SORE NIPPLES IN BREAST-FEEDING WOMEN - A CLINICAL-TRIAL OF WOUND DRESSINGS VS CONVENTIONAL CARE

Background: Sore nipples in breast-feeding mothers are a common cause of premature weaning, and are difficult to treat owing to recurrent tr auma and exposure to the infant's oral flora. Objective: To compare th e safety and efficacy of a hydrogel moist wound dressing (Elasto-gel, Southwest Technologies Inc, Baltimore, Md) with the use of breast shel ls and lanolin cream in the treatment of maternal sore nipples associa ted with breast-feeding. Design: Randomized controlled trial comparing the above treatments for sore nipples. Patients were seen for a maxim um of 3 follow-up visits within 10 days, or until the resolution of sy mptoms. Setting: The Maternal-Infant Lactation Center at the Mercy Hos pital of Pittsburgh, Pittsburgh, Pa, a tertiary care teaching hospital in inner-city Pittsburgh. Patients: A referred sample of 42 breast-fe eding women who presented to the Maternal-Infant Lactation Center for the treatment of sore nipples. All patients with breast infection or c hronic unrelated pain conditions were excluded from the study. Interve ntion: After informed consent, patients were randomized to receive eit her a hydrogel wound dressing or breast shells and lanolin. All patien ts underwent a history, physical examination of the infant and the mot her's breasts, assessment of breast-feeding technique, and breast-feed ing instruction. Main Outcome Measures: The degree of pain on self-rep ort questionnaires and the change in scores for physical examination, breast-feeding technique, and pain behaviors during breast-feeding. Re sults: Although both treatments, in association with instruction in br east-feeding technique, were effective, greater improvement was seen i n the group using breast shells and lanolin. This reached statistical significance for physician-rated healing (P<.01) and self-reported pai n (P<.05). There were significantly more infections in the dressing gr oup (P<.05), which resulted in early discontinuation of the study. Con clusions: Prevention of sore nipples by teaching proper technique on t he initiation of breast-feeding should be instituted. For those cases in which sore nipples do develop, breast shells and lanolin in associa tion with instruction in breast-feeding technique are more effective t han moist wound dressings. Lanolin and shells should remain first-line therapy.