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Evaluation of the Effectiveness of a Silver-Impregnated Medical Cap for Topical Treatment of Nipple Fissure of Breastfeeding Mothers
Abstract
This study evaluated the effectiveness of a medical topical treatment device named Silver Cap(®) (Depofarma S.P.A., Mogliano Veneto, Treviso, Italy) for the treatment of nipple fissure in lactating women and its local tolerability, compared with the standard of care for nipple fissure treatment during breastfeeding.
From December 2013 to September 2014, we recruited 40 women for symptomatic nipple fissures during lactation. Participants were randomized into two groups: the Silver Cap group (20 women; group A) or the control group (20 women; Group B, standard of breastfeeding care). All participants received breastfeeding education provided by a board-certified lactation consultant. Group A was instructed to use the Silver Cap. Group B had a handbook with the standard of care for nipple treatment after each breastfeeding. Both groups received a questionnaire for a daily assessment. The duration of both treatments was 15 days. We performed a clinical evaluation on Days 0 and 2 and a follow-up by telephone on Day 7, and all participants underwent final evaluation face to face on Day 15. We performed photographic recording of the nipple on Day 0 and Day 15.
There were no statistical differences in follow-up between the two treatments at Day 2. There was a significant and a more rapid resolution of painful symptoms in the Silver Cap group compared with the control group (p<0.05) at Days 7 and 15. Treatment with Silver Cap was more appreciated by the participants than standard care (p<0.05). Four participants in the Silver Cap group and six in the control group dropped out of the study. No local or systemic reactions were reported following Silver Cap application.
Results of treatment with Silver Cap were more effective than standard care of nipple fissure treatment in term of resolution of painful symptoms. It promoted the healing process of lesions, and it was well tolerated and accepted by participants.
... 4 Treating nipple ssure trauma quickly is an important factor in establishing successful breastfeeding and preventing complications such as mastitis or abscesses. 5 Topical creams, solutions or sprays, exposing nipple to dry heat or UV light, air drying, pre-or postnatal breastfeeding education, nipple shells, hydrogel, adhesive polyethylene lm wraps and distilled water are some of the widely-used available treatments and prevention options for nipple ssures. 5 Silver nipple cups have also been using in order to prevent and heal the nipple ssures. ...
... 5 Topical creams, solutions or sprays, exposing nipple to dry heat or UV light, air drying, pre-or postnatal breastfeeding education, nipple shells, hydrogel, adhesive polyethylene lm wraps and distilled water are some of the widely-used available treatments and prevention options for nipple ssures. 5 Silver nipple cups have also been using in order to prevent and heal the nipple ssures. It is speculated that the bene ts of using silver cups are due to its mechanical cover effect against possible trauma and prevention of the entry of microorganisms. ...
... In a study on 40 women with symptomatic nipple ssures, it was revealed that the use of silver cups in the treatment of symptomatic nipple ssures resulted with a more rapid resolution of painful symptoms, bleeding and nipple ssures compared to only applying breastmilk to the affected nipple. 5 In our study, 89,9% of mothers who used silver cups reported that this method was effective in preventing of nipple ssure. Meanwhile, there was no difference in the frequency of nipple ssures between two group. ...
Objectives
Breastfeeding, which is the ideal feeding method for babies, has many benefits for both babies and mothers. However, nipple problems during breastfeeding can cause early weaning. One of the methods used for nipple care is the use of silver nipple cups. In this study, we aimed to evaluate the experiences of breastfeeding mothers using silver cups for nipple care.
Methods
Mothers contacted via social media were asked to participate in a structured survey consisting of 33 questions related to breastfeeding, nipple care and silver cups use.
Results
A total number of 298 women were assessed with a structured questionnaire. There was no significant difference between mothers using and not using silver cups regarding their demographic features, breastfeeding starting time, frequency, duration and pumping. Ninthy three percent (n = 290) of mothers used at least one method for nipple care. The first three commonly used methods for nipple care were lanoline (52,2%), breastmilk (51,2%) and silver cups (49,8%). It was reported by 36,6% (n = 109) of mothers that they have not experienced any nipple problems. Among the 147 mothers who had used silver cups 89,9% (132) claimed that this method was effective for them. There was no difference between the frequency of nipple fissures in mothers using silver cups when compared to mothers who did not use it.
