Barbara,
        Interesting info from Dr. Newton.  Are all the studies cited
about artificially induced mastitis?  Interesting that in the presence of
endotoxin there was a decreased milk flow secondary to decreased lactose
synthesis.  Lactose synthesis drives milk volume in humans as well.
        It was not surprising that the risk of developing mastitis was
larger in cows with higher milk production before exposure to the
etiologic agent.  I have seen a greater propensity for mastitis in
mothers with high milk supplies- twins, or moms who are overproducing.
Possibly the high metabolism of the mammary alveolar cells makes them
more vulnerable?   Mastitis in the non-lactating breast is extremely
rare.  That would be consistent with this theory.
        What is a pump if not "pulsatile"?  Continuous suction?  We have
all seen the breast/nipple damage that can occur when a mom improperly
uses those cheap pumps that require manually releasing suction and
exposes herself to prolonged negative pressure... There is some research
from Ameda/Egnell showing that nipples can take a greater amount of
pressure if it is applied for a very short period of time.  All the pumps
invented by Mr. Egnell (including one of the Medela pumps) were designed
with this in mind.  Could the non-pulsatile pump be causing nipple trauma
that was providing a point of entry to the pathogen?
        I thought the most interesting point was that free fatty acids
were increased in 'infected' milk.  Isn't there an immunologic function
of free fatty acids?  Autolysis would cause saponification, no?  Maybe we
should scrutinize the moms with soapy ebm for subclinical mastitis?
        Love this stuff...
--
Catherine Watson Genna, IBCLC  NYC  [log in to unmask]