title: Neonatal mastitis: controversies in management.
abstract: OBJECTIVE
  To document the range of presentations, extent of investigations, and treatment choices of 'physicians treating' neonates with mastitis seen over a 9-year period at a tertiary care pediatric hospital.
  
  
  METHODS
  An email survey was sent to Emergency Department (ED) staff and fellows asking them how they would treat a well-looking neonate with localized mastitis. Secondly, a retrospective chart review of neonates presenting to the ED with a diagnosis of neonatal mastitis or breast engorgement from July 2000 to December 2009 was conducted to assess how such patients were actually treated.
  
  
  RESULTS
  46/107 surveys were returned, with a wide discrepancy in how clinicians would treat neonatal mastitis: 4.3% would perform a full sepsis work up, including lumbar puncture, followed by IV antibiotics and hospital admission; 28% chose discharge on oral antibiotics; and 28% suggested admission only if blood work was abnormal. From the chart review, 33 neonates were diagnosed with possible neonatal mastitis over a 9-year period: 12 met the inclusion criteria. Of these, 8 (66%) were admitted and treated with intravenous antibiotics, 2 (16.6%) were treated with oral antibiotics, and 2 (16.6%) did not receive antibiotics. None of the 12 patients had lumbar puncture performed.
  
  
  CONCLUSIONS
  There is significant disagreement among clinicians regarding the best way to treat the well-looking neonate with localized mastitis. Most elect to perform blood tests and start treatment with IV antibiotics with good Staphylococcus aureus coverage, followed by oral antibiotics if cultures are negative.
authors.affiliation: Department of Emergency Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
authors.forename: Nahar
authors.initials: N
authors.lastname: Al Ruwaili
authors.forename: Dennis
authors.initials: D
authors.lastname: Scolnik
keywords: Neonatal breast cellulitis; neonatal breast skin infection; neonatal mastitis
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