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Neonatal Breast Abscess – Summary & Management
1. Overview
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A localized infection in the breast tissue of neonates, usually caused by Staphylococcus aureus (often MRSA).
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Most commonly affects full-term neonates within the first 2-4 weeks of life.
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Can be unilateral or rarely bilateral.
2. Clinical Features
☐ Swelling, erythema, and warmth over the affected breast
☐ Tender, fluctuant mass (suggestive of abscess formation)
☐ Fever (rare) – Most cases are afebrile
☐ Purulent nipple discharge (in some cases)
3. Differential Diagnosis
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Neonatal mastitis (infection without abscess formation)
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Physiologic neonatal breast hypertrophy (due to maternal hormones)
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Galactocele (benign milk-filled cyst)
4. Investigations
☐ Clinical diagnosis – Based on examination
☐ Ultrasound (if needed) – To confirm abscess, differentiate from galactocele
☐ Aspiration for culture – If drainage is performed
☐ CBC, CRP (if systemic signs present) – To assess inflammation
5. Management Approach
A. Antibiotic Therapy (for mastitis or small abscess <1cm)
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Empirical oral antibiotics targeting Staph aureus (including MRSA):
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Cephalexin (for MSSA) OR
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Clindamycin or Trimethoprim-Sulfamethoxazole (TMP-SMX) (for MRSA risk)
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Duration: 7–10 days
B. Drainage (for larger abscesses >1cm or worsening symptoms)
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Needle aspiration preferred over incision and drainage (I&D)
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Repeat aspiration if abscess persists
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Surgical drainage if aspiration fails or large abscess with necrosis
6. Prognosis & Follow-Up
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Most cases resolve with early antibiotics and/or drainage.
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Follow-up in 2–3 days to assess response.
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Avoid excessive manipulation/massage, as it can worsen the infection.
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