For the sleepy baby, I would want to know if the baby's mom was GBS
positive, and if the baby has been looked at for sepsis. it is unusual for
a baby to remain this sleepy and I  wonder if the mom is using a lot of
narcotic pain relief.

As for the mom with persistent painful nipples, I did not get whether or
not there were openings in her nipples/slits or cracks? The article that
came to mind was Livingstone... JHL.  The citation was listed on Kellymom,
under sore nipple treatment.  Has the mom tried salt water soaks?  Just now
she's using APNO cream? As for Diflucan, it needs to be used until the mom
is pain free for one week acc to Hale, and is Fungistatic, not fungicidal,
so the problem is that it is slow working.

If the nipple is obviously infected, then talk to your health care provider
about the possibility of using an oral (systemic) antibiotic. One study
indicated that topical antibiotics and good breastfeeding techniques might
not be sufficient if infection is present. (See Livingstone V, Stringer LJ. The
treatment of Staphyloccocus aureus infected sore nipples: a randomized
comparative study<http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10578803&dopt=Abstract>.
J Hum Lact. 1999 Sep;15(3):241-6.) See also Oral antibiotic use for sore,
cracked nipples <http://www.med.umich.edu/pediatrics/ebm/cats/bfeed.htm>.)



-- 
Best regards,
Kathleen B. Bruce RN, BSN,  IBCLC

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