>Dear Fellow Lactnetters;
>
>Today I found yet another case of a yeast infection---which I would
>gestimate to be found in about 97% of my private practice as an LC.  How
can
>the numbers be so high ? I live in southern New Brunswick,  its humid and
>warm this time of year,  but not that hot compared to Florida !
>
>Anyway,  back to this poor mom (second child, nursed first time for 6
months
>or longer without problems ): 4 weeks ago she delivered a 33 week premie
>female,  and has been pumping expressed milk for gavage feedings ( and a
few
>nursings at the breast as tolerated ) since then.  6 days ago,  nurses in
>the Neonatal unit discovered "Thrush" in the baby's mouth (or so they call
a
>few small white spots in baby's cheeks), and immediately sent off a sample
>of expressed milk ( that had been previously frozen ) to the lab for
>culture. 1st report said no growth,  then a day or so later another updated
>report came on this same specimen stating 'colonies of yeast' were growing
>in her breastmilk.  Baby was immediately treated with mycostatin by mouth,
>and mother was also told to seek treatment and used Dr. Newman's
>recommendation for the Gentian Violet.  [ I WAS NOT CONSULTED RE THIS UNTIL
>NOW ].  This mother has been completely asymptomatic of the Thrush. IS IT
>POSSIBLE FOR THE YEAST TO BE IN THE DUCTS IN ANY GREAT AMOUNT WHEN THE
>MOTHER PRESENTS AS THRUSH FREE ???  This really baffles me as to where the
>yeast is besides the baby's mouth has cleared following a brief treatment.
>Now the Neonatal staff feel this mother should be treated again for 3 more
>days and then she can start saving her milk again as she will be "cured".
>
>This knowledgable mother has been told by the hospital's LC to "THROW OUT"
>all of her frozen expressed milk [ 4 weeks supply---its alot ! ] collected
>to date and has not really been given a fair explanation.The nurses already
>had thrown out what frozen supply she had already brought to the Neonatal
>Unit against mother's wishes.  Needless to say,  she is very upset today.
I
>talked to her at great length today to obtain a more in-depth history of
>this case,  and suggested that she keep her frozen supply at home and just
>bring in her freshly expressed milk daily. I also advised her to have more
>of her expressed breastmilk sent for culture ASAP :  a few specimens back
>before the Thrush was diagnosed as well as another thawed specimen from
that
>same week of diagnosis,  as well as a manually expressed fresh "midstream"
>specimen of her milk sent immediately off to the lab following collection
> to avoid possible contamination of this specimen ];  and maybe even a swab
>could be sent from the outer areola / nipple for surface culture as well.
>Then,  if everything comes back with those "Yeastie Beasties" in them,  a
>better decision can be made.
>
> AM I BEING REASONABLE HERE ? I was shocked to hear that the milk was sent
>to be cultured as fast as it was,  as this is a true rarity around
>here---even the staff remarked about it. CAN THE DIAGNOSIS OF YEAST BE MADE
>SOLELY ON THIS BASIS ?
>
>I will continue to work with / support this mother to hopefully a
>satisfactory solution, and any advice,  suggestions,  references or
comments are welcome.

>I have looked into the archives:  unsuccessful search.
>
>Please e-mail me privately as well as lactnet---I am very behind in my
>reading.
>
>Thank You All !
>
>We all "know" that the nursing dyad must both be treated simutaneously,
>usually with the same course of treatment,  right ? Could they not have
>waited a little longer on starting treatment,  to see if the yeast might
>resolve on its own as a "self-limiting" infection ? Does any hospital do
any
>routine cultures on expressed breastmilk---what else do they find in it ?
>
>Sincerely ,
>
>Barbara A. Montague RN,  IBCLC
          e-mail address :
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>
>

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