How to understand that a newborn has mastitis Treatment of mastitis

Expert: pediatric surgeon, pediatric urologist, pediatric andrologist Alexander Ivanovich Sumin

The baby's body systems develop gradually in the womb, and the formation of mammary glands under the influence of estrogens and progesterone begins around the 10th week. At the beginning, the child “uses” maternal hormones, because before birth his endocrine system does not start working.

How does physiological mastopathy differ from mastitis in newborns?

What happens to the baby's mammary glands after birth? The endocrine system is activated, so the baby’s body needs maternal hormones less and less. The pituitary gland of a small organism begins to produce estrogens, resulting in the release of prolactin: this causes engorgement of the mammary glands in the child, from which a milky fluid can be released.

Within a week after birth, the baby experiences a condition called a hormonal crisis. Nature is designed in such a way that it is the hormonal crisis that forces the body to adapt to the world: having gone through it, the child receives certain protection from problems with the immune and neurological system.

Why does physiological mastopathy occur?

All organs and systems of the baby’s body in the womb develop gradually, and the formation of the anatomical structures of the reproductive system and mammary glands begins around the 9th -10th week under the influence of estrogens and progesterone, while maternal hormones are “used”, because before birth his endocrine system is practically does not start working.

Immediately after birth, the child’s body tries to adapt to the new world, all its systems are rebuilt to the conditions of the external environment. This is a moment of stress for a newborn, in which all the forces of his body are put to work and become active, including the endocrine system. But physiological mastopathy most often occurs due to the fact that before the moment of birth in the mother’s womb, the child received a large amount of female hormones, they helped him grow and develop normally. And after birth, such active receipt of maternal hormones stops, which entails a restructuring of the body. As a rule, the first symptoms of this condition appear on the 3-5th day of life. The peak of the crisis is observed on the 7-11th day - the child has not yet fully adapted, but a minimum of maternal hormone (estrogen) remains. In addition, during this period there is an increase in the level of pituitary hormones in the baby’s blood, including prolactin, which increases engorgement and enlargement of the mammary glands in girls and mammary glands in boys.

For some children, the adaptation process occurs physiologically, while others may experience problems. For example, when an infection enters the body, mastitis may develop in newborns.

In addition, you need to remember that there is also the concept of minipuberty - activation of the production of adenohypophysis hormones and the production of gonadotropins. And in girls with minipuberty, there is an enlargement of the mammary glands - isolated thelarche , which is not accompanied by the systemic action of sex hormones, and in boys testosterone production increases.

Minipuberty occurs:

- from 1.5 - 6 months - in boys; - from 3 months to 1.5 years - in girls.

This means that repeated enlargement of the mammary glands in girls from three months to 1.5 years can be both a variant of the physiological norm and a symptom of premature puberty, which must be excluded.

Mastopathy in newborns, which goes away before the 10th week of life, is a normal variant and does not require special treatment measures.

In all other cases of enlarged mammary glands in girls and mammary glands in boys, consultation with a pediatrician and possibly an endocrinologist is necessary.

Why does newborn mastitis develop?

If, during the development of physiological mastopathy, an infection enters the child’s body (usually staphylococcal or streptococcal), there is a risk of newborn mastitis: moreover, it can occur in both newborn girls and newborn boys. Staphylococcal or streptococcal bacteria can live in the mother's body (for example, on the surface of her skin or on the mucous membrane of the nasopharynx), and can also be found on surfaces in toilets and bathrooms.

Most often, mastitis in a newborn develops after discharge from the hospital - approximately on the 10th day of the baby’s life. By this time, the baby’s mammary glands should return to normal. And if the mother sees that this did not happen, it is necessary to urgently consult a pediatrician.

Microorganisms enter the body under certain conditions, usually when parents do not properly care for the child, not taking into account the special properties of his skin:

it has a lot of microvessels;
it has high permeability, so any substances from its surface immediately enter the body and the bloodstream;
the fatty tissue under the skin is very thick and loose;
sweat and sebaceous glands cannot yet function normally and create antibacterial protection; and if maternal immunity was unable to protect the child from bacteria (after all, the baby’s skin does not immediately accept all its microorganisms from the mother - the process of this colonization occurs gradually), they immediately cause an infectious pathology in the body;
the thermoregulation process has not yet been adjusted;
the skin is very saturated with liquid.
How and why can an infection occur?
if the child is dressed without taking into account the air temperature, and diaper rash occurs on his skin;

if the baby’s clothes have rough seams or edges that injure delicate skin;

if, while treating the child’s skin, the mother accidentally scratches or damages the skin (for example, with a manicure).

