Cross posting for a mom who needs information

[Guest guest]

Jaye, how about contacting Tom Hale via his Infantrisk.org center? In addition

to his Webforum, he has a forum for mothers called " Forums For Mothers With

Special Conditions " .

Fay Bosman, IBCLC

www.nwmothernurture.com

>

> I'm 21 years old and I'm 32 weeks pregnant. I'm concerned about my baby

> being exposed to MRSA through breastmilk.

>

> Jaye Simpson, IBCLC, CIIM

> Breastfeeding Network

> Sacramento, CA

> www.breastfeedingnetwork.net

[Guest guest]

Sometimes the local health departments require previously + MRSA patients to

have a screen when they do not have evidence of completing antibiotic regimen

and subsequent negative MRSA test documented in their medical record. A lot of

people never complete the full treatment for MRSA and only take a portion of

their antibiotic.

Jaye Yahoo rips off the tail of your e-mail address but you can look in Riordan,

Lawrence etc., she should be encouraged to breastfeed. The JHL archives also

have plenty of articles related to this topic.

My local HD requires contact precautions be used with any patient who has 'ever'

tested positive for MRSA.

I can't imagine why on earth she is getting all of this conflicting information,

that's so discouraging.

>

> Hi All,

>

>

>

> I have permission to post but I don't have the answers she needs at this

> time. I appreciate any and all help, references and resources you can

> provide me to help her. Please respond privately to

> Ibclc@...

>

>

>

> Thank you!

>

> Jaye Simpson, IBCLC

>

>

>

[Guest guest]

Hi, Jaye.

Lawrence & Lawrence new ed, © 2011, states:

"Breastfeeding is acceptable after 24 hours of therapy, during which milk must be discarded [Dee's note: assumes the MRSA is mastitis]. If infant becomes ill during evaluation and treatment of mother, infant should be treated for presumed MRSA infection, and breastmilk should be withheld until proven to be culture negative."

She could express some colostrum and ask to have it tested now. If it is negative, it ought to be fine for her to breastfeed when her baby is born.

Dee Kassing

Subject: Cross posting for a mom who needs informationTo: LACTNET@..., pplc , Date: Saturday, March 5, 2011, 11:26 PM

Hi All,

I have permission to post but I don’t have the answers she needs at this time. I appreciate any and all help, references and resources you can provide me to help her. Please respond privately to Ibclc@...

Thank you!

Jaye Simpson, IBCLC

I’m 21 years old and I’m 32 weeks pregnant. I’m concerned about my baby being exposed to MRSA through breastmilk.

In the beginning of 2010 last year, I was bitten by a spider on my 'foot' and it became infected by MRSA staph. I was treated at the hospital for about a week and I was sent home and soon my wound healed.

My Obstetrician just recently did a nasal swab on me to check on the status of my MRSA (results say its active). I’m confused as to what that means and why he would need to check anyway because I already know that I am a MRSA carrier. He tells me not to worry about it. I do not have any open wounds of 'ANY' sort on my body! He wants to schedule another appointment for a nasal swab when I get closer to delivery.

If I have no open wounds on my body, then why is it necessary for my doctor to check to see if my MRSA is active?

Can it lay dormant?

What is he checking for?

Is it safe to breastfeed my daughter when she is born?

Can MRSA be transmitted through breastmilk?

What if my nipples crack and bleed while I am breastfeeding... can my newborn get MRSA that way?

Please help me because I have asked several consultants and specialists and I have been given different answers. I only want to breastfeed but I don’t want my daughter to be a carrier of MRSA like me! I’m seeking expert advice.

Jaye Simpson, IBCLC, CIIM

Breastfeeding Network

Sacramento, CA

www.breastfeedingnetwork.net

[Guest guest]

I've never read to advise mothers who have previously tested positive for MRSA,

and have complied with treatement should have culture of their colostrum

prenatally, particularly with no symptoms of active infection? Can you share

further?

I also work in a hospital, we see hundreds of mothers who have formerly had MRSA

infections, who now present with no symptoms. We've never withheld

breastfeeding, nor cultured their milk. We would be performing this culture

hundreds of times a year? And prenatally?

