Initial nipple damages in breastfeeding women: analysis of photographic images and clinical associations.

OBJECTIVE: to analyze the initial nipple damage degree by breastfeeding practice and to associate findings with clinical manifestations of breastfeeding women. METHODS: a retrospective, cross-sectional study with primary data and photographic images database from two randomized clinical trials. Photographic images were analyzed by two independent evaluators using the Nipple Trauma Score. For analysis, the chi-square, Mann-Whitney tests and Kappa coefficient were applied. RESULTS: 115 breastfeeding women and their respective 186 photographic images were analyzed. The degree of agreement of evaluators using the Nipple Trauma Score was 93.6%. The nipple pain score during breastfeeding was moderate and compromised more than 25% of the nipple surface area. CONCLUSIONS: assistance to breastfeeding women should prioritize nipple pain intensity instead of the nipple damage size.

Comparing the Efficacy of Breast Milk and Coconut Oil on Nipple Fissure and Breast Pain Intensity in Primiparous Mothers: A Single-Blind Clinical Trial.

Background: Nipple fissure is a prevalent problem for breastfeeding mothers. Virgin coconut oil (VCO) is an herbal medicine that can heal microbial infections and wounds. Objective: This study aims to evaluate the efficacy of VCO and breast milk on nipple fissures in primiparous mothers. Design, Setting, Participants, and Intervention: A single-blind clinical trial was conducted with 106 breastfeeding primiparous mothers suffering from nipple fissures in health centers of Zarand, Kerman, from August 2020 to November 2020. The participants were selected randomly and allocated to two 60-member groups using block randomization. Mothers in the first group were asked to apply 0.5 mL of coconut oil on their nipples three times a day. Mothers in the second group were trained to apply three to four drops of their milk on their nipples after every breastfeeding session. The level of nipple fissures and pain intensity were examined using Storr's scale and visual analog scale, respectively. The results were analyzed using the chi-square test, repeated measures analysis of variance, and the independent samples t-test in SPSS 22. In this study, the significance level was set at p < 0.05. Results: Within-group comparisons revealed a significant difference between baseline scores and the scores on the 7th and 14th days (p < 0.001). Between-group comparison indicated no significant difference in nipple fissure (p = 0.419) and pain intensity (p = 0.405) at baseline. Nonetheless, there was a significant difference on the 7th day (pfissure = 0.002, ppain <0.001) and on the 14th day (pfissure <0.001, ppain = 0.036). Conclusion: Given its effect on nipple fissures, VCO may be used as a complementary substance to treat nipple fissures. Trial Registration: This trial is registered with the Iranian Registry of Clinical Trials with the identifier: IRCT20190724044318N1.

Traumas mamilares em nutrizes: revisão de escopo / Nipple trauma in nursing mothers: scope review

OBJETIVO: investigar, na literatura, a definição de trauma mamilar relacionado à amamentação, os tipos de trauma e seus tratamentos. MÉTODO: revisão de escopo. Foram consultados: PubMed; Literatura Latino Americana e do Caribe em Ciências da Saúde (LILACS); Cumulated Index to Nursing and Allied Health Literature (CINAHL); SCOPUS; Web of Science; Base de dados de enfermagem (BDENF), EMBASE e Biblioteca Cochrane. Incluídos estudos publicados de 2015 a 2020. RESULTADOS: a amostra final foi composta por 23 artigos, sendo que 14 deles abordaram a definição de trauma mamilar. Esse evento inclui dor, sendo um dos problemas mais comuns durante a amamentação e relevante fator para desmame precoce. A melhor forma de preveni-lo e tratá-lo é por meio de posicionamento e pega adequados. CONCLUSÃO: não há padronização quanto à definição de trauma mamilar e os diferentes tipos. Há necessidade de refinamento da nomenclatura, a fim de auxiliar no diagnóstico e tratamento adequados.

OBJECTIVE: to investigate the definition of nipple trauma related to breastfeeding, the types of trauma and their treatments in the literature. METHOD: scope review. The following were consulted: PubMed; Latin American and Caribbean Literature in Health Sciences (LILACS); Cumulative Index to Nursing and Allied Health Literature (CINAHL); SCOPUS; Web of Science; Nursing database (BDENF), EMBASE and Cochrane Library. Studies published from 2015 to 2020 were included. RESULTS: the final sample consisted of 23 articles, 14 of which addressed the definition of nipple trauma. This event includes pain, one of the most common problems during breastfeeding and a relevant factor for early weaning. Proper positioning and latch-on is the best way to prevent and treat it. CONCLUSION: there is no standardization regarding the definition of nipple trauma and the different types. There is a need for refinement of the nomenclature, in order to assist in the diagnosis and adequate treatment.

Avaliação da efetividade do jogo sério aleitagame como recurso educacional no ensino sobre lesões mamilares / Evaluación de la efectividad del juego serio aleitagame como recurso educativo en la enseñanza de las lesiones en los pezones / Evaluation of the effectiveness of the serious game aleitagame as an educational resource in teaching about mammillary injuries

RESUMO Objetivo avaliar a efetividade de intervenção educativa utilizando o jogo sério AleitaGame como recurso educacional no ensino sobre lesões mamilares. Método estudo quase experimental, do tipo grupo único, antes e depois, não randomizado, desenvolvido entre agosto e outubro de 2021. A intervenção foi realizada com 43 profissionais atuantes em um hospital do Rio Grande do Norte. Os dados foram analisados a partir de estatística descritiva e inferencial. Resultados o recurso educacional apresentou efeito positivo, com aumento significativo no conhecimento dos participantes da intervenção educativa (p<0,05). No que concerne à avaliação da satisfação dos participantes quanto ao AleitaGame como recurso educativo, a maioria dos participantes consideraram ótimos todos os itens das categorias "conteúdo", "linguagem", "organização e layout", "motivação e aprendizagem". Conclusão e implicações para a prática os resultados do estudo são critérios convidativos para docentes da área passarem a incorporar o AleitaGame em suas salas de aula, bem como para utilização do recurso como estratégia para educação permanente dos profissionais nos serviços de saúde. O jogo sério está disponível através do link: <https://aleitagame.github.io/>.

