Mkb 10 acute mastitis. Non-lactation mastitis

MASTITIS honey.
Mastitis is an inflammation of the mammary gland. Dominant age
Mastitis of newborns occurs in the first days of life as a result of infection of hyperplastic glandular elements.
Postpartum mastitis - during breastfeeding
Periductal mastitis (plasmocytic) - more often during menopause.
Predominant sex
Mostly women are affected
Juvenile mastitis - in adolescents of both sexes during puberty.

Classification

With the flow
Acute: serous, purulent (phlegmonous, gangrenous, abscessing: subareolar, intramammary, retromammary)
Chronic: purulent, non-purulent
By localization - intracanalicular (galactophoritis), periductal (plasmacytic), infiltrative, spilled.

Etiology

Lactational (see)
carcinomatous
Bacterial (streptococci, staphylococci, pneumococci, gonococci, often combined with other coccal flora, Escherichia coli, Proteus).

Risk factors

Lactation period: violation of the outflow of milk through the milk ducts, cracks in the nipples and areola, improper care of the nipples, violations of personal hygiene
Purulent diseases breast skin
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 epithelium of the ducts of the mammary glands
Intraductal epithelial hyperplasia
Fat necrosis
Expansion of the ducts of the mammary glands.

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, tense, the skin over the focus is hyperemic, on palpation - a painful infiltrate with fuzzy boundaries
Lymphangitis, 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, has a bluish tint
Lymphangitis.
Acute purulent abscess mastitis
Fever, chills
Pain in the gland
Mammary gland: 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 ESR
A bacteriological study is required to determine the sensitivity of microorganisms to antibiotics.

Special Studies

ultrasound
Mammography (breast cancer cannot be completely ruled out)
Thermal Imaging Research
Biopsy of the breast.

Differential Diagnosis

Carcinoma (inflammatory stage)
Infiltrative breast cancer
Tuberculosis (may be associated with HIV infection)
Actinomycosis
Sarcoid
Syphilis
Hydatid cyst
Sebaceous cyst.

Treatment:

Conservative therapy
Isolation of mother and child from other mothers and newborns
Stopping breastfeeding with the development of purulent mastitis
Bandage that suspends the mammary gland
Dry heat on the affected mammary gland
Expression of milk from the affected gland in order to reduce its engorgement
If pumping is not possible, to suppress lactation, bromocriptine is prescribed at 0.005 g 2 r / day for 4-8 days
Antimicrobial therapy: erythromycin 250-500 mg 4 r / day, cephalexin 500 mg 2 r / day, cefaclor 250 mg 3 r / day, amoxicillin-clavulanate (Augmentin) 250 mg 3 r / day, clindamycin 300 mg 3 r / day (if anaerobic microflora is suspected)
NSAIDs
Retromammary novocaine blockade.

Surgery

Aspiration of contents under ultrasound guidance
Opening and drainage of the abscess with careful separation of all ligaments
Operational incisions
With subareolar abscess - along the edge of the peripapillary field
Intramammary abscess - radial
Retromammary - along the submammary fold
With a small size of the abscess, it is possible to excise it with adjacent inflammatory tissues according to the type of sectoral resection with active drainage of the wound with a double-lumen tube and suturing tightly
Opening of all fistulous passages
With the progression of the process - removal of the gland (mastectomy).

Complications

Fistula formation
Sepsis
Subpectoral phlegmon.
The 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 care
Compliance with feeding hygiene
Use of emollient creams
Expression of milk.

Synonyms

Mastitis
see also

ICD

N61 Inflammatory diseases mammary gland

Disease Handbook. 2012 .