Riordan concludes, " ...in summary MRSA infections are minimized when mother hold

and nurse their babies immediately after birth, start breastfeeding while still

in the delivery room. "

When you write that Lawrence describes breastfeeding as acceptable after 24

hours of therapy and discarding of the milk, this is in regards to a mother with

MRSA mastitis, yes? Not a mother who has no symptoms of MRSA, although she may

be colonized?

Just looking for clarification.

Thanks,

>

>

>

> Subject: Cross posting for a mom who needs information

> To: LACTNET@..., pplc ,

> Date: Saturday, March 5, 2011, 11:26 PM

>

>

[Guest guest]

This isn't specific to MRSA, but a general response I have to any and all mothers who have a medical condition or feel their milk could be hazardous in some way (smoking, etc).... I try to gently point out that in almost all cases, their baby is better off breastfeeding and try to get them out of the paradigm where formula and human milk are somehow equal choices.  It's easy for fall into the trap of " is it safe to breastfeed when.... " because we want to show that it's safe.  I find more clarity in considering how it could possibly benefit this baby to withhold it's mother's milk.  Exceedingly rare that it would.

 

I've never read to advise mothers who have previously tested positive for MRSA, and have complied with treatement should have culture of their colostrum prenatally, particularly with no symptoms of active infection? Can you share further?

I also work in a hospital, we see hundreds of mothers who have formerly had MRSA infections, who now present with no symptoms. We've never withheld breastfeeding, nor cultured their milk. We would be performing this culture hundreds of times a year? And prenatally?

Riordan concludes, " ...in summary MRSA infections are minimized when mother hold and nurse their babies immediately after birth, start breastfeeding while still in the delivery room. "

When you write that Lawrence describes breastfeeding as acceptable after 24 hours of therapy and discarding of the milk, this is in regards to a mother with MRSA mastitis, yes? Not a mother who has no symptoms of MRSA, although she may be colonized?

Just looking for clarification.

Thanks,

>

>

>

> Subject: Cross posting for a mom who needs information

> To: LACTNET@..., pplc ,

> Date: Saturday, March 5, 2011, 11:26 PM

>

>

[Guest guest]

I wrote what Lawrence lists in the table of precautions for infectious diseases. Then I *added* the idea of testing the colostrum. It's not that I think this is necessary. I don't. But I was trying to find a way where she might find information acceptable to the doctor who is telling her she can't breastfeed, that yes she can. Around here, you can't always change a doc's mind, even with information from very up-to-date texts! So giving some concrete proof that the milk is negative might be helpful *in this particular case*. Would never suggest it for every single mother who ever tested positive.

Dee Kassing

I've never read to advise mothers who have previously tested positive for MRSA, and have complied with treatement should have culture of their colostrum prenatally, particularly with no symptoms of active infection? Can you share further?I also work in a hospital, we see hundreds of mothers who have formerly had MRSA infections, who now present with no symptoms. We've never withheld breastfeeding, nor cultured their milk. We would be performing this culture hundreds of times a year? And prenatally?Riordan concludes," ...in summary MRSA infections are minimized when mother hold and nurse their babies immediately after birth, start breastfeeding while still in the delivery room."When you write that Lawrence describes breastfeeding as acceptable after 24 hours of therapy and discarding of the milk, this is in regards to a mother with MRSA mastitis, yes? Not a mother who has no symptoms of MRSA, although she may be

colonized?Just looking for clarification.Thanks,

[Guest guest]

This from Stanford University June 2010:

Mastitis/Breast Abscess Management

CA-MRSA increasingly more common in puerperal mastitis and

especially abscesses

Continue first line mastitis treatment in routine cases

Consider cultures if tx failure, recurrence, high prevalence, RF’s

Consider CA-MRSA therapy

– Recurrence, tx (beta lactam) failure, abscess, severe infection until

cultures obtained

– Local epidemiology

– Adjunct drainage or aspiration may be warranted

Treatment/Management for MRSA mastitis

– Continue breastfeeding/pumping

– TMP/SMX = first line (efficacy, cost, compliance)

– Clindamycin and Linezolid 2nd line alternatives

– I & D or aspiration/catheter drainage for abscess

Stafford 2008, Reddy 2007, Moazzez 2009

 

Here's the link:

http://www.ucsfcme.com/2010/slides/MOB10003/UpdatesIP.pdf (see page 28)

Sources listed were CDC; also UCSF. The concensus here appears to be that it is NOT something to NOT breastfeed for.

Marie