Despite the significant advances that modern medicine has made in the treatment and prevention of infections, purulent mastitis continues to remain a pressing surgical problem. Long hospitalization periods, a high percentage of relapses and the associated need for repeated operations, cases of severe sepsis, and poor cosmetic results of treatment continue to accompany this common pathology.
ICD-10 code
N61 Inflammatory diseases of the breast
Causes of purulent mastitis
Lactation purulent mastitis occurs in 3.5-6.0% of women in labor. In more than half of women it occurs in the first three weeks after childbirth. Purulent mastitis is preceded by lactostasis. If the latter does not resolve within 3-5 days, then one of the clinical forms develops.
The bacteriological picture of lactation purulent mastitis has been studied quite well. In 93.3-95.0% of cases it is caused by Staphylococcus aureus, detected in monoculture.
Non-lactation purulent mastitis occurs 4 times less frequently than lactation mastitis. The reasons for its occurrence are:
- breast injury;
- acute purulent-inflammatory and allergic diseases skin and subcutaneous tissue of the mammary gland (furuncle, carbuncle, microbial eczema and etc.);
- fibrous- cystic mastopathy;
- benign breast tumors (fibroadenoma, intraductal papilloma, etc.);
- malignant neoplasms of the breast;
- implantation of foreign synthetic materials into gland tissue;
- specific infectious diseases of the mammary gland (actinomycosis, tuberculosis, syphilis, etc.).
The bacteriological picture of non-lactation purulent mastitis is more diverse. In approximately 20% of cases, bacteria of the Enterobacteriaceae family, P. aeruginosa, as well as non-clostridial anaerobic infection in association with Staphylococcus aureus or Enterobacteriaceae are detected.
Among the many classifications of acute purulent mastitis given in the literature, the widespread classification of N. N. Kanshin (1981) deserves the greatest attention.
I. Acute serous.
II. Acute infiltrative.
III. Abscessing purulent mastitis:
- Apostematous purulent mastitis:
- limited,
- diffuse.
- Breast abscess:
- solitary,
- multi-cavity.
- Mixed abscessing purulent mastitis.
Symptoms of purulent mastitis
Lactation purulent mastitis begins acutely. Usually it goes through the stages of serous and infiltrative forms. The mammary gland slightly increases in volume, and hyperemia of the skin above it appears, from barely noticeable to bright. Upon palpation, a sharply painful infiltrate without clear boundaries is determined, in the center of which a focus of softening can be detected. The woman’s well-being suffers significantly. Severe weakness, sleep disturbance, loss of appetite, increased body temperature to 38-40°C, and chills appear. A clinical blood test reveals leukocytosis with a neutrophilic shift, increase in ESR.
Non-lactation purulent mastitis has a more blurred clinical picture. At the initial stages, the picture is determined by the clinic of the underlying disease, which is accompanied by purulent inflammation of the breast tissue. Most often, non-lactation purulent mastitis occurs as a subareolar abscess.
Diagnosis of purulent mastitis
Purulent mastitis is diagnosed based on typical symptoms inflammatory process and does not cause any difficulties. If there is doubt about the diagnosis, puncture of the mammary gland with a thick needle provides significant assistance, which reveals the location, depth of purulent destruction, the nature and amount of exudate.
In the most difficult cases for diagnosis (for example, apostematous purulent mastitis), ultrasound of the mammary gland allows us to clarify the stage of the inflammatory process and the presence of abscess formation. During the study, in the destructive form, a decrease in the echogenicity of the gland tissue is determined with the formation of zones of hypoechogenicity in places where purulent contents accumulate, expansion of the milk ducts, and tissue infiltration. For non-lactational purulent mastitis Ultrasound helps identify breast tumors and other pathologies.
Treatment of purulent mastitis
The choice of surgical approach depends on the location and volume of affected tissue. For subareolar and central intramammary purulent mastitis, a paraareolar incision is performed. On a small mammary gland, from the same access it is possible to perform a CHO, occupying no more than two quadrants. In the surgical treatment of purulent mastitis extending to 1-2 upper or medial quadrants, with the intramammary form of the upper quadrants, a radial incision is made according to Angerer. Access to the lateral quadrants of the mammary gland is made through the external transitional fold according to Mostkovoy. When the focus of inflammation is localized in the lower quadrants, with retromammary and total purulent mastitis, an incision is made into the mammary gland using a Henning approach, in addition to an unsatisfactory cosmetic result, the development of Bardengeuer mammoptosis, which runs along the lower transitional fold of the mammary gland, is possible. The Gennig and Rovninsky approaches are not cosmetic, they do not have any advantages over those mentioned above, and therefore are practically not used at present.
The surgical treatment of purulent mastitis is based on the CHOGO principle. The extent of excision of affected breast tissue is still decided ambiguously by many surgeons. To prevent deformation and disfigurement of the mammary gland, some authors prefer gentle treatment methods, which consist of opening and draining a purulent focus from a small incision with minimal necrectomy or without it at all. Others, often noting with such tactics the long-term persistence of intoxication symptoms, the high need for repeated operations, cases of sepsis associated with insufficient removal of affected tissue and progression of the process, in our opinion, are rightly inclined in favor of radical COGO.
Excision of non-viable and infiltrated breast tissue is carried out within healthy tissue, before capillary bleeding appears. In case of non-lactation purulent mastitis against the background of fibrocystic mastopathy, fibroadenomas, an intervention is performed using the type of sectoral resection. In all cases of purulent mastitis, it is necessary to carry out a histological examination of the removed tissues to exclude malignant neoplasm and other breast diseases.
The issue of using a primary or primary-delayed suture after radical COGO with drainage and flow-aspiration washing of the wound in the abscess form is widely discussed in the literature. Noting the advantages of this method and the associated reduction in the duration of hospital treatment, one should still note the rather high frequency of wound suppuration, the statistics of which are largely ignored in the literature. According to A.P. Chadayev (2002), the frequency of wound suppuration after the application of a primary suture in a clinic aimed at treating purulent mastitis is at least 8.6%. Despite the small percentage of suppurations, it should still be considered safer for widespread clinical use. open method wound management followed by the application of a primary delayed or secondary suture. This is due to the fact that clinically it is not always possible to adequately assess the extent of tissue damage by the purulent-inflammatory process and, therefore, carry out a complete necrectomy. The inevitable formation of secondary necrosis and high contamination of the wound with pathogenic microorganisms increase the risk of relapse purulent inflammation after applying the primary suture. The extensive residual cavity formed after radical CHO is difficult to eliminate. The accumulated exudate or hematoma leads to frequent suppuration of the wound even in conditions of seemingly adequate drainage. Despite the healing of the breast wound by primary intention, the cosmetic result after surgery when using a primary suture usually leaves much to be desired.
Most clinicians adhere to a two-stage treatment strategy for purulent mastitis. At the first stage, we carry out radical COGO. We treat the wound openly using water-soluble ointments, iodophor solutions or draining sorbents. In cases of SIRS and extensive damage to the mammary gland, we prescribe antibacterial therapy (oxacillin 1.0 g 4 times a day intramuscularly or cefazolin 2.0 g 3 times intramuscularly). For non-lactation purulent mastitis, empirical antibacterial therapy includes cefazolin + metronidazole or lincomycin (clindamycin), or amoxiclav in monotherapy.
