---------- > From: The Breastfeeding Center of Maine <[log in to unmask]> > To: LACTNET @LIBRARY.UMMED.EDU > Subject: NEUTROPENIA/CHRONIC BR. INFECTION - LONG > Date: Wednesday, February 17, 1999 8:20 PM > > 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