F Kose, E Ozcan, K Sonmez, C Turkyilmaz, R Karabulut, Z Turkyilmaz

Dear Editor,

We wanted to present a case of neonatal mastitis and abscess caused by massage to breast and the use of foeniculum vulgare (FV) tea twice a day by mother in the literature. A 3 kg newborn boy was exclusively breastfed and had no problem in the first 10 days. Inflammation at his both breasts was discovered on 10th day, also had red blotches and tenderness together with excessive growth after the 15th day. Surface ultrasound detected hyperemic breast tissue and a 3 x 3 cm avascular echogenic area suggestive of abscess. He was hospitalised with the diagnosis of a suppurative mastitis and abscess and systemic antibiotic therapy given. Only high level of CPR and white blood cell were shown. Upon enquiry, it was found out that the mother had been drinking FV tea a few times a day since the birth of the baby in order to get rid of gas pains and increase the amount of her breast milk. It was discovered that the inflammation on breasts had been increasing since the birth of the baby and the grandmother had been doing massage on the breasts of the baby (Figure 1). His estrogen level was twice as much as a normal baby's. Abscess was incised and 20-25 cc pus was drained. Also, FV tea consumption was stopped. The post-drainage course was uneventful and he was discharged on the post operative 7th day. The breast findings of the second month follow-up examination of the patient were normal.

Figure 1 Breast abscess and mastitis in newborn.

The most accepted theory of the pathogenesis of neonatal mastitis involves a maternal hormonally stimulated neonatal breast allowing skin and mucous membrane pathogens to reach the breast tissue via the nipple and mammary ducts. Neonatal mastitis is an uncommon condition that occurs in full term infants in the first few weeks of life. Girls are affected twice as often as boys. Breast abscesses will present as tender, indurated, or fluctuant erythematous masses. The initial treatment may be antibiotics, and either needle aspiration or incision and drainage can be used.^1,2 FV is a plant that has been known for its calming and gas-eliminating effects since the ancient Egyptians time. It is widely used as a tea to eliminate gas pain and regulate bowel movements in Asia and Europe.³ In breast-feeding mothers, it is used to increase milk production. The contents of FV are fennel oil (anethole), 60% to 80%, and fenchone, 10% to 30%. Anethole has significant estrogenic activity.^4,5

Alternative treatment therapies such as foreniculum vulgare tea and growing breast tissue massage, which may cause mastitis and excessive breast growth must be questioned while in region where such practice is prevalent.

References

1. Borders H, Mychaliska G, Gebarski KS. Sonographic features of neonatal mastitis and breast abscess. Pediatr Radiol 2009;39:955-8.

2. Efrat M, Mogilner JG, Iujtman M, Eldemberg D, Kunin J, Eldar S. Neonatal mastitis-diagnosis and treatment. Isr J Med Sci 1995;31:558-60.

3. Türkyilmaz Z, Karabulut R, Sönmez K, Can Başaklar A. A striking and frequent cause of premature thelarche in children: Foeniculum vulgare. J Pediatr Surg 2008;43:2109-11.

4. Javidnia K, Dastgheib L, Mohammadi Samani S, Nasiri A. Antihirsutism activity of fennel (fruits of Foeniculum vulgare) extract. A doubleblind placebo controlled study. Phytomedicine 2003;10:455-8.

5. Dhar SK. Anti-fertility activity and hormonal profile of trans-anethole in rats. Indian J Physiol Pharmacol 1995;39:63-7.