How to understand that a newborn has mastitis Treatment of mastitis

Expert: pediatric surgeon, pediatric urologist, pediatric andrologist Alexander Ivanovich Sumin

The baby's body systems develop gradually in the womb, and the formation of mammary glands under the influence of estrogens and progesterone begins around the 10th week. At the beginning, the child “uses” maternal hormones, because before birth his endocrine system does not start working.

Immediately after birth, the child’s body tries to adapt to the new world, all its systems are rebuilt to the conditions of the external environment. This is a moment of stress for a newborn, in which all the forces of his body are put to work and become active. For some children, the adaptation process occurs physiologically, while others may experience problems. For example, when an infection enters the body, mastitis may develop in newborns.

How does physiological mastopathy differ from mastitis in newborns?

What happens to the baby's mammary glands after birth? The endocrine system is activated, so the baby’s body needs maternal hormones less and less. The pituitary gland of a small organism begins to produce estrogens, resulting in the release of prolactin: this causes engorgement of the mammary glands in the child, from which a milky fluid can be released.

Within a week after birth, the baby experiences a condition called a hormonal crisis. Nature is designed in such a way that it is the hormonal crisis that forces the body to adapt to the world: having gone through it, the child receives certain protection from problems with the immune and neurological system.

Treatment of atheroma in children

The optimal method of treating atheroma in children is its surgical removal.
However, the age of the patient decides a lot here. Thus, most pediatric surgeons, in the absence of severe clinical symptoms, recommend a wait-and-see approach. Sometimes the swelling may resolve on its own. This is especially true for newborns and infants. In such cases, the development of the neoplasm is observed until the age of three, and if it persists, only then is it removed. Surgical intervention can be carried out traditionally using a scalpel or minimally invasively using a laser. In the first case, the surgeon excises the tumor with a capsule, which eliminates the risk of relapse. After this, cosmetic stitches are applied to the tissue to achieve the best aesthetic result.

Laser removal in children is used for small tumors. Using this technique, it is possible to avoid incisions and the formation of postoperative scars. In both cases, a comprehensive examination of the child is first carried out with the selection of the optimal treatment option.

In the postoperative period, the child may be prescribed the following groups of medications:

painkillers;
anti-inflammatory;
antibacterial.

Drug therapy is aimed at eliminating discomfort and preventing infection of the postoperative wound.

Why does newborn mastitis develop?

If, during the development of physiological mastopathy, an infection enters the child’s body (usually staphylococcal or streptococcal), there is a risk of newborn mastitis: moreover, it can occur in both newborn girls and newborn boys. Staphylococcal or streptococcal bacteria can live in the mother's body (for example, on the surface of her skin or on the mucous membrane of the nasopharynx), and can also be found on surfaces in toilets and bathrooms.

Most often, mastitis in a newborn develops after discharge from the hospital - approximately on the 10th day of the baby’s life. By this time, the baby’s mammary glands should return to normal. And if the mother sees that this did not happen, it is necessary to urgently consult a pediatrician.

Microorganisms enter the body under certain conditions, usually when parents do not properly care for the child, not taking into account the special properties of his skin:

it has a lot of microvessels;
it has high permeability, so any substances from its surface immediately enter the body and the bloodstream;
the fatty tissue under the skin is very thick and loose;
sweat and sebaceous glands cannot yet function normally and create antibacterial protection; and if maternal immunity was unable to protect the child from bacteria (after all, the baby’s skin does not immediately accept all its microorganisms from the mother - the process of this colonization occurs gradually), they immediately cause an infectious pathology in the body;
the thermoregulation process has not yet been adjusted;
the skin is very saturated with liquid.
How and why can an infection occur?
if the child is dressed without taking into account the air temperature, and diaper rash occurs on his skin;

if the baby’s clothes have rough seams or edges that injure delicate skin;

if, while treating the child’s skin, the mother accidentally scratches or damages the skin (for example, with a manicure).

Pediatric mammology

Hello, dear parents!

Allow me to introduce myself: Sergey Vladimirovich Kaplunov – I am a pediatric surgeon and pediatric oncologist. And today I would like to talk with the parents of my potential patients aged 0 to 18 years on such a very rare topic as pediatric and adolescent mammology. The relevance of this topic is due to the fact that parents do not know who to contact with this or that problem that has arisen in such a sensitive and intimate area, and doctors - pediatricians, gynecologists and ordinary pediatric surgeons are not fully aware of all the variants of pathology that can occur in the area of the mammary glands in children of different ages, and therefore cannot prescribe qualified treatment.