Synonyms:

See what "MASTITIS" is in other dictionaries:

    Mastitis- ICD 10 N61.61. ICD 9 611.0611.0 DiseasesDB ... Wikipedia

    MASTITIS- (thorax) 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. With mastitis, it suddenly rises ... ... The Concise Encyclopedia of the Household

    mastitis- breast Dictionary of Russian synonyms. mastitis n. chest Dictionary of Russian synonyms. Context 5.0 Informatics. 2012. mastitis ... Synonym dictionary

    MASTITIS- MASTITIS, breast, mastitis, mammitis, mas tadenitis (from Greek mastos female breast), inflammation of the mammary gland. Distinguish acute and hron. inflammatory processes. Acute inflammation of the breast can occur at all periods of life, but more often ... ... Big Medical Encyclopedia

    mastitis- a, m. mastite mastos breast, nipple. Inflammation of the mammary gland. Krysin 1998. Lex. Michelson 1866: mastitis; BASS 1: suits / t ... Historical Dictionary of Gallicisms of the Russian Language

    mastitis- MASTITIS, colloquial. reduced chest ... Dictionary-thesaurus of synonyms of Russian speech

    MASTITIS- (from the Greek. mastos nipple chest) (breast), an inflammatory disease of the mammary gland in humans and animals, usually as a result of infection through nipple cracks; occurs more often in the postpartum period ... Big Encyclopedic Dictionary

    MASTITIS- MASTITIS, husband. Inflammation of the mammary gland. | adj. venerable, oh, oh. Dictionary Ozhegov. S.I. Ozhegov, N.Yu. Shvedova. 1949 1992 ... Explanatory dictionary of Ozhegov

    Mastitis- (from the Greek mastos nipple, breast) (breast), an inflammatory disease of the mammary gland in humans and animals, usually as a result of infection through cracked nipples; occurs more often in the postpartum period. … Illustrated Encyclopedic Dictionary

    Mastitis- I Mastitis (mastitis; Greek mastos chest + itis; synonymous with breast) inflammation of the parenchyma and interstitial tissue of the mammary gland. There are acute and chronic mastitis. Depending on the functional state of the mammary gland (Mammary gland) (the presence of ... Medical Encyclopedia

    MASTITIS- (chest), acute or chronic inflammation mammary gland, usually associated with its infection during lactation. MASTITIS IN HUMANS Mastitis usually occurs in women, although occasionally cystic mastopathy observed in men. Spicy… … Collier Encyclopedia

Books

  • Acute purulent lactational mastitis, A. P. Chadaev, A. A. Zverev. The book covers the issues of etiology and pathogenesis, clinic, prevention and treatment of acute purulent lactational mastitis, as well as the principles surgical treatment according to various forms...

Despite the significant progress made modern medicine in the treatment and prevention of infections, purulent mastitis continues to be an urgent surgical problem. Long hospital stays, high recurrence rates and the associated need for reoperations, cases of severe sepsis, and poor cosmetic outcomes continue to accompany this common pathology.

ICD-10 code

N61 Inflammatory diseases of the mammary gland

Causes of purulent mastitis

Lactational 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 is not resolved within 3-5 days, then one of the clinical forms develops.

The bacteriological picture of lactational purulent mastitis has been studied quite well. In 93.3-95.0% of cases, it is caused by Staphylococcus aureus, which is detected in monoculture.

Non-lactational purulent mastitis occurs 4 times less often than lactational. Its cause is:

  • breast trauma;
  • acute purulent-inflammatory and allergic diseases of the skin and subcutaneous tissue of the mammary gland (furuncle, carbuncle, microbial eczema, etc.);
  • fibrocystic mastopathy;
  • benign tumors mammary gland (fibroadenoma, intraductal papilloma, etc.);
  • malignant neoplasms of the breast;
  • implantation of foreign synthetic materials into the gland tissue;
  • specific infectious diseases mammary gland (actinomycosis, tuberculosis, syphilis, etc.).

The bacteriological picture of non-lactational purulent mastitis is more diverse. In about 20% of cases, bacteria of the family Enterobacteriaceae, P. aeruginosa, as well as non-clostridial anaerobic infection are detected in association with Staphylococcus aureus or enterobacteria.

