Medicina

WHO/FCH/CAH/00.13 ORIGINAL: ENGLISH DISTR: GENERAL

Mastitis
Causes and Management

DEPARTMENT OF CHILD AND ADOLESCENT HEALTH AND DEVELOPMENT

World Health Organization Geneva
2000

© World Health Organization 2000 This document is not a formal publication of the World Health Organization (WHO), and all rights are reserved by the Organization. The document may, however, be freelyreviewed, abstracted, reproduced or translated, in part or in whole, but not for sale or for use in conjunction with commercial purposes. The designations employed and the presentation of the material in this document do not imply the expression of any opinion whatsoever on the part of the Secretariat of the World Health Organization concerning the legal status of any country, territory, city or areaor of its authorities, or concerning the delimitation of its frontiers or boundaries. The views expressed in documents by named authors are solely the responsibility of those authors.

Cover illustration adapted from a poster by permission of the Ministry of Health, Peru.

Contents

1. Introduction…………………………………………………………………. 1 2. Epidemiology………………………………………………………………... 2.1Incidence………………………………………………………………… 2.2 Time of occurrence……………………………………………………… 3. Causes of mastitis…………………………………………………………… 4. Milk stasis…………………………………………………………………… 4.1 Breast engorgement……………………………………………………… 4.2 Frequency of breastfeeds………………………………………………... 4.3 Attachment at the breast…………………………………………………. 4.4 Preferred side and efficient suckling…………………………………….. 4.5 Other mechanical factors………………………………………………... 5.Infection……………………………………………………………………... 5.1 Infecting organisms……………………………………………………… 5.2 Bacterial colonisation of the infant and breast…………………………... 5.3 Epidemic puerperal mastitis……………………………………………... 5.4 Routes of infection………………………………………………………. 1 1 2 6 6 7 7 7 8 8 9 9 9 10 10

6. Predisposing factors………………………………………………………… 11 7. Pathology and clinical features…………………………………………….. 7.1 Engorgement…………………………………………………………….. 7.2 Blockedduct…………………………………………………………….. 7.3 Non-infectious mastitis………………………………………………….. 7.4 Immune factors in milk………………………………………………….. 7.5 Sub-clinical mastitis……………………………………………………... 7.6 Infectious mastitis……………………………………………………….. 7.7 Breast abscess…………………………………………………………… 8. Prevention…………………………………………………………………… 8.1 Improved understanding of breastfeeding management………………… 8.2 Routine measures as part of maternity care……………………………...8.3 Effective management of breast fullness and engorgement…………….. 8.4 Prompt attention to any signs of milk stasis…………………………….. 8.5 Prompt attention to other difficulties with breastfeeding………………... 8.6 Control of infection……………………………………………………… 9. Treatment…………………………………………………………………… 9.1 Blocked duct…………………………………………………………….. 9.2 Mastitis…………………………………………………………………... 9.3 Breastabscess…………………………………………………………… 13 13 13 14 15 15 16 17 17 17 18 18 19 19 20 20 21 21 24

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10. Safety of continuing to breastfeed………………………………………... 11. Long term outcome………………………………………………………... 12. Management of mastitis in women who are HIV-positive………………

25 26 27

13. Conclusion………………………………………………………………….. 28 Annex 1. Breastfeeding techniques to prevent and treat mastitis………….. Annex 2. Expression of breastmilk…………………………………………… Annex 3.Suppression of lactation……………………………………………. References………………………………………………………………………. 29 32 34 35

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Acknowledgements
The authors of this review were Ms Sally Inch and Dr Severin von Xylander, with editorial assistance from Dr Felicity Savage. Many thanks are due to the following lactation experts for reviewing the document in draft and for providing helpful constructive criticism: Dr Lisa Amir(Australia), Ms Genevieve Becker (Eire), Ms Chloe Fisher (UK), Dr Arun Gupta (India), Dr Rukhsana Haider (Bangladesh), Ms Joy Heads (Australia), Dr Evelyn Jain (Canada), Dr Miriam Labbock (USA), Ms Sandra Lang (UK), Dr Verity Livingstone (Canada), Dr Gro Nylander (Norway), Dr Marina Rea...