Abstract
The report of methicillin-resistant Staphylococcus aureus (MRSA) cultured from breast abscesses by Berens et al. 1 tells about abscesses. But, it is also a learned summary of the problem of mastitis during lactation in the United States. This retrospective chart review in two hospitals that do deliveries in Houston, TX, was conducted covering cases admitted from January 1, 2000 to December 31, 2006. Fifty-two women were identified with puerperal breast abscesses. The total number of deliveries during that period of time was not recorded. The total number of cases of mastitis in this population was unknown. The total incidence of mastitis in any population is unknown because it is usually an “ambulatory” disease and may even be treated with antibiotics by telephone without confirmation by physical examination. 2 The authors, however, point out the significance of MRSA in these abscesses and the need to treat for MRSA when treating for mastitis in keeping with local geographical frequency of MRSA. If the European literature is examined, there is a notable trend to avoid using antibiotics in simple infections. In Sweden only 9% of cases of mastitis are treated, and the incidence of abscess is 3%. The Netherlands has the lowest use of antibiotics in all Europe.
A study of hepatitis B and breastfeeding in Hangzhou, Zhejiang Province, People's Republic of China, authored by Qiu et al. 3 provides some interesting data about hepatitis management and some remarkable information about breastfeeding in China.
With respect to hepatitis B, 6% of 638 volunteer parturient mothers were hepatitis B positive, which mandated by their protocol that these infants be bottle fed for 3 days until cultures of the milk were reported for the presence of the virus. This took several days. Prelacteal feeds are common for all infants in Hangzhou, with 64% of all infants receiving some food other than breastmilk. When the milk cultures were reported, if there were fewer than 500 copies of DNA present, the child was vaccinated with hepatitis B and breastfed. Infants of mothers who were hepatitis B positive were at higher risk of not being breastfed exclusively for long. Fewer hepatitis B-positive mothers were breastfeeding at 3 months and 6 months compared to healthy mothers. The authors recognize the impact of their procedures and plan to follow the World Health Organization's recommendations for immediate breastfeeding at birth.
In China, however, several other statistics are noteworthy, as China recognizes the tremendous benefits of being breastfed. National goals are 90% initiation of breastfeeding, 85% exclusive breastfeeding at 3 months, 80% exclusive at 6 months, and continued breastfeeding to equal more than half of nutrient intake at 1 year and up to one-third of total nutrient intake the second year of life.
The authors also report that the incidence of cesarean section in the study was 77%, but that in larger cities it may be reported at 90%. Average maternal age of having her first baby is 28.5 years. The median length of hospital stay is 5.6 days.
This interesting article supports the concept that countries can learn a lot from each other and that the World Health Organization is in a good position to facilitate this knowledge exchange.
In this issue we also publish a case report of successful breastfeeding in a woman with membranous glomerulonephritis 4 because the literature is silent on good information about chronic renal disease in lactation. It is important to recognize that breastfeeding can be done safely in these circumstances. As more cases accumulate some collective observations can be reported. While most journals avoid single case reports, it is currently the editorial policy of this journal to record selected case reports that are well documented until a critical mass of cases has been confirmed. The editors encourage all reports also be submitted to our breastfeeding case reporting center, whether publishable or not, at the Breastfeeding and Human Lactation Study Center so that cumulative knowledge can be documented. Cases of diabetes, renal disease, immunologic syndromes, multiple sclerosis, gigantomastia, and any unique medical issues can be included. Submit communications to breastfeeding_medicine@urmc.rochester.edu.