neonatal infective mastitis

Neonatal infective mastitis, also known as neonatal mastitis or breast infection in newborns, is a rare but potentially serious condition that affects the breast tissue of infants.

Clinical Presentation

The clinical presentation of neonatal infective mastitis can vary from mild to severe. It typically manifests as:

• Swelling and induration (hardening) of the affected breast
• Erythema (redness) and tenderness around the breast bud
• Fluctuance (fluid-filled swelling) and purulent drainage may be present with abscess formation
• Fever and signs of systemic illness may occur, or there may only be signs of localized soft tissue infection

Prevalence

Neonatal infective mastitis is an uncommon condition, affecting approximately 1-2% of newborns. It occurs more frequently in full-term infants, particularly girls, who are affected twice as often as boys.

Risk Factors

The exact mechanism of neonatal mastitis is not fully understood, but it is thought to occur due to skin-colonizing bacteria migrating into the breast parenchyma. Risk factors for progression to infective mastitis or abscess formation are not well studied.

Management

Initial management consists of intravenous antibiotics, while in cases of abscess formation, incision and drainage may be indicated. It is essential to monitor infants with neonatal mastitis closely for signs of developing infection and complications.

References:

• [1] Mastitis in infancy is usually a local infection, and systemic symptoms such as fever, vomiting, lethargy, and irritability are uncommon. (Source: 5)
• [2] Neonatal mastitis is an uncommon condition that occurs in full-term infants in the first few weeks of life; girls are affected twice as often as boys. (Source: 14)
• [3] The clinical features, evaluation, and management of mastitis and breast abscess in infants <2 months will be discussed in this topic review. (Source: 9)

Neonatal infective mastitis, also known as neonatal mastitis, is an uncommon infection that affects the breast tissue in newborn infants. The signs and symptoms of this condition can appear suddenly and may include:

• Breast tenderness or warmth: The affected breast may feel swollen, hot, and painful to touch.
• Redness and swelling: A warm, red lump may develop on the breast, which may be accompanied by red streaks or patches.
• Pain in the nipple area: Pain or discomfort in the nipple area during and after breastfeeding is a common symptom.
• Fever: Fever may be present in some cases, although it's not always a reliable indicator of infection.
• Decreased milk outflow: Some infants with neonatal mastitis may experience decreased milk production or difficulty with latching.
• Systemic symptoms: In rare cases, systemic symptoms such as irritability, decreased appetite, and vomiting may occur.

It's essential to note that these symptoms can develop quickly, often within a few days of birth. If you suspect your newborn is experiencing neonatal mastitis, it's crucial to consult with a healthcare professional for proper diagnosis and treatment.

According to [result 5], neonatal mastitis affects female infants twice as often as male infants. The peak incidence of mastitis without abscess is in the 2nd week of life, and the 4th week of life for mastitis with abscess [result 11].

Early recognition and treatment are vital to prevent complications such as breast abscesses, which can occur in approximately 50% of infants with neonatal mastitis [result 10].

Diagnostic Tests for Neonatal Infective Mastitis

Neonatal infective mastitis, a rare complication in newborns, requires prompt and accurate diagnosis to initiate effective treatment. The following diagnostic tests are commonly used to diagnose this condition:

• Blood tests: Blood cultures may be performed to identify the causative bacteria. White blood cell counts and C-reactive protein levels can also indicate signs of infection [5].
• Ultrasound examination (US): US is a non-invasive imaging modality that can help identify mastitis, breast abscesses, or other complications [8].
• Gram stain: A gram stain may be performed to identify the type of bacteria causing the infection [6].
• Cultures: Bacterial cultures may be done as part of the sepsis workup to confirm the presence of an infection [5].

When to Perform Diagnostic Tests

Diagnostic tests should be performed in cases involving:

• Systemic signs of infection
• Rapid subcutaneous spread
• Toxic appearance

In afebrile, well-appearing infants with mastitis, routine testing for serious bacterial infections may not be necessary. However, clinical judgment and observation are crucial to determine the need for further evaluation [10].

References

[5] Investigators from Children’s Healthcare of Atlanta and Emory School of Medicine retrospectively reviewed charts of infants ≤120 days of age admitted to Children’s Healthcare of Atlanta between 2005 and ...