Causes

The main cause of the occurrence and development of mastitis are bacteria, mainly staphylococci, less often streptococci, enterococci, E. coli, etc. A bacterial infection can enter the tissue through cracks in the nipples or through the blood if there are foci of infection in the body (pyelonephritis, chronic tonsillitis, etc. .).

The most common mastitis is lactation mastitis, diagnosed in nursing women. The cause of mastitis in a woman can be a newborn.

The occurrence of the disease is also facilitated by cracks in the nipples, through which bacteria can easily penetrate due to insufficient hygiene during breastfeeding or through dirty underwear.

Non-lactation mastitis develops against a background of weakened immunity. Main causes:

hypothermia;
past infectious diseases;
hormonal disorders;
complications of concomitant diseases;
mammary gland injuries;

Important! Most often, infection with non-lactation mastitis enters through the affected areas of the skin - wounds, scratches, burns, abscesses.

Signs of mastitis in newborns

when touching the mammary glands, the baby cries;
as a rule, the infection penetrates into one of the glands (much less often it affects both), due to which the mammary gland becomes denser, the baby develops severe pain when touched;
in the area of infection the skin turns red;
The baby’s body temperature rises to 39 °C;
the child cries when he is swaddled or changed;
the baby refuses to breastfeed and becomes lethargic;
later, pus accumulates at the site of infection; when pressure is applied to this area, the child screams very loudly and experiences pain;
with purulent mastitis, pus may spontaneously (without pressure) be released from the nipples of a newborn.

This condition is extremely dangerous for a child. Therefore, at the first symptoms of mastitis, you should consult a pediatrician or call an ambulance. If help is not provided in time, the pus can melt the tissues near the mammary gland and penetrate into its other parts. This condition can lead to a diagnosis of phlegmon of the chest wall - purulent inflammation of fatty tissue. More serious conditions that mastitis in a newborn can lead to are sepsis and generalized infection (spread of infection throughout the body), which threatens the life of the child.

For a newborn girl, mastitis is more dangerous than for a boy: if the acini (components of the mammary gland) die during the disease, connective tissue appears in their place. In this case, when the girl grows up, her breasts will most likely develop asymmetrically. And during breastfeeding, an adult woman runs the risk of serious lactostasis (milk stagnation), which will be difficult to cure without surgery.

Symptoms

Common symptoms and signs of the disease are: the appearance of a painful lump in the mammary gland, redness and increased temperature of the skin in the lump area, fever and general symptoms of intoxication.

There are several stages of mastitis, and one can progress to another. To avoid this, you need to prevent and treat mastitis in a timely manner.

Signs of mastitis depend on the type of inflammatory process. The classification divides pathology into the following forms:

Serous mastitis is the primary stage, which is often confused with lactostasis in nursing women due to the similarity of symptoms. It manifests itself as an increase in temperature, enlargement and slight thickening of the mammary gland, redness, nagging pain, which intensifies with feeding.
Infiltrative mastitis - the second stage is characterized by a pronounced inflammatory process and a more severe general condition of the woman, hardening in the chest (infiltrate) with redness of the skin over it, increasing pain, enlargement of the axillary lymph nodes.
Purulent mastitis occurs in the absence of treatment. The general condition worsens - fever, chills, nausea, vomiting, weakness, lack of appetite. The breasts increase significantly in size, pronounced swelling and redness appear.

Destructive (purulent) mastitis of the breast, in turn, has several types, which differ in the localization of the source of inflammation and its spread to surrounding tissues:

abscess – cavities filled with pus appear in the chest, limited to a certain area of the mammary gland;
phlegmonous - spread of purulent inflammation to loose breast tissue, characterized by the formation of multiple abscesses, redness of the epidermis, increased local temperature;
gangrenous - advanced mastitis causes death of the affected tissues, the necrotic process becomes the main cause of sepsis.