RESUMEN Objetivo evaluar la efectividad de una intervención educativa utilizando el juego serio AleitaGame como recurso educativo en la enseñanza de las lesiones en los pezones. Método estudio cuasi-experimental, del tipo grupo único, antes y después, no aleatorizado, desarrollado entre agosto y octubre de 2021. La intervención fue realizada con 43 profesionales que actúan en un hospital de Rio Grande do Norte. Los datos se analizaron mediante estadística descriptiva e inferencial. Resultados el recurso educativo tuvo un efecto positivo, con un aumento significativo en el conocimiento de los participantes de la intervención educativa (p<0,05). En cuanto a la evaluación de la satisfacción de los participantes con AleitaGame como recurso educativo, la mayoría consideró excelentes todos los ítems en las categorías "contenido", "lenguaje", "organización y diseño", "motivación y aprendizaje". Conclusión e implicaciones para la práctica los resultados del estudio son criterios atractivos para que los profesores del área pasen a incorporar el AleitaGame en sus clases, así como a utilizar el recurso como estrategia para la formación continua de los profesionales de los servicios de salud. El juego serio está disponible a través del link: <https://aleitagame.github.io/>.

ABSTRACT Objective to evaluate the effectiveness of an educational intervention using the serious game AleitaGame as an educational resource in teaching about mammillary injuries. Method a quasi-experimental, single group, before and after, non-randomized study, developed between August and October 2021. The intervention was carried out with 43 professionals working in a hospital in Rio Grande do Norte. Data were analyzed using descriptive and inferential statistics. Results the educational resource had a positive effect, with a significant increase in the knowledge of the participants of the educational intervention (p<0.05). Regarding the evaluation of participants' satisfaction about AleitaGame as an educational resource, most participants considered all items in the "content", "language", "organization and layout", "motivation and learning" categories to be excellent. Conclusion and implications for practice the results of the study are inviting criteria for professors in the area to start incorporating AleitaGame in their classrooms, as well as for using the resource as a strategy for the continuing education of professionals in health services. The serious game is available on the link: <https://aleitagame.github.io/>.

Preventing nipple pain/trauma in breastfeeding women: a best practice implementation project at the Marqués de Valdecilla University Hospital (Spain).

OBJECTIVES: To assess compliance with recommendations to alleviate nipple pain and/or trauma (NPT) and to reduce the rate of breastfeeding abandonment for this reason. INTRODUCTION: As a fundamental priority, health programmes encourage mothers to breastfeed exclusively for the first 6 months of the baby's life and to supplement breast milk with other foods up to the age of 2 years. However, the presence of NPT can reduce or prevent compliance with this recommendation. METHODS: The project was designed and carried out using a framework based on the JBI Practical Application of Clinical Evidence System (JBI-PACES). Six audit criteria were used in preaudits and postaudits to observe any changes in compliance with the recommendations. Between audits, the Getting Research into Practice (GRiP) tool was used to identify stakeholders, barriers and facilitators of the project. RESULTS: Two hundred and sixty-seven breastfeeding women were studied in the baseline phase and 275 during follow-up. Compliance in four criteria improved, and the rates of NPT decreased (pain: from 63.3 to 53.5%; P  = 0.02; trauma: from 37.8 to 24.7%; P  = 0.01). The proportion of women advised by qualified personnel increased from 63 to 88% whereas those who cited pain as the reason for abandoning exclusive breastfeeding decreased from 1.5 to 1.1%. CONCLUSION: This evidence-based implementation project achieved significantly improved compliance rates in most of the evidence-based criteria considered. In consequence, the prevalence of NPT fell significantly. Nevertheless, there was no significant impact on the proportion of mothers abandoning breastfeeding for this reason.

Re-thinking lactation-related nipple pain and damage.

Nipple pain is a common reason for premature cessation of breastfeeding. Despite the benefits of breastfeeding for both infant and mother, clinical support for problems such as maternal nipple pain remains a research frontier. Maternal pharmaceutical treatments, and infant surgery and bodywork interventions are commonly recommended for lactation-related nipple pain without evidence of benefit. The pain is frequently attributed to mammary dysbiosis, candidiasis, or infant anatomic anomaly (including to diagnoses of posterior or upper lip-tie, high palate, retrognathia, or subtle cranial nerve abnormalities). Although clinical protocols universally state that improved fit and hold is the mainstay of treatment of nipple pain and wounds, the biomechanical parameters of pain-free fit and hold remain an omitted variable bias in almost all clinical breastfeeding research. This article reviews the research literature concerning aetiology, classification, prevention, and management of lactation-related nipple-areolar complex (NAC) pain and damage. Evolutionary and complex systems perspectives are applied to develop a narrative synthesis of the heterogeneous and interdisciplinary evidence elucidating nipple pain in breastfeeding women. Lactation-related nipple pain is most commonly a symptom of inflammation due to repetitive application of excessive mechanical stretching and deformational forces to nipple epidermis, dermis and stroma during milk removal. Keratinocytes lock together when mechanical forces exceed desmosome yield points, but if mechanical loads continue to increase, desmosomes may rupture, resulting in inflammation and epithelial fracture. Mechanical stretching and deformation forces may cause stromal micro-haemorrhage and inflammation. Although the environment of the skin of the nipple-areolar complex is uniquely conducive to wound healing, it is also uniquely exposed to environmental risks. The two key factors that both prevent and treat nipple pain and inflammation are, first, elimination of conflicting vectors of force during suckling or mechanical milk removal, and second, elimination of overhydration of the epithelium which risks moisture-associated skin damage. There is urgent need for evaluation of evidence-based interventions for the elimination of conflicting intra-oral vectors of force during suckling.