Among the many classifications of acute purulent mastitis given in the literature, the widespread classification of N. N. Kanshin (1981) deserves the most attention.

I. Acute serous.

II. Acute infiltrative.

III. Abscessing purulent mastitis:

  1. Apostematous purulent mastitis:
    • limited,
    • diffuse.
  2. Breast abscess:
    • solitary,
    • multi-cavity.
  3. Mixed abscessing purulent mastitis.

Symptoms of purulent mastitis

Lactational purulent mastitis begins acutely. Usually it goes through the stages of serous and infiltrative forms. The mammary gland slightly increases in volume, hyperemia of the skin appears above it from barely noticeable to bright. On palpation, a sharply painful infiltrate without clear boundaries is determined, in the center of which a softening center can be detected. The woman's well-being suffers significantly. There is a sharp weakness, sleep disturbance, appetite, fever up to 38-40 ° C, chills. V clinical analysis blood marked leukocytosis with neutrophilic shift, increased ESR.

Non-lactational purulent mastitis has a more blurred clinic. At the initial stages, the picture is determined by the clinic of the underlying disease, which is joined by purulent inflammation of the breast tissue. Most often, non-lactational purulent mastitis proceeds as a subareolar abscess.

Diagnosis of purulent mastitis

Purulent mastitis is diagnosed on the basis of typical symptoms of the inflammatory process and does not cause difficulties. If the diagnosis is in doubt, puncture of the mammary gland with a thick needle provides significant assistance, which reveals the localization, 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. In the course of the study, with a destructive form, a decrease in the echogenicity of the gland tissue is determined with the formation of hypoechoic zones in the places of accumulation of purulent contents, expansion of the milk ducts, and tissue infiltration. With non-lactational purulent mastitis, ultrasound helps to identify neoplasms of the mammary gland and other pathologies.

Treatment of purulent mastitis

The choice of surgical approach depends on the location and volume of the affected tissues. With subareolar and central intramammary purulent mastitis, a paraareolar incision is performed. On a small mammary gland, it is possible to produce HOGO from the same access, occupying no more than two quadrants. In the surgical treatment of purulent mastitis, spreading to 1-2 upper or medial quadrants, with an 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 along the outer transitional fold according to Mostkovy. When the focus of inflammation is localized in the lower quadrants, with retromammary and total purulent mastitis, a CHOG incision of the mammary gland is performed with the Hennig access, in addition to an unsatisfactory cosmetic result, Bardengeuer mammoptosis may develop along the lower transitional fold of the mammary gland. Gennig's and Rovninsky's accesses are not cosmetic, they have no advantage over the above, therefore, they are practically not used at present.

At the core surgical treatment purulent mastitis lies the HOGO principle. The volume of excision of the affected mammary gland tissues is still decided by many surgeons ambiguously. Some authors, for the prevention of deformation and disfigurement of the mammary gland, prefer sparing methods of treatment, which consist in opening and draining a purulent focus from a small incision with minimal or no necrectomy. Others, often noting with such tactics the long-term persistence of symptoms of intoxication, the high need for repeated operations, cases of sepsis associated with insufficient removal of affected tissues and the progression of the process, in our opinion, rightly incline in favor of radical CHO.

Excision of non-viable and infiltrated mammary gland tissues is performed within healthy tissues, until capillary bleeding occurs. With non-lactational purulent mastitis on the background fibrocystic mastopathy, fibroadenomas carry out intervention according to the type of sectoral resection. In all cases of purulent mastitis, it is necessary to produce histological examination removed tissues to exclude malignant neoplasms and other diseases of the mammary gland.