During postoperative treatment, the surgeon has the opportunity to control the wound process, directing it in the right direction. Over time, inflammatory changes in the wound area are steadily stopped, its contamination with microflora is reduced below a critical level, the cavity is partially filled with granulations.
At the second stage, after 5-10 days, we perform skin grafting of the breast wound using local tissue. Considering that more than 80% of patients with purulent mastitis are women under 40 years of age, we consider the restorative treatment stage to be extremely important and necessary to obtain good cosmetic results.
We perform skin grafting according to the J. Zoltan method. The edges of the skin, walls and bottom of the wound are excised, giving it, if possible, a wedge-shaped shape that is convenient for suturing. The wound is drained with a thin through perforated drainage brought out through counter-apertures. The residual cavity is eliminated by applying deep sutures of absorbable thread on an atraumatic needle. An intradermal suture is placed on the skin. The drainage is connected to a pneumatic aspirator. There is no need for constant washing of the wound with two-stage treatment tactics; only aspiration of the wound discharge is carried out. The drainage is usually removed on the 3rd day. With lactorrhea, the drainage may remain in the wound for a longer period. The intradermal suture is removed after 8-10 days.
Performing skin grafting after the purulent process has subsided can reduce the number of complications to 4.0%. At the same time, the degree of deformation of the mammary gland decreases and the cosmetic result of the intervention increases.
Usually the purulent-inflammatory process affects one mammary gland. Bilateral lactation purulent mastitis is quite rare, occurring in only 6% of cases.
In some cases, when as a result of purulent mastitis there is a flat wound of the mammary gland of small size, it is sutured tightly, without the use of drainage.
Treatment of severe forms of purulent non-lactational purulent mastitis, occurring with the participation of anaerobic flora, especially in patients with a complicated medical history, presents significant difficulties. The development of sepsis against the background of an extensive purulent-necrotic focus leads to high mortality.
But this opinion is erroneous, since it can appear in women who have never given birth to children, as well as in men and even in newborn babies.
What is mastitis (ICD code 10), what it is like and what are the reasons for the development of the disease - let's talk about it.
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Signs
This disease is characterized by inflammation of one, and in some cases both, mammary glands.
In this case, the person experiences pain, the breast becomes heterogeneous, lumps appear in it, it becomes rough, the skin turns red, body temperature rises, and sometimes unusual discharge (pus) appears.
When the first signs of this disease appear, you should consult a specialist, especially if we are talking about a nursing mother .
It is important to know: You cannot continue breastfeeding if you have a purulent form of mastitis, as this can harm the health of the newborn baby.
Based clinical course The disease mastitis can be:
- Acute is a form of the disease in which the inflammatory process affects the breast tissue. In most cases, it affects women who have become mothers for the first time, whose children are breastfed;
- Chronic is a form of disease observed over a long period of time, and sometimes throughout life. One of its varieties is plasmacytic mastitis, which occurs mainly in older women.
Causes of lactation mastitis:
- Insufficient expression of milk, resulting in stagnation. You can fight it with careful hand expression or a breast pump. Otherwise, such stagnation can lead to the formation of mastitis;
- Damage to the mammary glands by infections through wounds and cracks that arise as a result of improper attachment of the child to the breast. A striking example Staphylococcus aureus serves.
Doctor's comment: various diseases of the thyroid gland, hypertension also contribute to the development of mastitis.
Causes of non-lactation mastitis:
- Damage to the mammary glands by infection;
- Poor health in adults or the perinatal period in newborns.
What is the main purpose of classification
There is an international classification of absolutely all diseases, the main purpose of which is to assign a class and code to each specific human condition.
Knowing him, another doctor, scientist or relative can find out what kind of disease the patient has and draw appropriate conclusions about his health. This document is periodically updated, supplemented and each time given a revision number.
The number 10 is the number of the latest revision, and this is what specialists should be guided by in their practice.
Disease code
Breast diseases are characterized by a disease class from N60 - N64, mastitis corresponds to N 61. Next comes a block of codes from 085 to 092, which describes the main complications that arose after standard childbirth.
In accordance with the International Classification of Diseases, 10th revision (ICD 10), mastitis corresponds to the following codes 091-092:
- Mastitis, the appearance of which is caused by the birth of a child – 091;
- Purulent – 091.1;
- Non-purulent – 091.2.
- The causes of the disease can be determined by the following code:
- Wound or crack of the nipple – 092.1;
- Violation of an unspecified nature 092.2;
- Disorders resulting in initially little or no milk 092.3;
- Decreased breast milk production 092.4;
- The absence of milk or its production in insufficient quantities after normal feeding is sometimes associated with the mother’s health 092.5;
- Disorders associated with excess milk production, and sometimes the development of lactostasis. Codes 092.6 and 092.7 respectively.
Disease code in children
The block of codes P00-P96 characterizes the condition of newborn children. Mastitis in newborns is classified by code P39.0.
Occurs in infants as a result higher level hormones passed to them with the mother's blood. Treatment in in this case is not required, since the disease goes away within a few weeks from the moment the child is born without the intervention of specialists.
Take note: a child who has been diagnosed with this disease is the most vulnerable, so it is necessary to make special demands on the cleanliness of the house, as well as ensure compliance with hygiene rules for all family members.
Using the codes of this classification of diseases, doctors summarize information from all over the world about the number of sick people, the most effective ways and methods of providing care, as well as an analysis of the patient’s condition.
Watch the following video about the features of a disease such as mastitis:
MASTITIS honey.
Mastitis is inflammation of the mammary gland. Predominant age
Neonatal mastitis occurs in the first days of life as a result of infection of hyperplastic glandular elements
Postpartum mastitis - during breastfeeding
Periductal mastitis (plasmacytic) - more often during menopause.
Predominant gender
Mostly women are affected
Juvenile mastitis occurs in adolescents of both sexes during puberty.
Classification
With the flowAcute: serous, purulent (phlegmonous, gangrenous, abscessing: subareolar, intramammary, retromammary)
Chronic: purulent, non-purulent
By localization - intracanalicular (galactophoritis), periductal (plasmacytic), infiltrative, diffuse.
Etiology
Lactation (see)Carcinomatous
Bacterial (streptococci, staphylococci, pneumococci, gonococci, often combined with other coccal flora, Escherichia coli, Proteus).
Risk factors
Lactation period: impaired outflow of milk through the milk ducts, cracks in the nipples and areola, improper care of the nipples, violations of personal hygienePurulent skin diseases of the breast
Mammary cancer
Diabetes
Rheumatoid arthritis
Silicone/paraffin breast implants
Taking glucocorticoids
Removal of a breast tumor followed by radiotherapy
Long history of smoking.
Pathomorphology
Squamous metaplasia of the mammary ductal epitheliumIntraductal epithelial hyperplasia
Fat necrosis
Dilation of the mammary gland ducts.
Clinical picture
Acute serous mastitis (may progress with the development of purulent mastitis)Sudden onset
Fever (up to 39-40 °C)
Severe pain in the mammary gland
The gland is enlarged in size, tense, the skin over the lesion is hyperemic, upon palpation there is a painful infiltrate with unclear boundaries
Lymphangiitis, regional lymphadenitis.
Acute purulent phlegmonous mastitis
Severe general condition, fever
The mammary gland is sharply enlarged, painful, pasty, the infiltrate without sharp boundaries occupies almost the entire gland, the skin over the infiltrate is hyperemic and has a bluish tint
Lymphangitis.
