I want to first thanks Dr. Livingstone for her great contributions to the study of sore nipples--causes and treatment!  Her first(that I know of) article Staphylococcus aureus and sore nipples, Can Fam Physician 1996 42:654-59, was a break through in helping us to understand why some sore nipples would not heal. In a sample of 227 mothers 51% has sore nipples, 45% had objective findings, and 23% had a positive nipple swab-15% with S aureus. She identified potential markers for nipple infection: Infant less than one month old, mother c/o moderate to severe nipple pain, and cracks, fissures, ulcers or exudate.
In her current research she reports data to suggest that when there is a positive culture, positioning and local treatment are not sufficient and may lead to further complications. In another paper sore cracked nipples were a predisposing factor to mastitis. This does not mean however that we shouldn't use positioning and topical treatments for sore nipples. I would like to know was "positioning" a part of their early protocol in the hospital. What was the criteria for "positioning". We still do not have clearly defined what each of us means when we say "positioning" to prevent and treat sore nipples!

I was intrigued by the idea of washing nipples with soap and water. We know that it can dry nipples and predispose to cracking, but is it something to consider when a "wound" is open? Does soaking in warm saline clean enough? Should we recommend that mothers clean and then apply breastmilk(antibacterial). Should we be stressing washing of hands much more than we do and more than washing of the nipples? Thoughts!
Carol L'Esperance, RN,MSN, IBCLC

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