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Savaş EH, Tümkaya MN, Semerci R, Eroğlu K. Comparison of the effect of natural products and breast milk for preventing and treating nipple trauma and pain in lactating women: A systematic review and meta-analysis. Explore (NY) 2024; 20:103019. [PMID: 38937192 DOI: 10.1016/j.explore.2024.103019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 04/19/2024] [Accepted: 06/18/2024] [Indexed: 06/29/2024]
Abstract
INTRODUCTION Prevention and management of nipple problems are crucial during the postpartum period for effective breastfeeding. Breastmilk is the most commonly recommended method for lactating women. However, insufficient studies have proven its superiority over other methods in the current literature. This study aims to determine the effects of natural products compared to breast milk in preventing and treating nipple trauma and pain in lactating women. METHODS In this review, we investigated studies from PubMed, Web of Science, Cochrane Library, MEDLINE, CINAHL, Scopus, and Google Scholar databases that met the inclusion criteria. We also assessed the studies' methodological quality with the Cochrane and JBI checklists. This study was performed based on the Guidelines of Systematic Reporting of Examination presented in the PRISMA checklist. The search protocol has been registered at the PROSPERO International Prospective Register of Systematic Reviews. RESULTS A total of ten published studies, including 1139 lactating women, were included in this review. The meta-analysis results showed a significant effect of natural product intervention on nipple trauma (Hedge's g -0.702, Q = 81,154, I2 =91,374 %, p < 0.001), soreness (Hedge's g =-0.648, Q = 7,092, I2 =71,801 %, p < 0.001), and pain levels (Hedge's g =-0.613, Q = 25,058, I2 =76,056 %, p < 0.001) experienced by lactating women. CONCLUSION The findings showed that natural products have greater potential than breast milk in managing nipple pain, trauma, and soreness. However, the evidence for these interventions is low or very low quality. Further research is needed to determine the most effective treatment for nipple trauma in lactating women.
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Affiliation(s)
- Eyşan Hanzade Savaş
- Koç University, Graduated School of Health Sciences, Davutpaşa St. No: 4, 34010, Topkapı, Istanbul, Türkiye.
| | - Maide Nur Tümkaya
- Halic University Faculty of Health Sciences, 5th Levent District, 15 Temmuz Sehitler St., No: 14/12, 34060 Eyüpsultan, Istanbul, Türkiye
| | - Remziye Semerci
- Koç University, School of Nursing, Davutpaşa St. No: 4, Koç University School of Nursing, 34010, Topkapı, Istanbul, Türkiye
| | - Kafiye Eroğlu
- Atlas University, School of Nursing, Hamidiye, Anadolu St. No:40, 34408, 34403 Kagithane, Istanbul, Türkiye
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Camargo BTS, Sañudo A, Kusahara DM, Coca KP. Initial nipple damages in breastfeeding women: analysis of photographic images and clinical associations. Rev Bras Enferm 2023; 77:e20220773. [PMID: 38088688 PMCID: PMC10704699 DOI: 10.1590/0034-7167-2022-0773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 08/14/2023] [Indexed: 12/18/2023] Open
Abstract
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.
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Affiliation(s)
| | - Adriana Sañudo
- Universidade Federal de São Paulo. São Paulo, São Paulo, Brazil
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Şahin E, Yildirim F, Büyükkayaci Duman N. Effect of Tea Tree Oil and Coconut Oil on Nipple Crack Formation in the Early Postpartum Period. Breastfeed Med 2023; 18:226-232. [PMID: 36763614 DOI: 10.1089/bfm.2022.0260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
Background: The aim of the study was to determine the effect of tea tree oil and coconut oil applied to the nipples during the early postpartum period on nipple crack formation. Methods: This randomized controlled experimental research included a total of 90 women in the research sample abiding by the research criteria, with 30 each in the intervention groups (coconut oil or tea tree oil application) and 30 in the control group. Women in the intervention groups applied coconut oil or tea tree oil to the nipples on the 3rd, 7th, and 10th days postpartum, whereas the control group did not have any intervention. Data in the research were collected with the Descriptive Information Form for Mothers, Early Postpartum Period Breast Problem Assessment Form, and Visual Analog Scale (VAS). Analysis of data used the chi-square test, Kruskal-Wallis test, and Friedman's test. Results: Mean age of women participating in the research was 28.23 ± 5.21 years. The differences between the groups applying coconut oil and tea tree oil on the 3rd, 7th, and 10th days postpartum and the control group were significant in terms of incidence of nipple cracks. In addition, the difference in mean VAS points for nipple pain in the groups using coconut oil and tea tree oil and the control group was found to be statistically significant (p < 0.05). Conclusions: According to the research findings, coconut oil and tea tree oil were determined to reduce nipple crack formation and nipple pain. It is recommended to increase the use of coconut oil and tea tree oil related to breast problems in nursing care during the postpartum period. Clinical Trials Registration Number: NCT05456438.