In the literature, the question of the use of a primary or primary delayed suture after radical CHO with drainage and flow-aspiration washing of the wound with an abscessing form is widely discussed. Noting the advantages of this method and the reduction in the duration of inpatient treatment associated with its use, one should still note a rather high incidence of wound suppuration, the statistics of which in the literature are generally ignored. According to A.P. Chadaev (2002), the frequency of wound suppuration after the application of a primary suture in a clinic that specifically deals with the treatment of purulent mastitis is at least 8.6%. Despite a small percentage of suppuration, it is still safer for wide clinical use to consider the open method of wound management, followed by the imposition of a primary-delayed or secondary suture. This is due to the fact that clinically it is not always possible to adequately assess the volume of tissue damage by a purulent-inflammatory process and, therefore, to carry out a complete necrectomy. The inevitable formation of secondary necrosis, high seeding of the wound with pathogenic microorganisms increase the risk of recurrence of purulent inflammation after the primary suture is applied. The extensive residual cavity formed after radical HOGO is difficult to eliminate. The exudate or hematoma accumulated in it 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 with the use of a primary suture usually leaves much to be desired.

Most clinicians adhere to the tactics of two-stage treatment of purulent mastitis. At the first stage, we carry out radical HOGO. The wound is treated openly using water-soluble ointments, iodophor solutions or draining sorbents. With the phenomena of SIRS and with extensive damage to the mammary gland, we prescribe antibiotic therapy (oxacillin 1.0 g 4 times a day intramuscularly or cefazolin 2.0 g 3 times intramuscularly). In non-lactational purulent mastitis, empiric antibiotic therapy includes cefazolin + metronidazole or lincomycin (clindamycin), or amoxiclav in monotherapy.

During postoperative treatment, the surgeon has the ability to control the wound process, directing it in the right direction. Over time, inflammatory changes in the area of ​​the wound are steadfastly 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 plasty of the mammary gland wound with local tissues. Given that more than 80% of patients with purulent mastitis are women under 40 years of age, we consider the stage of restorative treatment to be extremely important and necessary to obtain good cosmetic results.

We perform skin plastic surgery according to the J. Zoltan method. The edges of the skin, the walls and the bottom of the wound are excised, giving it, if possible, a wedge-shaped shape convenient for suturing. The wound is drained with a thin through perforated drainage, brought out through counter-openings. The residual cavity is eliminated by applying deep sutures from an absorbable thread on an atraumatic needle. An intradermal suture is applied to the skin. Drainage is connected to a pneumoaspirator. There is no need for constant washing of the wound with the tactics of two-stage treatment, only aspiration of the wound discharge is carried out. Drainage is usually removed on the 3rd day. With lactorrhea, drainage may be in the wound for a longer period. The intradermal suture is removed for 8-10 days.

Skin plasty after the purulent process has subsided can reduce the number of complications to 4.0%. This reduces the degree of deformation of the mammary gland, increases the cosmetic result of the intervention.

Usually, a purulent-inflammatory process affects one mammary gland. Bilateral lactational purulent mastitis is quite rare, only 6% of cases.

In some cases, when the outcome of purulent mastitis 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 aggravated history, presents significant difficulties. The development of sepsis against the background of an extensive purulent-necrotic focus leads to high mortality.

Postpartum mastitis is an inflammation of the mammary gland that develops after childbirth and is associated with lactation.

ICD-10 CODE
O91 Breast infections associated with childbearing.

EPIDEMIOLOGY

Postpartum mastitis is diagnosed in 2–11% of lactating women, but the accuracy of these figures is doubtful, since some experts include lactostasis here, and a significant number of patients simply do not go to doctors.

CLASSIFICATION OF MASTITIS

unified classification postpartum mastitis no. Some domestic experts propose to divide postpartum mastitis into serous, infiltrative and purulent, as well as into interstitial, parenchymal and retromammary.

In international practice, there are 2 forms of mastitis:
Epidemic - developing in a hospital;
endemic - developing 2–3 weeks after delivery in an outpatient setting.

ETIOLOGY (CAUSES) OF MASTITIS AFTER BIRTH

In the vast majority of cases (60–80%), the causative agent of postpartum mastitis is S. aureus.
Other microorganisms are found much less frequently: streptococci of groups A and B, E. coli, Bacteroides spp. With the development of an abscess, anaerobic microflora is somewhat more often isolated, although in this situation staphylococci dominate.

