Neonatal Suppurative Sialadenitis With Bilateral Gland Involvement in a Preterm Infant: A Rare Complication of...

Neonatal suppurative sialadenitis (NSS) is an uncommon but serious complication of salivary gland infection, with few cases reported in literature, most often affecting preterm infants. Typical cases involve the parotid gland and are caused by Staphylococcus aureus infection. Contributing factors include prematurity, dehydration, prolonged hospitalisation, and immature immunity. Sequential bilateral gland involvement through haematogenous spread is rare, and presents significant management challenges in prematurity.

We report the case of a preterm infant, born at 30 weeks gestation, who spontaneously developed acute left-sided parotid swelling at 3 weeks old in NICU. Inflammatory markers were significantly elevated and blood cultures grew Staphylococcus epidermidis. Initial treatment was with broad-spectrum intravenous antibiotics, and after no significant improvement, confirmatory ultrasound, and subsequent bedside percutaneous drainage was performed by ear, nose, and throat (ENT) surgeons. Subsequently, they developed a second abscess in the contralateral submandibular gland, needing further bedside aspiration. Pus cultures isolated Staphylococcus aureus, and they improved with culture-driven antibiotics.

We highlight the importance of combining early antimicrobial therapy with minimally invasive procedural intervention in managing NSS, as well as the rarity of multiple, sequential gland involvement. Early drainage limits progression when empirical treatment fails and helps guide antimicrobial choice. It minimises the need for more invasive surgical intervention, which is complex in preterm infants.

A high index of suspicion, early minimally invasive drainage and prompt initiation of targeted antibiotics, are key to optimal outcomes in NSS, particularly in preterm infants at higher risk of severe disease.