Below is the abstract of a case report of a breastfed infant made quite ill from 
1% steroid ointment on mother's bruised nipples...It is just one case from 26 
years ago. Also, I beleive the current APNO dose is ten times LESS strength 
than the dose in this case report and it may not be the exact same type of 
steroid preparation. Not being a licensed prescriber or pharmacist, I am clearly 
not an expert to interpret appropriate or safe doses which makes me wary of 
putting pharmaceuticals on mom's nipples...I know many women have reported 
great relief using APNO ("Saved the breastfeeding")but I too worry about the 
interpretation of "use sparingly" in a culture where for many "more is better" 
and buying things makes it better....


The March peepers are singing these past two nights and the crocuses are in 
bloom here along the south coast of New England!!

Cindi Zembo, RN IBCLC





	De Stefano P. Bongo IG. Borgna-Pignatti C. Severi F. Factitious 
hypertension with mineralocorticoid excess in an infant. [Case Reports. Journal 
Article] Helvetica Paediatrica Acta. 38(2):185-9, 1983 May. 
UI: 6874387 
Authors Full Name
De Stefano, P. Bongo, I G. Borgna-Pignatti, C. Severi, F.
 
A 2-month-old breast-fed baby is described, who, admitted for a prolongation 
of the QT interval on ECG, was found to be severely hypokalemic, alkalotic 
and hypertensive (blood pressure 200/100 mm Hg). Marked generalized 
hypotonia was present, and length was less than 3% for age. The results of 
endocrinological evaluation showed profound suppression of the pituitary-
adrenal function and of the renin-aldosterone mechanism. CT scan, 
cavography and pyelography were normal. A pharmacological cause for the 
symptoms was sought and found: the mother had been using for the care of 
bruised nipples a cream containing 1% 9-alpha-fluoroprednisolone-21-acetate. 
Blood pressure remained elevated for 6 months, but became normal after one 
year, and growth has resumed normally. The possible differential diagnoses are 
considered, and the risks presented by topical steroids are emphasized.

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