Dear Jack (and all other LACTNETers),

Please help me on a couple of points:

1) Wouldn't Multi-resistant Staph.. aureus be treated with one of the newer
synthetic drugs, many of which we hesitate to give even to adults? Even
chloramphenicol (not new) might be a problem, according to Tom Hale. I
would wonder what dose the mother was getting of which drug. If the
gestational age of the infant really was 35 weeks, does the birth weight of
8# 1 oz. cancel out the effect of an immature hepatic system? Would we also
want to know which antibiotic the baby was on, to know whether there was a
consideration of compounding dosages? Are we assuming that the infant is in
the NICU because of the risk of contracting/having MRSA or is it possible
that this baby is otherwise compromised?

2) I looked up S. aureus in Ruth Lawrence's 1994 edition and found that in
one study cited on page 262, it had been possible to culture S. aureus in
almost 50% of mastitis cases whereas only about 1% of samples from
uninfected mothers produced S. aureus in vitro. She also mentions on page
261 that  one portal of entry is through hematogenous spread. On the same
page , Ruth indicates that this kind of acute puerperal adenitis is
associated with an outbreak of skin infections in the infants. I wonder if
the infant was in the NICU because of such a rash. I guess we might wonder
whether the preterm infant gut with its relatively low acidity would be
able to "dispose" of the bacteria as well as a term or adult gut would be
able to.

3) If the consideration is one of infection through the milk, would the
hospital be equipped to pasteurize/sterilize the milk the way we would at a
milk bank? If the bacterial contamination is high, would there be an issue
of enzyme toxicity for the baby, depending on the infant's maturity? Does
pasteurization denature enzyme toxins like leukocidins, hemolysins,
coagulases, and staphylokinase?

4) Can anyone tell that I just finished a microbiology and pathology
course?

If I sound "uppity," I apologize. But I can empathize with practitioners
who might take a cautious approach. And it would be interesting to fill in
the missing details. I would love to hear the rationale directly from the
neonatologist. I hope I will not be drummed out of the corps for imagining
that we might have to add another situation to our short list of legitimate
reasons for pumping and dumping. Maybe a little knowledge is a dangerous
thing!

Thanking you in advance for you reply,

Bonny Nothern, BS, IBCLC