Preemie baby and MRSA - please help

[MizZan]

Would appreciate hearing from anyone with similar experience...

My baby (DS2) was born in early October 8 weeks premature. It was totally unexpected and unfortunately he had a number of complications which have kept him in hospital for the past 5 weeks.

I was able to start breastfeeding him (partially, he still got most feeds through a naso-gastric tube) when he was about 2 weeks old, however we were then informed that he had tested positive for MRSA, almost certainly transmitted to him by a member of staff who had touched another baby who had it, and then touched my son. I asked if I should continue breastfeeding him and was told yes, and that there was no danger to me.

We subsequently found out that his MRSA was localised in his nose and throat. At this point I asked the hospital staff if it was perhaps not best for me to stop breastfeeding him until they could attempt to clear the MRSA bacteria from his throat, since I was afraid he would pass the bacteria to me through the breast, and I would then pass it back to him through the breast, ad infinitum. I was again told this would not happen, but unfortunately when they tested me, they found out it was exactly what had happened. So I now have it on my breast, and he still has it in his throat. Once we found this out, I decided it would be best to stop breastfeeding him until we could try to clear the MRSA from one or both of us.

My situation now is that I'm expressing milk for him and giving it to him in bottles. The hospital has yet to tell us whether they will agree to treat us for the MRSA colonisation or not. What I would like to know is:

• has anyone at all had a similar experience (or heard of one), and what was the outcome for mom/baby?

• have any of you managed to express breastmilk (100% of the time, with no breastfeeding) to feed a sick or unable-to-breastfeed baby for any length of time? any words of wisdom or suggestions? I have managed so far for 5 weeks but was intending to breastfeed him for 6 months (that would be 6, plus the 2 extra preemie months, so 8 months) - I am not sure if it is realistic now though, to say I'd express milk 5 or 6 times a day over such a long period of time.

would be grateful for any advice or support - needless to say after the trauma of his premature birth and complications, this MRSA situation is the last thing we needed. thanks.

Gosh MiZZan,what a horrid experience.

One for the experts I think.

Will bump for you as necessary.

Sorry you and your little one have been through such a tough time. No direct experience, but I know that another MNetter, Fastasleep, expressed milk for several months for her son. She's not posting that often atm, as she's now expressing milk for a 5 week old daughter. I think there are a few other MNetters who have also expressed for several months, so it is possible, but it is very demanding. Fastasleep is expressing for 40 minutes every 3 hours atm.

HTH

Congratulations on the birth of your son. So sorry that it has been so difficult for you. A friend managed to express for 4 months and her DD was exclusively fed in this way. She found it very tiring and emotionally draining but was very determined and had lots of support.

I hope someone with personal experience comes along soon to offer advice. Good luck.

Don't know but. bump

And congrats on baby, and well done on keeping at the breast pumping. you poor dear.

I think the first thing you need to do is ring one of the breastfeeding helplines - I think the NCT have a register of people who have been in unusual situations with breastfeeding, so you might find someone who could help you through them. They will certainly give you general advice.

As for pumping, yes, it's possible to express longterm, and it might be that once the MRSA has gone, you'll be able to breastfeed him directly.

This is the Breastfeeding Network's Drugline - ring them for advice about any drugs you're prescribed for the MRSA

If I think of anything else, or find anything else online, I'll post again, but otherwise, I'll bump for you tomorrow. I really, really hope that the MRSA goes asap and you're able to really enjoy your little boy. Congratulations on his birth - and keep up the good work, you're doing brilliantly!

If you are not going to be treated for colonisation then I would continue to breastfeed him. The properties of breastmilk will be of far greater benefit to him as he is preterm. MRSA can be present but not cause any problems.

If you have not had any sort of treatment I cannot see the benefit of expressing and not directly feeding as surely the MRSA will still be present. Have you been reswabbed to make sure it isn't still there? Were you initially swabbed just after he fed?

It is possible to express and keep up milk supply. You need to express 6-8 times a day to keep the breast stimulated.
Talk to the staff about your concerns. By the sound of your post you have made the decision to directly stop breastfeeding yourself. That may not be necessary, especially if the colonisation is not going to be treated.
Amazingly the breast can manufacture the antibodies a baby requires to combat infection - continuing to breastfeed will help the situation. Good luck.

