Dear all,

Very soon, Danny Hirsch will be joining us to help us with the ongoing
Lactnet Journal Club. We are fortunate to have Danny's and Barbara
Wilson-Clay's assistance as we continue these valuable discussions.

Dr. Daniel (Danny) Hirsch is currently the Director of the Lactation
Institute of Westchester and an attending neonatologist at Westchester
and Sound Shore Medical Centers (in Westchester County, NY).  In
addition to being a certified lactation counselor, he is
board-certified in pediatrics and neonatal-perinatal medicine.  He
was  recently awarded a grant from the March of Dimes for "A Mother's
Gift, increasing breastfeeding in an underserved population."  Last, but
not least, he is a proud husband and a father of three exclusively
>breastfed children.

Danny will be joining Barbara and I as we continue to present the Journal
Club's ongoing series of articles and related discussions here on Lactnet.
Just for the record, here is the second article that we have discussed.
Danny will be presenting the third one very shortly.

The format of the Journal club will change just a bit as we try to hone the
discussions to make it as useful and interactive for participants as we can.
Many thanks to Danny and to Barbara Wilson-Clay for their continuing
professional contributions here and to those who have already contributed or
offered their support.

Kathleen

Journal Club  Article #2

"The Treatment of Staphyloccocus Aureus Infected Sore Nipples: A
Randomized Comparative Study." by Verity Livingstone, MBBS, FCFP, IBCLC
and L. Judy Stringer, MBBS, MRCGP, IBCLC, Journal of Human Lactation,
15(3), 1999.

        The authors suspected a link between delayed healing of cracked nipples
and Staph aureus infection.  Women presenting with cracked nipples, but
without mastitis, had their nipple lesions  cultured.  Those positive
for Staph aureus were randomized to one of four treatment groups:
- individualized bf technique assistance from an LC.
- topical mupiricin ointment (Bactroban) and bf technique assistance.
- topical fusidic acid ointment and bf technique assistance.
- beta lactamase resistant systemic antibiotics (dicloxacillin or
erythromycin 500mg/qid/10d) and bf technique assistance.

        Women were re-evaluated in 7 days, and nipples assessed as
better/resolved, no change, and worse based on pain and skin
appearance.  Any cellulitis, mastitis, or fever was considered a
treatment failure, and oral antibiotics were prescribed.

        Results: a large proportion of each of the non-systemic treatments
failed to improve, and a significant proportion progressed to mastitis.
79% of women in the oral antibiotic group improved and only 5%
worsened.  Fusidic acid outperformed mupiricin, but only a minority of
women were improved in one week with both topical treatments.  Optimal
technique alone showed improvement in only 9% of women in this study,
35% of them worsened over one week, and 30% progressed to mastitis.  In
all, 25% of mothers treated non-systemically progressed to mastitis, but
only 5% of those given oral antibiotics developed mastitis.  The authors
recommend that sore, cracked nipples be clinically diagnosed as impetigo
vulgaris, and be treated with systemic antibiotics for a minimum of 10
days until the skin is fully healed, while improving breastfeeding
technique to prevent added trauma or friction to the nippples.

        Other interesting points:
- 5 women in this study reported deep, radiating, burning breast pain
and episodic vasospasm of the nipples, unrelated to immediate sucking.
The authors attribute this to both repetitive gumming of the nipple and
the S. aureus infection.
- The advice to not use soap on the nipples contradicts hygeinic
adjuncts to impetigo treatment.
- 17% of the moms with S. aureus infections had poorly graspable
nipples.
- 10% of their infants had tongue tie, and 12% had significant
retrognathia.

--
Catherine Watson Genna, IBCLC  New York City  mailto:[log in to unmask]

Kathleen B. Bruce, BSN, IBCLC co-owner Lactnet, Indep. Consultant
Williston, Vermont
mailto:[log in to unmask]
http://homepages.together.net/~kbruce/kbblact.html
LACTNET Archives http://peach.ease.lsoft.com/archives/lactnet.html

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