Anquiloglosia en el lactante amamantado. Puesta al día / Ankyloglossia in breastfeeding infants. An update

El frenillo lingual corto, o anquiloglosia, puede generar problemas durante la lactancia con repercusión en el desarrollo del lactante, daño en el pezón de la madre y abandono precoz de la lactancia. Actualmente no existe homogeneidad en los criterios diagnósticos, lo que ocasiona tanto sobrediagnóstico como infradiagnóstico de esta alteración, con las consecuencias clínicas que ello conlleva. La dificultad en el abordaje radica en saber cuándo se trata de variantes anatómicas normales o de un frenillo lingual sin repercusión funcional, y cuándo los problemas de lactancia, que clásicamente se le atribuyen se deben realmente al frenillo. Alrededor del 50 % de los niños con frenillo lingual corto no presenta problemas de lactancia o estos se resuelven con apoyo y asesoramiento. En el resto de casos se puede recurrir a tratamiento quirúrgico. En este artículo se ha realizado una actualización de la clasificación y tratamiento de la anquiloglosia que permitirá a los profesionales un manejo adecuado de estos pacientes

Short frenulum, or ankyloglossia, may lead to breastfeeding problems, with an impact on infant development, nipple damage, and early abandonment of breastfeeding. There are currently no homogeneous diagnostic criteria, thus leading to both overdiagnosis and underdiagnosis and associated clinical consequences. The challenge to approach this condition lies in establishing whether it is a normal anatomical variation or a lingual frenulum without a functional impact and when breastfeeding difficulties which are typically attributed to it are actually caused by the frenulum. Approximately 50 % of ankyloglossia cases do not result in breastfeeding problems or these can be resolved with support and advice. Surgery may be proposed for the rest of the cases. This article offers an update on the classification and treatment of ankyloglossia, which will help health care providers to provide an adequate management to these patients

A aplicação da laserterapia no tratamento de traumas mamilares: revisão de literatura / Application of laser therapy in the treatment of nipple traumas: a literature review / Aplicación de laserterapia en el tratamiento del traumatismo del pezón: revisión de literatura

OBJETIVO: Identificar na literatura científica a aplicação da laserterapia de baixa intensidade no tratamento de traumas mamilares em puérperas. MÉTODO: Trata-se de uma revisão integrativa da literatura. O levantamento das publicações ocorreu no período de setembro a novembro de 2020, utilizando os descritores "low-level light therapy" e "laser therapy", além da palavra-chave: "nipple trauma", nas bases de dados da PubMed, EMBASE, CINAHL, Scopuse Web of Science.Após a leitura e análise dos artigos, 3 artigos foram selecionados para a amostra final. RESULTADOS: Os dados analisados compuseram dois eixos temáticos denominados: "Uso da laserterapia no alívio da dor mamilar" e "Uso da laserterapia na cicatrização de fissuras mamilares". CONCLUSÃO: A aplicação da laserterapia resultou na diminuição da dor e boa regeneração tecidual mamilar, contribuindo para manutenção do aleitamento materno.

OBJECTIVE: To identify in the scientific literature the application of low-level laser therapy in the treatment of nipple traumas in puerperal women. METHOD: This is an integrative literature review.The survey of publications took place from September to November2020, using the descriptors "low-level light therapy" and "laser therapy", in addition to the keyword"nipple trauma", in the PubMed, EMBASE, CINAHL, Scopus and Web of Science databases.After reading and analyzing the articles, 3 were selected for the finalsample. RESULTS: The analyzed data composed two thematic axes, namely: "The use of laser therapy for nipple pain relief" and "The use of laser therapy in the healing of nipple fissures". CONCLUSION: The application of laser therapy resulted in pain reduction and in good nipple tissue regeneration, contributing to the maintenance of breastfeeding.

OBJETIVO: Identificar en la literatura científica la aplicación de laserterapia de baja intensidad en el tratamiento del traumatismo del pezón en mujeres posparto. MÉTODO: Se trata de una revisión integradora de la literatura. El levantamiento de publicaciones se realizó de septiembre a noviembre de 2020, utilizando los descriptores "low-level light therapy" y "laser therapy", además de la palabra clave: "nipple trauma", en las bases de datos de PubMed, EMBASE, CINAHL, Scopus y Web of Science. Después de leer y analizar los artículos, se seleccionaron 3 artículos para la muestra final. RESULTADOS: Los datos analizados comprendieron dos ejes temáticos denominados: "Uso de laserterapia para aliviar el dolor del pezón" y "Uso de laserterapia para la cicatrización de las grietas del pezón". CONCLUSIÓN: La aplicación de laserterapia dio como resultado una disminución del dolor y una buena regeneración del tejido del pezón, contribuyendo al mantenimiento de la lactancia.

The effectiveness of the laid-back position on lactation-related nipple problems and comfort: a meta-analysis.