Acute purulent abscess mastitis
Fever, chills
Gland pain
Breast: redness of the skin over the lesion, retraction of the nipple and skin of the mammary gland, sharp pain on palpation, softening of the infiltrate with the formation of an abscess
Regional lymphadenitis.
Laboratory research
Leukocytosis, increased ESRA bacteriological study is necessary to determine the sensitivity of microorganisms to antibiotics.
Special studies
UltrasoundMammography (it is impossible to completely rule out breast cancer)
Thermal imaging research
Breast biopsy.
Differential diagnosis
Carcinoma (inflammatory stage)Infiltrative breast cancer
Tuberculosis (may be associated with HIV infection)
Actinomycosis
Sarcoid
Syphilis
Hydatid cyst
Sebaceous gland cyst.
Treatment:
Conservative therapyIsolation of mother and child from other mothers and newborns
Stopping breastfeeding with the development of purulent mastitis
Breast suspensory bandage
Dry heat on the affected mammary gland
Expressing milk from the affected gland to reduce engorgement
If expressing is not possible, bromocriptine is prescribed to suppress lactation, 0.005 g 2 times a day for 4-8 days.
Antimicrobial therapy: erythromycin 250-500 mg 4 times a day, cephalexin 500 mg 2 times a day, cefaclor 250 mg 3 times a day, amoxicillin-clavulanate (Augmentin) 250 mg 3 times a day, clindamycin 300 mg 3 times /day (if anaerobic microflora is suspected)
NSAIDs
Retromammary novocaine blockade.
Surgery
Ultrasound-guided aspiration of contentsOpening and draining the abscess with careful separation of all bridges
Operating incisions
With a subareolar abscess - along the edge of the areola
Intramammary abscess - radial
Retromammary - along the submammary fold
If the abscess is small, it is possible to excise it with adjacent inflammatory tissues using the type of sectoral resection with active drainage of the wound with a double-lumen tube and tightly sutured
Opening of all fistula tracts
As the process progresses, the gland is removed (mastectomy).
Complications
Fistula formationSepsis
Subpectoral phlegmon.
Course and prognosis are favorable
Full recovery occurs within 8-10 days with adequate drainage
After operations, scars remain, disfiguring and deforming the mammary gland.
Prevention
Careful breast careMaintaining feeding hygiene
Using emollient creams
Expressing milk.
Synonyms
Mastitissee also
ICD
N61 Inflammatory diseases of the breastDirectory of diseases. 2012 .
Synonyms:See what "MASTITIS" is in other dictionaries:
Mastitis- ICD 10 N61.61. ICD 9 611.0611.0 DiseasesDB ... Wikipedia
MASTITIS- (breast) inflammation of the mammary gland. Mastitis usually occurs as a result of penetration (through nipple cracks) of pyogenic microbes into the mammary gland. Most often it occurs in lactating women and pregnant women. When mastitis suddenly increases... ... Concise Encyclopedia of Housekeeping
mastitis- infant Dictionary of Russian synonyms. mastitis n. baby Dictionary of Russian synonyms. Context 5.0 Informatics. 2012. mastitis… Synonym dictionary
MASTITIS- MASTITIS, breast, mastitis, mammitis, mas tadenitis (from the Greek mastos female breast), inflammation mammary gland. There are acute and chronic. inflammatory processes. Acute inflammation of the mammary gland can occur at all periods of life, but more often... ... Great Medical Encyclopedia
mastitis- a, m. mastite mastos breast, nipple. Inflammation of the mammary gland. Krysin 1998. Lex. Michelson 1866: mastitis; BAS 1: suit/t... Historical Dictionary Gallicisms of the Russian language
mastitis- MASTITIS, decomposed. reduction breast... Dictionary-thesaurus of synonyms of Russian speech
MASTITIS- (from the Greek mastos nipple breast) (breast), inflammatory disease of the mammary gland in humans and animals, usually as a result of infection through cracks in the nipples; Occurs more often in the postpartum period... Big Encyclopedic Dictionary
MASTITIS- MASTITIS, ah, husband. Inflammation of the mammary gland. | adj. mastitis, oh, oh. Ozhegov's explanatory dictionary. S.I. Ozhegov, N.Yu. Shvedova. 1949 1992 … Ozhegov's Explanatory Dictionary
Mastitis- (from the Greek mastos nipple, breast) (breast), inflammatory disease of the mammary gland in humans and animals, usually as a result of infection through cracks in the nipples; occurs more often in the postpartum period. ... Illustrated Encyclopedic Dictionary
Mastitis- I Mastitis (mastitis; Greek mastos breast + itis; synonym breast) inflammation of the parenchyma and interstitial tissue of the mammary gland. There are acute and chronic mastitis. Depending on the functional state mammary gland (Mammary gland) (presence ... Medical encyclopedia
MASTITIS- (breast), acute or chronic inflammation mammary gland, usually associated with its infection during lactation. MASTITIS IN HUMANS Mastitis, as a rule, occurs in women, although cystic mastopathy is occasionally observed in men. Spicy… … Collier's Encyclopedia
Books
- Acute purulent lactation mastitis, A. P. Chadayev, A. A. Zverev. The book covers the etiology and pathogenesis, clinical picture, prevention and treatment of acute purulent lactation mastitis, as well as the principles of surgical treatment depending on the various forms...
Depending on genesis:
1. Lactation (postpartum).
2. Non-lactational.
Depending on the course of the inflammatory process:
1. Spicy.
2. Chronic.
According to the nature of the inflammatory process:
1. Non-purulent:
Serous;
Infiltrative;
2. Purulent:
Abscess;
Infiltrative-abscessing;
Phlegmonous;
Gangrenous;
Depending on the side of the lesion:
1. Left-handed.
2. Right-handed.
3. Double-sided.
Depending on the location of the abscess in the gland:
1. Subtotal.
2. Subcutaneous.
3. Inbramammary.
4. Retromammary.
According to the prevalence of the process:
1. Limited (1 quadrant of the gland).
2. Diffuse (2-3 quadrants of the gland).
3. Total (4 quadrants of the gland).
Main etiological factors:
1. Microtrauma of the nipples of the mammary gland (cracks and excoriation of the nipples, damage to the skin of the gland; develops especially often in nursing first-time mothers);
2. Lactostasis – stagnation of milk in the mammary gland:
1) Objective reasons:
Stiff or cracked nipples;
Mastopathy;
Scarring of breast tissue after injuries and operations;
Thin, long and convoluted milk ducts;
Other congenital and acquired changes in the mammary gland that interfere with the outflow of milk;
2) Subjective reasons:
Non-compliance with breastfeeding;
Insufficient or irregular expression of milk after breastfeeding, violation of pumping technique.
Infection in the mammary gland can penetrate endogenously or exogenously; much more often it is exogenous. The entry gates are nipple cracks (50%), abrasions, nipple eczema, and small wounds that occur during breastfeeding. At this time, there is no consensus on the direct source of infection, but it is believed that most often the source of infection is the newborn, who transmits the infection to the mother during breastfeeding. Endogenous infections most often penetrate lymphogenous route, but sometimes galactogenic and hematogenous.
In 85% of cases, mastitis is preceded by lactostasis. In most patients, its duration does not exceed 3-4 days. The combination of lactostasis and contamination with pyogenic microflora is the main cause of the occurrence and progression of mastitis, and lactostasis becomes a “trigger mechanism”.
With incomplete expression, a significant amount of microbial bodies remain in the ducts, causing lactic acid fermentation, milk coagulation and damage to the epithelium of the milk ducts. Curdled milk obstructs the milk ducts, causing lactostasis.
