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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 trauma and exposure to the infant's oral flora.


OBJECTIVE
To compare the safety and efficacy of a hydrogel moist wound dressing (Elasto-gel, Southwest Technologies Inc, Baltimore, Md) with the use of breast shells and lanolin cream in the treatment of maternal sore nipples associated with breast-feeding.


DESIGN
Randomized controlled trial comparing the above treatments for sore nipples. Patients were seen for a maximum of 3 follow-up visits within 10 days, or until the resolution of symptoms.


SETTING
The Maternal-Infant Lactation Center at the Mercy Hospital of Pittsburgh, Pittsburgh, Pa, a tertiary care teaching hospital in inner-city Pittsburgh.


PATIENTS
A referred sample of 42 breast-feeding women who presented to the Maternal-Infant Lactation Center for the treatment of sore nipples. All patients with breast infection or chronic unrelated pain conditions were excluded from the study.


INTERVENTION
After informed consent, patients were randomized to receive either a hydrogel wound dressing or breast shells and lanolin. All patients underwent a history, physical examination of the infant and the mother's breasts, assessment of breast-feeding technique, and breast-feeding instruction.


MAIN OUTCOME MEASURES
The degree of pain on self-report questionnaires and the change in scores for physical examination, breast-feeding technique, and pain behaviors during breast-feeding.


RESULTS
Although both treatments, in association with instruction in breast-feeding technique, were effective, greater improvement was seen in the group using breast shells and lanolin. This reached statistical significance for physician-rated healing (P<.01) and self-reported pain (P<.05). There were significantly more infections in the dressing group (P<.05), which resulted in early discontinuation of the study.


CONCLUSIONS
Prevention of sore nipples by teaching proper technique on the initiation of breast-feeding should be instituted. For those cases in which sore nipples do develop, breast shells and lanolin in association with instruction in breast-feeding technique are more effective than moist wound dressings. Lanolin and shells should remain first-line therapy.