PATHOGENESIS

Entrance gates for infection most often become nipple cracks, intracanalicular penetration of pathogenic flora is possible during feeding or pumping milk.

Predisposing factors:
lactostasis;
Structural changes in the mammary glands (mastopathy, cicatricial changes, etc.);
Violations of hygiene and rules breastfeeding.

CLINICAL PICTURE (SYMPTOMS) OF POSTPARTUM MASTITIS

The clinical picture is characterized by local soreness, hyperemia and compaction of the mammary glands against the background of an increase in body temperature. A purulent discharge from the nipple may appear.

DIAGNOSTICS

Diagnosis is based primarily on the assessment of clinical symptoms. Laboratory methods insufficiently accurate and are of an auxiliary nature.

CRITERIA FOR DIAGNOSIS

Fever, body temperature >37.8 °C, chills.
Local pain, hyperemia, induration and swelling of the mammary glands.
Purulent discharge from the nipple.
Leukocytes in milk> 106/ml.
Bacteria in milk >103 cfu/ml.

Acute mastitis can develop during any period of lactation, but most often it occurs in the first month after childbirth.

ANAMNESIS

Lactostasis and nipple cracks are the main predisposing factors for mastitis.

PHYSICAL EXAMINATION

It is necessary to examine and palpate the mammary glands.

LABORATORY RESEARCH

·Clinical blood test.
Microbiological and cytological examination milk.

INSTRUMENTAL RESEARCH METHODS

Ultrasound of the mammary glands allows you to identify foci of abscess formation in most cases.

SCREENING

All puerperas need to examine and palpate the mammary glands.

DIFFERENTIAL DIAGNOSIS

Differential diagnosis between lactostasis and acute mastitis is quite complicated. An indirect confirmation of mastitis is the unilateral nature of the lesion of the mammary glands.

Expert advice may be required ultrasound diagnostics and mammologist.

EXAMPLE FORMULATION OF THE DIAGNOSIS

Ten days after natural childbirth. Left side mastitis.

TREATMENT OF MASTITIS AFTER BIRTH

GOALS OF TREATMENT

Stop the main symptoms of the disease.

INDICATIONS FOR HOSPITALIZATION

Abscessing of mammary glands.
The need for surgical intervention.

NON-DRUG TREATMENT

Apart from antibiotic therapy carry out additional decantation of the mammary glands, apply cold locally (many authors, including foreign ones, recommend warm compresses).

MEDICAL TREATMENT

The basis of the treatment of acute mastitis is antibiotic therapy, which must be started immediately (within 24 hours) after the diagnosis is established.

Recommended regimens for oral antibiotic therapy:
Amoxicillin + clavulanic acid (625 mg 3 times a day or 1000 mg 2 times a day);
oxacillin (500 mg 4 times a day);
Cephalexin (500 mg 4 times a day).

The duration of treatment is 5-10 days. Therapy can be completed 24-48 hours after the disappearance of the symptoms of the disease. If methicillin-resistant S. aureus is found, vancomycin is given.

In the absence of signs of clinical improvement within 48-72 hours from the start of therapy, it is necessary to clarify the diagnosis to exclude abscess formation.

Despite ongoing treatment, breast abscesses form in 4–10% of cases of acute mastitis. This requires mandatory surgical treatment (opening and drainage of the abscess) and transfer of the patient to parenteral antibiotic therapy. Given the significant role of anaerobes in the etiological structure of breast abscesses, it is advisable to start empirical therapy with parenteral administration of amoxicillin with sclavulanic acid, effective against both aerobic and anaerobic microflora.

To suppress lactation during abscess formation, cabergoline (0.5 mg orally 2 times a day for 1-2 days), or bromocriptine (2.5 mg orally 2 times a day for 14 days) is used.

SURGERY

Breast abscesses are opened and drained under general anesthesia.

