Neonatal mastitis

Prevention

Prognosis and Outcome

Promptly treated uncomplicated omphalitis usually resolves without serious morbidity. However, when presentation and treatment are delayed, mortality could be high, reaching 7–15%. Serious morbidity and mortality may occur from complications such as NF, peritonitis, and evisceration. Portal vein thrombosis may be fatal. Mortality may reach 38–87% following NF and myonecrosis. Also, certain risk factors such as prematurity, small size for gestational age, male sex, and septic delivery are associated with poor prognosis.

The incidence of omphalitis is low in well-resourced countries and for those born in hospital. In developing countries, and especially after home birth, however, the incidence is high enough to consider prophylaxis to prevent the morbidity and mortality associated with late presentation of the disease. Currently, not using any medicinal washes on the cord but just simply allowing the cord to dry and fall off is being advocated in developed parts of the world. There is little data to support any one cord care or lack there of over the other.

Breast infection (mastitis or breast abscess) typically occurs in infants younger than two months of age (neonatal mastitis) and lactating women. However, breast infection also may occur in prepubertal children and pubertal/postpubertal adolescents.

Neonatal mastitis occurs with equal frequency in girls and boys. Thereafter, it is more common in girls, with a female:male ratio of approximately 2:1. This is thought to be related to the longer duration of physiologic breast hypertrophy in female than in male infants.

This infection is usually caused by Staphylococcus aureus, coliform bacteria, or group β streptococcus. If treatment is delayed, mastitis may progress rapidly with involvement of subcutaneous tissues and subsequent toxicity and systemic findings.

Enlargement of breast tissue in new born infants is a common physiologic hormonal phenomenon. Excessive manipulation can result in secondary infection.

The diagnosis of mastitis and breast abscess can usually be made based on a physical examination.

The ultrasound provides a clear image of the breast tissue and may be helpful in distinguishing between simple mastitis and abscess or in diagnosing an abscess deep in the breast.

In cases of infectious mastitis, cultures may be needed in order to determine what type of organism is causing the infection. Cultures are helpful in deciding the specific type of antibiotics that will be used in curing the disease. These cultures may be taken either from the breast milk or of the material aspirated from an abscess.

Predisposing factors: Maternal skin or soft-tissue infection in the postpartum period may be associated with neonatal mastitis. Manipulation of the neonatal breast to express a clear or cloudy (milk-like) nipple discharge ("witch's milk") has been considered to be a risk factor for breast abscess, but this finding is not well substantiated. Factors that predispose to breast infection in children and nonlactating adolescents include trauma (eg, breast manipulation during sexual activity, nipple piercing), obesity, mammary duct ectasia, local skin infection, and epidermoid cysts. Peripheral mastitis may be associated with diabetes mellitus, rheumatoid arthritis, glucocorticoid therapy, granulomatous disease, and trauma.

Дата добавления: 2014-10-15