BACKGROUND: The importance of breastfeeding for maternal and child health is agreed upon worldwide. However, lactation-related nipple problems are common and are important factors affecting breastfeeding. Multiple studies recommended laid-back breastfeeding, but they are of various levels of quality, and the results are inconclusive. METHODS: We systematically searched the following twelve databases from inception to January 28,2020: Cochrane Library, EMBASE, Medline, Ovid, PubMed, Web of Science, CINAHL, Scopus, Chinese National Knowledge Infrastructure (CNKI), China Biology Medicine disc (CBM), WanFang, and VIP. All studies regarding laid-back breastfeeding or biological nurturing were considered, regardless of whether they were randomized controlled trials. Two trained investigators independently evaluated the quality of the selected articles and screened the data. All the data were analysed separately using Review Manager Version 5.3 and STATA/SE Version 15.1. RESULTS: A total of 12 studies involving 1936 groups of postpartum women and their newborns were included. The results of the meta-analysis showed that nipple pain (RR = 0.24; 95% CI 0.14, 0.40; p < 0.00001), nipple trauma (RR = 0.47; 95% CI 0.29, 0.75; p = 0.002) and correct latching position (RR = 1.22; 95% CI 1.11, 1.33; p < 0.0001) in the experimental groups were all better than those of the control groups, and the differences were statistically significant (p < 0.05), which indicates that the laid-back position has a positive effect on maternal breastfeeding. However, the results of position comfort showed that there was no statistical significance between the two groups (ES = 0.09; 95% CI -0.63, 0.81; p = 0.798). CONCLUSION: Compared with traditional breastfeeding positions, the laid-back position has been proven to be related to a decreased incidence of nipple pain and nipple trauma and is seemingly conducive to the use of the correct latching position. It is suggested that the laid-back position is helpful in solving lactation-related nipple problems and can be recommended as a position for breastfeeding. However, no significant difference in position comfort was found between the two groups based on the current evidence, and further studies are still needed to validate these results due to the limitations of the included studies.

Low- level laser: cost of therapy fornipple trauma / Laser de baixa intensidade: custo da terapia no trauma mamilar

Abstract Objectives: to measure the micro-cost of local laser therapy (LL) and transcutaneous laser therapy application by Irradiation Laser Intravascular of Blood (ILIB) to treat nipple trauma and compare the most effective and efficient alternative treatment. Methods: a cross-sectional analytical and quantitative study with analysis on the micro absorption cost, implemented as a clipping, from a randomized clinical trial that used two types of laser therapy to treat nipple trauma due to breastfeeding. The sample consisted of 101 nipple lesions. Patients were randomized into three groups (Control - CG, Local Laser -LLG and ILIB-ILIBG). Materials used, direct labor (DL) and laser equipment were predictors of costs. The delta calculation (effect size) was the indicator for measuring effectiveness and efficiency. Results: after three sessions, the average final cost was R$ 40.04for CG, R$ 53.55for LLG and R$ 67.29for ILIBG. After three sessions of treatment, ILIBG showed a great reduction in the lesion area, but with a higher cost (p<0.05). Conclusions: ILIBG had a better effect on healing the nipple trauma when compared to CG and LLG, even though it is more expensive, it suggests a positive cost-benefit and the most effective and efficient alternative treatment.

Resumo Objetivos: mensurar o microcusteio da aplicação de Laserterapia Local (LL) e trans-cutânea por Irradiation Laser Intravascular of Blood (ILIB) no tratamento de traumas mamilares e comparar a alternativa de tratamento mais eficaz e eficiente. Métodos: estudo transversal analítico do tipo quantitativo com análise de microcusteio de procedimento por absorção, implementado como recorte, de um ensaio clínico rando-mizado que utilizou duas modalidades de laserterapia para tratamento de traumas mamilares ocasionados pela amamentação. A amostra foi composta de 101 lesões mamilares. As pacientes foram aleatorizadas em três grupos (Controle - GG, Laser Local - GLL e ILIB -GILIB). Foram preditores de custos os materiais consumidos, Mão de obra Direta (MoD) e o equipamentos de laser O cálculo Delta (tamanho do efeito) foi o indicador para a medida da eficácia e eficiência. Resultados: após três sessões, a média do custo final foi de R$ 40,04 para o GC, R$ 53,55 para o GLL e R$ 67,29 para o GILIB. Após três sessões de tratamento, GILIB apresentou maior redução da área da lesão, contudo custo mais elevado (p<0,05). Conclusão: o GILIB teve efeito melhor na cicatrização dos traumas mamilares quando comparado com o GC e GLL, mesmo sendo mais caro sugere um custo benefício positivo e a alternativa de tratamento mais eficaz eficiente.

A retrospective analysis of debridement in the treatment of chronic injury of lactating nipples.

Treatment strategies for nipple injury are mainly based on aetiology. However, some damaged nipples do not heal after the aetiology was corrected. This study retrospectively analyses the effect of debridement for treating chronic injury of lactating nipples. The medical records on nipple injury management in the authors' department from December 2015 to January 2020 were retrospectively analysed. A total of 167 patients were enrolled and grouped based on the presence or absence of nipple debridement. The difference in the healing effect, pain relief rate and recurrence rate of nipple injury between the two groups after 1 week was examined. The cure rate of nipple injury in the intervention group (54.3%) was significantly higher than in the control group (26.7%). In addition, the complete pain relief rate in the intervention group (48.1%) was significantly higher than in the control group (23.3%). However, the recurrence rates between the two groups (36.4% (16/44) vs. 34.8% (8/23)) had no statistically significant differences. For patients with no improvement after correction of the aetiology of the in the nipple damage, debridement can improve the healing environment of nipple breakage and thus relieve nipple pain.

