Mastitis in Breastfeeding Russell W Lake MD CPT

Mastitis in Breastfeeding Russell W. Lake, MD CPT MC USA Dept. of Family Medicine Eisenhower Army Medical Center

Mastitis in Breastfeeding �Mastitis �“Painful inflammation of the breast occurring in conjunction with flu-like symptoms (e. g. , fever, malaise)” �Diagnosis �Clinical �Culture rarely used to confirm bacterial infection Spencer JP. Mastitis in Breastfeeding. Am Fam Phys. 2008; 78(6): 727 -731.

Mastitis in Breastfeeding �Incidence � 1 -3% of lactating women � 9. 5% up to 33% of breastfeeding women �Most common in 2 nd and 3 rd weeks postpartum � 75 -95% of cases occur before infant is 12 weeks old �Right and left breasts affected equally Hopkinson J and Schanler RJ. Common problems of breastfeeding in the postpartum period. Up to Date. Updated February 5, 2009. Department of Child and Adolescent Health and Development. Mastitis: causes and management. Geneva, Switzerland: World Health Organization; 2000. http: //whqlibdoc. who. int/hq/2000/WHO_FCH_CAH_00. 13. pdf. Accessed June 15, 2009. Foxman B, D'Arcy H, Gillespie B, Bobo JK, Schwartz K. Lactation mastitis: occurrence and medical management among 946 breastfeeding women in the United States. Am J Epidemiol. 2002; 155(2): 103 -114. Spencer JP. Mastitis in Breastfeeding. Am Fam Phys. 2008; 78(6): 727 -731.

Mastitis in Breastfeeding Risk factors Cleft lip or palate Previous mastitis Cracked nipples Primiparity† Infant attachment difficulties Restriction from a tight bra Local milk stasis Short frenulum in infant Missed feeding Sore nipples Nipple piercing* Use of a manual breast pump Plastic-backed breast pads Yeast infection Poor maternal nutrition *outside of pregnancy †inconsistently demonstrated � Causes � MRSA Spencer JP. Mastitis in Breastfeeding. Am Fam Phys. 2008; 78(6): 727 -731.

Mastitis in Breastfeeding �Differential diagnosis �Plugged milk duct(s) �Abscess �Inflammatory breast cancer Spencer JP. Mastitis in Breastfeeding. Am Fam Phys. 2008; 78(6): 727 -731.

Mastitis in Breastfeeding �Management �Continued breast feeding; “Pump & dump” if infant dislikes taste �Warm compresses �Supportive care, NSAIDs �Antibiotic initiation and duration poorly studied Antibiotics Amoxicillin/clavulanate 875 mg BID Cephalexin 500 mg QID Ciprofloxacin 500 mg BID Clindamycin 300 mg QID Trimethoprim/Sulfamethoxazole* 160 mg/800 mg BID Spencer JP. Mastitis in Breastfeeding. Am Fam Phys. 2008; 78(6): 727 -731.

Mastitis in Breastfeeding �Complications �Breast abscess in 5 -11% of women with mastitis �Cessation of breastfeeding Spencer JP. Mastitis in Breastfeeding. Am Fam Phys. 2008; 78(6): 727 -731.

Mastitis in Breastfeeding �Prevention �Optimization of breast feeding techniques � Lactation consultant �Bedside hand disinfection Spencer JP. Mastitis in Breastfeeding. Am Fam Phys. 2008; 78(6): 727 -731. Peters F, Flick-Filliés D. Hand disinfection to prevent puerperal mastitis. Lancet. 1991; 338(8770): 831.

References �Department of Child and Adolescent Health and Development. Mastitis: causes and management. Geneva, Switzerland: World Health Organization; 2000. http: //whqlibdoc. who. int/hq/2000/WHO_FCH_CAH_00. 1 3. pdf. Accessed June 15, 2009. �Foxman B, D'Arcy H, Gillespie B, Bobo JK, Schwartz K. Lactation mastitis: occurrence and medical management among 946 breastfeeding women in the United States. Am J Epidemiol. 2002; 155(2): 103 -114. �Hopkinson J and Schanler RJ. Common problems of breastfeeding in the postpartum period. Up to Date. Updated February 5, 2009. �Spencer JP. Mastitis in Breastfeeding. Am Fam Phys. 2008; 78(6): 727 -731.