSA]] proliferation.<ref name = "Masoodi"/><ref name = "Kaplan"/>
**Add additional coverage for [[MRSA]] if indicated
*Outpatient (rare)
**Consider local antibiotic resistance patterns<ref name = "Masoodi"/><ref name = "Kaplan"/>

==Disposition==
*Should generally be admitted for antibiotics and close monitoring in the NICU.<ref name = "Masoodi"/><ref name = "Kaplan"/>
**Though mortality is very low, severe sequelae have been documented.<ref name = "Kaplan"/>

==See Also==
*[[Pediatric fever of uncertain source]]
*[[Sepsis (peds)]]
*[[Mastitis]]

==External Links==
[https://pedemmorsels.com/neonatal-mastitis/ Pediatric EM Morsels: Mastitis]

==References==
<references/>