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Affiliation(s)
- Ebru Şahin
- Department of Obstetrics and Gynecology Nursing, Faculty of Health Sciences, Ordu University, Ordu, Turkey
| | - Fatma Yildirim
- Department of Obstetrics and Gynecology Nursing, Faculty of Health Sciences, Hitit University, Çorum, Turkey
| | - Nuriye Büyükkayaci Duman
- Department of Obstetrics and Gynecology Nursing, Faculty of Health Sciences, Hitit University, Çorum, Turkey
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Reynaert V, Gutermuth J, Wollenberg A. Nipple eczema: A systematic review and practical recommendations. J Eur Acad Dermatol Venereol 2023; 37:1149-1159. [PMID: 36695082 DOI: 10.1111/jdv.18920] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 01/16/2023] [Indexed: 01/26/2023]
Abstract
The nipple is the focal point of the human breast and serves important physiological, sexual, and aesthetic purposes. It can be affected by atopic, irritant, and allergic contact eczema, which often reduce the patient's quality of life. The objective of this article is to discuss the different types of nipple eczema and highlight relevant differential diagnoses and treatment options. A systematic search of PubMed was conducted to identify and critically appraise the existing literature on the topic. All articles on nipple eczema were considered eligible, regardless of publication date, language or study design. A final of 33 manuscripts on nipple eczema remained. The scarce literature and the limited number of high-quality manuscripts impedes provision of structured data on nipple eczema. To securely reach the educative value of this manuscript, the systematic review was combined with a manual databank search and selected manual search of textbooks. The differential diagnosis of nipple eczema encompasses among others nipple psoriasis, nipple candidiasis and Paget's disease. In case of diagnostic uncertainty, swabs or biopsies are indicated. Treatment of nipple eczema needs to rapidly control the signs and symptoms of the disease, since it can have a negative effect on quality of life and can lead to premature arrest of breastfeeding. The key treatment step is starting with topical corticosteroids or calcineurin inhibitors, both of which are considered safe during lactation. Avoidance of provoking factors, such as repetitive friction, chemical agents, or allergens, can help. The use of nipple protection devices can be proposed for nursing women and sometimes adjusting of latch/suck positioning during breastfeeding is needed. Furthermore, patients should be advised to moisturize the nipple intensively and to switch to emollient wash products. Warm water compresses, black tea compresses or commercially available tannin containing topicals can provide comfort.
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Affiliation(s)
- V Reynaert
- Department of Dermatology, SKIN Research Group, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - J Gutermuth
- Department of Dermatology, SKIN Research Group, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - A Wollenberg
- Department of Dermatology, SKIN Research Group, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium.,Department of Dermatology and Allergy, Ludwig-Maximilian-University, Munich, Germany
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Cecilio JO, MendonçaVieira FV, Oliveira FS, Guimarães JV, Del'Angelo Aredes N, Evangelista DR, Campbell SH. Breast shells for pain and nipple injury prevention: A non-randomized clinical trial. PEC INNOVATION 2022; 1:100101. [PMID: 37213752 PMCID: PMC10194121 DOI: 10.1016/j.pecinn.2022.100101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 10/10/2022] [Accepted: 11/07/2022] [Indexed: 05/23/2023]
Abstract
Objective This study aimed to analyze the effectiveness of breast shells in preventing pain and nipple injury during breastfeeding. Method A non-randomized clinical trial was carried out with blinding to the evaluators of the study results. The study included women with ≥35 weeks of singleton pregnancy, no nipple changes, and a desire to breastfeed. Resulting in 62 lactating women. The experimental group used breast shells and health education with clinical demonstration (n = 29), whereas the control group used no breast shells (n = 33). Pain and nipple injury were assessed three times, twice prenatally and once up to 14 days postpartum. Results Nipple injury (50.0%) and nipple pain (67.7%) presented with similar frequency in both groups (p = 1). Breast engorgement (35,5%) was associated with nipple pain (p = 0.019) and its onset was delayed in the experimental group (p = 0.001). Health education contributes to breast and nipple care and increases favorable breastfeeding patterns. Conclusion Breast shells do not prevent nipple pain or injury. Innovation As far as we know, this is the first clinical research evaluating the use of breast shells since the antenatal care to prevent the occurrence of nipple pain and injury.