The amount of microflora that continues to develop in a confined space reaches a “critical level” and inflammation occurs. In parallel with lactostasis, the venous outflow of blood and lymph is disrupted. The swelling of the interstitial tissue increases, compresses the ducts of neighboring lobes of the gland, which leads to the progression of lactostasis and the inflammatory process.
In 15% of patients with purulent mastitis, nipple cracks occur, which arise due to a discrepancy between excessive negative pressure in the child’s oral cavity and the elasticity and extensibility of the nipple tissue. New formation and progression of nipple cracks are caused by: frequent and prolonged contact of the nipple with a bra wet from milk, which causes irritation and maceration of the skin; stiffness and insufficient erection of the nipples; failure to adhere to precise feeding times. As a result of the above, the function of the mammary gland is impaired; women are forced to give up breastfeeding and careful pumping. Therefore, in order to prevent mastitis, it is necessary to maintain a certain rhythm of feeding and pumping.
The development of lactational mastitis is also influenced by: toxicosis of the first or second half of pregnancy, anemia, nephropathy, threats of miscarriage or premature birth.
A certain role in the pathogenesis of LM is played by sensitization of the body to various drugs, staphylococcus; autoimmune reactions to organ-specific antigens (milk and breast tissue). Disturbances in the kallikrein-kinin system of the body play a certain role in the development and course of LM.
Staphylococcus aureus plays the main role in the development of mastitis, which in 97% of cases is cultured from pus and milk. These strains are characterized by pronounced pathogenicity and resistance to many antibacterial drugs, and the components of Staphylococcus aureus, such as protein A and teichoic acid, have a significant immunosuppressive effect. In other cases, mastitis can be caused by Staphylococcus epidermidis, Escherichia coli, Streptococcus, Enterococcus, Proteus and Pseudomonas aeruginosa.
There is a risk group for developing LM, which includes women with the following pathology:
Having a history of purulent-septic diseases;
Suffering from mastopathy;
With abnormal development of the mammary glands and nipples;
Those who have had trauma to the mammary gland or surgery on it;
Prone to the formation of cracks in the skin and mucous membranes;
Having a pathological premenstrual syndrome, accompanied by diffuse enlargement and tenderness of the mammary glands in the II phase of the menstrual cycle;
With weak labor, those receiving oxytacin or prostaglandins (in this category, milk comes late and in large quantities);
With the pathology of pregnancy, childbirth and the immediate postpartum period.
The following factors also influence the development of LM:
1. Reduced immunological reactivity of the body. Foods poor in proteins and carbohydrates reduce the body's resistance to infectious diseases. A pregnant woman's daily diet should include approximately 60-70% animal proteins. To increase immunological activity, it is necessary to take vitamins A, C, and group B. Pregnant and nursing mothers need good vacation and walks on fresh air(2-3 hours a day, including before bedtime), sleep - at least 10 hours a day. Smoking and drinking alcohol are incompatible with pregnancy and the postpartum period. It is necessary to create a favorable environment for the psycho-emotional mood of a woman (pregnant, lactating), which also affects the condition immune system.
2. Lack of personal hygiene. Pregnant and lactating women should take at least twice a day (morning and evening) warm shower and change your underwear. The mammary glands need special care. During pregnancy, it is necessary to additionally wash them with water at room temperature, followed by rubbing with a clean terry towel. This helps to harden and increase the resistance of the nipples to mechanical damage problems that may occur when feeding a child. From the second half of pregnancy and in the postpartum period, daily 15-20 minute air baths for the mammary glands are useful: in the summer - in direct sunlight near an open window, in the winter - in combination with small doses of ultraviolet radiation.
3. Excessive negative pressure created in the child’s oral cavity during feeding is the main cause of cracked nipples of the mammary glands. To prevent this complication, it is recommended to periodically gently squeeze the cheek areas of the newborn’s mouth with two fingers in time with the baby’s sucking movements. You should carefully follow the feeding technique and do not hold the baby at the breast for a long time. If the baby sucks sluggishly and slowly, it is advisable to take short breaks. After feeding, the mammary glands should be washed with warm water without soap, dried with a clean soft towel and left open for 10-15 minutes. Between the bra and the areola of the gland, it is necessary to place a sterile gauze napkin (or a folded piece of sterile bandage), which is changed when soaked in milk. When caring for the mammary glands and skin of other parts of the body, you should not use lotions, creams and other products that have a scent.
4. Formation of nipple cracks during feeding. For successful treatment cracks, you must first of all temporarily stop breastfeeding, make sure that there is no prolonged contact of milk with the crack. The milk is expressed by hand into a sterile container, the baby is fed from a bottle through a nipple, in which a small hole is made with a sewing needle heated over a fire. If the hole is made large, the baby may refuse to take the breast in the future. When treating cracked nipples, use sea buckthorn or rosehip oil, solcoseryl ointment (apply to a sterile gauze pad and apply to the affected area).
Prevention of lactostasis.
The following measures include the prevention of lactostasis:
1. The following are subject to special medical supervision:
All primiparous;
Women with pathologies of pregnancy or childbirth;
Women with anatomical changes in the mammary glands.
2. Do not use tight bandaging of the mammary glands, which is used to stop lactation. (tight bandaging is extremely dangerous, since milk production continues for some time and lactostasis always occurs, and poor circulation in the mammary gland leads to the development of severe purulent forms mastitis).
3. Wear a bra made of cotton or cotton fabric (synthetic underwear irritates the nipples and can lead to cracking). The bra should provide good support, but not squeeze the mammary gland. It must be washed daily (separately from other linen) and worn after ironing with a hot iron.
4. Take into account physiological mechanisms stimulating milk secretion. Early attachment of a newborn to the breast (in the first 30 minutes after birth) activates the release of prolactin into the blood and stimulates milk production.
It is possible to use a circular shower on the mammary gland 20 minutes before feeding.
Follow the correct technology for expressing milk (the manual method is most effective in preventing lactostasis). Particular attention should be paid to expressing milk from the outer quadrants of the gland, where lactostasis and purulent inflammation most often occur.
Differences in the course of the inflammatory process during mastitis from that during acute purulent surgical infection of another localization.
Differences in the course of the inflammatory process during mastitis from that during acute purulent surgical infection of another localization are associated with a postpartum increase in functional activity and characteristics anatomical structure glands.
Features of the anatomical structure of the mammary gland:
Lobular structure;
A large number of natural cavities (alveoli and sinuses);
Wide network of dairy and lymphatic ducts;
Abundance of fatty tissue.
Brief anatomical characteristics of the mammary gland (according to M.G.Prives).
Mammary glands, mammae (Greek mastos) are characteristic devices for feeding newborns in mammals. Mammary glands are derivatives of sweat glands. Their number depends mainly on the number of cubs born. Monkeys and humans have one pair of glands located on the chest, hence they are also called mammary glands. In men, the mammary gland remains in a rudimentary form for the rest of their lives, but in women, from the beginning of puberty, it increases in size. The mammary gland reaches its greatest development towards the end of pregnancy, although lactation occurs already in the postpartum period.
