O0493 Oct.4: 5:45pm - Neonatal Mastitis and Omphalitis: Presentation, Outcomes, and Concurrent Serious Bacterial Infection

Sunday, October 4, 2020

5:45 PM – 5:53 PM

Background: Neonatal mastitis and omphalitis are uncommon but potentially serious infections in neonates. Clinical findings may range from localized soft tissue infection to more invasive necrotizing local infection or systemic illness with other concurrent serious bacterial infections. Modern literature on these diseases is scant, and there is very little evidence available to guide evaluation and treatment decisions.

Objective: Describe the clinical presentation, prevalence of concurrent serious bacterial infection (SBI), and outcomes among infants with neonatal mastitis and omphalitis.
Design/

Methods: Utilizing the framework of the Pediatric Emergency Medicine Collaborative Research Committee (PEMCRC), 28 sites performed retrospective chart reviews of infants < 90 days of age with neonatal mastitis or omphalitis seen in the emergency department (ED) from 1/1/2008 – 12/31/2017. Subjects were identified using ICD codes, and charts were reviewed to confirm a clinical diagnosis consistent with mastitis or omphalitis. Demographic, clinical, laboratory, treatment, and outcome data were obtained from ED and inpatient medical records.

Results: 657 infants with mastitis and 566 with omphalitis were included. Most were described as “well-appearing,” and few had self-reported or measured fever in the ED, reported fussiness, or poor feeding (Table 1). For mastitis, 581 (88%) had blood cultures sent, of which 19 were positive (3.3% [95% CI 2.0-5.1]), representing 2.9% [95% CI 1.7-4.5] of all patients. Of the 19 positive blood cultures, 17 (89%) grew coagulase negative staphylococci. 274 (42%) had urine cultures sent, of which 8 were positive (2.9% [95% CI 1.3-5.7]), representing 1.2% [95% CI 0.5-2.4] of all patients. 216 (33%) had CSF cultures sent, of which 2 were positive (0.9% [95% CI 0.1-3.3]), representing 0.3% [95% CI 0.0-1.1] of all patients. For omphalitis, 472 (83%) had blood cultures sent, of which 22 were positive (4.7% [95% CI 2.9-7.0]), representing 3.9% [95% CI 2.5-5.8] of all patients. Of the 22 positive blood cultures, 17 (77%) grew coagulase negative staphylococci. 326 (58%) had urine cultures sent, of which 11 were positive (3.4% [95% CI 1.7-6.0]), representing 1.9% [95% CI 1.0-3.5] of all patients. 222 (39%) had CSF cultures sent, of which 3 were positive (1.4% [95% CI 0.3-3.9]), representing 0.5% [95% CI 0.1-1.5] of all patients. For both diagnoses, most were admitted to the hospital (88% in both groups), but very few had a clinical diagnosis of sepsis or shock, or documented severe cellulitis or necrotizing soft tissue infection (Table 1). There were no deaths in either cohort.
Conclusion(s): In these cohorts, the vast majority of infants with neonatal mastitis or omphalitis had relatively mild localized disease, and prevalence of concurrent SBI and adverse outcomes was low. Routine testing for SBI with cultures is likely not necessary in all infants with mastitis or omphalitis.

Presenting Author(s)

Ron L. Kaplan

Associate Professor of Pediatrics
University of Washington School of Medicine, Seattle Children's Hospital
Seattle, Washington
Disclosure: No Financial Relationships Disclosed

Co-Author(s)

Andrea T. Cruz

Associate Professor
Baylor College of Medicine
Houston, Texas
Disclosure: American Academy of Pediatrics (Honorarium, Editorial board member)
KM

Kenneth Michelson

Assistant Professor
Boston Children's Hospital/Harvard University
Boston, Massachusetts
Disclosure: No Financial Relationships Disclosed
CM

Constance McAneney

Professor of Pediatrics
Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine
Cincinnati, Ohio
Disclosure: No Financial Relationships Disclosed
MB

Mercedes M. Blackstone

Attending Physician, Emergency Medicine/Associate Professor of Clinical Pediatrics
Children’s Hospital of Philadelphia/Perelman School of Medicine at the University of Pennsylvania
Philadelphia, Pennsylvania
Disclosure: No Financial Relationships Disclosed
Christopher M. Pruitt

Associate Professor of Pediatrics
Medical University of South Carolina
Mount Pleasant, South Carolina
Disclosure: No Financial Relationships Disclosed
Nipam Shah

Instructor
University of Alabama at Birmingham
Birmingham, Alabama
Disclosure: No Financial Relationships Disclosed
Kathleen A. Noorbakhsh

