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A Neonatal Imaging Model of Gram-Negative Bacterial Sepsis
Published on: August 12, 2020
Neonatal Mastitis and Concurrent Serious Bacterial Infection
Ron L Kaplan1, Andrea T Cruz2, Kenneth A Michelson3
1Department of Pediatrics, School of Medicine, University of Washington and Seattle Children's Hospital, Seattle, Washington ron.kaplan@seattlechildrens.org.
Insights
Neonatal mastitis typically presents as mild, localized disease. Serious bacterial infections (SBI) and adverse outcomes are rare, suggesting SBI evaluation may be unnecessary for well-appearing, afebrile infants.
Area of Science:
- Pediatric Emergency Medicine
- Neonatology
- Infectious Diseases
Background:
- Neonatal mastitis is a condition affecting infants, with potential for concurrent serious bacterial infections (SBI).
- Understanding the clinical presentation, prevalence, and outcomes of SBI in infants with mastitis is crucial for appropriate management.
Purpose of the Study:
- To describe the clinical presentation, prevalence, and outcomes of concurrent serious bacterial infection (SBI) among infants diagnosed with mastitis.
- To determine if routine evaluation for SBI is necessary in infants presenting with mastitis.
Main Methods:
- A multicenter retrospective cohort study was conducted involving 28 sites.
- Records of infants aged ≤90 days with mastitis seen in the emergency department between January 2008 and December 2017 were reviewed.
- Demographic, clinical, laboratory, treatment, and outcome data were collected and summarized.
Main Results:
- Among 657 infants, 98% were well-appearing. Pathogen growth was rare in blood (0.3%), urine (1.1%), and cerebrospinal fluid (0.4%) cultures.
- Methicillin-resistant Staphylococcus aureus was the most common pathogen (54%) in cultures from the site of infection.
- Serious bacterial infections (sepsis, shock, severe cellulitis) occurred in 1.5% of infants, with no deaths.
Conclusions:
- Neonatal mastitis is typically a mild, localized condition.
- Serious bacterial infections and adverse outcomes are infrequent in infants with mastitis.
- Routine evaluation for SBI may not be necessary for afebrile, well-appearing infants with mastitis.
Objectives:
Describe the clinical presentation, prevalence, and outcomes of concurrent serious bacterial infection (SBI) among infants with mastitis.
Methods:
Within the Pediatric Emergency Medicine Collaborative Research Committee, 28 sites reviewed records of infants aged ≤90 days with mastitis who were seen in the emergency department between January 1, 2008, and December 31, 2017. Demographic, clinical, laboratory, treatment, and outcome data were summarized.
Results:
Among 657 infants (median age 21 days), 641 (98%) were well appearing, 138 (21%) had history of fever at home or in the emergency department, and 63 (10%) had reported fussiness or poor feeding. Blood, urine, and cerebrospinal fluid cultures were collected in 581 (88%), 274 (42%), and 216 (33%) infants, respectively. Pathogens grew in 0.3% (95% confidence interval [CI] 0.04-1.2) of blood, 1.1% (95% CI 0.2-3.2) of urine, and 0.4% (95% CI 0.01-2.5) of cerebrospinal fluid cultures. Cultures from the site of infection were obtained in 335 (51%) infants, with 77% (95% CI 72-81) growing a pathogen, most commonly methicillin-resistant Staphylococcus aureus (54%), followed by methicillin-susceptible S aureus (29%), and unspecified S aureus (8%). A total of 591 (90%) infants were admitted to the hospital, with 22 (3.7%) admitted to an ICU. Overall, 10 (1.5% [95% CI 0.7-2.8]) had sepsis or shock, and 2 (0.3% [95% CI 0.04-1.1]) had severe cellulitis or necrotizing soft tissue infection. None received vasopressors or endotracheal intubation. There were no deaths.
Conclusions:
In this multicenter cohort, mild localized disease was typical of neonatal mastitis. SBI and adverse outcomes were rare. Evaluation for SBI is likely unnecessary in most afebrile, well-appearing infants with mastitis.
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