Neonatal mastitis: controversies in management.

Area of Science:

• Neonatal care
• Pediatric infectious diseases
• Clinical practice variation

Background:

• Neonatal mastitis presents a diagnostic and therapeutic challenge for clinicians.
• Limited data exists on the current management practices for neonatal mastitis.

Purpose of the Study:

• To document the spectrum of clinical presentations of neonatal mastitis.
• To assess the diagnostic investigations and treatment strategies employed by physicians for neonatal mastitis.
• To identify variations in clinical decision-making for this condition.

Main Methods:

• An email survey was distributed to Emergency Department (ED) staff and fellows regarding treatment of localized neonatal mastitis.
• A retrospective chart review was conducted for neonates diagnosed with mastitis or breast engorgement between 2000 and 2009.
• The review assessed actual treatment protocols, including investigations and antibiotic use.

Main Results:

• Survey responses revealed significant disagreement on management, with approaches ranging from sepsis workup and admission to discharge on oral antibiotics.
• The chart review identified 12 neonates meeting inclusion criteria; 66% were admitted and treated with intravenous antibiotics.
• No neonates underwent lumbar puncture, and antibiotic treatment varied, with some receiving oral antibiotics and others no antibiotics.

Conclusions:

• There is considerable discordance among clinicians in managing well-appearing neonates with localized mastitis.
• The prevailing practice involves blood tests and initiation of intravenous antibiotics with Staphylococcus aureus coverage.
• Further research is needed to establish evidence-based guidelines for neonatal mastitis treatment.