探讨新生儿化脓性腮腺炎(NSP)患儿的临床表现、治疗策略及预后。

选择2017年5月14日，成都市妇女儿童中心医院收治的1例于生后24 d被诊断为NSP的女性患儿为研究对象。以"化脓性腮腺炎""新生儿""腮腺感染"为关键词，在中国知网、维普、万方数据库中，检索NSP相关文献。文献检索时间设定为1980年1月1日至2019年6月30日。对本例NSP患儿及文献纳入研究NSP患儿的临床表现、并发症、治疗及预后进行分析。本研究遵循的程序符合2013年新修订的《世界医学协会赫尔辛基宣言》要求。

本例NSP患儿因生后24 d"发热伴吸允困难，右侧耳前肿胀8 h"被诊断为NSP后收入院，入院对其采取哌拉西林钠舒巴坦钠250 mg/(kg·d)×10 d治疗后，腮腺肿胀消失，痊愈出院。对其出院后随访1个月的结果提示，NSP未复发。根据本研究设定的文献检索策略，共计筛选30篇国内NSP相关文献，纳入71例NSP患儿进行研究。对包括本例患儿在内的这72例NSP患儿的临床资料进行分析的结果如下。①一般临床资料：男性患儿为44例(61.1%)，足月儿为51例(70.8%)；临床诊断NSP时，日龄为生后1～26 d。②临床表现：72例(100.0%)患儿均有以耳垂为中心出现肿胀、肿胀腮腺导管脓性分泌物溢出，患儿不明原因哭闹为52例(72.2%)，吸吮困难为51例(70.8%)，发热为49例(68.1%)。③相关并发症发生率为9.7%(7/72)，并发NSP患侧外耳道瘘、患侧面神经麻痹、化脓性脑膜炎分别为4例(5.6%)、2例(4.2%)及1例(1.4%)。④对腮腺导管脓性分泌物进行细菌培养结果呈阳性为43例(59.7%)，其中金黄色葡萄球菌、铜绿假单胞菌、大肠埃希菌、链球菌、表皮葡萄球菌、溶血性葡萄球菌呈阳性者分别32例(44.4%)、4例(5.6%)、3例(4.2%)、2例(2.8%)、1例(1.4%)与1例(1.4%)；细菌培养结果呈阴性为27例(37.5%)；结果不详为2例(2.8%)。同时完善血样标本细菌培养者为17例，其中6例(35.3%，6/17)结果呈阳性。⑤治疗及预后：72例患儿中，59例(81.9%)接受保持口腔清洁及足量、足疗程抗菌药物治疗有效，13例(18.1%)接受上述方案联合腮腺脓肿处穿刺术或外科切开引流术治疗。其中，70例(97.2%)治愈出院患儿中，随访期内69例(95.8%)无复发，1例(1.4%)于出院后1个月内复发，再次入院治疗后治愈出院；2例(2.8%)死亡。

NSP是新生儿期较少见感染性疾病。该病起病急，临床表现特异，金黄色葡萄球菌是导致该病的常见致病菌，患儿接受早期、积极抗感染治疗后，预后良好，并发症少。

To explore clinical manifestations, treatment strategy and prognosis of neonates with neonatal suppurative parotitis (NSP).

A female neonate who was diagnosed as NSP at 24 days after birth in Chengdu Women′s and Children′s Central Hospital on May 14, 2017 was selected as research subject. Relevant literatures of NSP were retrieved in CNKI, VIP and Wanfang database by taking " suppurative parotitis" " neonate" and " parotid gland infection" as keywords in Chinese. Retrieval time was set from January 1, 1980 to June 30, 2019. Clinical manifestations, complications, treatments and prognoses of NSP neonates were analyzed. This study was in line with World Medical Association Declaration of Helsinki revised in 2013.

This neonate was admitted to hospital 24 days after birth for " fever, poor sucking, swelling of the right pre-auricular for 8 h" and was diagnosed as NSP, and after treatment with piperacillin sodium and sulbactam sodium 250 mg/(kg·d) × 10 days, swelling of parotid gland disappeared, and she had no recurrence within 1 month after discharge. According to the literature search strategy set in this study, a total of 30 domestic NSP-related literatures were screened out, involving 71 neonates with NSP. Combined with this case of NSP neonates, clinical data analysis results of a total of 72 cases of NSP neonates were as follows. ①General clinical data: 44 cases (61.1%) were male, 51 cases (70.8%) were term neonates, and they were diagnosed as NSP at the age of 1 to 26 days after birth. ②Clinical manifestations: 72 cases (100.0%) with swelling centered on the earlobe, and all of them with swollen parotid duct purulent discharge, 52 cases (72.2%) with incessant crying for unknown reasons, 51 cases (70.8%), with poor sucking, and 49 cases (68.1%) with fever. ③Incidence of complications was 9.7% (7/72), including 4 cases (5.6%) of fistula in external auditory canal of ipsilateral NSP, 2 cases (4.2%) of ipsilateral facial paralysis and 1 case (1.4%) of suppurative meningitis. ④Among them, 43 cases (59.7%) were with positive results of parotid duct purulent discharge culture, including 32 cases (44.4%) of Staphylococcus aureus, 4 cases (5.6%) of Pseudomonas aeruginosa, 3 cases (4.2%) of Escherichia coli, 2 cases (2.8%) of Streptococcus, 1 case (1.4%) of Staphylococcus epidermidis, and 1 case (1.4%) of Staphylococcus hominis; 27 cases (37.5%) were with negative results, and pathogenic bacteria of 2 cases (2.8%) were unknown. Among the 72 neonates with NSP, only 17 cases received examination by blood culture at the same time, and 6 cases (35.3%, 6/17) had positive results of blood culture. ⑤Treatment and prognosis: Among 72 NSP neonates, 59 cases (81.9%) received conservative treatment programs, such as keeping oral cavity clean, adequate and full-course antimicrobial therapy, 13 cases (18.1%) received conservative treatment programs combined with puncture or surgical incision and drainage of parotid abscess. After treatment, 70 cases (97.2%) were cured, and 69 cases (95.8%) discharged without recurrence, 1 case (1.4%) relapsed within 1 month after discharge and cured after rehospitalization; 2 cases (2.8%) died.

NSP is a rare infectious disease in neonatal period. The onset of NSP is acute and its clinical manifestations are specific. Staphylococcus aureus is a common pathogenic bacteria causing NSP. The prognosis of NSP neonate is good and with few complications by active and early anti-infective treatment.