The mammary gland is placed on the fascia of the pectoralis major muscle, to which it is connected by loose connective tissue that determines its mobility. With its base, the gland extends from the III to VI ribs, reaching medially to the edge of the sternum. Somewhat downwards from the middle of the gland, on its anterior surface there is a nipple (papilla mammae), the top of which is pitted with milky passages opening on it and is surrounded by a pigmented area of skin, the areola mammae. The skin of the isola is tuberous due to the large glands embedded in it, between which lie large sebaceous glands. In the skin of the areola and nipple there are numerous smooth muscle fibers, which partly run circularly, partly longitudinally along the nipple; the latter tenses up when they contract, which alleviates the condition.
The glandular body itself consists of 15-20 lobi glandule mammarial, which converge radially with their apices to the nipple. The mammary gland, by its type of structure, belongs to the complex alveolar-tubular glands. All excretory ducts of one large lobule (lobus) are connected into the milky passage (duktus lactiferus), which is directed to the nipple and ends at its apex with a small funnel-shaped opening.
Arterial blood supply(according to V.N. Shevkunenko) is carried out from the external mammary artery, which is a branch of the axillary artery, as well as intercostal arteries from the third to the sixth, the internal mammary artery, a branch of the subclavian artery. It gives branches to the gland in the third, fourth, fifth intercostal spaces.
Vienna partly they accompany the named arteries, partly they go under the skin, forming a network with wide loops, which is partly visible through the skin in the form of blue veins.
Lymphatic vessels are of great practical interest due to the frequent incidence of breast cancer, the transfer of which occurs through these vessels.
Brief topographical and anatomical characteristics of the lymphatic system of the mammary gland (according to V.N. Shevkunenko and B.N. Uskov).
Lymphatic system The mammary gland consists of two sections: superficial and deep.
From the lateral parts of the gland, lymph flows through 2-3 large lymphatic vessels passing through the pectoralis major muscle, partially along its lower edge, and flowing into the axillary lymph nodes. These vessels represent the main pathways for the drainage of lymph from the mammary gland.
At the level of the third rib, these vessels often have a break in the form of one or more lymph nodes lying under the edge of the pectoralis major muscle. Cancer metastases most often occur in these nodes.
There are additional pathways for lymph drainage from the mammary gland. Thus, part of the lymphatic vessels is directed through the thickness of the pectoralis major muscle to the deep axillary nodes located under the pectoralis minor muscle. Some of the lymphatic vessels from the upper parts of the gland are directed, bypassing the subclavian region, to the supraclavicular region and further to the neck.
Lymphatic vessels from the internal parts of the mammary glands are directed to nodes located behind the sternum along the internal mammary artery. From here, the passage of cancer cells into the lymphatic pathways of the pleura and mediastinum is possible. Superficial lymphatic vessels Both mammary glands along their inner edges are widely anastomosed with each other, as a result of which cross metastases are possible.
Pathways of outflow from the mammary gland to the regional lymph nodes (according to B.N. Uskov):
· axillary nodes;
· pectoral nodes of the pectoralis major and minor muscles;
· thoracic nodes of the sternum;
· subclavian nodes;
· deep cervical nodes;
· supraclavicular nodes.
In acute mastitis, two stages of the inflammatory process are distinguished: non-purulent (serous and infiltrative forms) and purulent (abscess, infiltrative-abscess, phlegmonous and gangrenous forms).
The acute inflammatory process begins with the accumulation of serous exudate in the intercellular spaces and leukocyte infiltration. At this stage the process is still reversible. However, the inflammation is poorly limited and tends to spread to adjacent areas of the mammary gland. LM from serous and infiltrative forms quickly turns into purulent forms with simultaneous damage to new areas of gland tissue. The purulent inflammatory process is often intramammary, involving two or more quadrants of the gland, often protracted with frequent relapses. Among purulent forms, infiltrative-abscessing and phlegmonous forms are more common.
In 10% of cases, LM has an erased (latent) course, which is caused by long-term antibiotic therapy for abscess or infiltrative-abscess forms.
In some cases, gangrene of the mammary gland develops as a local manifestation of the body’s autosensitization to organ-specific antigens (milk and inflamed gland tissue). Then the inflammatory process is especially malignant, with extensive skin necrosis and rapid spread to the cellular spaces chest.
Purulent mastitis always accompanied by regional lymphadenitis.
Clinical picture acute purulent mastitis(LM) depends on the form of the inflammatory process. The following forms are distinguished: 1) serous (initial); 2) infiltrative; 3) abscess; 4) infiltrative-abscessing; 5) phlegmonous; 6) gangrenous.
Serous(initial) form is widespread in surgical practice. This form is characterized by the formation of inflammatory exudate without any focal changes in the tissues of the gland. The disease begins acutely with the appearance of pain, a feeling of heaviness in the mammary gland, chills, and an increase in body temperature to 38°C and above. Objectively: the gland is increased in volume, slight hyperemia of the skin appears in the area of inflammation. Palpation in the area of hyperemia is painful. The amount of expressed milk is reduced. There is moderate leukocytosis in the blood and increased ESR. On the microscopic specimen, accumulations of leukocytes are visible around the blood vessels. With a favorable course of the disease, the serous form can become abortive; with inadequate and ineffective treatment, this form progresses with the development of the following phases and complications.
Infiltrative the form of mastitis is a continuation of the first and may be its brief manifestation. Usually proceeds in an aseptic manner, and with inadequate treatment it develops into various purulent complications. With this form, patients present the same complaints as with the serous one, the above symptoms persist, but a painful infiltrate without clear boundaries, areas of softening and fluctuation is determined in the tissues of the gland. High body temperature and chills in both serous and infiltrative forms are caused by lactostasis, in which milk, which has a pyrogenic effect, is absorbed into the blood through damaged milk ducts. When desensitizing therapy is carried out and lactostasis is relieved, in most patients the temperature drops to 37.5°C. In the absence of treatment and inadequate therapy, serous and infiltrative forms of mastitis turn into purulent after 3-4 days.
Abscess the form is characterized by the appearance of a focus of softening and melting with the formation of a delimited purulent cavity. With this form, the well-being of patients worsens, general and local symptoms become more pronounced, and intoxication increases; body temperature above 38°C; swelling and hyperemia of the skin of the mammary gland increases. Objectively: a sharply painful infiltrate (abscess) is palpated in the mammary gland, delimited by a pyogenic capsule; in 50% of patients – occupies more than one quadrant; in 60% - the abscess is located inframammary, less often - subareolar or subcutaneous; 99% have a positive symptom of fluctuation; often in the center of the infiltrate there is an area of softening.
Infiltrative - abscessing The form of mastitis is more severe than the abscess form. Characterized by: an increase in body temperature to 38°C and above, severe hyperemia, swelling, independent and palpable pain; in the tissues of the gland, a dense infiltrate is determined, consisting of many small abscesses of various sizes, like a “honeycomb” (therefore, the fluctuation symptom is positive in 5% of cases). In 50%, the infiltrate occupies no more than two quadrants of the gland and is located intramammary.
Phlegmonous the form is characterized by a deterioration in general condition and pronounced signs of intoxication. Pain in the mammary gland intensifies, weakness increases, appetite decreases, skin becomes pale, body temperature ranges from 38°C (in 80% of patients) and more than 39°C (in 20%). Objectively: the mammary gland is sharply increased in volume, swollen, severe hyperemia of the skin, in places with a cyanotic tint; the nipple is often retracted. On palpation, the gland is tense, sharply painful, the tissues are pasty, in 70% of patients the symptom of fluctuation is positive. In 60% of patients, 3-4 quadrants are immediately involved in the inflammatory process. In a clinical blood test: the number of leukocytes is increased, blood hemoglobin is decreased, the blood formula shifts to the left. A clinical urine test reveals albuminuria and the presence of granular casts.
