Neonatal mastitis - Revision history

Ostermayer at 21:00, 17 January 2026

2026-01-17T21:00:36Z

← Older revision		Revision as of 21:00, 17 January 2026
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	{{~~Peds top~~}} ~~[[mastitis]]~~ (also for adolescent patients)''		{{PediatricPage\|mastitis}} (also for adolescent patients)
	==Background==		==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>		*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>

Ntategomez: /* Disposition */

2025-12-08T17:03:39Z

Disposition

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

Rossdonaldson1: /* Management */

2025-11-05T19:15:46Z

Management

← Older revision		Revision as of 19:15, 5 November 2025
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	*Inpatient (most)		*Inpatient (most)
	**IV [[Nafcillin]] (first choice)<ref name = "Masoodi"/><ref name = "Kaplan"/>		**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"/>		***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		**Add additional coverage for [[MRSA]] if indicated
	*Outpatient (rare)		*Outpatient (rare)

Rossdonaldson1: /* Management */

2025-11-05T19:15:22Z

Management

← Older revision		Revision as of 19:15, 5 November 2025
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	==Management==		==Management==
	*IV ~~antibiotics unless strong cause to consider discharge and close outpatient follow-up exists.~~<ref name = "Masoodi"/><ref name = "Kaplan"/>		*Inpatient (most)
	**Antibiosis should focus on anti-staphylococcal coverage with consideration given for local MRSA proliferation.<ref name = "Masoodi"/><ref name = "Kaplan"/>		**IV [[Nafcillin]] (first choice)<ref name = "Masoodi"/><ref name = "Kaplan"/>
	***IV [[~~Nafcillin~~]] ~~is generally a reasonable first choice.~~ Consider ~~consultation with a clinical pharmacist or the likely admitting team to assist with dosing.~~<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==		==Disposition==

Rossdonaldson1: /* Disposition */

2025-11-05T19:11:54Z

Disposition

← Older revision		Revision as of 19:11, 5 November 2025
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	==Disposition==		==Disposition==
	*Should generally be admitted for antibiosis and close monitoring in the NICU.<ref name = "Masoodi"/><ref name = "Kaplan"/>		*Should generally be admitted for antibiosis and close monitoring in the NICU.<ref name = "Masoodi"/><ref name = "Kaplan"/>
	**Though mortality is very low ~~in the largest multi-center study~~, severe sequelae have been documented.<ref name = "Kaplan"/>		**Though mortality is very low, severe sequelae have been documented.<ref name = "Kaplan"/>

	==See Also==		==See Also==

Rossdonaldson1: /* Disposition */

2025-11-05T19:11:35Z

Disposition

← Older revision		Revision as of 19:11, 5 November 2025
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	==Disposition==		==Disposition==
	*~~Patients diagnosed with neonatal mastitis should~~ generally be admitted for antibiosis and close monitoring in the NICU.<ref name = "Masoodi"/><ref name = "Kaplan"/>		*Should generally be admitted for antibiosis and close monitoring in the NICU.<ref name = "Masoodi"/><ref name = "Kaplan"/>
	**Though mortality is very low in the largest multi-center study, severe sequelae have been documented.<ref name = "Kaplan"/>		**Though mortality is very low in the largest multi-center study, severe sequelae have been documented.<ref name = "Kaplan"/>
	**A heavy preference for IV nafcillin as a first-choice antibiotic is shown throughout current literature when MRSA is not strongly suspected.
	*If considering discharge with oral antibiotics, strongly consider a consultation with a neonatologist to confirm local practice trends or direct conversation with the patient's pediatrician for confirmation of close follow-up.

	==See Also==		==See Also==

Rossdonaldson1: /* Management */

2025-11-05T19:10:37Z

Management

← Older revision		Revision as of 19:10, 5 November 2025
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	==Management==		==Management==
	*~~Initiate~~ IV antibiotics unless strong cause to consider discharge and close outpatient follow-up exists.<ref name = "Masoodi"/><ref name = "Kaplan"/>		*IV antibiotics unless strong cause to consider discharge and close outpatient follow-up exists.<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"/>		**Antibiosis should focus on anti-staphylococcal coverage with consideration given for local MRSA proliferation.<ref name = "Masoodi"/><ref name = "Kaplan"/>
	***IV Nafcillin is generally a reasonable first choice. Consider consultation with a clinical pharmacist or the likely admitting team to assist with dosing.<ref name = "Masoodi"/><ref name = "Kaplan"/>		***IV [[Nafcillin]] is generally a reasonable first choice. Consider consultation with a clinical pharmacist or the likely admitting team to assist with dosing.<ref name = "Masoodi"/><ref name = "Kaplan"/>

	==Disposition==		==Disposition==

Rossdonaldson1: /* Evaluation */

2025-11-05T19:10:05Z

Evaluation

← Older revision		Revision as of 19:10, 5 November 2025
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	==Evaluation==		==Evaluation==
	===Febrile ~~and/~~or Ill-Appearing===		===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>		*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		**Neonatal Mastitis should not be relied upon as a diagnosis to exclude other SBI in the febrile or ill-appearing infant
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	===Afebrile, Well-Appearing===		===Afebrile, Well-Appearing===
	*Head-to-toe physical examination		*Head-to-toe physical examination
	**~~The infant 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>		**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		*Laboratory workup to include
	**Complete blood count		**Complete blood count
	**Basic metabolic panel		**Basic metabolic panel
	**Consider blood cultures		**Consider [[blood cultures]]
	**Consider sending swabs for local site cultures		**Consider sending swabs for local site cultures
	***Catheterized urine sample and LP are not required <ref name = "Shah"/>		***Catheterized urine sample and LP are not required <ref name = "Shah"/>

Rossdonaldson1: /* Diagnosis */

2025-11-05T18:48:48Z

Diagnosis

← Older revision		Revision as of 18:48, 5 November 2025
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	===Diagnosis===		===Diagnosis===
	*Clinical diagnosis which does not require imaging or microbiological confirmation to plan for disposition or begin treatment.<ref name = "Masoodi"/><ref name = "Kaplan"/>		*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.		*Other diagnoses, such as [[sepsis]], disseminated [[cellulitis]], or [[necrotizing fasciitis]] may be made concurrently and should be managed appropriately.

	==Management==		==Management==

Rossdonaldson1: /* Diagnosis */

2025-11-05T18:48:27Z

Diagnosis

← Older revision		Revision as of 18:48, 5 November 2025
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	===Diagnosis===		===Diagnosis===
	*~~Neonatal mastitis is a clinical~~ diagnosis which does not require imaging or microbiological confirmation to plan for disposition or begin treatment.<ref name = "Masoodi"/><ref name = "Kaplan"/>		*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.		*Other diagnoses, such as sepsis, disseminated cellulitis, or necrotizing fasciitis may be made concurrently and should be managed appropriately.