Lanolin for the treatment of nipple pain in breastfeeding women: a randomized controlled trial

Nonpharmacological Interventions for Treating Breastfeeding Nipple Pain: Systematic Review and Meta-Analysis

Objective: To evaluate the efficacy and safety of nonpharmacological topical interventions for treating breastfeeding nipple pain. Methods: Randomized clinical trials (RCTs) assessing lactating women suffering from breastfeeding painful nipples were included. Primary outcomes were pain, healing process, and adverse events. A comprehensive search was conducted on June 02, 2023, without date or language restrictions. Methodological quality was assessed using the Cochrane risk of bias tool and the certainty of the evidence, the GRADE approach. Results: Nineteen RCTs with unclear to high risk of bias were included. There was uncertain evidence regarding the effects of photobiomodulation versus placebo on pain reduction (mean difference [MD] -0.15; 95% confidence interval [95% CI] -1 0.49 to 1.19; 139 participants, 2 RCTs). There are uncertainties concerning the effects of lanolin versus breast milk on pain (MD -1.80; 95% CI -2.43 to -1.17; 1 RCT; 180 participants), wound healing (MD 0.10; 95% CI -0.26 to -0.46; 1 RCT; 180 participants), and any adverse events (zero events in both groups). Similar effects were observed by the other interventions assessed. Conclusion: The evidence of nonpharmacological topical interventions for painful nipples is imprecise, and future RCTs with higher methodological quality are needed to support recommendations. Considering the accessibility and low cost of these alternative treatments, the findings of this evidence synthesis could support clinical decision-making and guide future research. PROSPERO CRD42020170320.

Determination of the effectiveness of beeswax in preventing nipple pain and cracks in primiparous breastfeeding mothers: A randomized controlled trial

OBJECTIVE

Beeswax is a natural ingredient used effectively for wound healing. This study aimed to determine the effectiveness of beeswax and breast milk in preventing nipple pain and cracks in the early postpartum period.

MATERIALS AND METHODS

This non-blinded, randomized controlled trial was carried out between November 15, 2019, and April 1, 2020, in the postpartum clinic of a state university hospital and at mothers' homes. Ninety primiparous mothers meeting the inclusion criteria were randomly divided into beeswax (n=30), breast milk (n=30), and control (n=30) groups using simple randomization. Mothers in the beeswax, breast milk, and control groups were assessed for nipple pain and cracks on postpartum days 1st, 3rd, 5th, 7th, and 10th.

RESULTS

On postpartum day 10, nipple pain and cracks occurred highest in the control group (%53.3), whereas nipple pain and cracks were encountered least in the beeswax group (%20,0) on postpartum observation days. The differences between the groups in terms of nipple cracks and pain severity were statistically significant (p < 0.05, p=0.004, and p=0.000, respectively).

CONCLUSION

Beeswax is more effective than breast milk in preventing nipple pain and crack formation. A beeswax barrier can be used to prevent nipple pain and cracks.

"I Pumped That Milk Off My Breast and Dumped It in Trash": Breastfeeding Experiences of Mothers Working in hospital radiation settings-A Qualitative Study

Purpose: The qualitative study was conducted to determine the breastfeeding experiences of mothers working in radiation areas in hospitals. Materials and Methods: The study was conducted in Turkey between December 2022 and February 2023 through in-depth interviews held with 13 mothers who met the inclusion criteria. The content analysis method was used in the analysis of the data. Results: As a result of the analyses of the data obtained in the interviews, four themes regarding the breastfeeding experiences of health professionals working in radiation environments in hospitals were identified. These themes were institutional/administrative obstacles, support systems, unhealthy childcare, and feeling of incompetence as a mother. The main theme of unhealthy childcare consisted of four categories, which were low-quality breast milk, toxic breast milk, frequent diseases, and future risk of cancer. The main theme of feeling of incompetence as a mother was composed of three categories, which were fear, feeling of guilt, and "Am I a mother?" The theme of institutional/administrative obstacles consisted of three categories, namely working environment, working duration, and awareness of managers. Finally, the theme of support systems included two categories, positive perceptions and negative perceptions. Conclusion: In this study, it was determined that the mothers who worked in radiation areas in hospitals experienced problems due to individual, social, and institutional factors. The main concern of the mothers was found to be hurting their infants with their breast milk. Suitable working environments and the adequacy of practices related to daycare centers, social support, and motherhood rights are the main needs of working mothers aiming to keep breastfeeding their infants.