At gangrenous In this form, the condition of the patients is defined as extremely severe; there is extensive necrosis of the skin and underlying tissues. This form is more often observed in patients who seek medical help late. The purulent process occurs with rapid tissue melting and spread to the cellular spaces of the chest and is accompanied by a pronounced systemic inflammatory reaction. Most patients have a temperature above 39°C. General and local symptoms of the disease are pronounced, fluctuation is detected in 100% of cases.
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Mastitis in newborns is an inflammation of the mammary gland in a child in the first month after birth. This process also occurs in older children, but more often in newborns due to the peculiarities of the structure and functioning of the mammary gland. Any inflammatory process in such a baby threatens with serious complications and generalization of inflammation, which is why the problem of mastitis is so important for timely diagnosis.
ICD-10 code
P39.0 Neonatal infectious mastitis
Epidemiology
The epidemiology of mastitis in newborns is such that about 65% of all children in the first month of life suffer from physiological mastopathy, and about 30% of cases are complicated by purulent mastitis. The mortality rate from purulent mastitis is 1 in 10 cases of the disease, which is an incredibly high figure, despite the availability of new modern treatment methods. About 92% of cases of mastitis are primary, caused by exogenous entry of the pathogen through cracks or scratches in the nipple. Such data makes it possible to prevent the disease by simple conversations with parents about the rules of child care, which will reduce the amount of mastitis.
Causes of mastitis in newborns
Mom is the first person to notice any changes in her baby’s health. Mastitis develops very quickly in such a child, so it is sometimes difficult to accurately determine its cause. But you definitely need to know about all the possible factors that influence the development of mastitis, so that the mother can prevent their development.
The mammary glands of a newborn baby have their own anatomical and physiological characteristics. The mammary gland consists of glandular tissue, loose connective tissue and milk ducts. In newborns, it lies on a large “fat pad”, which consists of connective tissue with a loose structure. The milk ducts themselves are not very developed, but they have slight branching in the radial direction. Under the influence of the mother's hormones, the synthesis of myocytes and connective tissue cells may be activated just before childbirth, which some time after birth gives clinical manifestations of physiological engorgement of the mammary glands. This process is considered normal and is not accompanied by inflammation. A small amount of secretion may even be released from the nipple - colostrum, which is also not a pathology. But often parents, due to inexperience or simply carelessness, injure the gland or try to somehow treat engorgement by squeezing out the secretion. This is often the main cause of mastitis, as a primary complication of physiological mastopathy.
The pathogenesis of the development of the inflammatory process lies in the fact that with the slightest crack in the nipple or halo, bacteria that are on the surface of the skin enter the gland tissue. This leads to the activation of immune defense and leukocytes are activated at this site of bacterial penetration. After this, an active immune reaction begins and the inflammatory process causes the appearance of symptoms. But a feature of the structure of the mammary gland of newborns is a large amount of loose connective tissue, which in turn allows the inflammatory process to instantly spread further with rapid damage to other tissues. Such features of the pathogenesis of mastitis lead to the early appearance of complications, which must be taken into account during timely diagnosis.
Another common cause of mastitis in newborns is improper skin care for the baby. This group of reasons includes not only insufficient hygiene measures, but also excessive care. This term means that mothers often massage their baby incorrectly, or try to wash it thoroughly by wiping the skin with a washcloth. All of these are additional factors of trauma, and as a consequence, entry points for infection. Therefore, a healthy newborn baby does not need such measures; a light bath in water without rubbing is enough.
The cause of mastitis can be not only a local inflammatory reaction, but also a systemic one. For example, a child with a sore throat or otitis media that is not diagnosed on time may spread the infection by lymphogenous or hematogenous routes. In this case, against the background of weakened immunity or in premature babies, there may be a generalization of infection with the development of mastitis secondary to tonsillitis.
Speaking about the causes of mastitis in newborns, it is necessary to highlight the main etiological factors specifically in children of this age. The cause is most often streptococci, staphylococci, enterococci. This is important not only for diagnostic purposes, but also for choosing treatment tactics.
The causes of mastitis in a newborn are pathogenic bacteria that cause an inflammatory process. Today, group B streptococci (which are a common cause of mastitis in newborns) and group C (which are the cause of sepsis in newborns) are of etiological importance in the development of mastitis. Since the 80s, the number of diseases, pyogenic infections caused by coagulase-negative strains of staphylococci St.epidermidis, St.saprophiticus, St. hemoliticus, St. xylosus, that is, the species composition of staphylococci changes. Therefore, the division of staphylococci into “pathogenic” and “non-pathogenic” is currently conditional. The pathogenic effect of staphylococci is explained by their ability to secrete toxins (lethal toxin, enterotoxin, necrotoxin, hemotoxin, leukocidin) and aggressive enzymes (coagulase, fibrinolysin, hyaluronidase), which greatly facilitate the spread of the pathogen in the tissues of the baby’s body. In addition, most pathogenic strains secrete penicillinase and cephalosporinase, which destroy penicillins and cephalosporins in normal therapeutic doses.
Further next to staphylococcal infection, which occurs in 45-50% of mastitis and other skin infections in newborns, the proportion of gram-negative flora increases. Outbreaks caused by Escherichia coli, Klebsiella, Serratia, Proteus, Pseudomonas aeruginosa (30-68%) and their association begin to appear. Gram-negative opportunistic flora has pronounced biological plasticity, which allows them to adapt to different ecological niches. Some of them: Escherichia coli, Klebsiella, Proteus, Enterobacter are representatives of the normal human microflora, others Serration, Pseudomonas are mainly found in the environment. They can cause different pathological processes in addition to mastitis, omphalitis, enteritis, pneumonia, conjunctivitis, meningitis, sepsis. Of particular danger are hospital strains that form in hospitals as a result of the widespread, often irrational use of antibiotics. wide range actions. As a result, strains with high resistance to antibiotics and disinfectants are formed.
Another feature of the etiological flora of mastitis is the presence of pathogenicity factors (enterotoxigenicity, adhesiveness), aggressive enzymes (proteases, DNAases), and hemolytic activity in bacteria, which enhance their pathogenic potential. A special feature is their resistance in the external environment (their ability to remain and reproduce for a long time in the external environment at low temperatures). Moistened places are especially favorable for them: toilets, sinks, soap dishes, brushes for washing hands, resuscitation equipment. All this contributes to their widespread distribution in hospital settings and is a risk factor for the development of mastitis in a child if he is infected while still in the hospital.
Thus, the cause of the development of mastitis in newborns is bacteria that can represent the normal flora of the child or can be infected with them from the external environment. But in this case, a prerequisite for the development of inflammation in the child’s mammary gland is the presence of an incoming gate for infection. This may be a scratch or damage to the skin of the mammary gland, a crack in the nipple due to physiological engorgement, which allows the pathogen to get under the skin and contributes to further development inflammatory process.
The causes of mastitis in newborns are directly related to external factors Therefore, proper care of the baby during this period is very important.