Let me look at breast problems in children according to the age at which these situations may arise.

But first, just a little bit of anatomy: both girls and boys have rudiments of glandular tissue located immediately under the nipple area - so from these tissue rudiments in adolescence, girls will develop glandular tissue of the mammary gland, and in boys these rudiments of glandular tissue will develop. the tissues will normally remain in their rudimentary form.

I. Newborn period. During this period, the so-called “sexual crisis” often occurs, one of the manifestations of which is engorgement (swelling, thickening, increase in volume) of those same rudiments of mammary gland tissue due to the passage of female sex hormones (estrogens) from the mother to the newborn child (sometimes it can even be released scanty secretion from the nipples) – usually this condition can be observed on the 3rd – 10th days of the child’s life, followed by a slow decrease in the severity of tissue engorgement in the nipple area.

But when infections penetrate through the thin and therefore easily vulnerable skin of a baby, against the background of this transient and physiological state, purulent-inflammatory diseases such as mastitis of newborns and necrotizing phlegmon of newborns (which is often localized in the area of the anterior chest wall) can occur.

Already in the neonatal period, parents may notice various developmental anomalies associated with the mammary glands in the child, such as:

atelia - absence of a nipple (absence of a nipple can be a symptom of syndromic pathology - an anomaly in the development of all tissues of the chest wall on the side of the missing nipple);

polythelia - an increase in the number of nipples: most often there is one additional nipple (on one side), which is located along the so-called “milky line” (from the armpit to the groin area), as a rule, the additional nipple is smaller in size (the nipple itself is also reduced and the surrounding areolar area of the skin) – a vestigial appearance

II. Girls in the period from 9 months to 1.5 years. During this period of life, female children sometimes experience a “second wave” of tissue engorgement in the area of the future mammary glands and, as a rule, this condition occurs precisely in those girls whose mothers continue to feed them breast milk. This condition is explained by the fact that hormonal changes occur in the mother’s body associated with the resumption of the cyclic production of sex hormones (as before pregnancy).

III. Pre-adolescence in girls. Often, mothers are concerned about the fact that the first signs of the beginning of the formation of mammary glands in girls begin at 8–9 years of age. This very often looks like a one-sided thickening (engorgement) of tissue in the retro-nipple area, measuring no more than 1 cm (“pea-sized”) on one side. On the opposite side, such engorgement is either absent or less pronounced. So this unilateral engorgement of the tissue under the nipple (girls complain of some tactile pain in this area) can be perceived by parents as a tumor (neoplasm) or as premature development of the mammary gland. However, we must remember that tumor diseases at this age in the area of the future mammary glands in girls are extremely rare, and the asymmetry of the beginning of the growth of the mammary glands in the first few months is not a sign of pathology starting from 8-9 years of age. Moreover, it has been noticed that more often it is the tissue of the future mammary gland on the left that begins to swell. The development of glandular tissue of the mammary glands often occurs not smoothly, slowly and gradually, but spasmodically. And, as a rule, a noticeable increase in mammary gland tissue begins only from 10 to 12 years of age - at this age, tissue development occurs more or less symmetrically.

But an increase in the size of the mammary glands in girls under 8 years of age - “thelarche” - requires the attention of both parents and a doctor! Thelarche can be isolated (i.e., only an increase in the size of the mammary glands without the appearance of secondary sexual characteristics) or as one of the symptoms of premature sexual development. Premature sexual development of a girl requires, first of all, the exclusion of hormone-producing tumor processes (most often in the ovaries) and a careful detailed examination by an endocrinologist! False thelarche can be mistakenly mistaken for true thelarche (proliferation of glandular tissue of the mammary gland) - this is an increase in subcutaneous tissue in the area of future mammary glands due to adipose (and not glandular) tissue. This condition usually occurs in overweight girls, and in diagnosing this condition, the key diagnostic role is assigned to an ultrasound specialist.

IV. Teenage years. This period accounts for the maximum amount of various pathologies, because during this period the greatest activation of the development of glandular tissue of the mammary glands occurs. Let's look at just a few of the problems.

