Just look at the rash – then scroll down to reveal the diagnosis. That’s it. This is a baby with swollen, erythematous skin of the chest wall.

It’s Neonatal Mastitis!

This is a skin and soft tissue infection of the breast tissue in a newborn. The treatment is directed towards S. aureus and you should never squeeze or incise this tissue in the ED.

Well-appearing

Get a CBC and Blood Culture and admit those under 2 months of age on IV antibiotics.

• Clindamycin
• Nafcillin (if you do not suspect MRSA)
• Vancomycin

Ill-appearing

After obtaining urine and CSF studies you’ll want to treat with multiple drugs. Options include:

• Vancomycin + nafcillin + ceftriaxone or cefotaxime
• Vancomycin + nafcillin + gentamicin

Drainage of abscesses

I&D is warranted if there is not spontaneous drainage. I will not drain a breast abscess, especially in a newborn female. You should always consult pediatric surgery/gynecology. You run the risk of breast hypoplasia and scarring even with a successful I&D.

References

Montague EC, Hilinski J, Andresen D, Cooley A. Evaluation and treatment of mastitis in infants. Pediatr Infect Dis J. 2013 Nov;32(11):1295-6. doi: 10.1097/INF.0b013e3182a06448.