> she had to rush baby to ped for rapid breathing yesterday and then took baby to ER at 11pm last night for irregular pulse and rapid
> breathing

> Mom woke up today with 104 degree fever and half her left breast
> bright red. She got an antibiotic

> the person at the clinic said mom should not give milk from
> infected breast to baby (just to be sure)because of bacteria present
> in the milk(milk has not been cultured).
> Now I know with a healthy infant this is
> not a problem but is it a concern for this infant who has an enlarged
> liver, anemia and possible a congenital heart problem.

Yes. I agree with the person at the clinic, that mom should "pump and
dump" until the antibiotics have had a chance to work. Under the
circumstances, I do not think this unreasonable: I believe an earlier
post mentioned this baby is hemolyzing her red blood cells as well.
Could this baby have hemolytic beta-strep sepsis possibly acquired from
mom's breast infection? I'm sure (baby's blood) cultures will be back by
the time this is read (and I certainly hope blood cultures were taken in
the ER), but this is always a very real, if not fairly rare, diagnosis
with infectious mastitis - and can be this dangerous *even for "healthy
infants"*!!. Usually the mother "declares" her infection sooner than
this mom did. The fever seems to have been quite delayed - what
postpartum meds was she taking for her lupus that may have suppressed
the clinical signs of the infection?

The issue for us is figuring out the difference between infectious (rare
and dangerous for the baby) and non-infectious (common and not dangerous
for the baby) mastitis. It only takes one "real bad case" of hemolytic
beta-strep sepsis (and they are *all* "real bad cases") for an MD to
declare BFing "off-limits" for all mastitis until treated with
antibiotics - I only mention this as a reminder that there are usually
reasons (if not entirely appropriate because) for what we LCs view as
unreasonable orders from the physicians we work with.

This has been a very difficult case to diagnosis and care for; I think
all parties have done very well so far under very confusing
circumstances. Keep us posted.

Sending my best wishes to all parties,
Katharine West, RN, MPH, IBCLC(exp)
Sherman Oaks, CA