The growing mammary gland requires the most gentle approach to itself in order to avoid problems with breastfeeding in the future associated with the presence of scars on the skin and inside the breast tissue, which will interfere with the formation and release of milk and the very process of feeding the baby. In such cases, there is an equally effective alternative to surgical treatment - a puncture type of treatment, which does not leave any scars behind!, is less painful, there is no need for general anesthesia and long-term painful dressings. The choice of treatment method for a purulent process in the mammary gland (surgical or puncture or even conservative) is, of course, a matter for an experienced specialist and depends on each specific clinical situation. The main rule for parents is to contact a specialist early with inflammatory changes in the mammary gland area in a teenage girl.

The most common tumor in the mammary glands in teenage girls is fibroadenoma - a benign tumor! Cancerous tumors of the mammary glands in children under 18 years of age (carcinoma, lymphoma, sarcoma) are a rare situation.

It is believed that fibroadenoma is a hormonally dependent tumor, the development of which depends on the reaction of breast tissue to the increasing concentration of estrogen in the growing female body. Often, fibroadenomas can be multiple, ranging in size from 5 mm to 5 cm (sometimes they occupy most of the breast tissue - leaf-shaped or phylloid fibroadenoma).

The only method of treating breast fibroadenoma is a surgical approach - operations in this case (especially in adolescents) should be organ-preserving and aesthetic in nature. Incisions and sutures are made using cosmetic techniques, and only the tumor is removed without involving surrounding healthy tissue.

In this informational article, I focused only on some of the most common problems that can arise in the mammary glands, mainly in girls. A separate topic is the occurrence of tissue proliferation (increase) in the area of the mammary (mammary) glands in boys - this is especially relevant (emotional, cosmetic, social aspects) in adolescence: the so-called gynecomastia. There are also a number of nuances and differences here. This topic will be discussed in the next information article.

Kaplunov S.V.

pediatric surgeon, pediatric oncologist of the highest category

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Signs of mastitis in newborns

when touching the mammary glands, the baby cries;
as a rule, the infection penetrates into one of the glands (much less often it affects both), due to which the mammary gland becomes denser, the baby develops severe pain when touched;
in the area of infection the skin turns red;
The baby’s body temperature rises to 39 °C;
the child cries when he is swaddled or changed;
the baby refuses to breastfeed and becomes lethargic;
later, pus accumulates at the site of infection; when pressure is applied to this area, the child screams very loudly and experiences pain;
with purulent mastitis, pus may spontaneously (without pressure) be released from the nipples of a newborn.

This condition is extremely dangerous for a child. Therefore, at the first symptoms of mastitis, you should consult a pediatrician or call an ambulance. If help is not provided in time, the pus can melt the tissues near the mammary gland and penetrate into its other parts. This condition can lead to a diagnosis of phlegmon of the chest wall - purulent inflammation of fatty tissue. More serious conditions that mastitis in a newborn can lead to are sepsis and generalized infection (spread of infection throughout the body), which threatens the life of the child.

For a newborn girl, mastitis is more dangerous than for a boy: if the acini (components of the mammary gland) die during the disease, connective tissue appears in their place. In this case, when the girl grows up, her breasts will most likely develop asymmetrically. And during breastfeeding, an adult woman runs the risk of serious lactostasis (milk stagnation), which will be difficult to cure without surgery.

Symptoms of atheroma in children

In 80-85% of cases, apart from the visual defect, children do not present any other complaints. Uncomplicated atheroma is characterized by:

painlessness;
mobility;
elasticity upon palpation.

The skin over the surface of the tumor is smooth and does not fold. The clinical picture may change when the contents of the atheroma become inflamed against the background of the addition of bacterial flora. In this case, patients may note:

pain when pressed;
redness and increase in size of the tumor itself;
local increase in body temperature.

If the above symptoms occur, you should immediately seek help.
This situation threatens the penetration of infection into nearby tissues and blood with the spread of microorganisms to distant areas of the body and can cause a deterioration in the general condition of the child. Atheromas occur in areas of the skin that are rich in sebaceous glands. Therefore, they especially often have the following localization:

scalp;
face and neck area;
shoulder girdle, armpit area;
back.

Neoplasms occur less frequently in the groin area and scrotum (in boys). In these areas they have the appearance of a skin growth and require differential diagnosis with other skin tumors.

How is mastitis treated in newborns?

Clinical guidelines for the treatment of neonatal mastitis state that before prescribing therapy, it is necessary to establish the stage of development of the disease.