Conclusion
Nipple fissure is one of the most common causes of early cessation of breastfeeding. Mothers use many methods for nipple care. Silver cups is one of the methods preferred by mothers in the prevention of nipple fissures and it is reported to be beneficial.
... Index to Nursing and Allied Health Literature ( Nipples OR Nipple OR Areola OR Areolae ) AND ( "Wounds and Injuries" OR "Injuries and Wounds" OR "Wounds and Injury" OR "Injury and Wounds" OR "Wounds, Injury" OR Trauma OR Traumas OR "Injuries, Wounds" OR "Research-Related Injuries" OR "Injuries, Research-Related" OR "Injury, Research-Related" OR "Research Related Injuries" OR "Research-Related Injury" OR Injuries OR Injury OR Wounds OR Wound ) AND ( "Breast Feeding" OR "Feeding, Breast" OR Breastfeeding OR "Breast Feeding, Exclusive" OR "Exclusive Breast Feeding" OR "Breastfeeding, Exclusive" OR "Exclusive Breastfeeding" ) Limitadores -Data de publicação: 20150101-20201231 SCOPUS TITLE-ABS-KEY ( nipples OR nipple OR areola OR areolae ) AND TITLE-ABS-KEY ( "Wounds and Injuries" OR "Injuries and Wounds" OR "Wounds and Injury" OR "Injury and Wounds" OR "Wounds, Injury" OR trauma OR traumas OR "Injuries, Wounds" OR "Research-Related Injuries" OR "Injuries, Research-Related" OR "Injury, Research-Related" OR "Research Related Injuries" OR "Research-Related Injury" OR injuries OR injury OR wounds OR wound ) AND TITLE-ABS-KEY ( "Breast Feeding" OR "Feeding, Breast" OR breastfeeding OR "Breast Feeding, Exclusive" OR "Exclusive Breast Feeding" OR "Breastfeeding, Exclusive" OR " Mostrou-se concordância de que o trauma mamilar, conjuntamente com a dor, é um dos problemas mais comuns durante a amamentação, sendo um fator significativo para desmame. O tratamento foi abordado em 14 artigos, o que abrangeu comparação de tratamentos, avaliação de novas intervenções e dispositivos (12,13,18,19,(23)(24)(25)(27)(28)(29)32) . ...
... (23,25) . Quanto aos sintomas, o mais citado foi dor, que pode ser leve a insuportável (12,18,(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33) . Nove artigos mencionaram a localização do trauma mamilar. ...
... Nove artigos mencionaram a localização do trauma mamilar. Geralmente, as lesões estão na junção mamilo-areolar, envolvendo a derme e epiderme (12,14,16,17,21,24,26,28,29,30) , classificadas como circulares ou longitudinais (17,28) . Não há consenso quanto à descrição da localização ou grau de comprometimento. ...
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 em diagnóstico e tratamento adequados.
... An alternative approach to create a moist and hypoxic environment is represented by the use of 99.9% pure silver trilaminate cups-marketed as Silver Cap ® (Depofarma S.P.A., Mogliano Veneto, Italy)-to be placed on the nipple [23]. ...
... The safety and effectiveness of Silver Cap ® device in treating nipple fissures have been already proven in an observational prospective study, providing encouraging results [23]. With the aim of expanding such previous findings, in the current study, the effectiveness and tolerability of Silver Cap ® have been investigated from the perspective of preventing nipple fissure formation, focusing on the importance of creating a healthy and elastic nipple tissue to prevent skin damages [25]. ...
... Indeed, the majority of PL patients reported to feel the skin around the nipple as "softer" (52.6%) and "softer and more elastic" (29.0%) after using the device during the pre-partum period. Such skin changes might have played a crucial role in pre- Therefore, together with the findings of a previously conducted study [23], the results herein discussed indicate that Silver Cap ® device serves as a safe and effective strategy to treat and prevent nipple pain and fissure formation in lactating women. ...
... According to the results, mothers using A. vera gel were found to be more effective on nipple crack and pain than mothers using lanolin lotion (Tafazoli et al., 2010). Silver cap application is one of the alternative methods used for nipple pain and cracks and has been useful in the literature study (Marrazzu et al., 2015). ...
... After breastfeeding, the nipples are gently washed or wiped, and the cups are placed directly on the nipple and fixed with a bra. It can be applied to the area for 24 hours after cleaning with water (Marrazzu et al., 2015). ...