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Affiliation(s)
| | - Flaviana Vely MendonçaVieira
- School of Nursing, Federal University of Goias, Goiânia, Brazil
- Corresponding author at: Setor Leste Universitário, Street 227 Quadra 68, Goiania, Goias 74.605-220, Brazil.
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Perić O, Pavičić Bošnjak A, Mabić M, Tomić V. Comparison of Lanolin and Human Milk Treatment of Painful and Damaged Nipples: A Randomized Control Trial. J Hum Lact 2022; 39:236-244. [PMID: 36401521 DOI: 10.1177/08903344221135793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND Painful and damaged nipples are frequently associated with breastfeeding cessation in the early postpartum period. The results of researchers' studies utilizing different treatments have been inconclusive. RESEARCH AIM To compare the intensity of nipple pain and the healing of damaged nipples during the first 10 days postpartum using either lanolin or human milk treatments. METHODS This single-blind randomized controlled trial included participants (N = 206) who were primiparous with painful and damaged nipples. Participants were recruited from the tertiary teaching hospital within the first 72 hr after delivery and randomized to the intervention group with lanolin (n = 103) and a human milk control group (n = 103). Data were collected in the maternity ward, 3 and 7 days after randomization. The primary outcome was nipple pain intensity and quality measured 3 and 7 days after randomization by the McGill Pain Questionnaire - short form. The nipple damage self-assessment questionnaire was used for the assessment of nipple healing. Breastfeeding self-efficacy, breastfeeding duration, and exclusivity were assessed as secondary outcomes. RESULTS Participants in both groups reported a statistically nonsignificant reduction in pain (quality and intensity of pain) as well as improved nipple healing 7 days after randomization. Participants in the lanolin group exclusively breastfed their infants 3 days after randomization-significantly more often than participants in the control group (p = .026). The study did not reveal any statistically significant differences for other secondary outcomes. CONCLUSION Both lanolin and human milk are equally effective in treating painful and damaged nipples.Registered with Clinicaltrials.gov (NCT04153513).
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Affiliation(s)
- Olivera Perić
- Faculty of Health Studies, University of Mostar, Mostar, Bosnia and Herzegovina.,Department of Gynecology and Obstetrics, University Clinical Hospital Mostar, Mostar, Bosnia and Herzegovina
| | - Anita Pavičić Bošnjak
- Division on Breastfeeding Support, Human Milk Bank, Croatian Tissue and Cell Bank, Department for Transfusion Medicine and Transplantation Biology, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Mirela Mabić
- Faculty of Economics, University of Mostar, Mostar, Bosnia and Herzegovina
| | - Vajdana Tomić
- Faculty of Health Studies, University of Mostar, Mostar, Bosnia and Herzegovina.,Department of Gynecology and Obstetrics, University Clinical Hospital Mostar, Mostar, Bosnia and Herzegovina
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The effect of vernix caseosa in preventing nipple problems among early postpartum women: A randomized-controlled single-blind clinical trial ☆. Complement Ther Clin Pract 2021; 45:101475. [PMID: 34411802 DOI: 10.1016/j.ctcp.2021.101475] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 08/11/2021] [Accepted: 08/13/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND AND PURPOSE Vernix caseosa, a natural substance similar to mother's milk with protective effects on the skin, might be effective in preventing nipple problems. The purpose of this study was to examine the potential efficacy of vernix caseosa compared to the conventional use of mother's milk in the prevention of postpartum nipple problems. MATERIALS AND METHODS This randomized, controlled, single-blind experimental study involved 64 primipara mothers who underwent cesarean section and were randomly and equally divided between the vernix caseosa group and the mother's milk group. All mothers received nipple care four times daily during the first postpartum week. Data were collected using personal information and nipple monitoring forms. RESULTS The incidence of nipple pain, rashes, and an abnormal appearance was similar in both groups on the first day postpartum (p = 0.132, p = 0.516, and p = 0.132, respectively), and none of the mothers had nipple cracks. On the seventh day, mothers in the vernix caseosa group had significantly less pain (p = 0.042), significantly reduced rash (p = 0.048), significantly higher satisfaction (p = 0.023), and no nipple cracks. CONCLUSION Nipple care with vernix caseosa is more effective than with mother's milk in preventing postpartum nipple pain, rashes, and cracks.
