I need help from lacnetters with a knack for writing letters to the editor
(expecially MD's as they may be more willing to take input from "their
own").

I ran across an article in Contemporary  Ob/Gyn:  in the "protocal" section
of the Journal:

Hager, David, M.D. " Puerperal Mastitis" Cont OB/Gyn April 1998 vol 43,
No.4 page 27-33

Although I felt much info was accurate, I felt other info was not and  am
asking your imput and comments:

Altough it said it was not necessary to stop BF'ing with acute puerperal
mastitis, (Thank Goodness), 

It did mentioned as one of the predisposing factors to mastitis:

"Incorrect preparation and care of the nipples and proper positioning of
the infant for nursing may foster nipple fissuring" -(I agree with the
positioning part, but not with the "preparing" part.)

"Discourage cessation of nursing because it increases the  risk of
prolonged infection and abscess. Alert the mother that since milk from the
infected breast has been found to have increased sodium, the infant may
reject it. Milk from mastitis patients also has been reported to be lower
in lactose, fat and total protein. (no mention is made to use a pump to
avoid this situation) If the infant continues to reject the mother's
breast, investigate the possibilty of carcinoma of the breast."

"If a breast abscess is diagnosed, instruct the pateint to stop nursing
from the breast. Treat her with  parenteral anitibiotics such as
cefazolin,, ampicillin, or methicillin." (from what I read it  is not
necessary  to stop Bf''ing on affected even if it needs to be drained as
long as it is far enough away from the nipple to avoid baby's mouth
touching it.)

Please correct me if I am wrong. Any one willing to look at the article and
 comment to the list or to the editors would be greatly appreciated. If you
cannot get a copy , E-mail me.

Thanks,

Jeannette Newman-Velez, R.D, MPH, IBCLC
YWCA WIC PROGRAM
Breastfeeding Promotion Coordinator
[log in to unmask]

Also no mention is made about the risk of secondary yeast infection to
which the HCP should be alert.
 
The closing paragraph stated:

"Although good data are lacking to confirm the protective benefit of nipple
care, we have found UPS-modified lanolin applied directly onto the nipple
are areola to be the best prepartory agent availalbe".

While I do think lanolin has a place in helping healing traumatized nipple
and areolar tissue, I do not view it as someithing to we s;hould recommend
as a "preventative measure" or to prepare nipple". 
What do you think about this?

I believe letters to the editor can be sent to:

Equal Time
Contemporary OB/Gyn
Five Paragon Dirive, 
Montvale, NJ  07645-1742