A 10-day-old male infant, born at 38 weeks of gestation to a primigravida mother following an uncomplicated antenatal course, was brought with progressively increasing bilateral breast swelling. The infant was delivered by normal vaginal delivery with a birth weight of 3100 g and had Apgar scores of 7 and 9 at 1 and 5 minute, respectively. The immediate postnatal period was uneventful, and the neonate was discharged on day 3 of life. The parents noticed bilateral breast enlargement beginning on the 5th day of life, which gradually increased in size and was associated with a clear, milky, nonbloody nipple discharge over the subsequent 3 days. The mother reported repeatedly squeezing the breasts. There was no history of fever, irritability, poor feeding, excessive crying, purulent discharge, or trauma. The infant was exclusively breastfed and thriving well. There was no maternal history of endocrine disorders, medication use, or intake of herbal preparations during pregnancy or the postnatal period. On examination, the neonate was active and hemodynamically stable, with a temperature of 37°C, heart rate of 143/min, respiratory rate of 38/min, and capillary refill time 3 cm. Neonatal mastitis presents with unilateral painful swelling, erythema, warmth, induration, and systemic symptoms such as fever or irritability, most commonly due to Staphylococcusaureus, while abscess is characterized by fluctuation and localized pus on imaging. In the present case, the absence of tenderness, inflammatory signs, and systemic features made infection unlikely. Unlike mastitis or abscess, which require antibiotics and sometimes drainage, physiological breast enlargement and giant mastauxe are managed conservatively with reassurance and follow-up.3 Long-term observation, especially in female infants, has been suggested due to a theoretical risk of altered estrogen sensitivity.4 Accurate diagnosis and counseling prevent unnecessary antibiotics, hospitalization, or surgery while ensuring appropriate care. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form, the legal guardian has given his consent for images and other clinical information to be reported in the journal. The guardian understands that names and initials will not be published and due efforts will be made to conceal patient identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.
Dangi et al. (Wed,) studied this question.