Hello all,

Earlier in the week I spoke with a mom whose twins were discharged from 
our NICU about 2 weeks ago (at 34+6 weeks, exclusively BFing).  She had 
had an infection shortly after delivery and yeast symptoms began after 
the antibiotic use.  She had had nearly 2 weeks of diflucan and APNO 
when I last saw her and was much better, though symptoms were not 
totally gone.  She was boiling pump parts and nipple shields daily and 
babies were both given mycostatin qid, though they were assymptomatic 
and continued diflucan and APNO.

Her symptoms increased again after being home a week or so. . .both 
internally and externally (stabbing pain internally and soreness and 
itchiness externally).  We have had really hot, humid weather recently, 
too.  She is now on her fourth week of treatment and is not getting 
better, wonders what else she should do.  She said she started boiling 
her nipple shields after every use (not that that would help).  Her ped 
said he would give the babies diflucan, too (but they are still 
assymptomatic).

I spoke with both a neo whose research is in yeast and our unit 
pharmacist to see if any other systemic meds could be tried.  Two of 
the three they suggested are not available orally, but voriconazole is. 
  Of course, it is not recommended for breastfeeding mothers.  I have 
posted the question to Dr. Hale's website, but have not heard anything 
there yet.

We had a discussion about whether it really is still yeast and 
considering her symptoms, believe it is. . .she has also always had a 
large supply, which I think predisposes to yeast.
Other topical treatments (gentian violet, etc.) wouldn't help such 
intrenched ductal yeast, so I am asking for any other suggestions.

Thanks for your help,

Grace Doolittle, RNC, IBCLC

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