Neonatal Acute Paronychia

Abstract

Neonates with oral self-soothing behaviors may be more at risk for developing paronychia of mixed anaerobic and aerobic infections. Initial therapy with broad-spectrum antibiotics amoxicillin/clavulanate or clindamycin is suggested. Incision and drainage in the perinatal setting coupled with antibiotics is curative.

Paronychia in a Neonate

“…However, paronychia is uncommon among infants younger than age 1 month. 2 In our case, the patient was only 3 weeks old at the time of presentation, and he presented with multiple fingers affected. There is a paucity of literature that describes paronychia in neonates.…”

“…Her paronychia was attributed to prolonged finger sucking as a source for self-soothing for NAS, which is also a possible predisposing factor in our case. 2 There are other case reports of paronychia in neonates as well. 3,4 The differential diagnosis for paronychia is broad, but the most common diagnoses include eczema, herpetic whitlow, and psoriasis.…”

Nail disease in neonatal abstinence syndrome

“…Severe NAS symptoms can also result in self-soothing behaviors, which predispose pediatric patients to nail trauma and paronychia with both anaerobic and aerobic oral flora. 8,9 Since agitation, hyperactivity, and self-soothing increase with NAS severity, it is logical that noticeable nail findings would occur more frequently with increasing NAS severity. A neonate's maternal staphylococcus carrier status may also contribute to inoculation of traumatized nail beds resulting in paronychia.…”

“…Both patients were successfully treated with mupirocin ointment. Cutaneous excoriations occurred in 66.7% (8), none of which were noted to develop secondary infection.…”

“…To our knowledge, only a single case of paronychia in a neonate younger than 1 month has been reported, which occurred in the setting of NAS and was attributed to NAS-related oral self-soothing behavior. 8 Within recent years at our academic institution, we have observed an increase in nail abnormalities and/or acute paronychia in neonates with NAS admitted to the neonatal intensive care unit (NICU). We hypothesize that such nail findings are an underrecognized NAS manifestation that should be considered during patient management.…”