TIA for any light shed down this endless tunnel! My client has a Hx of
neutropenia, her WBC count is normally 2.5, rising to 3.5 with infection
(but not with her current breast infections). Baby was born 1/3/99, by day
4 one nipple had a superficial crack, pain bilaterally. By day 7 usual
interventions no help, superficial cracks now bilateral, severe pain,
pumping all feedings, using sore-nipple breast cups, redness under one
breast. Day 9 redness resolved but wounds deeper, start bacitracin, tries
baby to breast once a day or less. Day 15 mastitis (other breast), started
on keflex (PCN allergy). Day 18 baby to breast once (first time in 8 days)
fever gone but not redness or lumpiness, and wounds healing VERY slowly.
Contacted CNM for management review. Started on Ceclor over phone. Day 29
no improvement, saw OB. Milk culture (strep, e-coli). No wound culture (OB
says it will make no diff). On Vit. C, ecchinecea, bacitracin BID.
Hematologist and primary doc consulted. Told not to breastfeed baby RT
introduction of germs to wounds and compromised immune response, but keep
pumping, lansinoh to wounds, stop bacitracin. Started on keflex,
clindamycin, & neupogen to increase bone marrow response. Told to pump and
dump, in spite of info otherwise. Tearful, wants to breastfeed desperately.
No culture to infant's mouth. Day 40 admitted with fever, bilateral
mastitis. Now on Clindamycin, vancomycin, fortaz, diflucan, neupogen. Used
lidocaine oint. but one nipple blistered (?lidocaine), not using now.
Stopped breastcups, but can't tolerate clothing (or hold baby against
chest). Sent for large breastshields for pump. Lansinoh to wounds than
betadine, hydrogen peroxide soak before and after pumping. Nipples
edematous so ordered to lie flat 20 min. (?plus soak) prior to pumping, and
vary suction. Still throwing milk RT multiple drug combos. WHAT A MESS!
Bettina Pearson RN, IBCLC