Breastfeeding at Any Cost? Adverse Effects of Breastfeeding Pain on Mother-Infant Behavior

Breast milk is considered the ideal infant nutrition, and medical organizations encourage breastfeeding worldwide. Moreover, breastfeeding is often perceived as a natural and spontaneous socio-biological process and one of the fundamental roles of new mothers. While breastfeeding is beneficial, little scientific consideration has been given to its potential psychological challenges. Here, we investigate the phenomenon of breastfeeding pain in mothers and its association with maternal and infant behavioral regulation. During the postpartum weeks, the mother-infant dyad can be considered one allostatic unit directed at infant regulation and development. We hypothesize that pain comprises an allostatic challenge for mothers and will thus impair the capacity for dyadic regulation. To test this, we recruited 71 mothers with varying levels of breastfeeding pain and videotaped them with their infants (2-35 weeks old) during spontaneous face-to-face interactions. We quantified the individual differences in dyadic regulation by behaviorally coding the second-by-second affective expressions for each mother and infant throughout their interactions. We tested the extent to which breastfeeding pain alters affect regulation during mother-infant interactions. We discovered that mothers with severe breastfeeding pain express less affective expressions and less infant-directed gaze during interactive moments of engagement and play than mothers with no or moderate pain. Moreover, infants of mothers experiencing pain during breastfeeding express less affective expressions and more mother-directed gaze while interacting with their mothers than infants of mothers who are not in pain. This demonstrates that the allostatic challenge of maternal pain interferes with the behavioral regulation of both mothers and infants. Since the mother-infant dyad is a codependent allostatic unit, the allostatic challenges of one partner can impact the dyad and thus potentially impact child development, bonding, and mother and infant well-being. The challenges of breastfeeding should be considered in addition to the nutritional advances.

Multi-residue analysis of certain lanolin nipple care products for trace contaminants

BACKGROUND

Topical lanolin is commonly used on nipples to aid breastfeeding success. The raw material undergoes refinement to remove contaminants such as pesticides, which may accumulate from exogenous environmental sources. The level of refinement influences final lanolin purity. For use in nipple creams, a lanolin which complies with a published monograph (either USP or Ph. Eur.) is desirable to ensure a non-toxic product with neutral taste and smell, and low allergenicity.

METHODS

The aim of this study was to determine the residual trace pesticide levels and quantify the Free Lanolin Alcohols (FLA) levels in two commercially available lanolin products (HPA LANOLIN (Lansinoh Laboratories Inc.); PURELAN (Medela AG)) and two lanolin ingredients (PHARMALAN PH EU-SO-(RB) and CORONA-8 SO-(RB) (Croda, Goole, UK)) using established validated methods. Test samples were subjected to Gas-Chromatographic and Liquid-Chromatographic analysis to quantify and identify a panel of 178 pesticide residues. FLA levels and the presence of oxidative metabolites were also determined.

RESULTS

The purity of the lanolin ingredients was consistent with expectations based on their level of refinement; lanolin in compliance with the Ph. Eur. monograph demonstrated the highest level of purity. Differences were seen between the lanolin nipple creams tested, in terms of FLA levels and pesticide residue levels. Specifically, the HPA LANOLIN contained an extremely low level of FLA (0.61%), which was fourfold less than in the PURELAN (2.76%). Additionally, the HPA LANOLIN did not contain any detectable pesticide residues. The PURELAN was found to contain a number of pesticide residues, however the detected levels were low and within the permitted limits and so despite their presence, the PURELAN was still compliant with the relevant monographs.

CONCLUSIONS

This data reinforces that the purity of monograph compliant Lanolin makes it suitable for use on the nipples of breastfeeding mothers. A higher level of refinement leads to a reduction in pesticide contaminants also reduces FLA levels in the final material, minimizing the risk of allergenicity.

