Neonatal Mastitis: Clinical Presentation and Approach to Evaluation and Management

Mastitis is an uncommon but potentially serious infection in neonates. Characteristic findings include erythema, induration, and tenderness around the breast bud. Fluctuance 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. Until recently, there have been very few cohort studies of neonatal mastitis in high-income countries, and no literature available regarding the incidence of concurrent serious bacterial infection such as meningitis or urinary tract infection. A recent large, multicenter study suggests that most neonatal mastitis presents as localized soft tissue infection, with very low rates of concurrent serious bacterial infection or adverse outcomes. Treatment of neonatal mastitis consists primarily of antibiotic administration. Surgical intervention, such as incision and drainage or intraoperative debridement, may be needed for frank abscesses. While antibiotics are typically administered intravenously, there may be a role for oral antibiotics in some lower risk infants with mastitis.