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Subject:
From:
"Catherine Watson Genna BS, IBCLC" <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Wed, 28 Dec 2011 11:35:07 -0500
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It's a staph infection, despite the lack of symptoms other than the 
clumped milk. The clumping is caused by a protein called coagulase that 
the bacteria coats itself with (it acts on prothrombin to activate 
protease to convert fibrinogen to fibrin, which is part of the process 
responsible for blood clots). Scientists think the fibrin network around 
the bacteria helps keep the immune system at bay.

The milk can be fed to the baby/the mom can breastfeed, but the mother 
should probably be treated. I'd advise her to wash her nipples with soap 
and water 2-3 times a day, in one study (Graves & Oddy, if I'm 
remembering correctly), that strategy was sufficient to eliminate staph 
infection from nipples in 1/3 of mothers, the others needed systemic 
antibiotics. The researchers were NOT following moms with symptoms other 
than pink/red sore nipples, though, so it is unknown if hygiene will 
help reduce the infection at this point. I do think we have sufficient 
evidence to advise all mothers with injured nipples to wash them with 
soap several times a day to reduce the number of organisms that can 
ascend into the breast when the milk goes back up the ductal tree at the 
end of feedings/expressions.

Catherine Watson Genna BS, IBCLC  NYC  cwgenna.com


On 12/27/2011 4:09 PM, Vanderstoep, Doreen wrote:
> Dear lactnet friends:
>
> I have a question about a mom I saw earlier today.  Her baby is 5 days
> old.  Mom describes only brief latches, but has abrasions at the tip of
> each nipple.  After a brief attempt to latch babe on mom's flat nipple
> today, a 24mm nipple shield was introduced.  This facilitated a more
> prolonged latch, but no signs of milk transfer.  When babe came off the
> breast, the nipple was bleeding.  Double pumping was initiated, with the
> pump on minimum suction.  This was the first time mom had pumped, she
> feels her milk started "coming in" earlier today.  Yielded about 45 ml
> of transitional milk.  When the flanges were removed, a long string of
> mucousy, gel-like milk was attached to the nipple on both breasts.  When
> I transferred the pumped milk to a "take-home" container, there were
> large (size of  large grapes) clumps, again appeared like gel, from each
> breast.  I have read that clumpy milk may indicate the presence of MRSA,
> but this mom has no symptoms of mastitis, or nipple infection, although
> does have the abrasions at the tip of the nipples.  I gave her a sterile
> specimen container, and suggested she bring a sample for culture to her
> appointment with her GP, if she continues to see this.  Any idea what
> this could be?
>
> Thanks in advance,
> Doreen Vanderstoep RN, IBCLC
>
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