Prebiotic Activity of Vaginal Lactobacilli on Bifidobacteria: from Concept to Formulation

The gut of babies born vaginally is rapidly colonized by Bifidobacterium spp. after birth, while in infants born by cesarean section (C-section), the presence of bifidobacteria drops dramatically, increasing the risk of developing gastrointestinal disorders. Considering that newborns naturally come into contact with maternal lactobacilli as they pass through the birth canal, the aim of this work is to exploit for the first time the bifidogenic activity exerted by the cell-free supernatants (CFSs) from lactobacilli of vaginal origin, belonging to the species Lactobacillus crispatus, Lactobacillus gasseri, Limosilactobacillus vaginalis, and Lactiplantibacillus plantarum. CFSs were recovered after 7 h, 13 h, and 24 h of fermentation and assessed for the ability to stimulate the planktonic growth and biofilms of Bifidobacterium strains belonging to species widely represented in the gut tract. A bifidogenic effect was observed for all CFSs; such activity was maximal for CFSs recovered in exponential phase and was strongly dependent on the species of lactobacilli. Importantly, no stimulating effects on an intestinal Escherichia coli strain were observed. CFSs from L. vaginalis BC17 showed the best bifidogenic profile since they increased bifidobacterial planktonic growth by up to 432% and biofilm formation by up to 289%. The CFS at 7 h from BC17 was successfully formulated with a hyaluronic acid-based hydrogel aimed at preventing and treating breast sores in lactating women and exerting bifidogenic activity in infants born mainly by C-section. IMPORTANCE Bifidobacteria in the gut tract of infants play crucial roles in the prevention of gastrointestinal diseases and the maturation of the immune system. Consequently, strategies to trigger a bifidogenic shift in the infant gut are highly desirable. Evidences suggest that the presence of a maternal vaginal microbiota dominated by health-promoting lactobacilli and the development of a bifidobacterium-enriched gut microbiota in newborns are interconnected. In this context, we found out that the cell-free supernatants from lactobacilli of vaginal origin were able to effectively stimulate the proliferation of Bifidobacterium spp. grown in free-floating and biofilm forms. The cell-free supernatant from Limosilactobacillus vaginalis BC17 showed excellent bifidogenic behavior, which was preserved even after its incorporation into a nipple formulation for lactating women. Lactobacilli derivatives, such as cell-free supernatants, have gained increasing interest by virtue of their safer profile than that of living cells and can be proposed as an ecosustainable approach to favor gut colonization of infants by bifidobacteria.

Comparison of Lanolin and Human Milk Treatment of Painful and Damaged Nipples: A Randomized Control Trial

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).

Cacao Butter as Prophylaxis for Nipple Problems: A Pilot Randomized Controlled Study

Objective: Cacao butter is a type of oil extracted from the fruit of the Theobroma Cacao plant. This study was conducted to compare the use of breast milk and cacao butter for the prevention of nipple problems in the early postpartum period. Materials and Methods: This randomized controlled study involved 72 participants, who were randomized into the cacao and mother's milk groups. Data were collected using Descriptive questionnaire, Nipple assessment form, and IMDAT (Amount of Urine Output, Condition of Breasts, Amount of Stool, Weight Increase and Satisfaction Status). Results: On postpartum day 10, the rates of nipple pain (11.40% cacao group versus 40.50% mother's milk group), rashes (14.30% cacao group versus 35.10% mother's milk group), and cracks (14.30% cacao group versus 43.20% mother's milk group) significantly reduced in the cacao group when compared with the mother's milk group (p < 0.05). Conclusion: The application of cacao butter to the nipples is possibly a more effective method than the application of mother's milk for preventing nipple pain, rashes, or cracked nipples. Cacao butter can be used prophylactically to prevent nipple problems in the early postpartum period.

Lanolin Allergic Reactions: North American Contact Dermatitis Group Experience, 2001 to 2018

BACKGROUND

Lanolin is an important cause of allergic contact dermatitis.

OBJECTIVES

The aims of this study were to describe the epidemiology of lanolin allergy and to assess trends in patch test reactions to lanolin over time.

METHODS

This study used a retrospective analysis of patients patch tested with lanolin alcohol 30% or Amerchol L-101 50% in petrolatum by the North American Contact Dermatitis Group between 2001 and 2018 (n = 43,691).