... In the study by Marrazzu et al. (2015), the effect of the silver cap on nipple fissure and pain in nursing mothers was investigated. The mothers were randomly divided into two groups: the intervention group (20 women) and the control group (20 women). ...
Breastfeeding is a natural method that offers significant benefits for
infant and maternal health, especially for proper nutrition of children
and protection against disease (Lawrence, 2010). The World Health
Organization (WHO) emphasizes the importance of breastfeeding and
recommends that babies be fed only breast milk in the first six months
of their lives (Karaçam & Sağlık, 2018). However, in the postpartum
period, postpartum women may experience various problems during the
breastfeeding process depending on the reasons arising from the baby and
the mother. These problems cause the mother to not be able to breastfeed
her baby effectively and to benefit sufficiently from breast milk. According
to WHO, it has been observed that 98% of mothers breastfeed their babies,
but then this rate drops to 35% in the first five months due to problems
experienced during the breastfeeding process (Heller, Fullerton‐Stone,
& Murase, 2012; Agunbiade, & Ogunleye, 2012). The main reasons for
these problems are: inadequate emptying of the breast, wrong positioning
of the baby, not paying attention to hygiene, not breastfeeding regularly
and frequently, late transition to breastfeeding after cesarean section, and
incorrect application of breastfeeding techniques by mothers (Carlander,
Edman, Christensson, Andolf, & Wiklund, 2010). According to Karacam
et al. (2018), the most frequently reported breast-related problems that
interrupt breastfeeding in the postpartum period were flat/sunken/small
nipple (7.7%), pain/tenderness (3.9%), swelling/fullness/engagement
(10.8%), redness/temperature change (28.8%), crack/wound/bleeding
(26.1%), and mastitis (5.6%).
In addition to modern medicine applications in the treatment of
breastfeeding problems, alternative approaches such as tea, lanolin,
peppermint, and massage have been extremely beneficial (Arora, Vatsa, &
Dadhwal, 2008).
In our study, breast engorgement, breast congestion, mastitis, breast
abscess, sunken or flat nipple, nipple pain, and cracks, which are the most
problematic breast-related problems in breastfeeding problems, will be
explained in detail with their alternative approaches.
... It can be defined as a painful rupture or ulceration of the nipple skin at the tip and areola around the breast that manifests as a cleft, skin loss, wound, or clinical signs of erythema, edema, and blisters. [3]. The nipple fissure is experienced by 80% to 90% of the breastfeeding women [1]. ...
... Since ancient times, silver has been known as a useful and natural measure against a broad range of microorganisms [7]. Despite the fact that its use has declined due to the discovery of new antibiotics, it has lately been re-evaluated following occurrences of antibiotic resistance [3]. ...
... Owing to its unique design and scrape on the inside side, it promotes a good latch to the nipple while keeping the atmosphere wet and hypoxic. According to an observational and prospective study by Marrazzu et al. (2015) it was stated that Silver Cap provided a noteworthy resolution of painful symptoms in lactating women compared with the Silver Cap® non-using control group. In addition, it was suggested that treatment with Silver Cap® was more appreciated by the participants compared to the standard care in the study [3]. ...
Breastfeeding is considered a gold standard for infant development. However, several complications such as nipple fissure, infection and ulceration might be accomplished during nursing, which may lead to early cessation of breastfeeding. For this purpose, silver-made nipple cap SilverNurse® (SN) has been designed to control symptoms of nipple fissure in lactating women by aiming to eliminate antimicrobial resistance compared to the alternative treatment methods. Therefore, aim of the present study is to assess antimicrobial efficacy and dermal safety of silver-made SN in context of biocompatibility with cytotoxicity assay, in vitro EpiDerm skin irritation and in vivo skin irritation tests. According to the represented results, SN exhibited potent antimicrobial activity on Staphylococcus aureus, Escherichia coli, Enterococcus hirae, and Pseudomonas aeruginosa bacteria as well as Candida albicans fungi. Cytotoxicity by MTT assay showed that prepared extract of SN has a lack of cytotoxicity in tested concentrations. In addition, in vitro EpiDerm skin irritation model and in vivo skin test demonstrated that SN can be classified as biocompatible and non-irritant for dermal use without any sign of erythema and edema. Therefore, in the present study, it was evaluated that SN can be applied safely in daily comfort fields for lactating women without dermal complications related to infection and skin irritation.
