Sore, cracked nipples are commonly experienced by breastfeeding mothers. We have previously reported a strong correlation between sore, cracked nipples and S. aureus colonization. A prospective, randomized clinical trial was performed to compare four treatment regimes for S. aureus infected sore nipples. Eighty-four breastfeeding mothers were enrolled in the study. After 5 days to 7 days of treatment, only 8% of mothers showed improvement in the "optimal breastfeeding technique alone" group, 16% improved with topical mupiricin, 29% improved with topical fusidic acid, yet 79% improved with oral antibiotics (p < .0001). Optimal breastfeeding techniques and topical antibiotics ointment failed to heal most infected, sore, cracked nipples. Mastitis developed in 12% to 35% of mothers not treated with systemic antibiotics compared to 5% of mothers treated with systemic antibiotics (p < .005). In conclusion, S. aureus infected sore, cracked nipples should be diagnosed as a potentially widespread impetigo vulgaris and treated aggressively with systemic antibiotics in order to improve healing and decrease the risk of developing mastitis due to an ascending lactiferous duct bacterial infection.
Insufficient milk syndrome is defined as failure to thrive in infants due to insufficient daily breastmilk intake. This discussion examines a possible association between insufficient milk syndrome and maternal postpartum hemorrhage. Ten consecutive cases of insufficient milk syndrome associated with maternal postpartum hemorrhage were identified. The mothers presented between 3 and 35 days postpartum. Maternal postpartum blood loss ranged from 500-1500 ml in eight cases (mean: 963 ml); in two cases, blood loss was noted as 400++ and 200++, respectively. Six mothers experienced a drop of hemoglobin by > 30g/L; two had a drop in blood pressure > 30mmHg for > 20 minutes. All infants were failing to thrive. Five infants suffered hypernatremic dehydration with serum sodium levels ranging from 148-166mmol/L. Breastmilk electrolytes were measured in six cases, and elevated sodium levels, ranging from 21-100mmol/L, in five cases. These data serve to heighten awareness of insufficient milk syndrome as a potential consequence of postpartum hemorrhage. Early postpartum review of all breastfeeding mothers and infants is strongly encouraged.
Background: Preference for formula versus breast feeding among women of Chinese descent remains a concern in North America. The goal of this study was to develop an intervention targeting Chinese immigrant mothers to increase their rates of exclusive breastfeeding.
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