RESULTS

Overall, 1431 (3.3%) had a positive reaction, and 1238 (2.8%) were currently relevant. Prevalence of lanolin allergy was 4.63% between 2011 and 2018 (P < 0.0001). Most lanolin-allergic patients had + (52%) reactions; 18%, and 6% had ++ and +++ reactions, respectively. Common primary anatomic sites of dermatitis were the hands (20.7%), scattered/generalized distribution (19.6%), and face (17.0%). Allergic reactions to lanolin were more common in children (4.5%) than in adults (3.2%, P = 0.0018). Compared with nonallergic patients, lanolin-allergic patients were more likely to have history of eczema or hay fever, male sex, older than 40 years, or Black race (P < 0.05). Common lanolin sources were personal care products and drugs/medications. Only 2.24% of the positive reactions were linked to occupation.

CONCLUSIONS

Lanolin sensitivity was common. Reactions were often clinically relevant and linked to personal care products and medications.

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.

The effect of vernix caseosa in preventing nipple problems among early postpartum women: A randomized-controlled single-blind clinical trial☆

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.

A guide to anticipatory guidance for breastfeeding-related pain: A concept analysis

AIM

This article provides a concept analysis of anticipatory guidance regarding breastfeeding-related pain and establishes a definition to inform the concept's practical use.

BACKGROUND

Breastfeeding-related pain is a barrier to achieving optimal breastfeeding outcomes, which can impede maternal and infant health. Education through anticipatory guidance that addresses breastfeeding-related pain can improve breastfeeding outcomes, but no formal definition is currently available for practitioner use.

DESIGN

Walker and Avant's protocol for concept analyses was employed.

DATA SOURCE

A comprehensive literature review was conducted using CINAHL, PubMed, Scopus, and OMNI. Search terms included anticipatory guidance, breastfeeding, pediatrics, nursing, and lactating. This identified 379 articles, of which six addressed anticipatory guidance for breastfeeding-related pain.

REVIEW METHODS

Inclusion criteria asked that literature be available in English and published between 2000 and 2020.

RESULTS

Three key characteristics of anticipatory guidance regarding breastfeeding-related pain were identified: timing, content, and intention. Antecedents included maternal intention to breastfeed and interaction with a healthcare provider. Consequences included improved breastfeeding outcomes, enhanced maternal understanding of challenges, and maternal empowerment in relation to pain management.

CONCLUSIONS

Anticipatory guidance about breastfeeding-related pain can empower women to sustain breastfeeding in spite of challenges, thus prolonging the breastfeeding period, and subsequently improving infant nutrition and health outcomes.

Postpartum Nipple Symptoms: Risk Factors and Dermatologic Characterization

Background: Nipple discomfort inhibits breastfeeding goals, particularly between 0 and 8 weeks postpartum (PP), and yet the specific dermatologic entities that contribute to nipple soreness have not been clearly delineated. Moreover, there remains a lack of evidence-based guidelines for nipple symptoms and skin diseases. Methods: A survey was distributed to 6-8-week PP women, 18-50 years of age, with an intent to exclusively or partially breastfeed ("at the breast" or "pump"). The study aimed to characterize nipple skin symptoms (pain and itching) and lesions (eczema, redness, cuts, or wounds) and any association between these nipple problems and past dermatologic history, breastfeeding outcomes, and the ability to meet her breastfeeding goals. Results: Findings paralleled Centers for Disease Control and Prevention (CDC) statistics with a 25% decline in breastfeeding rates between birth, 86.3% (189), and 6-8 weeks PP, 64.5% (145). By 6-8 weeks PP, exclusive "formula" and "exclusive feeding at the breast" showed the largest increase (+16.4%) and decrease (-22.9%), respectively. Although no significant difference was found in comparison of nipple problems to feeding methods or skin history, women who reported pumping or PP redness/eczema had higher odds ratios of a change in feeding practice, history of eczema, and sensitive skin. Strong pumping intentions were also associated with the highest risk of unmet breastfeeding goals. Conclusion: Regardless of feeding method, product, or provider use, PP nipple problems predominantly arose between 1 and 3 weeks PP. Clinical Trial Registration number 201901737.

The effect of spousal support perceived by mothers on breastfeeding in the postpartum period

Objective

To examine the effect of mothers' perceived spousal support on breastfeeding during lactation.

Material and Methods

This is a descriptive cross-sectional study. The sample of the study consist of 80 mothers who were registered with a Pediatric Adolescent Women and Reproductive Health Center. The socio-demographic and obstetric descriptive information form and Women's Perceived Spouse Support Scale in Early Puerperium Process were used for the collection of data. Data were analyzed with number and percentage, t-test, chi-square test, ANOVA, and Tukey test.