Dificuldade no aleitamento materno exclusivo no alojamento conjunto: revisão integrativa / Exclusive breastfeeding difficulty in rooming-in care: integrative review

RESUMO Objetivos Identificar e analisar os estudos que avaliaram as dificuldades enfrentadas pelas puérperas para implementação do aleitamento materno exclusivo até 72 horas após o parto, durante o período em que permaneceram no alojamento conjunto. Estratégia de pesquisa Foi realizada busca de artigos nas plataformas PubMed, BVS e SciELO. Critérios de seleção Foram selecionados artigos originais, com resumo disponível, publicados entre os anos de 2010 e 2020, em português, inglês ou espanhol, que investigaram as dificuldades observadas no aleitamento materno exclusivo durante o período em que a díade mãe/bebê permaneceu no alojamento conjunto. Resultados A amostra final consistiu em 11 artigos publicados entre os anos de 2010 e 2019, sendo o Brasil o país com maior número de publicações. O tamanho das amostras nos estudos variou de 40 a 1.691 puérperas, com faixas etárias entre 13 e 46 anos. Observou-se prevalência de amamentação na primeira hora após o nascimento entre 43,9% e 77,3%. Conclusão A maioria dos artigos indicou que a principal dificuldade no aleitamento materno no período pós-parto se refere aos traumas mamilares. Os traumas mamilares são ocasionados por características do aleitamento, da mulher, da mama, da gestação, do parto e da rede de apoio da puérpera.

ABSTRACT Purpose Identify and analyze the studies that evaluated the difficulties faced by the puerperal women to implement exclusive breastfeeding up to 72 hours after delivery during the period in which they stayed in the rooming-in. Research strategy The search for articles was carried out on the PubMed, BVS, and SciELO platforms. Selection criteria Original articles were selected, with an available summary, published between 2010 and 2020 in Portuguese, English or Spanish that investigated the difficulties observed in exclusive breastfeeding during which the mother-baby dyad stayed in the period of Rooming-in Care. Results The final sample of this study consisted of 11 articles published between the years 2010 and 2019, having Brazil being the country with the largest number of publications. The sample sizes in the studies ranged from 40 to 1,691 puerperal women, having ages between 13 and 46 years. It was observed a prevalence of breastfeeding in the first hour after birth between 43.9% and 77.3%. Conclusion Most articles pointed out that the main difficulty in relation to breastfeeding in the postpartum period refers to nipple trauma. Nipple trauma is caused by characteristics of breastfeeding, women, breast, pregnancy, childbirth and the postpartum support network.

Breastfeeding technique and the incidence of nipple traumas in puerperal women attended in a city hospital: intervention study / Técnica de amamentar e a incidência de traumas mamilares em puérperas atendidas em um hospital municipal: estudo de intervenção

Abstract Objectives: to evaluate the effect of an intervention on the incidence of nipple trauma and the quality of breastfeeding technique in the first month of postpartum. Methods: this is a quasi-randomized intervention study with 180 puerperal women equally distributed between experimental and control groups. The intervention was performed at a maternity and consisted of an educational session on breastfeeding technique. A descrip-tive analysis of the groups' characteristics was performed, comparing the frequencies of unfa-vorable parameters related to breastfeeding technique between groups. Pearson's chi-square test and Fisher's test were used, and p≤0.05 was adopted as the critical level of significance. Results: at 30 days, 64% and 15% of the mothers used the technique correctly, respec-tively, in the experimental and control groups with RR=4.87 (CI95%=2.93-8.34); NNT=1.96 (CI95% =1.61-2.72); p<0.001. In the experimental group, a decrease was observed in the unfavorable parameters of the breastfeeding technique (p≤0.05). The incidence of nipple trauma was 30% in the experimental group and 38.9% in the control group (p=0.21). Conclusions: the intervention was insufficient to prevent nipple trauma in the experi-mental group, but significantly improved the quality in the breastfeeding technique.

Resumo Objetivos: avaliar o efeito de uma intervenção na incidência de traumas mamilares e na qualidade da técnica de amamentar no primeiro mês pós-parto. Métodos: trata-se de um estudo de intervenção quasi randomizado com 180 puérperas distribuídas entre os grupos experimental e controle. A intervenção foi realizada na mater-nidade e consistiu de sessão educativa sobre a técnica de amamentar. Foi realizada análise descritiva das características dos grupos, comparadas as frequências dos parâmetros desfa-voráveis da técnica de amamentar. O teste do qui-quadrado de Pearson e teste de Fisher foram utilizados, sendo adotado p≤ 0,05 como nível crítico de significância. Resultados: aos 30 dias, 64% e 15%, das mães apresentaram técnica correta, respectiva-mente, nos grupos experimental e controle com RR= 4,87 (IC95%=2,93-8,34); NNT= 1,96 (IC95%=1,61-2,72); p<0,001.No grupo experimental percebeu-se que houve diminuição dos parâmetros desfavoráveis da técnica de amamentar (p≤0,05). A incidência de trauma mamilar foi de 30% no grupo experimental e 38,9% no grupo controle (p=0,21). Conclusão: no grupo experimental a intervenção realizada não foi suficiente para prevenir a ocorrência de traumas mamilares, porém melhorou significantemente a qualidade da técnica de amamentar.

The effectiveness on health education to prevent nipple trauma from breastfeeding: a systematic review / A eficácia da educação em saúde na prevenção do trauma mamilar na amamentação: revisão sistemática

Abstract Objectives: to analyze the effectiveness on health education to prevent nipple trauma in breastfeeding compared to other interventions. Methods: systematic literature review was carried out in January 2019, according to PRISMA recommendations. The searches were conducted in Cinahl, PubMed, Web of Science, Scopus, and in the references cited in the selected articles. The studies were assessed for quality and level of evidence according to the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE). Results: twelve studies were selected, all conducted at the maternities. The interventions were classified in two categories: health education on breastfeeding and the use of nipple covers. Health education on breastfeeding presents a moderate level of evidence on the prevention of nipple trauma. There is a moderate to high level of evidence on the positive effects of guaiazulene, gel or peppermint water applied in the postpartum period to prevent nipple trauma. Conclusion: health education on breastfeeding with clinical demonstration is an important strategy to prevent nipple trauma and requires more than one educational approach. The use of nipple covers requires some consideration, since they must be removed prior to breastfeeding. All interventions were conducted in the postpartum period, which points out for the necessity of clinical research to prevent nipple trauma in prenatal care.

