Acute Suppurative Parotitis in the Newborn
Authors: R. H. R. White
Journal: BMJ (1952)

Acute Suppurative Parotitis in the Newborn As reports of this condition are few in number the following case is thought to be worth recording.CASE REPORT .On October 11 a primigravida was delivered of a female infant which suffered from a severe degree of "white asphyxia."Attempts at breathing amounted merely to an occasional gasp, and lobeline, nikethamide, aspiration of mucus from the pharynx, nasal oxygen, immersion in warm water, and, finally, mouth-to-mouth inflation through an ordinary double-layer face-mask were all employed.Normal respiration was established after 75 minutes.During the first five days of life the baby remained restless, and was spoon-fed with difficulty.She eventually settled down, but the fluid intake was barely sufficient, and oesophageal tube- feeding was employed from the seventh to the tenth day, when sucking was established.At this time, October 20, the right side of the face appeared to be slightly swollen, and by midday a large, tense, and obviously tender swelling could be felt in the parotid region, the overlying skin being red, hot, and oedematous.Pus was exuding from the orifice of Stensen's duct, and from this a heavy growth of a coagulase- positive Staphylococcus aureus was cultured.The.rectal temperature was 99.80 F. (37.7°C.) and constitutional dis- turbance was not marked.Septicaemia was not suspected and blood culture was not done.There was no evidence of infection elsewhere.The infant was given penicillin, 50,000 units three-hourly, and the mouth was cleansed hourly.It soon became apparent that drainage was inadequate, for the swelling enlarged and became fluctuant.On October 23 a small incision was made obliquely just below the angle of the mandible, and on thrusting a sinus forceps upwards into the parotid swelling about 5 ml. of thick pus was liberated.A gauze wick was inserted, and warm sodium sulphate dress- ings were applied four-hourly.Drainage of pus ceased after three days.At this stage it became known that the organism was resistant to penicillin, sulphadimidine, and sulphadiazine, but was sensitive to streptomycin.Penicillin injections were therefore discontinued.On October 28 the swelling reappeared and again became fluctuant.A sinus forceps was introduced through the original incision, and a multilocular abscess was opened, liberating a further 4 ml. of pus.A small rubber drain was inserted, and streptomycin, 100 mg.intramuscularly twice daily, was given.The drain was removed after four days, and by November 10 the discharge had ceased completely, although a small quantity of pus could still be expressed from Stensen's duct.Streptomycin was discontinued.The incision was allowed to heal, and the discharge into the mouth gradually diminished until by November, 16 it had ceased.The mouth was cleansed frequently, and the infant was successfully fed by bottle on a full-cream dried milk throughout the illness.She was seen again at the age of 13 weeks, two months after discharge from the ward, and appeared very healthy.She was taking her feeds well and weighed 12 lb. 4oz.(5.5 kg.).There was no facial swelling, and salivary secre- tion from Stensen's ducts on both sides was normal.The incision had healed well, and there was no evidence of salivary fistula or facial paralysis.