Results

The mean age of the mothers who participated in the study was 27.05±3.50, while the mean age of the spouses was 30.58±4.12. It was determined that 41.3% of the mothers and 48.8% of the spouses were high school or higher graduates and 68.8% of the mothers didn't work and all of the spouses worked. Most of the mothers (63.7%) were primiparous and 60% had a cesarean section, 56.3% did not receive lactation education and consultation, and most of the women had exclusive breastfeeding. The mean score of the Women's Perceived Spousal Support Scale in the Early Puerperium Period of the exclusively breastfeeding mothers was 72.93 while the partial breastfeeding mothers' was 54.93 (p=0.00). Also, it was found that males with younger age group and high school and lower education level had less support for their spouses (p=0.03, p=0.02), and the rate of exclusive breastfeeding was higher in the spouses of males in higher education level (p=0.01).

Conclusion

Mothers who received more support from their spouses during the postpartum period had higher breastfeeding rates. It was determined that males with younger age and education level below high school gave less support to mothers in breastfeeding.

Latch-related nipple pain in breastfeeding women: the impact on breastfeeding outcomes

Background

Nipple pain is a common issue experienced by breastfeeding mothers and if not resolved, can contribute to early cessation of breastfeeding.

Aims

To investigate mothers experiences of nipple pain, the solutions used to manage their issues, and the perceived impact on breastfeeding outcomes with particular focus on latch-related nipple pain with no clear underlying cause (LRNP).

Methods

Data was collected via an online survey of UK-based women (n=1084).

Findings

LRNP was the most common issue as experienced by 52% of mothers surveyed. Various solutions were utilised to try to manage LRNP. Use of Highly Purified Anhydrous (HPA) Lanolin to manage LRNP was associated with a substantial increase in breastfeeding duration (average 33.2 weeks compared to 26.5 weeks for those who didn't report using HPA Lanolin).

Discussion

HPA Lanolin is a key solution used by mothers in the management of latch-related nipple pain and one which they perceive as having a significant positive effect on the physical symptoms and pain associated with nipple trauma. Use of HPA Lanolin was also associated with a substantial increase in breastfeeding duration which ultimately aids women in meeting their personal breastfeeding goals and improves overall breastfeeding rates.

Maternal Emotions and Experiences of Mothers Who Had Breastfeeding Problems: A Qualitative Study

BACKGROUND AND PURPOSE

Many women are ceasing to breastfeed in the early period due to the breastfeeding problems and difficulties they perceive. Consequently, the approach and support of health professionals to mothers in the post-partum period is very important. The objective of the study is to determine the emotions and experiences of mothers who had breastfeeding problems by using Watson's Theory of Human Caring.

METHODS

The research is a descriptive and qualitative type of study. The data were collected from 20 women with the semi-structured interview method based on Watson's Theory. The data were analyzed according to the Caritas Processes of Watson's Theory.

RESULTS

It was determined that the health professionals did not show enough assistance, support and interest to the mothers who had breastfeeding problems and that the mothers expected respect, empathy, sincerity, understanding, trust, and assistance during this period.

IMPLICATION FOR PRACTICE

The use of the interview methods based on Watson's Theory of Human Caring in the determination of the difficulties and emotions experienced by the women who had breastfeeding problems will be a guide for the health professionals. It is thought that the approaches based on Watson's Caritas Processes that would be made to women who had breastfeeding problems would be effective for understanding their experience and emotions.

Moving toward a better understanding of the experience and measurement of breastfeeding-related pain

Purpose: Despite how commonly breastfeeding-related pain is experienced in the postpartum period, and its frequent implication in breastfeeding cessation, this unique type of pain is not well evaluated nor assessed. The purpose of this study was to gain a comprehensive description and understanding of breastfeeding-related pain among postpartum breastfeeding women. Methods: This study employed a mixed methods approach using a descriptive-interpretive qualitative approach, in addition to administering the Short-Form McGill Pain Questionnaire, second version, to comprehensively gain both quantitative and qualitative descriptors of breastfeeding-related pain. Fourteen partnered and educated women living in Southern Ontario with experience of breastfeeding-related pain took part in this study. Results: The results from this study suggest that breastfeeding-related pain is often experienced as severe and distressing, and comprises various elements of pain including continuous, intermittent, neuropathic, and affective components. Conclusion: Breastfeeding-related pain is multidimensional and can be severe and distressing for women. Current measurement tools may not adequately reflect the multidimensional components of this unique type of pain, which may limit the effectiveness of health care providers to help with its identification and management.