If this is the initial (infiltrative) stage, then treatment of mastitis in a newborn is recommended:

special ointments applied to the bandage;
ultraviolet irradiation or UHF, which has a detrimental effect on bacteria;
compresses with magnesium to relieve swelling and pain;
compresses of dimexide with saline as an antiseptic;
alcohol compresses;
Vishnevsky ointment;
suppositories or syrup with paracetamol to relieve pain and fever;
Treatment of neonatal mastitis can be enhanced with broad-spectrum antibiotics.

However, all of the above actions can be effective until a purulent focus has formed in the gland. If it occurs, the newborn will most likely require surgery, during which the pus will be removed and the cavity will be washed. After surgery, a bandage with a hypertonic solution will be applied to the wound. In addition, the doctor will prescribe a course of antibiotics.

Description of the disease

Atheroma is one of the relatively harmless tumors due to the fact that it does not transform into a malignant neoplasm.
However, there is a risk of significant increase in size, so medical attention is required in all cases. Teenage children are more likely to experience this problem. Boys and girls get sick about the same. The main reason why parents first turn to a surgeon is the presence of a visually noticeable tumor.

The atheroma itself is a small capsule filled with pasty contents. It is sebum, which, due to blockage of one or more glands, did not come out, but remained in the subcutaneous tissue.

How to prevent mastitis in a newborn

take care of your baby’s skin correctly, prepare the baby’s first clothes in advance: wash them with a special baby powder and be sure to iron them (this must also be done during the entire first month after discharge from the hospital);
when, as a result of a hormonal crisis, the child’s mammary glands become engorged, do not touch or put pressure on them, and under no circumstances squeeze out their contents;
dress the child in accordance with the temperature regime, do not overheat his body;
On the eve of giving birth, get rid of long manicures and carefully treat your nails.

Diagnosis of atheroma in children

It is relatively easy to identify atheroma.
Even at the stage of the initial conversation with the patient or his parents, the surgeon assesses the general well-being of the child, collects anamnesis and analyzes complaints. When examining a neoplasm, the doctor pays attention to its size, location, pain, and the presence of redness. Before surgery, the surgeon prescribes a number of tests to comprehensively assess the child’s condition:

general and biochemical blood test;
general urine analysis;
blood test for infections (HIV, syphilis, viral hepatitis B, C);
ECG, fluorography.

The child is also examined by an anesthesiologist and pediatrician before the operation. A mandatory diagnostic method is histological examination of tumor tissue after its removal. At this stage, it is possible to determine whether it was an atheroma or a lipoma (a tumor similar in appearance).

External causes of the development of allergic dermatitis in children

The disease can be caused by one of the factors or a combination of several.

Physical - friction or pressure on the skin of fabrics, leather products, high or low temperatures, humidity, electric current, ultraviolet or x-rays.
Chemical - various acids and alkalis, substances included in creams and hygiene products, medicines, tobacco smoke.
Biological - sap and pollen of plants, bites and secretions of insects and animals.

Of the plant agents, the most dangerous are the juice of celandine, hogweed, nettle, pollen of meadow and weeds.

In industrial cities in winter, there are widespread cases of contact dermatitis under the eyes and on the hands of children. Three factors are combined here: cold, chemical impurities in the air and touching the skin with wet mittens.

In infants, allergic inflammation can be caused by a combination of high humidity in diapers, fabric friction and the action of inappropriate cream.

A special type of contact dermatitis is phototoxic, when sunscreens degrade in sunlight and cause allergic damage to the epidermis.

Questions

Which doctor treats atheroma in children?
A pediatric surgeon is involved in identifying and treating atheroma in children.
Is it possible to cure atheroma without surgery?
Sometimes in the early stages of the disease the surgeon chooses a wait-and-see approach. In 20-35% of cases, atheroma can resolve on its own. However, if the capsule is formed and the tumor is large, it will not be possible to do without surgical intervention.
How dangerous is atheroma in childhood?
Atheroma is a relatively safe tumor. It does not become malignant, rarely becomes complicated and is not accompanied by the development of permanent defects. However, this does not eliminate the need to consult a pediatric surgeon. Only a doctor can establish the correct diagnosis and select treatment. In addition, atheroma can sometimes become inflamed due to the addition of bacterial flora and cause a deterioration in the child’s well-being.
Is it possible to play sports after surgery?
After surgical removal of atheroma, it is recommended to refrain from active activities for 2-3 weeks. This will allow the tissues to fully heal and recover.