INDICATIONS FOR CONSULTATION OF OTHER SPECIALISTS

Consultation of the surgeon is necessary for abscessing of the mammary glands.

APPROXIMATE TIMES OF INABILITY TO WORK

Postpartum mastitis is the basis for granting postpartum leave of 86 calendar days (an additional 16 days).

TREATMENT EFFECTIVENESS ASSESSMENT

Drug treatment is effective if the main symptoms of the disease stop within 48-72 hours from the start of therapy.

PREVENTION OF MASTITIS AFTER BIRTH

Compliance with the rules of breastfeeding.
Prevention of formation of nipple cracks and lactostasis.

INFORMATION FOR THE PATIENT

Women in childbirth should be informed about the need to immediately consult a doctor with an increase in body temperature, the appearance of local pain and compaction of the mammary glands.

FORECAST

The prognosis is favorable. With inadequate therapy, generalization of infection and the development of sepsis are possible.

Mastitis (chest) - breast inflammation. Periductal mastitis (plasmocytic mastitis, subareolar abscess) - inflammation of the additional glands in the areola area. Mastitis of newborns is mastitis that occurs in the first days of life as a result of infection of hyperplastic glandular elements.

Code by international classification ICD-10 diseases:

  • O91.2
  • P39.0
  • P83.4

Classification. Downstream .. Acute: serous, purulent, phlegmonous, gangrenous, abscessing .. Chronic: purulent, non-purulent. By localization: subareolar, intramammary, retromammary, spilled (panmastitis).
Etiology. Lactational (occurs in the postpartum period; see Breastfeeding). Bacterial (streptococci, staphylococci, pneumococci, gonococci, often combinations with other coccal flora, Escherichia coli, Proteus). Carcinomatous.

Causes

Risk factors. Lactation period: violation of the outflow of milk through the milk ducts, cracks in the nipples and the areola, improper care of the nipples, violations of personal hygiene. Purulent diseases of the skin of the breast. SD. Rheumatoid arthritis. Silicone/paraffin breast implants. GC reception. Removal of a breast tumor followed by radiotherapy. Long history of smoking.

Symptoms (signs)

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, tense, the skin over the focus is hyperemic, on palpation - a painful infiltrate with fuzzy borders .. Regional lymphadenitis.
. Acute purulent abscess mastitis.. Fever, chills .. Pain in the gland .. Mammary gland: redness of the skin over the lesion, sharp pain on palpation, softening of the infiltrate in the center with the presence of fluctuation .. Regional lymphadenitis.
. Acute purulent phlegmonous mastitis.. Severe general condition, fever.. The mammary gland is sharply enlarged, painful, pasty, infiltrate without sharp boundaries occupies almost the entire gland, the skin over the infiltrate is hyperemic, has a bluish tint.. Lymphangitis, regional lymphadenitis.

Diagnostics

Treatment

TREATMENT
Conservative therapy. Isolation of mother and child from other puerperas and newborns. Bandage or bra that supports the mammary gland. Dry heat on the affected mammary gland. Expression of milk from the affected gland in order to reduce its engorgement. Cessation of breastfeeding with the development of purulent mastitis. If pumping is not possible and there is a need to suppress lactation, drugs that suppress the formation of prolactin are used - cabergoline 0.25 mg 2 r / day for two days, bromocriptine 0.005 g 2 r / day for 4-8 days. Antimicrobial therapy with continued breastfeeding - semi-synthetic penicillins, cephalosporins: cephalexin 500 mg 2 r / day, cefaclor 250 mg 3 r / day, amoxicillin + clavulanic acid 250 mg 3 r / day; if anaerobic microflora is suspected, clindamycin 300 mg 3 r / day (in case of refusal to feed, any antibiotics can be used). NSAIDs. In case of termination of feeding - a solution of dimethyl sulfoxide in a dilution of 1: 5, topically.

