Just a comment on resistant mastitis, and especially bilateral: in an
older Ruth Lawrence edition, it was mentioned that bilateral mastitis is
quite rare, and when it occurs it is often caused by Strep B. A nasal and
oro culture were recommended on baby, as this could be the first warning
of a possible infant problem. My LC mentor/co-leader knew this, but had
forgotten it temporarily when her sister had a second baby and presented
with bilateral mastitis in the third week. Baby developed a fever and some
malaise, was taken to the doctor, checked, and put on antibiotics.  Mom
was fingerfeeding because baby wasn't feeding well. That night, the fever
"broke", baby shut down, and then stopped breathing. After a day on life
support, baby died of meningitis due to GBS; mom's p.p. vaginal culture
turned out to be positive. My friend was in agony for a year, recalling
this info after the fact and wishing that she had flagged the bilateral
mastitis earlier and had her nephew cultured. It's hard to say whether
that would have saved the baby, but she felt responsible for a long time,
as did the NP/CLC who did the medical check up in the office.

I wanted to cite this reference and have discovered that it is no longer
in the current edition of Lawrence; does anyone know why? Was the
documentation shaky?  After my colleague's experience, I will always
respond to bilateral mastitis aggressively and recommend a culture of
both mother's milk and baby's nasal and oropharynx; why take chances?

Does anyone know more on this?

-Lisa

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Lisa A. Marasco, IBCLC                                /  [log in to unmask]
International Board Certified Lactation Consultant    /  [log in to unmask]

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