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.