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Rusty Pipe Syndrome: Cause for Alarm or Just a Phenomenon?

Newborn baby breastfeeding

In a previous post, I addressed funny-colored milk in general. Today, I’d like to talk about a rare condition when the funny-colored milk is called “rusty pipe” syndrome. You could think of it as a “limited edition” because the funny color persists for only a few days during the colostral period.

What is rusty pipe syndrome?

To the best of my knowledge, this term was coined by Chele Marmet some 40 years ago. It never got much attention in the formal literature until the last few years.

Here’s an analogy to help you understand this phenomenon — and likely, the origin of the phrase “rusty-pipe.” Let’s say you’ve got a cabin in the woods or a cottage at the lake. After several months away from your cozy abode, you show up and turn on the spigot. Out of the pipes comes this rusty-looking water. But the longer you run the water, the clearer it becomes.

This appears to be the case with the mother’s so-called rusty pipe syndrome.

Who gets rusty pipe syndrome, and where is it?

By now you’re wondering: Have I ever seen this? Shucks, have I ever had this?

  • It can happen in late pregnancy, or immediately after birth.
  • Rusty pipe syndrome will start within the first few hours of birth.
  • It usually occurs in both breasts, but it might occur in only one.
  • Most mothers never have rusty pipe syndrome.
  • It is more likely to occur in first-time mothers
  • Some mothers have rusty pipe syndrome with each baby.
  • It appears to be entirely harmless and usually after a few days, the milk becomes a normal color

What percentage of mothers have rusty pipe syndrome? Well, we may never know, right?

We only see the milk when the mother has pumped or hand-expressed her milk.

What causes rusty pipe syndrome?

According to Virdi et al, Thota et al, Guèye et al, and Cizmeci et al this rare condition is likely to be attributed to the increased vascularity that occurs in the alveolar and ductal tissue.

How is it managed?

When I get the call, it’s usually — although not always — it’s from someone working in the NICU. That professional has been butting heads with another professional about whether to discard the milk or give it to the baby. I’m not surprised; that aligns with what I’ve seen in the published literature, too.

What does it look like?

This funny-colored colostrum looks ominous. Sometimes, it’s just a mild tinge of color. Other times, it can be a fairly dark brown. And everything in between.

I’ve seen this rusty-pipe effect to be very slight (slightly orange-tinged) or fairly dramatic (more of a thick brownish red.) Here’s a very good example of what rusty pipe syndrome looks like.

And, understandably, parents are alarmed, and good counseling skills are needed in this situation. And, not surprisingly, this issue can result in a barrier to exclusive breastfeeding.

Could it be pathologic?

Pathology is always possible. I admit to being very cavalier about this sort of thing because I have spent a career teaching that women and childbearing are normal. However, interviews and physical assessments are fairly simple, so I’d start there:

  • Interview: Any history of breast pain or history of trauma?
  • Physical assessment: Breast tenderness is normal. Engorgement usually happens after the first two of days. A plugged duct, while possible, is not likely to show up in the first few days, so I’d have suspicions about an immovable lump in that timeframe. Cracks in the nipple skin, although fairly common, could explain the bloodiness.

But if the mother and the healthcare team wish to leave no stone unturned, then go for:

  • Diagnostics: Bilateral ultrasound to rule out solid or cystic glandular or ductal lesions
  • Diagnostics: Collect a sample for cytological analysis to exclude the presence of malignant cells.

So what’s the bottom line here?

Is it safe to give to the baby? Well, you tell me.

If the baby had been at breast, none of us would be any the wiser about the funny color!

There has been more interest in this topic in recent years, and a review of the literature on rusty-pipe syndrome has been published. It may be a while, though, before we know all there is to know about this unusual phenomenon.

What have you heard or seen as related to rusty pipe syndrome?

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