How is mastitis treated in newborns?

Clinical guidelines for the treatment of neonatal mastitis state that before prescribing therapy, it is necessary to establish the stage of development of the disease.

If this is the initial (infiltrative) stage, then treatment of mastitis in a newborn is recommended:

special ointments applied to the bandage;
ultraviolet irradiation or UHF, which has a detrimental effect on bacteria;
compresses with magnesium to relieve swelling and pain;
compresses of dimexide with saline as an antiseptic;
alcohol compresses;
Vishnevsky ointment;
suppositories or syrup with paracetamol to relieve pain and fever;
Treatment of neonatal mastitis can be enhanced with broad-spectrum antibiotics.

However, all of the above actions can be effective until a purulent focus has formed in the gland. If it occurs, the newborn will most likely require surgery, during which the pus will be removed and the cavity will be washed. After surgery, a bandage with a hypertonic solution will be applied to the wound. In addition, the doctor will prescribe a course of antibiotics.

When is swelling normal?

Every parent should clearly know how to distinguish a normal phenomenon from the primary symptoms of the disease. When a newborn girl’s mammary glands are swollen, then in certain cases the help of a specialist is not needed. Let's list them:

If the child continues to feel well: he eats well and sleeps peacefully.
When both mammary glands swell symmetrically in a newborn girl.
The diameter of the resulting edema does not exceed 3 centimeters.
The skin continues to remain clean and does not develop any redness or swelling.

On days 6-18 of a girl’s life, the crisis usually ends, so the mammary glands should return to normal by this time.

How to prevent mastitis in a newborn

take care of your baby’s skin correctly, prepare the baby’s first clothes in advance: wash them with a special baby powder and be sure to iron them (this must also be done during the entire first month after discharge from the hospital);
when, as a result of a hormonal crisis, the child’s mammary glands become engorged, do not touch or put pressure on them, and under no circumstances squeeze out their contents;
dress the child in accordance with the temperature regime, do not overheat his body;
On the eve of giving birth, get rid of long manicures and carefully treat your nails.

Causes of breast engorgement

Physiological reasons

At the stage of puberty, under the influence of estrogens, the structure of the mammary glands changes: milk tubes grow, alveoli form, and the amount of adipose and connective tissue increases.
This process may be accompanied by periodic engorgement. In the absence of clearly localized lumps in the chest during adolescence, the symptom is considered a physiological norm. Subsequently, slight short-term engorgement is noted before the start of each menstruation and disappears when menstruation appears. The next period of long-term persistence of symptoms is pregnancy. The first episode of engorgement occurs on days 7-8 from the moment of fertilization. Breast changes persist until 10-12 weeks, then temporarily decrease, and then progress again, starting from week 20.

The beginning of lactation is marked by another episode of physiological engorgement of the mammary glands. After starting feeding, the symptom disappears. Final normal engorgement, associated with the decline of reproductive function, is sometimes observed in the phase of involutive restructuring of the mammary glands in the premenopausal and menopausal periods.

Pathological causes during lactation

In women who refuse breastfeeding, unpleasant symptoms persist for several days until milk production stops. The causes of engorgement due to violation of feeding rules are:

late start of feeding;
irregular feeding or pumping;
improper breast latch by baby
incomplete emptying of the mammary gland due to additional feeding with dry formulas, appetite disorders of various origins in the child;
sudden cessation of breastfeeding;
wearing tight underwear that compresses the overcrowded milk ducts.

Less commonly, lactostasis, against which engorgement occurs, is caused by hyperlactation, spasms, or blockage of the milk ducts. Stagnation of milk contributes to the development of lactation mastitis.

Breast engorgement

Pathological causes for cyclic changes

Cyclic fluctuations in hormone levels sometimes lead to periodic swelling and tenderness of the mammary glands - mastodynia. The pathology is more often detected in women aged 20-40 who have not given birth or who have one child. Predisposing factors are irregular sex life and the presence of diseases of the reproductive system.

In patients with premenstrual syndrome, engorgement is more pronounced than usual. It can be combined with insomnia, irritability, weakness, emotional instability, decreased mood, vegetative-vascular symptoms, swelling of the face and body.

