Evidencia de la estimulación de puntos de acupuntura en el tratamiento de la hipogalactia: revisión sistemática con metaanálisis / Evidence of the acupuncture points stimulation for the treatment of hypogalactia: a systematic review and meta-analysis

Objetivo: Realizar una revisión de la literatura para analizar si la estimulación de puntos de acupuntura aumenta la cantidad de leche producida durante la lactancia. Método: Se recopilaron estudios de cinco bases de datos electrónicas siguiendo las recomendaciones internacionales para la elaboración de revisiones sistemáticas y metaanálisis. Los criterios de elegibilidad fueron artículos de texto completo en inglés o español con diseño de ensayos clínicos y estudios observacionales, sin restricción en el tiempo de publicación, en los cuales se hubiera evaluado el efecto de la estimulación de puntos de acupuntura en la mejora de la cantidad de lactancia mediante acupuntura convencional, electroacupuntura, láser, agujas de fuego, estimulación manual, Tui Na o catgut. Dos autores extrajeron de forma independiente los datos de las características y los resultados principales de los estudios seleccionados para su inclusión. Se realizaron las evaluaciones de riesgo de sesgo y de calidad (GRADE). Para la síntesis cuantitativa se calculó la diferencia de medias estandarizada para cada estudio individual seleccionado y luego se combinaron los datos mediante un metaanálisis de efectos aleatorios. Resultados: En la presente revisión se incluyeron un total de 14 estudios, la mayoría de ellos mostraron riesgo de sesgo y una calidad moderada. El metaanálisis mostró que la estimulación manual del punto de acupuntura aumenta la cantidad de leche materna (DME 95% IC=1,63 [1,13-2,13]; p<0,0001). Conclusión: La literatura sugiere que la estimulación manual de puntos de acupuntura mejora la cantidad de leche producida durante de lactancia.(AU)

Objective: To perform a literature review aimed to analyze if acupoint stimulation increases lactation quantity. Method: Studies were collected from five electronic databases following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for systematic reviews. Eligibility criteria were full-text articles in English or Spanish with clinical trial design and observational studies, with no restriction on time of publication, in which the effect of acupoint stimulation on improving the quantity of lactation by conventional acupuncture, electroacupuncture, laser, fire needling, manual stimulation, tuina or catgut had been evaluated. Two authors independently extracted data for the characteristics and main outcomes of the studies selected for inclusion. The risk of bias (RoB 2 and Robins-I) and the quality assessments (GRADE) were performed. For the quantitative synthesis, the standardized mean difference was calculated for each individual study selected and then the data were combined using a random-effects meta-analysis. Results: A total of 14 studies were included in the present review. Most of the included studies exhibited some concerns in the risk of bias assessment. The quality of the studies was moderate. The meta-analysis showed that manual acupoint stimulation improves the lactation quantity (SMD 95% CI=1.63 [1.13-2.13]; p<0.0001). Conclusion: The literature suggests that manual stimulation of acupuncture points improves the amount of milk produced during lactation.(AU)

Evidence of the acupuncture points stimulation for the treatment of hypogalactia: A systematic review and meta-analysis.

OBJECTIVE: To perform a literature review aimed to analyze if acupoint stimulation increases lactation quantity. METHOD: Studies were collected from five electronic databases following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for systematic reviews. Eligibility criteria were full-text articles in English or Spanish with clinical trial design and observational studies, with no restriction on time of publication, in which the effect of acupoint stimulation on improving the quantity of lactation by conventional acupuncture, electroacupuncture, laser, fire needling, manual stimulation, tuina or catgut had been evaluated. Two authors independently extracted data for the characteristics and main outcomes of the studies selected for inclusion. The risk of bias (RoB 2 and Robins-I) and the quality assessments (GRADE) were performed. For the quantitative synthesis, the standardized mean difference was calculated for each individual study selected and then the data were combined using a random-effects meta-analysis. RESULTS: A total of 14 studies were included in the present review. Most of the included studies exhibited some concerns in the risk of bias assessment. The quality of the studies was moderate. The meta-analysis showed that manual acupoint stimulation improves the lactation quantity (SMD 95% CI = 1.63 [1.13-2.13]; p < 0.0001). CONCLUSION: The literature suggests that manual stimulation of acupuncture points improves the amount of milk produced during lactation.