Assistant Professor of Pediatrics
Children’s Hospital of Pittsburgh of UPMC
Pittsburgh, Pennsylvania
Disclosure: No Financial Relationships Disclosed
TA

Thomas Abramo

Pediatric Emergency Medicine Associates
Children's Hospital of Atlanta
Atlanta, Georgia
Disclosure: No Financial Relationships Disclosed
LM

Leah Middelberg

Assistant Professor/Attending Physician, Pediatric Emergency Medicine
Department of Pediatrics, Ohio State University College of Medicine/Nationwide Children's Hospital
Columbus, Ohio
Disclosure: No Financial Relationships Disclosed
KS

Kathleen Smith

Associate Physician, Pediatrics
UCSD School of Medicine, Rady Children's Hospital Division of Emergency Medicine
San Diego, California
Disclosure: No Financial Relationships Disclosed
Nirupama Kannikeswaran

Professor of Pediatrics
Children's Hospital of Michgan
Detroit, Michigan
Disclosure: No Financial Relationships Disclosed
DS

David Schnadower

Professor of Pediatrics, Academic Director
Cincinnati Children’s Hospital Medical Center
Cincinnati, Ohio
Disclosure: No Financial Relationships Disclosed
GS

Geetanjali Srivastava

Medical Director, Clinical Assistant Professor (Affiliated)
Valley Children’s Hospital, Madera, CA/Stanford University School of Medicine
Madera, California
Disclosure: No Financial Relationships Disclosed
Amy D. Thompson

Pediatric Emergency Medicine Attending Physician.
Division of Emergency Medicine. Department of Pediatrics. Nemours Alfred I. Hospital For Children.
Wilmington, Delaware
Disclosure: No Financial Relationships Disclosed
Roni D. Lane

Associate Professor, PEM QI Medical Director
Primary Children’s Hospital/University of Utah
Salt Lake City, Utah
Disclosure: No Financial Relationships Disclosed
Julia Freeman

Assistant Professor
University of Colorado
Aurora, Colorado
Disclosure: No Financial Relationships Disclosed
Kelly R. Bergmann

Physician, Emergency Research Director, Pediatric Emergency Medicine
Children's Minnesota
Minneapolis, Minnesota
Disclosure: No Financial Relationships Disclosed
OM

Oihane Morientes

Pediatric Emergency Department
Biocruces Bizkaia Health Research Institute. Hospital University Cruces
Bilbao, Pais Vasco, Spain
Disclosure: No Financial Relationships Disclosed
JG

James Gerard

Attending physician - Pediatric Emergency Medicine
Saint Louis University School of Medicine
St. Louis, Missouri
Disclosure: No Financial Relationships Disclosed
OB

Olakemi Badaki-Makun

Assistant Professor of Pediatrics
Johns Hopkins University
Baltimore, Maryland
Disclosure: No Financial Relationships Disclosed
Usha Avva

Physician Specialist, Pediatric Emergency Medicine
Joseph M Sanzari Children’s Hospital, Hackensack Meridian Health
Paramus, New Jersey
Disclosure: No Financial Relationships Disclosed
PC

Pradip P. Chaudhari

Associate Research Director, Assistant Professor of Clinical Pediatrics
Children's Hospital Los Angeles
Glendale, California
Disclosure: No Financial Relationships Disclosed
SF

Stephen Freedman

Professor of Pediatrics
Alberta Children's Hospital/University of Calgary
Calgary, Alberta, Canada
Disclosure: No Financial Relationships Disclosed
MS

Margaret Samuels-Kalow

Assistant Professor of Pediatrics
Massachusetts General Hospital
Boston, Massachusetts
Disclosure: No Financial Relationships Disclosed
EH

Elizabeth Haines

Associate Division Chief, Pediatric Emergency Medicine
Ronald O. Perelman Department of Emergency Medicine/NYU Langone Health
Brooklyn, New York
Disclosure: No Financial Relationships Disclosed
JS

Jonathan Strutt

Assistant Professor
University of Minnesota
Minneapolis, Minnesota
Disclosure: No Financial Relationships Disclosed
KK

Kajal Khanna

Clinical Assistant Professor
Stanford University
Stanford, California
Disclosure: No Financial Relationships Disclosed
CV

Cheryl Vance

Clinical Professor Emergency Medicine and Pediatrics
University of California, Davis School of Medicine
Sacramento, California
Disclosure: No Financial Relationships Disclosed

Senior Author(s)

Lalit Bajaj

Professor of Pediatrics and Emergency Medicine
University of Colorado
Aurora, Colorado
Disclosure: No Financial Relationships Disclosed