Diagnosis. Clinical Presentation

Clinical Presentation

Consider mastitis in the neonate with edema, induration, and tenderness of the breast tissue. Erythema and fluctuation to palpation ensue if treatment is delayed (Image 7.9).

Image 7.9 Neonatal mastitis. Abscesses of the breast develop as a consequence of mastitis.

In neonates, particular attention should be given to the presence of abscess formation, fever, and other systemic symptoms (eg, poor appetite, lethargy) as these may indicate a serious systemic infection. If the lesion is fluctuant, purulent material from aspiration (with or without ultrasonographic guidance) or I&D (incision and drainage ) also should be sent for Gram stain and culture. If I&D are performed, it is important not to injure the underlying breast bud; appropriately trained personnel (eg, a breast surgeon or pediatric gynecologist) should be consulted when this procedure is necessary. A CBC and blood culture should be obtained prior to antimicrobial therapy. If present, nipple drainage should be sent for Gram stain and culture (aerobic and anaerobic). Urine and cerebrospinal fluid cultures should be obtained if these studies are clinically indicated (eg, if the infant is febrile, ill appearing, younger than 28 days of age, or has leukocytosis).

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