Management of nipple pain and/or trauma associated with breast‐feeding
Management of nipple pain and/or trauma associated with breast‐feeding
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母乳喂养相关乳头疼痛和/或创伤的治疗
DOI：
10.1046/j.1479-697x.2003.00004.x
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发表时间：
2003
期刊：
影响因子：
--
通讯作者：
Kylie Guest
中科院分区：
文献类型：
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作者：
T. Page;C. Lockwood;Kylie Guest
目的 本系统评价的目的是提供与母乳喂养妇女产后乳头疼痛管理相关的最佳现有证据。本次审查的具体目的是确定母乳喂养妇女使用的干预措施预防和/或减少乳头疼痛和创伤的有效性。选择标准 该评价考虑了所有研究，包括母乳喂养的女性，无论是否有任何产后乳头疼痛或外伤的情况。感兴趣的干预措施是：（i）旨在预防或减少母乳喂养开始后乳头疼痛和/或创伤的干预措施； (ii) 母乳喂养开始后乳头疼痛或受伤的治疗。感兴趣的主要结局是与预防和治疗妇女产后乳头疼痛和/或创伤有关的结局，具体包括： 乳头疼痛的发生率和患病率 疼痛强度 乳头创伤的发生率和患病率 受伤乳头的愈合率 母乳喂养持续时间。本综述考虑了随机对照试验（RCT），这些试验评估了与母乳喂养实践相关的干预措施和治疗的有效性。在缺乏随机对照试验的情况下，其他研究设计（例如非随机对照试验和前后研究）被考虑纳入叙述性总结中，以便能够识别当前的做法和未来可能的策略。检索策略 检索旨在查找已发表和未发表的英语研究。检索的数据库截至 2002 年 8 月，包括 MEDLINE、CINAHL、Current Contents、Cochrane Library、ExpandedAcademic Index、Electronic Collections Online、Turning Research Into Practice (TRIP)、The Australian Breast-feeding Association Lactation Resource Centre、Dissertation Abstracts and Proceedings First。搜索了所有已确定研究的参考文献列表以查找其他研究。方法学质量评估 所有研究均由两名评审员检查方法学质量，并使用数据提取工具提取数据。结果 有大量研究评估了许多用于预防或治疗哺乳期妇女乳头疼痛和/或创伤的干预措施的有效性。大多数研究在样本人口统计、评估干预措施和评估结果方面存在异质性。因此，大部分评论都是以叙述形式进行，并通过元视图图来图形化呈现更具统计意义的结果。在教育课程中向母乳喂养妇女提供一致的信息将有助于确定哪种类型的指导最有效；然而，研究中提供了不同的教育信息，或者没有提供实际接受的教育的详细信息。本次综述中的许多随机对照试验都是基于小样本量和特定的社会文化背景。小样本量限制了可靠地概括研究结果的能力，因为存在假阳性结果的风险。此外，在某些情况下，研究并未达到统计学显着性，尽管如果使用更大的样本量，研究可能会具有统计学显着性。这些是与随机对照试验相关的常见局限性。该综述的作者建议在实施该综述建议之前充分考虑样本量和研究环境，以确定其对不同临床环境的适用性。结果部分强调了每项纳入研究的样本量问题。由于证据有限，没有发现任何单一干预措施可以在治疗母乳喂养妇女的疼痛和/或创伤方面产生显着效果。然而，它在减轻疼痛和增加舒适度方面可能有一些好处，从而最大限度地延长母乳喂养时间。结论在预防方面，建议温水热敷预防乳头疼痛，单纯保持乳头清洁干燥预防乳头皲裂。在治疗方面，建议使用温水热敷来减轻乳头疼痛，吸出母乳可以缩短乳头皲裂的持续时间。水凝胶敷料与高感染发生率相关，不推荐使用。如果金黄色葡萄球菌培养呈阳性，建议全身使用抗生素。对母乳喂养的妇女进行婴儿定位和附着在乳房上的教育需要进一步研究，以评估它是否作为乳头疼痛和/或创伤的预防措施更有效。温水敷布对于乳头疼痛的有效性值得进一步研究。建议开展研究评估肿胀、奶嘴和奶瓶对乳头疼痛和/或创伤的影响。对许多研究中使用的干预措施的进一步调查可以一次使用一种干预措施与不治疗进行比较。具体的研究重点应包括随机对照试验来评估：(i) 羊毛脂与不治疗的比较； (ii) 羊毛脂和贝壳与未处理的比较； (iii) 与未治疗相比，吸出母乳。
Objective The objective of this systematic review was to present the best available evidence related to the management of nipple pain, post childbirth in breast‐feeding women. The specific objective of the review was to determine the effectiveness of interventions used by and for breast‐feeding women to prevent and/or reduce nipple pain and trauma. Selection criteria The review considered all studies that included women who breast‐fed with or without painful or traumatised nipples of any aetiology post childbirth. Interventions of interest were: (i) interventions aimed to prevent or reduce pain and/or trauma to nipples post commencement of breast‐feeding; and (ii) treatments for painful or traumatised nipples post commencement of breast‐feeding. The primary outcomes of interest were those related to the prevention and treatment of nipple pain and/or trauma in women post childbirth, in terms of: Incidence and prevalence of nipple pain Pain intensity Incidence and prevalence of nipple trauma Healing rates of traumatised nipples Breast‐feeding duration. This review considered randomised‐controlled trials (RCT) that evaluated the effectiveness of interventions and treatments associated with breast‐feeding practices. In the absence of RCTs other research designs such as non‐randomised controlled trials and before and after studies were considered for inclusion in a narrative summary to enable the identification of current practices and possible future strategies. Search strategy The search sought to find both published and unpublished studies in the English language. Databases were searched up to and