Accidental out-of-hospital delivery complicated by acute neonatal parotitis: Case report and a review of the literature

Abstract

Neonatal suppurative parotitis is a rare and unusual infection. It presents with swelling, pain and erythema over the affected gland. The most common causative organism is Staphylococcus aureus. The infection is thought to be an ascending infection from the oral cavity. Most cases are managed conservatively with antibiotics. We present the case of a 10-day old, full-term girl who presented with restlessness and a fever. The delivery was an out-of-hospital unattended delivery that took place near the hospital parking facility. The child was offered antibiotic preventive treatment due to the contaminated delivery but the parents declined. The patient was admitted to the pediatric ward for a full workup of neonatal fever. Empiric antibiotic treatment was commenced. After admission an erythematous swelling was seen over the left preauricular area. Intraorally, pus was seen draining from the left Stensen duct. These findings were compatible with acute parotitis. Pus from the oral cavity grew Staphylococcus aureus . Acute suppurative parotitis is rare in the neonatal period. In the past 42 years, only 38 cases have been described in the English language medical literature. Parotitis is unilateral in most cases. We discuss the typical presentation and pathogenesis of this disorder. Unplanned, unattended and out-of-hospital deliveries carry an increased risk of perinatal morbidity and mortality. It is possible that the contaminated delivery and the parental refusal of prophylactic antibiotic treatment contributed to the onset of infection in this case.