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> 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