Resumo Objetivos: analisar a eficácia da educação em saúde para a prevenção do trauma mamilar na amamentação comparado a outras intervenções. Métodos: revisão sistemática realizada em janeiro de 2019, segundo recomendações PRISMA. As buscas foram realizadas na Cinahl, PubMed, Web of Science, Scopus e referências citadas nos artigos selecionados. Os estudos foram avaliados quanto à qualidade e nível de evidência conforme o sistema Grading of Recommendations, Assessment, Development and Evaluation. Resultados: foram selecionados 12 estudos, todos executados em maternidades. As intervenções foram representadas em duas categorias: educação em saúde sobre amamentação e uso de coberturas mamilares. A educação em saúde sobre amamentação apresenta moderada evidência na prevenção do trauma mamilar. As coberturas de gel ou água de hortelã-pimenta, de guaiazulene, aplicadas no pós-parto, têm efeito positivo na prevenção do trauma mamilar, com moderada a alta evidência. Conclusão: a educação em saúde sobre amamentação, com demonstração clínica, configura-se importante estratégia para prevenção do trauma mamilar, devendo ser realizada mais de uma abordagem educativa. A implementação de coberturas mamilares precisa ser ponderada, pois todas exigiram remoção antes da mamada. Todas as intervenções foram conduzidas no pós-parto, o que aponta para a necessidade de pesquisas clínicas sobre a prevenção do trauma mamilar no pré-natal.

Description of 101 cases of nipple cracks and risk factors via case-control study in eight units of a perinatal network.

Nipple crack are a frequent complication of breastfeeding, causing pain for the mother and feeding difficulties for the baby with the risk of early cessation of breastfeeding. The characteristics of nipple cracks have rarely been described. Treatment varies according to the period of breasfeeding and the maternity ward. Eight maternity wards in a perinatal health network in western France followed up maternal nipple cracks. The cracks were described and their treatment was noted. The variables regarding the mothers, delivery conditions, health of newborns, and their ability to breastfeed were analyzed. Each case patient was matched with a control patient who was in a room adjacent to the case patient. Case-control analysis was univariate, followed by multivariate analysis via logistic regression (SPSS 20.0) with adjusted odds ratios (aOR). In all, 101 cases of women with nipple cracks were studied. The cracks were predominantly located in the upper external quadrants as well as in the central part of the nipple. There were no lateralization effects (right or left). The most frequent treatments after breastfeeding were oils, hydrophilic gel, and maternal milk. Compared with the 101 controls without cracks, the features associated with cracks in multivariate analysis were fair skin (aOR=1.92 [1.01-3.60]; P=0.04), history of nipple cracks (aOR=11.38 [3.69-35.13]; P=0.0001), first breastfeeding (aOR=4.21 [1.27-13.86]; P=0.018), and normal weight or no obesity (aOR=0.33 [0.14-0.75]; P=0.008). Two more specific analyses were performed in primiparous and multiparous women. In conclusion, the practitioners learned to describe nipple cracks and analyze their treatments. Knowledge of the risk factors should enable practitioners to propose active prevention to mothers with fair skin, a history of cracks, or a lack of experience in breastfeeding by helping them to breastfeed during the first days of their infant's life, especially for primiparous and overweight or obese women.

Prevalence of nipple traumas and related factors among post-partum women assisted in a teaching hospital / Prevalencia de traumas mamilares y factores relacionados en puerperas asistidas en un hospital de enseñanza / Prevalência de traumas mamilares e fatores relacionados em puérperas assistidas em um hospital de ensino

Abstract Objectives: To estimate the prevalence of nipple traumas and to correlate this occurrence with socio-demographic and obstetric factors in a sample of assisted post-partum patients in a teaching hospital. Method: Cross-sectional, quantitative study of 320 post-partum patients assisted in the maternity from October 2015 to October 2016. Results: The prevalence of nipple trauma in the sample was 35.3%, and only previous experience with breastfeeding has behaved as a protective factor for trauma. No statistical associations were found with other variables. Conclusions and implications for practice: The data presented allowed us to delineate a profile of the post-partum patients assisted in a teaching hospital, as well as the characterization of the occurrence of nipple traumas. From this profile, guidelines can be established on the subject, both in the institution where the study was carried out and in other institutions, since from the literature, the need for this orientation in different contexts and institutions is identified.

Resumen Objetivos: Estimar la prevalencia de traumas mamilares y correlacionar su ocurrencia con factores sociodemográficos y obstétricos en muestra de puérperas asistidas en un hospital de enseñanza. Método: Estudio cuantitativo y transversal, realizado con 320 puérperas asistidas en un Alojamiento Conjunto, en el período de octubre de 2015 a marzo de 2016. Resultados: La prevalencia de trauma mamilar en la muestra fue de 35,3%, y solo la experiencia previa con la lactancia actuó como un factor de protección para el trauma. No se encontraron asociaciones estadísticas con otras variables. Conclusiones e implicaciones para la práctica: Los datos presentados permiten delinear un perfil de puerperas asistidas en un hospital de enseñanza, así como la caracterización de la ocurrencia de traumas mamilares. A partir de este perfil se podrán establecer orientaciones sobre el tema tanto en la institución en que se realizó el estudio, como en otras instituciones, ya que a partir de la literatura se pudo identificar la necesidad de esta orientación en diferentes contextos e instituciones.