... This combination of effects appears to have a positive impact on healing damaged nipples and reducing the pain levels of the affected mothers. Marrazzu et al. [22] conducted a pilot study (n=40) to examine the effect of silver-impregnated caps on the perception of pain of the breastfeeding mothers. After 7 and 15 days, the women in the group being treated with silver-impregnated caps reported significantly lower levels of pain than the women whose nipples were being treated with expressed breastmilk. ...
... In practice, rapid healing of damaged/bleeding nipples is observed after the breastfeeding mother has used pewter nursing caps. Presumably, the effect of the pewter nursing caps is comparable with that of silver-impregnated caps [22]. Both the precious metal silver and the semi-precious metal pewter have antiseptic properties. ...
... Both the precious metal silver and the semi-precious metal pewter have antiseptic properties. In combination with the exclusion of air within the cap when it is placed on the nipple and the effect of a moist environment on wound healing, this accelerates the healing of damaged nipples thus also alleviating pain [22]. In Great Britain the use of silver-impregnated nursing caps is more widespread, while in Germany pewter nursing caps are being marketed. ...
Background: The use of pewter nursing caps for the treatment of painful
and/or damaged nipples is widespread in Germany. It is not known
Andrea Komlew1
Christine Hupfer2
whether components of tin dissolve when the caps are worn, are ab-
Bernd Reuschenbach1
sorbed by the (damaged) skin and are detectable in breastmilk the next
time the child is nursed. The statutory limit for infants is 50mg tin per
kilogramme of food. 1 Catholic University of Applied
Objective: In preparation for a study on the effectiveness of pewter Sciences, Munich, Germany
nursing caps for the treatment of sore nipples during breastfeeding,
2 Bavarian Health and Food
Safety Authority, Erlangen,
Germany
this study aims to determine whether the tin concentration in breastmilk
after the use of pewter nursing caps exceeds acceptable levels for
newborns.
Subjects and methods: The tin content of breastmilk which accumulated
inside the cap was measured in an in vitro test after one, three and four
hours of use. Further, the tin content in the breastmilk of 24 breastfeeding
women with different stages of nipple damage was tested in an in
vivo test between April and December 2018. The degree of damage to
the nipples was assessed by the recruiting midwife using the Nipple
Trauma Score. Breastfeeding women with a score=0 were included, as
even breastfeeding women with no visible damage can experience
painful nipples, which is the indication for the use of pewter nursing
caps. All breastmilk samples were tested for tin content using atomic
absorption spectrometry in the laboratory of the State Office of Public
Health and Food Safety.
Results: The highest tin content in the in vitro test was 3.92 mg/kg,
well below the 50 mg/kg recommended for infants. In the in vivo test,
regardless of the severity of nipple damage, none of the 47 breastmilk
samples (1 dropout) showed a critical level of tin.
Conclusions: There is no indication that any tin constituents will dissolve
out of the alloy during use and be present in breastmilk the next time
the child is breastfed. The study is an essential basis for now pending
comparative efficacy studies.
... "breastfeeding AND cracked AND pain"). Data were collected between July 2017 -February 2018 using the following databases: 1997;Jackson & Dennis, 2017;Lavergne, 1997;Marrazzu et al., 2015;Mohamed Essa & Ebrahim, 2013;Pugh et al., 1996;Shanazi et al., 2015;Vieira et al., 2017), three were cross-sectional studies (Blair, Cadwell, Turner-Maffei, & Brimdyr, 2003;McClellan et al., 2012;Shimoda, Aragaki, Sousa, & Silva, 2014), and two were cohort studies (Buck et al., 2014;Indraccolo, Bracalente, Di Iorio, & Indraccolo, 2012). ...
... We identified a total of seven pain scales used to assess nipple pain in breastfeeding women. The most commonly used instruments to measure pain were one-dimensional tools: NRS (nine studies) (Araújo et al., 2013;Brent et al., 1998;Buck et al., 2014;Chaves et al., 2012;Indraccolo et al., 2012;Jackson & Dennis, 2017;Marrazzu et al., 2015;Pugh et al., 1996;Vieira et al., 2017) and VAS (seven studies) (Lavergne, 1997;Shanazi et al., 2015). This last scale was referred to as the Nipple Soreness Rating by the author in one study (Lavergne, 1997) (Table 2). ...