including August 2002 and included MEDLINE, CINAHL, Current Contents, Cochrane Library, Expanded Academic Index, Electronic Collections Online, Turning Research Into Practice (TRIP), The Australian Breast‐feeding Association Lactation Resource Centre, Dissertation Abstracts and Proceedings First. The reference lists of all identified studies were searched for additional studies. Assessment of methodological quality All studies were checked for methodological quality using two reviewers, and data were extracted using a data extraction tool. Results There is a plethora of research that evaluates the effectiveness of the many interventions used to prevent or treat nipple pain and or trauma for breast‐feeding women. Most of the studies were heterogeneous with regard to sample demographics, interventions evaluated and outcomes assessed. For this reason the majority of the review is in narrative form, with graphical presentation via meta‐view graphs of the more statistically significant outcomes. Consistent information given in education sessions to breast‐feeding women would assist in identifying which type of instruction is the most effective; however, different education information was given in the studies or no details were supplied as to what education was actually given. Many of the RCTs in this review were based on small sample sizes and specific sociocultural settings. Small sample sizes limit the ability to reliably generalise findings, as there is a risk of false positive results. Furthermore, in some cases, studies did not attain statistical significance although they may have if larger sample sizes had been used. These are common limitations associated with RCTs. The authors of this review recommend full consideration be given to the sample size and study setting prior to implementation of the review recommendations in order to determine applicability to varied clinical settings. The results section highlights sample size issues for each included study. With this limited evidence, no single intervention was identified that offers a dramatic effect in terms of treating pain and or trauma in breast‐feeding women. However, there is potential for some benefits for reducing pain and increasing comfort and thereby maximising breast‐feeding duration. Conclusions In terms of prevention, warm water compresses are recommended for the prevention of nipple pain, and simply keeping the nipples clean and dry is recommended for the prevention of cracked nipples. In terms of treatment, warm water compresses are recommended for the reduction of nipple pain, and expressed breast‐milk reduces the duration of cracked nipples. Hydrogel dressings were associated with a high incidence of infections and their use cannot be recommended. Systemic antibiotics are recommended if a positive culture for Staphylococcus aureus is obtained. Education for positioning and attachment of the baby to the breast for breast‐feeding women needs further studies to assess whether it is more effective as a preventative measure for nipple pain and/or trauma. Warm water compresses warrant further investigation into their effectiveness in nipple pain. Studies assessing the impact of engorgement, pacifiers and feeding bottles on nipple pain and/or trauma are suggested. Further investigation of the interventions used in many of these studies could be conducted using one intervention at a time in comparison to no treatment. Specific research priorities should include RCTs to assess: (i) lanolin in comparison to no treatment; (ii) lanolin and shells in comparison to no treatment; and (iii) expressed breast‐milk in comparison to no treatment.