Surgery. Fine needle aspiration of contents. With the ineffectiveness of punctures - opening and drainage of the abscess with careful separation of all bridges. Surgical incisions.. With subareolar abscess - along the edge of the peripapillary field.. Intramammary abscess - radial.. Retromammary - along the submammary fold. With a small focus of fungal or tuberculous etiology, chronic abscess, it is possible to excise it with adjacent altered tissues. With the progression of the process with the development of panmastitis - removal of the gland (simple mastectomy).

Complications. Fistula formation. Subpectoral phlegmon. Sepsis.
The course and prognosis are favorable. Full recovery occurs within 8-10 days with adequate drainage.
Prevention. Careful care of the mammary glands. Compliance with food hygiene. Use of emollient creams. Expression of milk.

ICD-10. O91.2 Non-suppurative mastitis associated with childbearing P39.0 Neonatal infectious mastitis N61 Inflammatory diseases of the mammary gland. P83.4 Breast swelling of newborn

This disease often occurs in the first months of a child's life. It proceeds acutely, with an increase in temperature to high values, swelling of the mammary gland, a change in the color of the skin in the area of ​​the areola, and the development of an abscess. At improper treatment a generalization of the process with the development of a septic component may occur. The incidence of this disease is similar in girls and boys from birth to three years (according to statistics).

According to ICD10 (International Statistical Classification of Diseases), mastitis in newborns has the code P39.0.

Doctors around the world very often refer to this classification. It helps to display statistical data and answer a number of questions related to the diagnosis, treatment, prognosis of various diseases.

Infectious suppuration of the mammary gland in an infant is common. It can occur in children of both sexes of different age groups. However, girls under one month are more susceptible to this pathology.

Very often, the development of mastitis in an infant occurs against the background of physiological mastopathy. The cause may be maternal estrogen hormones. They pass on the 7th month of pregnancy from mother to fetus and infants have an imbalance of hormones. At right approach and hygiene, the disease can resolve on its own within a week. Self-medication can lead to infection. The reason can often be the use of disinfecting ointments, compresses that mothers apply to the gland, and tight bandaging of the breast.

Dr. Komarovsky believes that it is important not to harm in cases where you can just leave the child alone and follow simple hygiene rules.

Often, excessive care can cause infection (rubbing with a washcloth, removing rough areas, squeezing out a secret). Purulent mastitis can develop in a weakened child with reduced immunity. Other reasons are tight, rough or dirty clothes, infrequent bathing of the baby.

Besides external causes, may be internal, leading to this pathology. These are concomitant infectious and inflammatory processes in the child's body. They can spread through the blood or lymph. Their timely treatment can prevent the development of new pathologies.

At this age, it is better to refrain from kissing. The infection can enter through the child's mouth and spread internally. The danger of purulent mastitis is associated with the possibility of instant development of sepsis. Risk factors also include a burdened obstetric and gynecological history, urogenital diseases, respiratory viral infections mother.

An important place is given today to natural feeding. Breast milk is powerful immune protection for child's body. Artificial feeding from the first days is often a prerequisite for reducing the defenses of the child's body and the development of a purulent infection.

Symptoms of mastitis in a child

The clinical picture of purulent mastitis and breasts is similar, and mothers often confuse these diagnoses.

With physiological mastopathy, which develops as a result of hormonal disruptions, there is no infection and high temperature. The child feels quite normal, calm. The only manifestation is an increase in the size of the mammary glands, but the color of the skin over them does not change. It is possible to secrete a certain amount of gray or white secretion, similar to colostrum. At proper care breasts will often go away on their own without treatment. To do this, mom only needs:

  • iron the child's clothes, bed linen well
  • use soft cotton fabrics
  • bathe your baby regularly

You can, in order to avoid the ingress of bacteria, apply a dry, clean, soft cloth to the mammary gland, changing it often. Do not make compresses (cold, hot), use ointments, folk recipes, squeeze out the secret.