Promising effects of purslane cream on the breast fissure in lactating women: A clinical trial

OBJECTIVES

The traditional uses of Portulaca oleracea L. (purslane) with anti-inflammatory and anti-cancer activity as well as anti-oxidants properties were expressed previously. This is a double-blind randomized clinical trial to evaluate the protective effects of purslane cream on the nipple fissure.

METHODS

After expressing the goals and methods of the study and obtaining written consent from 86 lactating women with nipple fissure, they were randomly divided into two groups: 43 in purslane cream group and 43 in lanolin ointment group. The score of nipple fissure before the intervention and on the third and eighth day after the study was measured using the Stour scale.

RESULTS

The mean score of left and right breast fissures in the group of treatment with lanolin group similar to the group of treatment with purslane cream showed a significant decrease at the third day and eighth day (P=0.001). Mann-Whitney test comparing mean score of the fissure between two groups showed that two groups were homogeneous before the intervention, but there was a significant difference between two groups on the third and eighth days (p < 0.001). The recovery process occurred faster in the group of treatment with purslane cream.

CONCLUSION

We showed that the use of purslane cream without any complications could accelerate the repairing of nipple fissure. Based on this clinical trial, purslane cream (2% w/w) can be used as an accelerator for improving the nipple fissure in lactating women.

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

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.

A Systematic Review on Prevention and Treatment of Nipple Pain and Fissure: Are They Curable?

Averagely 80% to 90% of breastfeeding women experience the nipple pain and fissures. The important factor for successful breastfeeding is to treat this problem. This study has done as a review with the aim of analysis of the clinical trials in the field of the prevention and treatment of the nipple fissures and pain due to the importance of breastfeeding. For this purpose, the key words of sore, nipples, fissure, trauma, wound, prevention, treatment, therapeutics, therapy, clinical trial, breastfeeding and their Persian synonyms and all of their possible combinations were searched in the national databases: SID and Iran Medex and Magiran, and in the international databases: PubMed, Scopus, Medline, Science direct by May 2017. The Jadad criterion was used to assess the quality of the articles and the articles with a score of 3 or more were included in this study. Finally, 48 clinical trials were reviewed that 17 of them (sample size 1801) scored 3 or more based on the Jadad criterion. Seven articles were also in the non- drug treatment group (sample size 491) and 2 articles in the drug treatment group (sample size 337) and 8 articles in the herbal treatment group (sample size 973).The results show that menthol and warm water compress as well as teaching the correct breastfeeding methods are effective treatments to prevent and treat the nipple pain and fissures. Moreover, applying the herbal medicine for prevention and treatment of the issues raised from breastfeeding may have beneficial such as Aloe vera, Portulaca olearacea. However, more studies with a great methodology are necessary to obtain more accurate evidence.

Emollient treatment of atopic dermatitis: latest evidence and clinical considerations

Aim

To review current classes of emollients in the market, their clinical efficacy in atopic dermatitis (AD) and considerations for choice of an emollient.

Methods

PubMed Clinical Queries under Clinical Study Categories (with Category limited to Therapy and Scope limited to Narrow) and Systematic Reviews were used as the search engine. Keywords of ‘emollient or moisturizer’ and ‘atopic dermatitis’ were used.

Overview of findings

Using the keywords of ‘emollient’ and ‘atopic dermatitis’, there were 105 and 36 hits under Clinical Study Categories (with Category limited to Therapy and Scope limited to Narrow) and Systematic Reviews, respectively. Plant-derived products, animal products and special ingredients were discussed. Selected proprietary products were tabulated.

Conclusions

A number of proprietary emollients have undergone trials with clinical data available on PubMed-indexed journals. Most moisturizers showed some beneficial effects, but there was generally no evidence that one moisturizer is superior to another. Choosing an appropriate emollient for AD patients would improve acceptability and adherence for emollient treatment. Physician’s recommendation is the primary consideration for patients when selecting a moisturizer/emollient; therefore, doctors should provide evidence-based information about these emollients.