Resumo Objetivos: Estimar a prevalência de traumas mamilares e correlacionar a sua ocorrência com fatores sociodemográficos e obstétricos em amostra de puérperas assistidas em um hospital de ensino. Método: Estudo quantitativo, transversal realizado com 320 puérperas assistidas no Alojamento Conjunto, no período de outubro de 2015 a março de 2016. Resultados: A prevalência de trauma mamilar na amostra foi de 35,3% e apenas a experiência prévia com aleitamento comportou-se como fator de proteção para o trauma. Não foram encontradas associações estatísticas com outras variáveis. Conclusões e implicações para a prática: Os dados apresentados possibilitaram delinear um perfil das puerpéras assistidas em um hospital de ensino, assim como a caracterização da ocorrência dos traumas mamilares. A partir deste perfil poderão ser instituídas orientações sobre o tema tanto na instituição que foi realizado o estudo, quanto em outras instituições, já que a partir da literatura, identifica-se a necessidade desta orientação em diferentes contextos e instituições.

Comparative study of the use of HPA lanolin and breast milk for treating pain associated with nipple trauma / Estudo comparativo do uso de lanolina HPA e leite materno para o tratamento da dor associada ao trauma mamilar

Abstract Objective To compare two different treatments—the use of highly purified anhydrous (HPA) lanolin and expressed breast milk—for women with pain and nipple trauma during the breastfeeding process. Method A total of 180 puerperal women were randomly assigned to 2 groups: one was treated with HPA lanolin and the other with their own expressed breast milk. All of the participants received the same breastfeeding technique instructions and therapeutic care standard. Three assessments were performed: at the time of inclusion in the study (after randomization); after 48 hours; and after 7 days. At each interval, data was collected in relation to pain and trauma. A numerical/verbal category scale was used for the pain variable, and the nipple trauma score for the trauma variable. The results were subjected to statistical analysis using the chi-squared test, the Fisher exact test, the student t-test, and the Kolmogorov-Smirnov test. Generalized estimating equations were calculated using the STATA 12 statistical software package (StataCorp LLC, College Station, TX, USA) and IBM SPSS Statistics for Windows, Version 20.0 (IBM Corp, Armonk, NY, USA). Results There was pain improvement from the second to the third assessment in the group that used HPA lanolin, while the pain remained unchanged between these two periods (p< 0.001) in the breast milk group. In terms of trauma, improvement was identified in its extension and depth from the first to the third assessment, and it was higher in the HPA lanolin group than in the breast milk group (p= 0.025). Conclusion The treatment of pain and nipple trauma with HPA lanolin achieved better results than the one with breast milk, based on a 7-day treatment period.

Resumo Objetivo Comparar dois tratamentos distintos—o uso de lanolina anidra altamente purificada (HPA, na sigla em inglês) e o próprio leite materno—para mulheres com dor e trauma mamilar durante o processo de amamentação. Métodos Participaram do estudo 180 puérperas randomizadas para 2 grupos: um utilizou tratamento com lanolina HPA e o outro o próprio leite materno. Todas receberam a mesma orientação quanto à técnica de amamentação e rigor terapêutico e foram avaliadas em três momentos: na inclusão no estudo (após a randomização), em 48 horas e em 7 dias. Em todos os momentos, foram colhidos dados em relação à dor e ao trauma. Para a variável dor, utilizou-se escala de categoria numérica/nerbal e, para a variável trauma, a pontuação de traumas mamilares. Os testes estatísticos utilizados foram: Qui-quadrado, teste exato de Fisher, t de Student, e Kolmogorov-Smirnov, sendo que os modelos de equações de estimação generalizadas foram calculados por meio dos pacotes STATA 12 (StataCorp LLC, College Station, TX, EUA) e IBM SPSS Statistics for Windows, Versão 20.0 (IBM Corp, Armonk, NY, EUA). Resultados Houve melhora da dor da segunda para a terceira avaliação no grupo que utilizou a lanolina HPA, enquanto que no grupo que usou leite materno a dor permaneceu inalterada entre esses dois momentos (p< 0,001). Quanto ao trauma, foi identificada melhora em sua extensão e profundidade, da primeira para a terceira avaliação, e a melhora foi maior no grupo tratado com lanolina HPA do que no grupo tratado com leite materno (p= 0,025). Conclusão O tratamento da dor e do trauma mamilar com lanolina HPA teve melhor resultado comparado com o leite materno, com base em um período de tratamento de 7 dias.

Comparative Study of the Use of HPA Lanolin and Breast Milk for Treating Pain Associated with Nipple Trauma.

OBJECTIVE: To compare two different treatments-the use of highly purified anhydrous (HPA) lanolin and expressed breast milk-for women with pain and nipple trauma during the breastfeeding process. METHOD: A total of 180 puerperal women were randomly assigned to 2 groups: one was treated with HPA lanolin and the other with their own expressed breast milk. All of the participants received the same breastfeeding technique instructions and therapeutic care standard. Three assessments were performed: at the time of inclusion in the study (after randomization); after 48 hours; and after 7 days. At each interval, data was collected in relation to pain and trauma. A numerical/verbal category scale was used for the pain variable, and the nipple trauma score for the trauma variable. The results were subjected to statistical analysis using the chi-squared test, the Fisher exact test, the student t-test, and the Kolmogorov-Smirnov test. Generalized estimating equations were calculated using the STATA 12 statistical software package (StataCorp LLC, College Station, TX, USA) and IBM SPSS Statistics for Windows, Version 20.0 (IBM Corp, Armonk, NY, USA). RESULTS: There was pain improvement from the second to the third assessment in the group that used HPA lanolin, while the pain remained unchanged between these two periods (p < 0.001) in the breast milk group. In terms of trauma, improvement was identified in its extension and depth from the first to the third assessment, and it was higher in the HPA lanolin group than in the breast milk group (p = 0.025). CONCLUSION: The treatment of pain and nipple trauma with HPA lanolin achieved better results than the one with breast milk, based on a 7-day treatment period.

