Dear Lucy,

MRSA stands for "Methicillin Resistant Staph Aureus" and is one
of those new resistant strains of bacteria that you are hearing so
much about lately.  It may be harbored in the upper respiratory or
GI tract by carriers who are often healthy themselves but able to
tranfer the organism to others.  If these "others" are in an already
comprised state due to disease, malnutrition, surgery, etc. then
they are at risk of developing a serious MRSA infection which could
even be fatal.

Hospital patients can pick up "nosocomial" (hospital-acquired)
infection from doctors, nurses or other staff who are carriers
themselves or are transferring the organism from one patient to
another.  Morbidity and mortality are much higher in patients who
develop MRSA infections.  In order to prevent the transfer of
organisms from known MRSA infected patients to others, patients
with a known infection are put into strict isolation - everyone
entering the room must glove, gown, and mask and then do
thorough hand-washing upon exiting.  Many times objects in the
room such as tables, floors, blood pressure cuffs may also be
contaminated and must be thoroughly decontaminated after the
patient is discharged.  The patients remain in isolation so long as
cultures for staph remain positive.

Newborns and premature babies, especially, are considered to be
in a compromised immune state and thus more susceptible to
infection from MRSA.  If the mother has an active infection, then it
is probable that the doctors would not allow direct contact with the
baby.  If pumped breastmilk cultures negative for MRSA, then it
would be very advantageous for the baby to at least receive the
pumped milk.  If the breastmilk cultures positive for MRSA, then it
becomes more problematic, especially in terms of a premature or
already sick baby.  Do the advantages of giving breastmilk
outweigh the risk of exposure to this organism?  The answer will
differ depending on individual circumstances. A robust newborn
who is nursing is probably not at great risk. A sick premie probably
is.  Perhaps the milk could be pasteurized and then given.  If the
amount of organisms present is rather low, then just leaving the
milk to set for a few hours may be enough to allow the natural
bacterial die-out that occurs in pumped milk for the first 6-8 hours
post-collection.

Another strategy could be for the mother to be gowned, gloved and
masked while feeding the baby, if the breast area has not cultured
positive for MRSA. However, the baby may also then have to be
placed in isolation as well to prevent possible transfer to other
babies in the nursery.   Certainly not an ideal situation, but better
than nothing.  If the baby is receiving breastmilk, directly or
pumped, he would presumably be receiving antibodies to the
MRSA which would certainly be desirable.

Another thing to be considered, is that they may not be able to
completely irradicate the MRSA from the mother's body.  Even
though the cultures may come up negative for a while, she may
revert to a carrier state at some time in the future and the baby
would then be exposed anyways.  Much better that the baby was
still breastfeeding at that point and not weaned due to the earlier
infection.  So at the very least, even if the mother is not allowed to
breastfeed or even give the baby her milk, she should continue
pumping to protect her milk supply for the future.

The irony is that there will be a certain percentage of moms in
every hospital who are undiagnosed carriers of MRSA and noone
will ever know.  They will nurse their babies and those babies will
do just fine.  It will be the diagnosed cases with problems that the
doctors will hear about and that will form the basis for their future
actions.   But isn't that so often the case for so many situations
that we deal with.



Warmly,
Sharon Knorr, BSMT, LLLL, IBCLC
Newark, NY (near Rochester) USA
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