Making Sense of Studies That Claim Benefits of Frenotomy in the Absence of Classic Tongue-Tie

By performing an in-depth analysis of one high profile example, this article aims to help breastfeeding support professionals understand the methodological flaws that characterize recent studies claiming to show the efficacy of frenotomy for the diagnoses of posterior tongue-tie and upper lip-tie. The example study does not address definitional confusion or control for the effects of the passage of time. It does not consider the effects of caring attention, validation, and lactation consultant support. It also does not consider the extensive research over the past three decades that has established that reflux in the first 6 months of life is benign, even though increased reflux frequency may correlate with unsettled infant behavior. The study authors relied on the hypothesis that reflux is caused by excessive air swallowing in infants with poor latch due to posterior tongue-tie and upper lip-tie, which lacks credible physiological mechanisms or supporting evidence. The authors' claim that conducting a randomized controlled trial to investigate the efficacy of frenotomy would be unethical contradicts the basic principles of good science. This article argues that our breastfeeding women and their babies deserve the most rigorous scientific methods available, and acknowledgment of the biases inherent in less rigorous research, if we are to make appropriate decisions concerning intervention with frenotomy and to prevent unnecessary oral surgery.

Interventions to Improve Breastfeeding Self-Efficacy and Resultant Breastfeeding Rates: A Systematic Review and Meta-Analysis

BACKGROUND

Maternal breastfeeding self-efficacy (BSE) is reflective of a mother's confidence in breastfeeding and is a modifiable factor that may improve breastfeeding rates. Breastfeeding self-efficacy theory purports that women with higher BSE will have better breastfeeding outcomes. Research aim: The aim of this systematic review was to explore the theoretical link between BSE and breastfeeding outcomes by investigating (a) if interventions to improve BSE were successful and (b) if improvements in BSE resulted in improved breastfeeding rates.

METHODS

The authors performed a systematic search of 10 databases for studies that investigated the effect of interventions for mothers of full-term infants on BSE and breastfeeding rates. They used an inverse-variance, random-effects meta-analysis.

RESULTS

Of 1,366 titles and abstracts identified, 58 full-text articles were screened and 11 met the study criteria. Compared with mothers in control groups, mothers in intervention groups had significantly higher BSE, scoring 4.86 points higher, 95% confidence interval [3.11, 6.61], at 2 months postpartum. Mothers in the intervention groups were 1.56 and 1.66 times more likely to be breastfeeding at 1 month and 2 months postpartum, respectively. Interventions that were implemented in the postpartum period, used combined delivery settings, or were informed by BSE theory had the greatest influence on breastfeeding outcomes. Meta-regression indicated that for each 1-point increase in the mean BSE score between the intervention and control groups, the odds of exclusive breastfeeding increased by 10% in the intervention group.

CONCLUSION

Breastfeeding self-efficacy is a modifiable factor that practitioners can target to improve breastfeeding rates in mothers of full-term infants.

Lanolin for the treatment of nipple pain in breastfeeding women: a randomized controlled trial

Nipple pain and damage are commonly experienced by breastfeeding women and are associated with negative breastfeeding outcomes. Health care providers often recommend the application of lanolin to treat painful/damaged nipples, yet no randomized controlled trial has evaluated the effectiveness of lanolin on nipple pain and breastfeeding outcomes. The purpose of this study was to evaluate the effect of lanolin on nipple pain among breastfeeding women with damaged nipples. A randomized, single-blind, controlled trial was conducted at a tertiary care hospital in Hamilton, Ontario, Canada. Breastfeeding women (N = 186) identified as having nipple pain/damage were randomized to apply lanolin (intervention group; n = 93) or to receive usual postpartum care (control group; n = 93). The primary outcome was nipple pain at 4 days post-randomization measured by the Numeric Rating Scale. Additional outcomes included nipple pain measured by the Short Form McGill Pain Questionnaire, breastfeeding duration/exclusivity, breastfeeding self-efficacy, and maternal satisfaction with lanolin treatment versus usual care. The results revealed no significant group differences in mean pain scores at 4 days post-randomization. Women in both groups experienced clinically relevant decreases in nipple pain by 7 days post-randomization. Significantly, more women in the lanolin group reported that they were satisfied with treatment compared with those receiving usual care. No significant group differences were found for other secondary outcomes. While more women were satisfied using lanolin, its application to sore/damaged nipples was ineffective for reducing nipple pain or improving breastfeeding outcomes.