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Sağlık DK, Kısacık ÖG. Comparison of the effects of olive oil and breast milk on the prevention of nipple problems in primiparous breastfeeding women: a randomized controlled trial. Health Care Women Int 2020; 42:877-894. [PMID: 33290192 DOI: 10.1080/07399332.2020.1840570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
We aimed to determine the effects of olive oil and breast milk on the prevention of nipple problems in this study. This study was conducted on 120 primiparous breastfeeding mothers. The mean scores for nipple pain demonstrated a statistically significant difference between the olive oil group and the control group (p = .006) and nipple damage was significantly less in the olive oil group (p = .003) on the 7th day of the follow-up. Our results illustrated that olive oil was effective in reducing pain severity and preventing the formation of nipple crack compared control group.
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Affiliation(s)
| | - Öznur Gürlek Kısacık
- Assistant Professor, Faculty of Health Science, Fundamentals of Nursing Department, Afyonkarahisar Health Science University, Afyonkarahisar, Turkey
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Lanolin and prenatal health education for prevention of nipple pain and trauma: Randomized clinical trial. ENFERMERIA CLINICA 2020; 31:82-90. [PMID: 33277168 DOI: 10.1016/j.enfcli.2020.10.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 10/13/2020] [Accepted: 10/27/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To investigate the effect of lanolin on nipple pain and trauma in breastfeeding after application of a health education. METHOD Randomized controlled clinical trial, with two arms, open, with 66 participants during prenatal care in the primary health care network in Goiania - Goias, Brazil. Participants were randomized (1:1) using computer generated numbers in both experimental group (EG) and control group (CG). The EG received lanolin and health education on breastfeeding at two different times with clinical demonstration using cloth didactic breast and illustrative album as the intervention, while the CG received standard health education. Health education was carried out by the same researchers in both groups. Measurement of pain, nipple trauma, and breastfeeding technique occurred on postpartum day eight. The analysis included descriptive statistics and inferential analysis by means chi-square or Fisher test, and Student's t-test, significance level set at 0.05. RESULTS A majority of the participants experienced no nipple trauma (59.1%) in both groups, and 60.6% of women experienced pain. In both groups, women showed favorable breastfeeding behaviors, except in the condition of the breasts. There were no significant differences between groups in pain prevention (p=0.61), nipple lesions (p=0.21), and breastfeeding technique (p>0.05). CONCLUSION It is not clear whether the intervention, lanolin combined with health education, has a positive effect on the prevention of nipple pain and trauma. Further research is needed to elucidate this question. Registration number: RBR-7tvhq8. Registry website: http://www.ensaiosclinicos.gov.br/.
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Oliveira FS, Vieira F, Cecilio JO, Guimarães JV, Campbell SH. The effectiveness on health education to prevent nipple trauma from breastfeeding: a systematic review. REVISTA BRASILEIRA DE SAÚDE MATERNO INFANTIL 2020. [DOI: 10.1590/1806-93042020000200002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
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.
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Lv X, Feng R, Zhai J. A combination of mupirocin and acidic fibroblast growth factor for nipple fissure and nipple pain in breastfeeding women: protocol for a randomised, double-blind, controlled trial. BMJ Open 2019; 9:e025526. [PMID: 30918032 PMCID: PMC6475339 DOI: 10.1136/bmjopen-2018-025526] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 02/17/2019] [Accepted: 02/21/2019] [Indexed: 01/12/2023] Open
Abstract
INTRODUCTION Nipple fissure and nipple pain are common complaints among breastfeeding mothers. Studies found that mupirocin was effective in preventing and treating infections of damaged nipple and nipple pain. Acidic fibroblast growth factor (aFGF) plays an important role in wound healing. However, current evidence on the efficacy and safety of mupirocin plus aFGF for nipple fissure and nipple pain in breastfeeding women is inconclusive due to the lack of well-designed randomised controlled trials on this topic. The purpose of this study is to test the hypothesis that mupirocin plus aFGF is more effective than mupirocin alone for nipple fissure and nipple pain in breastfeeding women. METHODS AND ANALYSIS This study is a randomised, double-blind, single-centre, parallel-group clinical trial. A total of 120 breastfeeding women with nipple fissure and nipple pain will be randomly assigned to either mupirocin plus aFGF group or mupirocin plus placebo group according to a computer-generated random allocation sequence. The treatment period lasts 14 days. The primary outcome is nipple pain intensity measured by the Visual Analogue Scale on day 14 during the treatment period. Secondary outcome measures include time to complete nipple pain relief, changes in the Nipple Trauma Score, time to complete healing of nipple trauma, quality of life measured by the Maternal Postpartum Quality of Life (MAPP-QOL) Questionnaire, the frequency of breast feeding, the rate of breastfeeding discontinuation, weight change in infants and adverse events. ETHICS AND DISSEMINATION The study has gained approval from the Ethics Review Committee of Tianjin Central Hospital of Gynaecology Obstetrics on 22 January 2018 (approval no. 2018KY001). We plan to publish our research findings in a peer-reviewed academic journal and disseminate these findings in international conferences. This study has been registered with the Chinese Clinical Trial Registry. TRIAL REGISTRATION NUMBER ChiCTR1800017248.
