Management of Acute Otitis Media in Afebrile Neonates

Acute otitis media (AOM) in the neonate may occur more frequently than previously assumed. From 2006 to 2010, our highly experienced, general pediatric outpatient rural practice has observed a cumulative AOM rate of 1% and 2% in “neonates” from 2 to 5 weeks and 2 to 8 weeks old, respectively. However, AOM at this age is very difficult to diagnose and perplexing to manage. In fact, the current 2004 and probably the new 2012 AAP/AAFP guidelines on AOM have avoided the issue altogether.1 To further compound the problem, many practitioners still rely on outdated middle ear microbiology data obtained between 1970 and 1989 that suggests Gram-negative bacilli are quite common in neonatal (under 60 days of life) AOM.2