Neonatal Orbital Abscess

Chien-Yu Lin, MD, ¹ Chyong-Hsin Hsu, MD, ²  Kuo-Sheng Lee, MD, ^3,4 Fu-Yuan Huang, Professor, ^2,5 Nan-Chang Chiu, MD. ^2,4

¹ Department of Pediatrics, Hsinchu Mackay Memorial Hospital, Hsinchu City, Taiwan

² Department of Pediatrics , Mackay Memorial Hospital, Taipei, Taiwan

³ Department of Otolaryngology, Mackay Memorial Hospital, Taipei, Taiwan

⁴ Mackay Medicine, Nursing and Management College, Taipei, Taiwan

⁵ Department of Pediatrics, Taipei Medical University, Taipei, Taiwan

Background and Aims:

Orbital abscess is life-threatening and rare in children. Neonatal orbital abscess is extremely rare, and prompt diagnosis and early treatment are mandatory.

Methods:

We report a term male neonate with Methicillin-resistant Staphylococcus aureus orbital abscess and provide a literature review of this disease (Figure).

Results:

11 neonates diagnosed with neonatal orbital abscess are reported in the literature (Table). There is no sexual predilection and one neonate is delivered prematurely. Leukocytosis, fever, ethmoiditis and associated URI are found in about half of them. 4 neonates have sepsis and 8 patients undergo surgical intervention. 1 patient expired. Staphylococcus aureus is identified in 8 out of 11 patients.

Conclusions:

Neonatal orbital abscess is rarely encountered but may be fatal. Timely diagnosis and intervention are required to ensure a favorable outcome. Appropriate antimicrobial agent against Staphylococcal aureus is essential in treating neonatal orbital abscess although the creep of Staphylococcal resistance increases difficulty of treatment. In the era of high resistance of Staphylococcus aureus, higher initial vancomycin dose may be considered as empirical regimen in life-threatening infection in neonates.

Congenital and neonatal infections