With anomalies of the hymen - imperforate hymen or hymenal atresia - engorgement occurs during menarche, is combined with other signs of menstruation, but due to the absence of an opening is not accompanied by bleeding from the vagina.

Early and late pregnancy

Breast engorgement appears not only during normal pregnancy, but also during pathological pregnancy. In girls, a possible cause of this condition may be teenage pregnancy, which manifests itself with the same symptoms as normal, but develops in an organism that is not yet fully matured to bear a child.

Late pregnancy in premenopause requires special attention. In this case, women sometimes regard the cessation of menstruation, engorgement of the mammary glands and other signs of gestation as the beginning of menopause. Patients do not consult a gynecologist on time, are not examined, and do not comply with the regimen, which increases the likelihood of complications and increases the risks during childbirth.

Pathological gestation

There are various types of ectopic pregnancy, which are also accompanied by breast engorgement:

Cervical.
When the trophoblast attaches directly to the cervix, a few days after a delay in menstruation, a woman develops bleeding due to tissue destruction. The gestation period does not exceed 8-12 weeks. When a large vessel grows, profuse bleeding is possible, which is life-threatening.
Isthmus-cervical.
The trophoblast attaches above, in the isthmus region. The clinic is more reminiscent of normal gestation; the baby can last up to 16-24 weeks, but very rarely is carried to term. In the 2nd trimester, signs resembling placenta previa may appear.
Pipe.
The most common. Until 6-12 weeks it proceeds as usual, accompanied by engorgement of the mammary glands, nausea and other typical symptoms. Possible bleeding. When a pipe ruptures, unbearable pain, cold sweat, severe weakness, fainting and other signs of an acute abdomen occur.
Ovarian.
It is characterized by typical manifestations of physiological pregnancy: changes in appetite, breast engorgement, early toxicosis. At the same time, 84% of women continue to have menstruation, and 80 experience spotting from the vagina. The intensity of subsequent bleeding depends on the location of the fertilized egg - the deeper it is, the greater the blood loss.
Abdominal.
The symptoms are the same as during normal pregnancy. Possible pain in the lower abdomen. With the germination of small vessels, progressive anemia develops. The rupture of a large vessel is accompanied by a picture of internal bleeding; other manifestations vary depending on the damage to a particular organ.

Frozen pregnancy in the 1st trimester and anembryonia are characterized by an improvement in general condition and the disappearance of engorgement of the mammary glands, which is replaced by chills and an increase in body temperature at the onset of spontaneous abortion. At later stages, there is a lack of fetal movements.

With false gestation, the fetus is absent from the uterus. The cessation of menstruation, morning sickness, engorgement of the breasts and enlargement of the abdomen are caused by the patient’s conviction that there is a child. During a gynecological examination and additional studies, the fetus is absent. Sometimes a similar condition is observed in men during their partner’s pregnancy.

Breast diseases

Unlike normal and pathological gestation, in which both mammary glands become engorged at the same time, unilateral changes are more typical for mammological diseases. The symptom is detected in the following pathologies:

Inflammation of the nipple.
Engorgement is observed mainly in the area of the nipple and areola. The affected area is swollen and hyperemic. Clear, bloody or purulent discharge is detected.
Mastopathy.
Dense mobile formations appear in the chest. The engorgement and soreness intensify before the onset of menstruation.
Breast cyst.
The formation is elastic and disappears when lying down.
Adenosis of the mammary gland.
A type of fibronodular mastopathy. Along with breast engorgement, pain and pathological discharge from the nipple are noted.

Hormonal disorders

Breast engorgement can be detected with the following diseases and conditions:

Hyperestrogenism.
Changes in the mammary glands appear in the second half of the cycle. Severe premenstrual syndrome and painful heavy menstruation are observed.
Complications of taking COCs.
Breast engorgement, emotional disturbances, unpleasant symptoms from the digestive system, headache and other symptoms occur in the first 3 months of taking hormonal contraceptives.
Ovarian stromal tecomatosis.
The main external sign is virilization. Male body changes and infertility are possible. Engorgement is more often detected in menopause and postmenopause.

