I have been looking over my client records since I read this study, and
have found that many women who had cracked nipples did indeed aquire
mastitis.  Usually I saw some redness or palpated induration or adeas of
increased consistency on the breast and "saw it coming" and gave
appropriate advice to try to fend it off or obtain early medical
treatment if it progressed.  I might be a little faster to encourage
mothers with incipient mastitis to see their physicians, rather than
taking a wait and see attitude after reading this study.
        However, a major weakness here is that there was no follow-up of the
mothers with negative nipple staph cultures, so we can't take for
granted that every cracked nipple has staph as the authors seem to
conclude, or that every cracked nipple is going to progress to
mastitis.  This is a great topic to continue this very interesting
research, as well as following antibiotic treated moms to see if there
is an increased prevalence of candidiasis.
        I thought it particularly interesting that such a large proportion of
the infants of these mothers with staph aureus infections had
retrognathia or tongue tie, which are prevalent problems in my client
population.  Better screening of infants after birth for these
difficulties would allow us to give these moms extra assistance with
breastfeeding, and perhaps prevent nipple damage and the resultant
infections.
        Finally, I would be interested to know where these women delivered.
Staph aureus is a common pathogen in hospitals.  I wonder if
particularly virulent strains are being introduced into the babies'
mouths during procedures surrounding the birth.  Jan Riordan speculated
in her old book for nurses (sorry, forgot the title) that introducing a
finger or suction tube into an infant's mouth before the maternal breast
could innoculate the "germ free" infant with hospital organisms rather
than the family normal flora.  Makes perfect sense to me.  I have rarely
seen a case of mastitis in my clients who have had homebirths, even with
a tongue-tied infant and cracked nipples.
        What do you all think about these issues?
--
Catherine Watson Genna, IBCLC  New York City  mailto:[log in to unmask]

             ***********************************************
The LACTNET mailing list is powered by L-Soft's renowned
LISTSERV(R) list management software together with L-Soft's LSMTP(TM)
mailer for lightning fast mail delivery. For more information, go to:
http://www.lsoft.com/LISTSERV-powered.html