Risk factors
Risk factors for developing mastitis:
- a premature baby has a reduced protective function of the immune system, which allows the purulent process to spread faster;
- physiological engorgement of the mammary glands may be a prerequisite for the development of mastitis;
- injury to the skin of the breast or nipple;
- previous operations in a child with a long hospital stay and contact with hospital flora;
- unfavorable obstetric history: long-term infertility, somatic diseases, extragenital pathology;
- pathological course of pregnancy, threat of miscarriage, urogenital diseases, acute respiratory viral infections, exacerbation of chronic foci, prolonged hypoxia;
- pathological course of labor, premature birth, long anhydrous period, obstetric interventions, etc. during childbirth;
- need for resuscitation and intensive care, mechanical ventilation, intubation, catheterization great vessels, food supply;
- artificial feeding from the first days.
Thus, mastitis can develop in an absolutely healthy baby without signs of pathology after birth, and the main factor in this case is infection with bacterial flora.
Pathogenesis
The pathogenesis of the formation of inflammation of the mammary gland in a newborn child is based on the characteristics of the development of the gland in children after birth. After birth, every child’s organs and systems adapt to environmental conditions. One of these states of child adaptation is sexual crisis. The appearance of a hormonal crisis is caused by the action of estrogenic hormones from the mother, which, starting from the 7th month of gestation, pass from mother to fetus in utero.
One of the manifestations of a sexual crisis is symmetrical swelling of the mammary glands, which appears on the 2-4th day of a child’s life, and reaches its maximum value until 6-7 days. This phenomenon is observed in both girls and boys. The mammary glands, as a rule, increase slightly; sometimes they swell to the size of a walnut. The skin over them becomes tense and may become hyperemic. When pressed, a whitish liquid resembling colostrum is released from the glands. Against this background, mastitis mainly develops. For this, a prerequisite for the inflammation process must be penetration pathogenic bacteria inside the breast tissue. Only this implies the development in the future against the background of physiological mastopathy - mastitis.
The susceptibility to infections in newborns is high, which is predetermined by the anatomical and physiological characteristics of the newborn’s skin and their reduced immunological reactivity, and the imperfection of the nonspecific defense system:
- Low phagocytic activity of leukocytes, complement activity, low levels of lysozyme impair the penetration of the epithelial-endothelial barrier protection
- Specific protection is provided by the humoral and cellular immunity, which also has its own characteristics that contribute to the development of mastitis in newborns:
- low synthesis of own Ig G, secretory Ig A;
- the predominance of the synthesis of macroglobulin Ig M, which, due to its structure, does not have sufficient protective properties;
- low cytotoxic activity of T-lymphocytes, cell failure.
Symptoms of mastitis in newborns
The first signs of mastitis in a newborn may appear against the background of physiological mastopathy. Then there is a disturbance in the child’s general condition, moodiness or even severe anxiety. After a few hours, you can already see objective symptoms of mastitis. The gland itself increases significantly in size, the skin over it becomes red or even tinged with blue. If you try a baby's breast, he will react instantly, as it is accompanied by severe pain. If an abscess has formed, you can feel the pus moving under your fingers during palpation - a symptom of fluctuation. This process is usually one-sided. There may also be discharge from the nipple on the affected side in the form of green or yellow pus. These are the main symptoms that indicate a local inflammatory process. They develop very quickly, sometimes over several hours. But it is not always possible to detect such changes. Sometimes the first symptom may be a significant increase in body temperature. Then the child screams, and sometimes there may be convulsions in the background.
Mastitis in newborn girls and boys occurs equally often and the symptoms also do not differ. But there are stages of the inflammatory process, which differ in manifestations. The dynamics of the stages cannot always be traced in newborns, since the process quickly moves from one to another.
Serous mastitis is an inflammation that is characterized by initial changes in the breast tissue and the accumulation of serous secretion. This stage is characterized by the initial manifestations of the disease in the form of a violation of the general condition and swelling of the gland. There may not yet be a change in skin color, but there may be an increase in body temperature.
The infiltrative stage occurs when an active immune response in the gland tissue is accompanied by infiltration and the formation of a diffuse lesion. This is already manifested by redness of the skin, pain, and high body temperature. Next, the foci of infiltration merge and the number of dead leukocytes forms pus, which leads to the next stage.
Purulent mastitis of a newborn is characterized by an extreme degree of severity of symptoms against the background of a massive infectious process, which can easily spread to tissues located deeper.
Forms
Types of mastitis are classified according to stages, which is sometimes difficult to distinguish due to the rapid dynamics in such children. Therefore, the main task of the mother is to promptly and immediately contact the doctor if there are symptoms of redness or enlargement of one gland with a violation of the general condition of the child.
Symptoms of mastitis in a newborn depend on the stage of the disease. There are several types of inflammation of the mammary gland.
- According to the clinical course.
- Spicy:
- stage of serous inflammation;
- infiltrative (phlegmonous) form;
- abscess formation stage;
- gangrenous.
- Chronic:
- nonspecific;
- specific.
- Spicy:
- By localization:
- Subareolar
- Antemamarny (premamarny).
- Intramammary:
- parenchymal
- interstitial.
- Retromarny.
- Panmastitis.
In newborns, the process often involves one mammary gland and all at once, so we are talking about panmastitis. The first signs of the disease appear local symptoms. The onset of the disease is usually acute. In most cases, the disease begins with the appearance of hardening of the mammary gland and rapidly increasing pain. The pain is intense, can be pulsating, does not radiate, and intensifies with palpation of the gland. This inflammatory process causes an early increase in body temperature to high numbers (39-40). As a result of the inflammatory process, the baby develops weakness, restlessness, and a piercing cry. Then pronounced hyperemia and fluctuation of the skin above the site of inflammation appears. General state disturbed, pronounced intoxication syndrome, decreased appetite, sluggish sucking. Going through successive stages of the disease, at the stage of formation of a gangrenous or phlegmonous process, the child’s condition can significantly worsen. Body temperature rises quickly and cannot be lowered. The child begins to refuse food, he may sleep constantly or, on the contrary, scream. The skin may show dark gray or blue inflammation that can show through your baby's thin skin. The inflammatory process spreads very quickly and the child’s condition can worsen within a few hours. Therefore, purulent mastitis in a newborn occurs most often when the process quickly moves from the serous stage to the stage of purulent inflammation. This plays a huge role in treatment and choice of tactics at each stage of the disease.
Complications and consequences
Complications of mastitis can include generalization of the infection with the development of sepsis literally in a matter of hours, so it is simply necessary to begin treatment immediately after diagnosis. The consequence of the operation may be lactation problems in the future, if it is a girl, but such consequences are not comparable to the health of the baby. The prognosis can be very serious, so it is necessary to prevent such pathology.
Diagnosis of mastitis in newborns
Diagnosis of mastitis is not difficult, even based on external characteristics. First you need to listen to all the mother’s complaints and find out how the symptoms developed. The benefits of mastitis are evidenced by high body temperature, acute onset of the disease, and impaired condition of the child.
Upon examination diagnostic signs the pathologies are very simple - an enlarged, hyperemic mammary gland is visible, and sometimes the local temperature may be elevated. Upon palpation, it may be noted that the child begins to cry and fluctuation or uneven consistency may be felt due to the accumulation of pus.
As a rule, the diagnosis is not in doubt if such objective symptoms are present. Additional testing methods for a newborn baby can be complex. Therefore, if the child was healthy before, then they are limited to general clinical tests. Changes may be characteristic of severe bacterial infection with high leukocytosis and increased ESR. But the absence of changes in the blood test does not exclude acute bacterial inflammation, since due to the immaturity of the immune system, there may not be a pronounced reaction.