If you do not follow the rules of hygiene, do not pay due attention to caring for the child, or, conversely, over-treat, you can introduce an infection. Suppuration of the swollen mammary gland will already lead to a pathological symptom complex - purulent mastitis.

In infants, this disease often begins on the seventh to tenth day after birth with symptoms of intoxication. Heat, sleep disturbance, the general condition of the child is unsatisfactory, appetite decreases, diarrhea may join. In parallel, local symptoms develop.

The mammary gland increases, more often on one side. Skin around the areola are initially hyperemic (blush), then become bluish-purple. When touched, the child reacts sharply with screaming and crying. Above the focus, the temperature is increased, later a fluctuation (pulsation) joins - a sign of a formed abscess. When pressed, there may be a release of a small amount of pus, but there is also a spontaneous release of a purulent secret. These symptoms, indicative of a local inflammatory process, develop rapidly, although sequentially. It is necessary to take into account the stage of purulent mastitis in order to choose the right type of treatment.

stages

  1. At the initial stage - serous mastitis, local phenomena are poorly expressed by the accumulation of serous fluid, skin color is often not changed. Characterized by swelling of the mammary gland, deterioration of the general condition of the child, the temperature is low. At this stage, carry out differential diagnosis with physiological mastopathy in order to choose the right treatment tactics.
  2. The stage of infiltration occurs when the process passes to neighboring tissues, the formation of a diffuse focus, which is accompanied by reddening of the skin, pain and high temperature.
  3. Then the foci of infiltration merge, leukocytes accumulate in large numbers, which fight the infection, pus is formed. Often the process can move to the underlying tissues with the formation of phlegmon and gangrene - a purulent stage.
  4. Complications and consequences. At this stage, mastitis in children is dangerous, as it can develop at lightning speed and turn into sepsis. It is necessary to start treatment as soon as possible, and if necessary, on the recommendation of a doctor, agree to a surgical operation. Although such an operation would have undesirable consequences for future mother, but it is carried out according to vital indications and is not discussed.

Diagnostics

For later life, mastitis in girls is more dangerous than in boys because the milk ducts can become blocked, and in the future, asymmetry of the mammary glands can be observed. V adolescence there are also undesirable consequences: when a girl grows up, becomes a mother, she may have problems with lactation. Then these women will be included in the risk group for oncology, mastopathy.

From additional methods surveys, it is enough to determine general clinical tests. General analysis the child's blood often shows high leukocytosis with a stab shift, an increase in ESR. However, due to the immaturity of the immune system, there may not be pronounced changes in the blood picture. But this does not exclude an acute infectious process.

Treatment

The tactics of therapeutic measures depends on the stage and prevalence of the process.

At the initial stages - serous and infiltrative - treatment is often limited to only conservative methods. Bed rest is established for the child, cold is applied to the mammary gland. They do a bacteriological study, and prescribe an antibiotic, taking into account the sensitivity of the bacterial flora. In parallel, antipyretic, analgesic and anti-inflammatory therapy is carried out. These are usually medicines active substance paracetamol acts - it can be used from the first days of a child's life. In addition, drugs are used local application- water-soluble ointments with painkillers, antibacterial action while promoting healing.

With the formation of phlegmon and abscess of the baby, they immediately operate. The affected areas of the gland are opened, washed and drained. Antibiotic treatment of the child is continued at the discretion of the doctor.

Complementary Therapy

Use funds traditional medicine with the application of various ointments, tinctures, camphor oil often not recommended by doctors. All this can lead to sad consequences, because. there is a danger of infection and allergens entering the child's body. Therefore, it is better to strictly follow the recommendations of the doctor and not engage in amateur activities.

Restorative, physiotherapeutic treatment is often prescribed during the recovery period. The appointment of vitamins, mineral complexes, as well as a proper balanced diet will help the child recover faster and get stronger.

Here are the consequences that can be as a result of inattentive attitude and neglect simple rules hygiene of the baby, and the "golden rule of medicine" - prevention of a disease is easier than treatment!