If it turns out that you need to express milk longterm for baby, there is a book that explains how to express exclusively till you choose to wean your baby. go to www.expressyourselfmums.co.uk

Hi MizZan, Just in case you didn't find the right bit of the website exclusively expressing info is here (quite easy to find though!)

I hope that after all these bottles your son takes to the breast again (as Mears says it sounds like you could just put him back on the breast after all!) in my experience as soon as bottles have been taken and enjoyed that pretty much spells the end for latch on... although other people have babies who have happily gone back to the breast!

If you end up expressing I find the most important thing is routine... I don't find that every 3 hours works for me as quite often my pumps get pushed back or forwards for some reason or other... I get the best supply of milk from having a (strict!) day plan like this express at 6am, 10am, 2pm, 5:30pm, 8pm, 11pm, 3am... if I end up expressing at say 6:30am I stick to the next time anyway... also my day plan was designed for maximum time during the busy daytime hours (when there are no husbands around)... but what works for me could be completely impractical for you!

Remember that night time pumps keep your supply up due to the extra special hormones released so try to do one in the night, (not saying it has to be 3am, I'm masochisic!)

Also you don't need to double pump, you can go for the cheaper option and just express for 40 minutes swapping from one breast to another when the milk flow stops and then back again etc.. I still use an Avent Isis although it gives me RSI!

Best of luck to you, hopefully you didn't need all that garbled advice and your little one is happily chomping away on your boob as I type

hi - thank you everyone who responded. my son is home now, thank god, and doing well. he still has mrsa though mine has now cleared. am still expressing for him but not quite keeping up (supplementing at the moment with frozen EBM left over from early days when I was making way too much for him).

so we are on week 10 of expressing. but all our at-home help is about to disappear, and between expressing, feeding baby, giving him his million medications (for other problems, not for mrsa), and caring for my older son, it is not realistic to say we'll continue with this. there just aren't enough hours in the day.

debating at the moment whether to try moving him back to breastfeeding (fully or partially) if he will go for it, and washing myself down with antibacterial soaps afterwards in an effort to keep from being recolonised with mrsa myself. obviously this is not practical if we're out and about, but would work if we're at home, which is most of the time anyway. I am anxious to avoid being recolonised on the breast, since if I get cracked nipples or mastitis I can end up with MRSA infection which is very nasty indeed and would put paid to any breastfeeding or expressing at all, I expect, as I'd have to be hospitalised.

alternative is to put him onto formula. or do part formula, part expressing, which is what I'm leaning towards if he'll tolerate it. does anyone know how much breastmilk they need in order to get the benefits (eg mum's immune system)?

fastasleep, I have just looked at that link about exclusively expressing, thank you SO much! It is such a help to know others are doing/have done this. my husband and parents think i'm insane to keep it up so support is very welcome.

hi - thank you everyone who responded. my son is home now, thank god, and doing well. he still has mrsa though mine has now cleared. am still expressing for him but not quite keeping up (supplementing at the moment with frozen EBM left over from early days when I was making way too much for him).

so we are on week 10 of expressing. but all our at-home help is about to disappear, and between expressing, feeding baby, giving him his million medications (for other problems, not for mrsa), and caring for my older son, it is not realistic to say we'll continue with this. there just aren't enough hours in the day.

debating at the moment whether to try moving him back to breastfeeding (fully or partially) if he will go for it, and washing myself down with antibacterial soaps afterwards in an effort to keep from being recolonised with mrsa myself. obviously this is not practical if we're out and about, but would work if we're at home, which is most of the time anyway. I am anxious to avoid being recolonised on the breast, since if I get cracked nipples or mastitis I can end up with MRSA infection which is very nasty indeed and would put paid to any breastfeeding or expressing at all, I expect, as I'd have to be hospitalised.

alternative is to put him onto formula. or do part formula, part expressing, which is what I'm leaning towards if he'll tolerate it. does anyone know how much breastmilk they need in order to get the benefits (eg mum's immune system)?

MizZan, I'm not an expert. I would talk to the NCT or the La Leche League, or the Association of Breastfeeding Mothers, or the Breastfeeding Network. Whichever.

That being said:

• if your baby is drinking more milk than you are pumping, then you're not pumping enough milk.
• pumping is hard work, breastfeeding directly is a lot easier.
• I suspect your body can protect itself from MRSA. Cracked nipples and mastitis aren't inevitable - I've breastfed two babies now, and not suffered from either, ever.
• You can always give breastfeeding a go (ideally with a bit of help from a BFC?), and see how it goes
• the benefits of exclusive breastfeeding are greater than the benefits of mixed feeding. But mixed feeding is still better for the baby than formula.