Instrumental diagnosis of mastitis is not often used, since there is no need for severe symptoms. Therefore, ultrasound examination can be performed only for the purpose of differential diagnosis.
Thermography: zones with local temperature increases are formed.
Invasive examination with biopsy of the site of inflammation and laboratory research exudate, determining the sensitivity of microflora to antibiotics is one of the most specific methods for further conservative diagnosis. This allows you to accurately determine the pathogen and, if necessary, prescribe those antibacterial drugs to which the pathogen is precisely sensitive.
Differential diagnosis
Differential diagnosis of mastitis in newborns should primarily be carried out with physiological mastopathy. Physiological “mastitis” is characterized by a symmetrical enlargement of the gland to a small size. There is no change in skin color and it does not cause concern to the child. At the same time, the baby’s appetite is preserved, sleep is not disturbed, he is gaining enough weight, stool is normal, and there are no signs of intoxication. And with purulent mastopathy, the symptoms are the opposite.
Mastitis also needs to be differentiated from erysipelas of the skin caused by hemolytic streptococcus. Erysipelas is an inflammation of the skin with clear boundaries of the process and a gradual onset of the disease. It causes a gradual and mild increase in body temperature without other general symptoms. The child’s appetite and sleep are usually preserved, unlike mastitis.
Treatment of mastitis in newborns
Treatment of mastitis is complex - surgical intervention and massive antibacterial therapy are required in such young children.
Treatment tactics depend on the stage of the disease and the spread of the inflammatory process. At the initial stages of the disease, serous and infiltrative, complex conservative therapy is carried out; when an abscess and purulent focus forms, surgical intervention is performed.
Conservative treatment.
- Mode: bed; for the child’s mammary gland, it is necessary to provide it with minimal conditions for traumatization with the help of a suspensor, which should hold the gland and not squeeze it.
- Locally apply a cold ice pack through gauze to the affected areas of the gland for 20 minutes every 1-1.5 hours.
- Retromammary novocaine blockade: 70-80 ml of 0.25-0.5% novocaine solution + antibiotic is rarely performed in newborns due to the complexity of the technique.
- Antibiotic therapy according to modern principles of its implementation and after conducting a bacterial analysis and sensitivity testing of the flora.
- Stimulation of the body's defenses: administration of antistaphylococcal J-globulin, immunomodulators, autohemotherapy.
- Gland massage.
Treatment of mastitis in a newborn with medication involves the use of two broad-spectrum antibiotics. For this purpose, the following preparations can be used:
- Ampicillin is an antibiotic from the aminopennicillin group that acts on most microorganisms that can cause skin inflammation and the development of mastitis in newborns. The drug destroys the wall of the bacterium and neutralizes the cell membrane, interfering with its reproduction. The dosage of the drug for infants is at least 45 milligrams per kilogram of the child’s body weight. The course of treatment is at least one week. Directions for use: in the form of a suspension, dividing the daily dose into three doses. Side effects may be in the form of allergic reactions, and also due to the effect on the intestines in newborns, diarrhea may occur. Precautionary measures - do not use if you have a history of allergies to this group of drugs.
- Amikacin is an aminoglycoside antibiotic that is widely used in combination with ampicillin to treat mastitis. The mechanism of action of the drug is associated with disruption of ribosomes and disruption of the incorporation of amino acids into the RNA chain. This leads to the death of the bacterial cell. For newborns with mastitis, it is advisable to use one antibacterial drug in oral form, and the other in parenteral form. Therefore, the recommended method of administration of this drug is intramuscular or intravenous. The dosage is 15 milligrams per kilogram in two doses. Side effects may be in the form of systemic or skin allergic reactions.
- Cefodox is an oral cephalosporin of the third generation, which does not die in the presence of bacteria that contain lactamases. The drug is well absorbed when taken internally and is immediately divided into fractions, circulating through the blood throughout the day. This allows you to maintain the required concentration of the drug at the site of inflammation, given that other antibiotics may not accumulate well in the breast tissue during mastitis. The mechanism of action of the drug is the activation of enzymes that contribute to the destruction of the bacterial wall and the release of bacterial endotoxin (disruption of the synthesis of polysaccharides in the cell wall of the microorganism). This ensures the death of the pathogen during mastitis and prevents the development of further infection. Dosage: 10 mg/kg per day, divided into one or two doses. The use of cefodox can be combined with a parenteral antibiotic from the group of macrolides or aminoglycosides, and in severe cases - with fluoroquinolones.
- Paracetamol is a drug that is used in the treatment of mastitis to reduce high body temperature in a newborn. The main mechanism of action of paracetamol is inhibition of prostaglandin synthesis. These substances potentiate the inflammatory response through the synthesis of inflammatory substances. The drug blocks the release of these substances and reduces fever and other symptoms of inflammation. Also, in addition to lowering body temperature, paracetamol has an analgesic effect. For newborns, this is the only drug that can be used from the first days. Best used as syrup. Dosage 10-15 milligrams per kilogram of body weight per dose. You can repeat the dose no less than 4 hours after the last time. The syrup is available in a dose of 120 milligrams in five milliliters, which is then calculated based on body weight. Side effects from the gastrointestinal tract in the form of dyspeptic disorders, erosions and stomach ulcers and duodenum, there may be bleeding and perforation.
From antibacterial agents use at least two, and sometimes three antibiotics, one of which must be administered intravenously.
Local treatment of mastitis is carried out depending on the phase of the inflammatory process against the background of the general conservative therapy. In phase I, the phase of inflammation, preference should be given to multicomponent water-soluble ointments based on polyethylene oxide: levosin, levomekol, oflocaine. They simultaneously have antibacterial, dehydrating and analgesic effects, and also, due to the presence of such a component as methyluracil in their composition, contribute to the activation of the reparative process. If there are areas of necrosis that were not removed during surgery, proteolytic enzymes are used. In the regeneration phase it is advisable to use aqueous solutions antiseptics dioxidine, chlorhexidine, furatsilin.
A mandatory element of the treatment of mastitis in newborns is surgical treatment, since the accumulation of pus in such a baby spreads quickly and the disease will not be resolved without surgery. Immediately after the diagnosis is made, the child is immediately hospitalized in the pediatric surgical department. An emergency operation is performed under general anesthesia. The scope of the operation consists of making incisions on the skin of the affected area of the mammary gland in a checkerboard pattern. There can be a large number of them, depending on the volume of the affected gland. The notches are made in such a way that they are located on the border between healthy and affected skin. Next, drains are installed through which active washing of such an area is carried out. Then the drains are left for better drainage of pus. Dressings need to be done after the operation several times a day and the mother must monitor this. Feeding such a child continues as usual breast milk, which provides better protection for the child. In addition, symptomatic therapy is also used.
For drainage, preference should be given to active methods: flow-flushing, vacuum aspiration. Methods of improved surgical treatment of a purulent wound, which are used to reduce the number of microorganisms in it, should include physiotherapeutic treatment:
- treatment of the wound with a pulsating stream of liquid;
- vacuum wound treatment;
- laser beam processing;
- ultrasonic treatment.
Vitamins and physiotherapeutic treatment can be carried out at the stage of convalescence, when it is necessary to support the baby’s defenses.
Traditional treatment, herbal treatment and homeopathic remedies for mastitis are not used, since such a disease in the neonatal period has lethal consequences that develop quickly. Traditional methods do not have the ability to quickly eliminate pus, and therefore are not recommended for use by doctors.
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