Inibição da lactação: (re) visitando a literatura / Lactation inhibition: (re) visiting the literature

Trata-se de um estudo descritivo, de natureza qualitativa, cujo objetivo é identificar o conhecimento que vem sendo produzido e veiculado em periódicos brasileiros e estrangeiros, acerca do tema inibição da lactação. Foi realizada uma busca detalhada na literatura, a partir das bases de dados MEDLINE, LILACS e SciELO, assim como a busca direta aos principais periódicos de enfermagem, durante o período de 1995 a 2008, e em alguns livros-texto. Os descritores utilizados foram: transtorno da lactação e desmame; selecionou-se 10 artigos sendo posteriormente catalogados e submetidos à categorização. Além disso, pesquisou-se referências específicas e revisitou-se as recomendações atuais da Organização Mundial da Saúde (OMS) e do Ministério da Saúde (MS), que incluíram normas técnicas. Após análise dos artigos, foram extraídas quatro categorias sobre a temática: indicações maternas para inibição da lactação, indicações neonatais para a inibição da lactação, métodos farmacológicos e não farmacológicos da inibição da lactação. Os resultados levam à conclusão de que apesar das técnicas e indicações da inibição da lactação serem relevantes para o cuidado de enfermagem às nutrizes e recém-nascidos, existe uma lacuna nas produções científicas acerca do tema e controvérsias entre os protocolos normativos adotados.

This is a qualitative study type. Its objective is to identify knowledge produced and propagated in brazilian and international newspapers concerning lactation inhibition. A detailed search was carried out in the existing literature of the MEDLINE, LILACS, and SciELO databases, a direct search through the main nursing newspapers published between 1995 and 2008 as well as some textbooks. Ten articles were selected and later catalogued and submitted to categorization. Beyond that, specific references have been researched and current recommendations from the World Health Organization (WHO) and also the Brazilian Ministry of Health (MS) have been revisited. This included technical norms and regulations. After analyzing the articles, the following four categories surrounding the topic were extracted: Maternal indications for nursing inhibition; neonatal indications for nursing inhibition; pharmacological methods for nursing inhibition and non-pharmacological methods for nursing inhibition. The results lead to the conclusion that although the techniques and indications for lactation inhibition are relevant for nursing care, wet-nurses and newborns; there is a gap in scientific production concerning the topic as well as controversies among the adopted normative protocols.

Se trata de un estudio de naturaleza cualitativa, cuyo objetivo es identificar el conocimiento que está siendo producido y transmitido en periódicos brasileros y extranjeros, acerca del tema inhibición de la lactancia. Se realizó una búsqueda detallada en la literatura, a partir de las bases de datos MEDLINE. LILACS E SciELO, así como la búsqueda directa en las principales publicaciones periódicas de enfermería, durante el periodo de 1995 al 2008 y en algunos libros. Se seleccionaron 10 artículos que fueron posteriormente catalogados y sometidos a la categorización. Además de eso, investigamos las referencias específicas y revisamos las recomendaciones actuales de la Organización Mundial de la Salud (OMS) y del Ministerio de Salud (MS), incluyendo las normas técnicas. Después de analizar los artículos, se extrajeron 4 categorías sobre la temática: Las indicaciones maternales para la inhibición de la lactancia; las indicaciones neonatales para la inhibición de la lactancia; métodos farmacológicos de inhibición de la lactancia y métodos no farmacológicos de inhibición de la lactancia. Los resultados llevan a la siguiente conclusión: a pesar de que las técnicas e indicaciones de la inhibición de la lactancia son relevantes para el cuidado de la enfermería por las mujeres que amamantan y los recién nacidos, existe una espacio vacío en las producciones científicas acerca del tema y, además, hay controversias entre los protocolos normativos adoptados.