Literature review for - Flourish Paediatrics

Several studies examined the risk factors for the development of mastitis but the results are
inconclusive and further research is required.
Spencer formed the following key recommendations for practice as a result of the evidence
on mastitis at the time of publication (Spencer 2008).
KEY RECOMMENDATIONS FOR PRACTICE (used the SORT evidence rating
system)
Clinical recommendation
Evidence rating
Optimizing lactation support is essential in women with
mastitis.
C (2 publications)
Milk culture is rarely needed in the diagnosis of mastitis,
but it should be considered in refractory and hospitalacquired
cases.
C (3 publications)
Antibiotics effective against Staphylococcus aureus are
C (2 publications)
preferred in the treatment of mastitis.
Breastfeeding in the presence of mastitis generally does
not pose a risk to the infant and should be continued to C (2 publications)
maintain milk supply.
A = consistent, good-quality patient-oriented evidence; B = inconsistent or limitedquality
patient-oriented evidence; C = consensus, disease-oriented evidence, usual
practice, expert opinion, or case series.
ABM protocol on mastitis
The ABM has listed predisposing factors in the development of mastitis in breastfeeding
women. The ABM note the extent of their association has not been verified. The predisposing
factors included traumatised nipples, especially if Staphylococcus aureus colonization is
present, infrequent or poor duration of feedings, missing feedings, poor attachment or weak
or uncoordinated suckling leading to inefficient removal of milk, illness in mother or baby,
oversupply of milk, rapid weaning, pressure on the breast (e.g., tight bra, car seatbelt),
blocked nipple pore or duct or Candida infection and maternal stress and fatigue (Academy of
Breastfeeding Medicine 2008).
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