OBJETIVO: Comparar dois tratamentos distintos­o uso de lanolina anidra altamente purificada (HPA, na sigla em inglês) e o próprio leite materno­para mulheres com dor e trauma mamilar durante o processo de amamentação. MéTODOS: Participaram do estudo 180 puérperas randomizadas para 2 grupos: um utilizou tratamento com lanolina HPA e o outro o próprio leite materno. Todas receberam a mesma orientação quanto à técnica de amamentação e rigor terapêutico e foram avaliadas em três momentos: na inclusão no estudo (após a randomização), em 48 horas e em 7 dias. Em todos os momentos, foram colhidos dados em relação à dor e ao trauma. Para a variável dor, utilizou-se escala de categoria numérica/nerbal e, para a variável trauma, a pontuação de traumas mamilares. Os testes estatísticos utilizados foram: Qui-quadrado, teste exato de Fisher, t de Student, e Kolmogorov-Smirnov, sendo que os modelos de equações de estimação generalizadas foram calculados por meio dos pacotes STATA 12 (StataCorp LLC, College Station, TX, EUA) e IBM SPSS Statistics for Windows, Versão 20.0 (IBM Corp, Armonk, NY, EUA). RESULTADOS: Houve melhora da dor da segunda para a terceira avaliação no grupo que utilizou a lanolina HPA, enquanto que no grupo que usou leite materno a dor permaneceu inalterada entre esses dois momentos (p < 0,001). Quanto ao trauma, foi identificada melhora em sua extensão e profundidade, da primeira para a terceira avaliação, e a melhora foi maior no grupo tratado com lanolina HPA do que no grupo tratado com leite materno (p = 0,025). CONCLUSãO: O tratamento da dor e do trauma mamilar com lanolina HPA teve melhor resultado comparado com o leite materno, com base em um período de tratamento de 7 dias.

Avaliação dos fatores associados ao trauma mamilar / Assessment of factors associated to nipple trauma

Objetivo: Avaliar os fatores associados ao trauma mamilar. Método: Estudo seccional realizado em alojamento conjunto com todas as puérperas e os recém-nascidos internados no período de julho a agosto de 2014. Resultados: Foram avaliadas 73 puérperas e 76 recém-nascidos (três gemelares). Verificou-se associação significativa entre trauma mamilar e dor ou ardência pós-mamada (0.000), orientação no pré-natal (0.016) e número de consultas no pré-natal (0.018), sendo que mesmo as puérperas que tiveram sete ou mais consultas de pré-natal apresentaram trauma mamilar. Conclusão: Esse estudo reforça a importância das orientações e do preparo para amamentação iniciarem no período da gestação, para que a mulher conheça as possíveis complicações e suas formas de prevenção e tratamento. Dessa forma, a gestante poderá sentir-se preparada para amamentar o seu filho, evitando o aparecimento de traumas e lesões

Objective: To evaluate the factors associated with nipple trauma. Method: Cross-sectional study with all mothers and newborns in rooming-in, admitted from July to August 2014. Results: A total of 73 mothers and 76 newborns (3 twins). There was a significant association between nipple trauma and pain or post-feeding burning (0.000), guidance on prenatal care (0.016) and number of visits in prenatal care (0.018), and even though, mothers who had seven or more visits prenatal showed nipple trauma. Conclusion: This study increase the importance of guidance and preparation for breastfeeding start in gestation period, so that women know the possible complications and ways of prevention and treatment. Thus, the pregnant woman may feel prepared to breastfeed her child, avoiding the appearance of traumas and injuries

Objetivo: Evaluar los factores asociados con el trauma del pezón. Método: Estudio transversal en el alojamiento conjunto con todas las madres y los recién nacidos ingresados entre julio y agosto de 2014. Resultados: Un total de 73 madres y 76 recién nacidos (3 gemelos). Se observó una asociación significativa entre el trauma del pezón y dolor o ardor después de la lactancia materna (0.000), orientación sobre el cuidado prenatal (0,016) y el número de consultas en el prenatal (0018), e incluso las madres que tenían siete o más visitas prenatal mostró lesiones del pezón. Conclusión: Este estudio refuerza la importancia de la orientación y preparación para la lactancia materna se inicia en el período de gestación, para que las mujeres conozcan las posibles complicaciones y formas de prevención y tratamiento. Así, la mujer embarazada puede sentir preparada para amamantar a su hijo, evitando la aparición de traumas y lesiones

Breastfeeding: Common Questions and Answers.

All major health organizations recommend breastfeeding as the optimal source of infant nutrition, with exclusive breastfeeding recommended for the first six months of life. After six months, complementary foods may be introduced. Most organizations recommend breastfeeding for at least one year, and the World Health Organization recommends a minimum of two years. Maternal benefits of breastfeeding include decreased risk of breast cancer, ovarian cancer, postpartum depression, hypertension, cardiovascular disease, and type 2 diabetes mellitus. Infants who are breastfed have a decreased risk of atopic dermatitis and gastroenteritis, and have a higher IQ later in life. Additional benefits in infants have been noted in observational studies. Clinicians can support postdischarge breastfeeding by assessing milk production and milk transfer; evaluating an infant's latch to the breast; identifying maternal and infant anatomic variations that can lead to pain and poor infant weight gain; knowing the indications for frenotomy; and treating common breastfeeding-related infections, dermatologic conditions, engorgement, and vasospasm. The best way to assess milk supply is by monitoring infant weight and stool output during wellness visits. Proper positioning improves latch and reduces nipple pain. Frenotomy is controversial but may reduce pain in the short term. The U.S. Preventive Services Task Force recommends primary care interventions to support breastfeeding and improve breastfeeding rates and duration.