Changes in the mammary glands in newborns

Sexual crisis in newborns develops due to a decrease in the level of maternal estrogens in the child’s blood. Breast engorgement is detected in infants of both sexes, appears on the 4th day, reaches a maximum by 7-10 days. The mammary glands are symmetrically enlarged and compacted. When pressed, a grayish secretion may be released from the nipples.

When soft tissues become infected in children in the first days of life, mastitis can form. Symptoms of the disease are usually detected 7-10 days after birth. The compaction is one-sided, painful to touch, palpation reveals an infiltrate, in the center of which an area of fluctuation subsequently forms. The general condition is disturbed, the temperature is elevated to febrile levels.

Oncological diseases

Unilateral engorgement is found in malignant tumors. Initially, the formation is palpated in the form of a local dense node, subsequently it grows into the surrounding tissues and deforms the mammary gland. Chorionic carcinoma can be located both in the genital organs and outside them. Develops during pregnancy or some time after childbirth. There is bloody discharge from the genital tract, breast engorgement, and colostrum-like discharge from the nipples.

Ultrasound of the mammary glands

Doctor Komarovsky's opinion

Evgeny Olegovich Komarovsky is the most famous pediatrician in Ukraine and Russia. He has created several programs broadcast on television and radio, in which he gives advice to young mothers on raising children and talks about the most common childhood diseases. In one of his programs, he told parents what to do if the mammary glands of a newborn girl are swollen.

The famous doctor claims that this phenomenon very often occurs due to hormonal changes in the body and requires absolutely no treatment. The only help that a young mother can provide to a baby is to relieve him of tight swaddling.

Komarovsky also noted that the physiological process can be distinguished from mastitis by only two main signs: an increase in body temperature (more than 38 degrees) and the formation of purulent discharge.

Methods of diagnosis and treatment

If a newborn girl has swollen mammary glands and associated symptoms appear, then only an experienced specialist can make a diagnosis after conducting a diagnostic examination. Perhaps, due to the sexual crisis, the baby’s immunity weakened, and against this background he developed a viral disease. Perhaps he is bothered by colic, which is why he behaves capriciously. Parents may mistake this behavior for a concomitant symptom of breast swelling, but in fact, it has nothing to do with mastitis. The specialist will make the most accurate diagnosis after conducting a diagnostic examination, which includes several stages:

compiling an anamnesis from the parents’ words;
visual examination of the child;
laboratory examination - blood and urine analysis;
Ultrasound of the breast;
studies of the nature of discharge, if any.

If, however, it is confirmed that the newborn’s mammary gland is swollen due to mastitis, then the baby will be prescribed a course of medical therapy, including antiviral drugs and the application of special compresses.

Depending on the patient’s condition, antipyretics and painkillers may be additionally prescribed. If mastitis is confirmed as a result of a diagnostic study, the child and mother will be sent for treatment in a hospital. This disease cannot be treated at home.

Generally, medical specialists adhere to conservative treatment methods; in rare cases, there is a need for surgical intervention.

But most often it turns out that it is because of a hormonal crisis that the newborn’s mammary glands swell. What to do in this case? No therapeutic measures are required; it is enough to provide the baby with care and proper care.

In what cases is it necessary to contact a specialist?

If a newborn girl has swollen mammary glands and associated symptoms appear, then you need to consult a doctor immediately. You should first visit your pediatrician, and after the examination, he may refer you to another specialist. Associated symptoms include:

Increase in body temperature. Do not be afraid of temperatures up to 37.5 degrees. In infants, heat exchange in the body has not yet formed, so this temperature is normal for him or appears if the child is dressed too warmly. But an increase in temperature of more than 37.5 degrees should alert parents.
Redness and swelling. There is a bright pink or reddish hue around the nipple halos.
The mammary glands have enlarged unevenly.
A transparent discharge appears from them or from the genitals.
Ulcers form.

In addition to the appearance of accompanying symptoms, the child’s behavior may also change. He will start crying in his sleep and will lose his appetite. The girl will cry loudly if the parent takes her in his arms; she will constantly fidget, feeling discomfort.

You should also be wary of the fact that the mammary glands do not return to normal when the child has already reached the age of 18 days. You should consult a doctor, even if there are no accompanying symptoms and the child is feeling well.