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Affiliation(s)
- Xiaofang Lv
- Galactophore Department, Tianjin Central Hospital of Gynecology Obstetrics, Tianjin, China
| | - Rui Feng
- Galactophore Department, Tianjin Central Hospital of Gynecology Obstetrics, Tianjin, China
| | - Jingbo Zhai
- Institute of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China
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Kirk AHP, Yang J, Sim WC, Chia LYX, Lau Y. Systematic Review of the Effect of Topical Application of Human Breast Milk on Early Umbilical Cord Separation. J Obstet Gynecol Neonatal Nurs 2019; 48:121-130. [PMID: 30660498 DOI: 10.1016/j.jogn.2018.12.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2018] [Indexed: 01/27/2023] Open
Abstract
OBJECTIVE To evaluate the efficacy of topical application of human breast milk to reduce umbilical cord separation time. DATA SOURCES We used a three-step search strategy. First, we searched six electronic databases from inception through July 16, 2018: PubMed, Cochrane, CINAHL, Embase, Scopus, and ProQuest Dissertations and Theses Global. We used the following search terms: infant, newborn, baby, babies, colostrum, breast milk expression, breast milk, breastmilk, mother milk, human milk, umbilical cord, and umbilicus. We included published trials in English without any time limit to optimize the search. Second, we searched for ongoing clinical trials and grey literature. Last, we conducted a manual review of the reference lists of the identified articles. STUDY SELECTION From 1,303 articles initially screened, eight articles reporting seven randomized controlled trials (RCTs) were included in the systematic review and meta-analysis. DATA EXTRACTION Two independent reviewers used a standardized extraction form to extract data from eligible articles. We evaluated the quality of individual and overall evidence according to risk of bias and the Grade of Recommendation, Assessment, Development, and Evaluation (GRADE) system. DATA SYNTHESIS Allocation concealment was not clearly identified in any of the studies. In only two trials were participants and personnel blinded to the intervention group, and in none was the assessment of outcomes blinded. The overall quality of evidence was very low for RCTs according to the GRADE criteria. We found a significant reduction in time to cord separation with the topical application of human breast milk (z = 6.22, p < .001), with a mean difference of -1.01 day (95% confidence interval [-1.3,-0.690]) compared with dry cord care. Incidence of omphalitis was not significantly different (risk ratio = 0.82, 95% confidence interval [0.57, 1.18], z = 1.06, p = .29) between human breast milk and dry cord care groups. CONCLUSION Topical application of human breast milk is an effective and safe way to reduce cord separation time. Given that the overall quality of the included RCTs was very low, further well-designed trials are needed.
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Coca KP, Amir LH, Alves MDRDS, Barbieri M, Marcacine KO, Abrão ACF. Measurement tools and intensity of nipple pain among women with or without damaged nipples: A quantitative systematic review. J Adv Nurs 2019; 75:1162-1172. [DOI: 10.1111/jan.13908] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 09/04/2018] [Accepted: 09/20/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Kelly Pereira Coca
- Judith Lumley Centre La Trobe University Melbourne Victoria Australia
- Department of Nursing Woman's Health Universidade Federal de São Paulo São Paulo Brazil
| | - Lisa H. Amir
- Judith Lumley Centre La Trobe University Melbourne Victoria Australia
- Breastfeeding Service Royal Women's Hospital Parkville, Melbourne Victoria Australia
| | | | - Márcia Barbieri
- Department of Nursing Woman's Health Universidade Federal de São Paulo São Paulo Brazil
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