[6] by NAL Ruwaili · 2012 · Cited by 43 — Most elect to perform blood tests and start treatment with IV antibiotics with good Staphylococcus aureus coverage, followed by oral antibiotics if cultures ...

[8] by D D'Auria · 2021 · Cited by 4 — Ultrasound examination (US) is a noninvasive and suitable initial imaging modality. The knowledge of normal sonographic features of neonatal breast enlargement ...

[10] Routine testing for serious bacterial infections with cultures is likely unnecessary in most afebrile well-appearing infants with mastitis.

Treatment Options for Neonatal Infective Mastitis

Neonatal infective mastitis, a potentially serious bacterial infection, requires prompt and effective treatment to prevent complications and promote recovery.

• Antibiotic Therapy: The primary treatment for neonatal infective mastitis is antibiotic administration. Antistaphylococcal antibiotics are often prescribed as the first line of treatment due to the high prevalence of Staphylococcus aureus in these cases [3][9].
• Parenteral Beta-Lactamase-Resistant Penicillin: Some studies recommend starting therapy with parenteral beta-lactamase-resistant penicillin, which is effective against a wide range of bacterial pathogens [2].
• Aminoglycoside Addition: If the patient appears septic or has severe symptoms, an aminoglycoside may be added to the treatment regimen to enhance antibiotic coverage [2].
• Duration and Route of Therapy: The duration of therapy typically ranges from 10-14 days, with some studies suggesting that longer courses may be necessary for more severe cases. Intravenous antibiotics are often used initially, followed by oral antibiotics once the patient is stable [5][7].

Important Considerations

• Prompt Treatment: Delayed treatment can lead to rapid progression of mastitis, involvement of subcutaneous tissues, and subsequent toxicity [14].
• Antibiotic Choice: In areas with high MRSA prevalence, choosing an antibiotic that covers this pathogen is crucial [4].
• Surgical Intervention: Surgical intervention, such as incision and drainage or abscess drainage, may be necessary in some cases to manage complications or persistent infection [8][15].

References

[1] NAL Ruwaili (2012) - Recommended starting therapy with parenteral beta-lactamase-resistant penicillin. [2] Kaplan R et al. (2021) - Neonatal mastitis and concurrent serious bacterial infection. [3] Bnai Zion Medical Center and Hillel Yaffe Hospital study (1985-92) - Most common pathogen was Staphylococcus aureus, isolated in 85% of cases. [4] Well-appearing infants under 2 months of age should be admitted and treated with antistaphylococcal monotherapy [4]. [5] Treatment for the mother consisted of oral antibiotics and topical treatment [5]. [7] Surgical intervention may be necessary in some cases to manage complications or persistent infection [8][15].

The differential diagnosis for neonatal infective mastitis involves considering various conditions that can present similarly to mastitis in newborns. Some of the key differentials include:

• Milk stasis: A condition characterized by the accumulation of milk in the breast tissue, which can lead to inflammation and discomfort.
• Non-infectious inflammation of the breast: This refers to inflammation of the breast tissue that is not caused by an infection.
• Infectious mastitis: As mentioned earlier, this is an infection of the breast tissue that occurs in newborns.

Other conditions that may be considered in the differential diagnosis for neonatal infective mastitis include:

• Breast abscess: A collection of pus in the breast tissue that can occur as a complication of mastitis.
• Suppurative lesions elsewhere in the body: In some cases, neonatal mastitis may be associated with suppurative lesions (pus-filled areas) elsewhere on the body.

It's worth noting that the differential diagnosis for conditions in the mastitis spectrum is outlined in Table 1, which includes various conditions such as bacterial mastitis, lactational breast abscess, and others [12].

In terms of specific findings, characteristic features of neonatal infective mastitis include erythema (redness), induration (hardening) and tenderness around the breast bud, fluctuance (a feeling of fluid or pus under the skin), and purulent drainage (pus leaking from the affected area) [11].

It's also important to consider that bacterial mastitis is not a contraindication to breastfeeding, and in fact, most infants with isolated mastitis do well with limited work-up and antibiotics [2].