Should a patient with sepsis continue breastfeeding?

Breastfeeding During Maternal Sepsis

Yes, patients with sepsis should continue breastfeeding when possible, as it benefits both the infant and does not pose significant risks to the mother's recovery. 1

Benefits of Continuing Breastfeeding During Sepsis

Breastfeeding provides numerous benefits that remain important even when the mother has sepsis:

• Infant protection against infections: Breast milk contains secretory IgA antibodies and other immune factors that protect the infant from infections 2
• Reduced risk of neonatal sepsis: Even partial breastfeeding significantly reduces the risk of neonatal sepsis (odds ratio of 18 in high-risk populations) 3
• Maternal health benefits: Breastfeeding is associated with reduced maternal risk of various conditions including type 2 diabetes, hypertension, and certain cancers 1

Management Considerations

Maternal Stabilization First

• Ensure the mother receives appropriate sepsis management per current guidelines:
  • Broad-spectrum antibiotics within 1 hour of sepsis recognition 4
  • Adequate fluid resuscitation (at least 30 mL/kg of IV crystalloid fluid within first 3 hours) 4
  • Hemodynamic support targeting MAP of 65 mmHg if needed 4
  • Source control as rapidly as possible 4

Breastfeeding Recommendations

1. Continue breastfeeding in most cases of maternal sepsis

   • Most maternal infections do not contraindicate breastfeeding 1, 5
   • The benefits of breastfeeding typically outweigh potential risks 5

2. Consider temporary cessation only in specific situations:

   • If the source of sepsis is breast abscess or mastitis with purulent drainage that may contact the infant's mouth 1
   • If the mother is hemodynamically unstable and unable to breastfeed safely

3. Expressed breast milk options:

   • If direct breastfeeding is temporarily not possible, expressed breast milk can be provided to maintain the infant's nutritional and immunological benefits 5

Nutritional Support for the Septic Mother

• Early enteral feeding is recommended for septic patients when possible 1
• Ensure adequate hydration and nutrition to support both maternal recovery and milk production
• Avoid mandatory full caloric feeding in the first week of sepsis; start with trophic/hypocaloric feeding and advance as tolerated 1

Special Considerations

Medication Compatibility

• Most antibiotics used for sepsis treatment are compatible with breastfeeding
• When possible, select antimicrobial regimens that are compatible with breastfeeding 5

Infection Control Measures

• Ensure proper hand hygiene before handling the infant or expressing milk
• If the mother has a respiratory infection component, consider wearing a mask while breastfeeding

Conclusion Points

• The decision to continue breastfeeding during maternal sepsis should generally favor breastfeeding unless specific contraindications exist
• Even if breastfeeding must be temporarily interrupted, efforts should be made to maintain milk supply through expression
• The immunological components of breast milk may actually help protect the infant during a time when maternal infection could potentially increase exposure risk

Remember that stopping breastfeeding when a diagnosis of infection is made often occurs too late to prevent exposure and only deprives the infant of nutritional and immunological benefits 5.