I hope someone who knows more (tiktok? mears?) will be along soon ...

there is some benefit to any breast milk given.

MizZan,
I expressed exclusively for my DS2 who was born with a cleft palate and was unable to latch on. Similarly to your situation, I also had DS1 who was three at the time and DS2 was a very unsettled baby so it was hard work at first. I kept it up for 5 months from birth and only stopped when it became too inconvenient for me, to be honest. My supply did increase gradually until I was easily expressing two bottles at a sitting and only expressed twice a day - remember your body will adjust to supply and demand so I demanded milk only at times that suited me i.e. in the evening when I could rest and in the morning with a cup of tea after breakfast. It does work and it does become easier. Let me know if you have any questions.

MizZan, this is way out of my league, sadly, and I take my hat off to you for persisting through all the challenges and confusions you have had. Wow - you deserve a medal.

I just don't understand about you passing MRSA back and forth via the breast - why is this particularly risky when handling him would be just as risky (especially as this is how he appears to have got it in the first place)?

I have no idea if babies can pass MRSA to their mothers via their saliva and breastfeeding - mothers and babies are in intimate body-fluid contact all the time, just through baby care.

As I say, I am at a loss, but I think you need to get a specialist opinion, who can share research with you - infection control people may not be the best source of this, as they rarely (in my experience) know much about breastfeeding. But you could speak to them, and filter your own knowledge of bf through what they say.....

I do hope things work out.

No experience to offer - my minor problems with getting b/f established post c-sections pale into insignificance beside what you have experienced and achieved for your ds2, I salute you MizZan.
I really hope you can get the specialist advice you need to keep on expressing. With all his other health issues your ds2 is doing really well to still be getting breastmilk.

Hi MizZan

Have nothing to offer on the MRSA front I'm afraid, but I did express milk for my premmie baby who was 10 weeks early.

You are doing really well to express and look after your baby at home, I did this for a couple of months and it is hard work. Luckily I had a freezer full of milk by the time Charlie came home (he was in SCBU for 10 weeks due to complications ) and that supplemented my supply for a while. In the end I did end up supplementing with formula, before moving on to formula completely when Charlie was about 5 months old - unfortunately Charlie kind of forgot how to breastfeed after his feeds were stopped for a few days for an operation and I just felt that by that point we'd both been through too much to try and get him breast feeding again when he was taking bottle milk quite happily.

If you do decide to supplement with formula ask your HV or GP if you are eligible for nutriprem 2 on prescription - it is specially made for premmies and saves on milk costs.

I had really wanted to give Charlie EBM for as long as possible but was determined not to feel guilty about changing to formula when I got to that point, lots of premmie babies don't get any breast milk for one reason or another; I had given Charlie the best start possible and he needed me to be fit and well and not constantly totally exhausted, which expressing and bottle feeding can do to you.

Hope this helps!!

CGMum

hi ladies and thanks again for all the helpful support.

charliegreensmum, sounds like your situation was effectively pretty similar to ours. thank you for the suggestion on the nutriprem 2, I do think we will ultimately end up topping up with formula or going on to it completely but I want to try to wait till winter and cold season is past so as to maximise chances of keeping the little guy healthy. we'll see if we can manage it.

I too had a freezer full of milk when our son came home from hospital and I've just had to start dipping into it over the past 2 weeks to supplement. at the same time, I've taken the decision to restart breastfeeding on a limited basis, because it just seemed like there was no way to make enough hours in the day for me to express enough times, and feed him, and do the other stuff that needs to get done (boy will I be glad when xmas is over...). I'm scrubbing down with disinfectant after breastfeeding in an effort to keep the MRSA off me though who knows if this will work.

the good news is my son had no problem going back to breastfeeding though he finds it a little tiring, and he seems happy enough switching back and forth between breast and bottle. I'll probably still keep expressing for part of the time and eventually get up to breastfeeding him 2 or 3 times a day (unless he gets rid of the MRSA but it seems unlikely that will happen for some time).

re whether I would get MRSA anyway just by handling him, the answer is maybe, but I haven't so far (I get retested whenever he gets retested). Being careful about washing hands goes a long way. He almost certainly got it by someone who was caring for him in the hospital neglecting to do this.