Suppurative salivary gland diseases are rare in neonates. Only 22 cases of neonatal suppurative parotitis are described in the English literature in the last 35 years(1). During a 9-year study by Sabatino, et al., five cases of neonatal suppurative parotitis were detected in 3624 hospital admissions. The relative risk of developing neonatal suppurative parotitis in admitted infants was 5.52 (0.62 - 49.35)(2). Staphylococcus aureus is the causative organism in most cases, which reaches parotid glands via Stensen’s duct. We report a term breastfed neonate with bilateral parotid abscess.

A 14-day-full term male neonate, second in birth order, delivered at home by trained health worker was brought with bilateral parotid swellings for last 7 days. The baby was exclusively breastfed. Examination revealed a 2.8 kg lethargic, toxic looking neonate with poor neonatal reflexes. There were bilateral, symmetrical and fluctuant parotid swellings, 2.5 × 4.5 cm each (Fig. 1). Overlying skin was red, hot and necrosed in the central part of the swelling. Aspiration of the swelling revealed thick pus. This was followed by excision and drainage on both sides. Staphylococcus aureus was isolated from pus and blood. HIV serology was negative. The neonate was treated with parenteral ampicillin and cloxacillin for 14 days resulting in complete recovery.

Fig. 1. Bilateral Symmetrical Parotid Swellings.

Reappraisal of history revealed maternal breast abscess on left side noted on 4th post partum day. Pus and breast milk culture, both isolated Staphylococcal aureus.

Acute suppurative infection of salivary gland is rare in neonatal period and occur more frequently in pre-term newborns(3). Dehydration, congenital anomalies, pro-longed orogastric feeding and septicemia have also been associated with suppurative parotitis in newborn(1,4,5). Protective role of exclusive breast-feeding in prevention of bacterial sialadenitis has not been defined. Various organisms known to cause suppurative parotitis are Staphylococcus aureus, Streptococcus pyogens, Streptococcus viridens, E. coli, Pseudomonas aeruginosa and N. catarrhalis(3). Suppurative parotitis is usually bilateral and may progress to abscess formation. In the reported case, bilateral parotid abscess also followed suppurative parotitis. The probable source of infection, in the present case, was maternal breast milk, which reached paratoid glands via Stensen’s ducts. Isolation of Staphylococcus aureus from breast and parotid abscesses as well as breast milk, supports a cause-effect relationship.

Karanjit Singh,
Department of Pediatrics,
Medical College,
Amritsar,
India.

1. Spiegel, Morin D, Sakran W; Horovitz Y. Acute Neonatal suppurative parotitis: Case reports and review. Pediatric Infect Dis J 2004; 23: 76-78.

2. Sabatino G, Verrotti A. Neonatal suppurative parotitis: A study of five cases. Eur J Pediatr 1999; 158: 312-314.

3. Leake D, Leake R. Neonatal suppurative parotitis. Pediatrics 1970; 46: 203-218.

4. Salaria M, Poddar B, Parmar V. Neonatal parotitis. Indian J Pediatr 2001; 68: 283.

5. David RB, O’Connell EJ, Minn R. Suppurative parotitis in children. Am J Dis Child 1970; 119: 332-335.