... , according to days postpartum when data were collected, assessment scales used and the reported presence or absence of nipple damage.Pain intensity in women with nipple damage was measured by the NRS in seven studies(Araújo et al., 2013;Brent et al., 1998;Chaves et al., 2012;Jackson & Dennis, 2017;Marrazzu et al., 2015;Vieira et al., 2017) and six by the VAS (Abou-Dakn et al., 2011; Akbari et al., 2014; Coca et al., 2016; Dennis et al., 2012; Duffy et al., 1997; McClellan et al., 2012). Data collection occurred between the 1st and the 90th day postpartum, predominantly on the first few days (Abou-Dakn et al., 2011; Buck et al., 2014; Coca et al., 2016; Dennis et al., 2012; Jackson & Dennis, 2017).The weighted mean of nipple pain was 6.2 for women with nipple damage in the first week and 5.8 after that period, combining the VAS and the NRS scales from 0 to 10. ...
Aims
To describe and evaluate pain scales used to measure nipple pain in breastfeeding women and to identify nipple pain intensity in women with or without nipple damage.
Background
Nipple pain is one of the most common reasons given for premature cessation of breastfeeding. However, there are no agreed tools to measure pain and no previous reviews have provided summary estimates of pain scores.
Design
Systematic review.
Data sources
Medline, CINAHL, Scopus, Web of Science, SciELO and LILACS.
Review methods. We followed the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses. The guiding question was: How is nipple pain in breastfeeding women measured and how severe is it? We analysed articles published up to February 2018, excluded review articles and those that did not present the level of nipple pain or tools to estimate pain severity.
Results
A total of 1,023 articles were identified and 25 included in the review after applying the exclusion criteria. The Numeric Rating Scale (nine studies) and Visual Analogue Scale (seven studies) were the most prevalent tools for measuring pain. Using a pain score between 0‐10, women with nipple damage reported a weighted mean of 6.2 in the first week and 5.8 after that period; women without damage reported a weighted mean of 2.7.
Conclusion
Women with nipple damage consistently reported a higher level of pain then women without damage. To prevent premature cessation of breastfeeding, it is important to help new mothers avoid nipple damage.
This article is protected by copyright. All rights reserved.
... It has anti-inflammatory, analgesic, antibacterial, antifungal and antioxidant properties, thus is effective in curing wounds (17,28). Breast milk is also used for preventing and treating nipple trauma, due to having healing elements such as growth factors, anti-inflammatory and anti-microbial substances (10,29). Current guidelines recommend the use of purified lanolin ointment and breast milk in the treatment of nipple fissures, based on moist wound healing principles (29). ...
... Breast milk is also used for preventing and treating nipple trauma, due to having healing elements such as growth factors, anti-inflammatory and anti-microbial substances (10,29). Current guidelines recommend the use of purified lanolin ointment and breast milk in the treatment of nipple fissures, based on moist wound healing principles (29). However, effectiveness of these treatments is controversial (29,30). ...
... Current guidelines recommend the use of purified lanolin ointment and breast milk in the treatment of nipple fissures, based on moist wound healing principles (29). However, effectiveness of these treatments is controversial (29,30). Furthermore, healing time in breast milk-treated mothers is longer compared to other treatments (31). ...
Introduction: Adequate nutrition during infancy is essential for lifelong health and wellbeing. However, painful nipple trauma is problematic for mothers and may lower the prevalence of breastfeeding. This systematic review was conducted to assess herbal prevention and treatment of nipple trauma and/or pain in Iranian studies. Methods: All the Iranian indexed publications in English and in Persian were searched with the key words of "nipple trauma" and "nipple pain" from inception to 26 December 2017 on indexing sites of PubMed, Proquest, Scopus, Science Direct, Medline, SID, IranMedex, Magiran, and Google Scholar. The results were reported qualitatively. Eleven randomized clinical trials (RCTs) with total sample size of 1218 were included in this systematic review. Different herbal remedies were used in included articles. The articles were investigated through Jadad scale. Studies that scored 3 or more on Jadad scale were selected. The results were reported qualitatively. Only RCTs were considered. Results: Pistacia atlantica (Saqez), Ziziphus jujuba, curcumin, menthol, Aloe vera, Calendit - E (Calendula officinalis and Echinacea angustifolia) were the most effective treatments of nipple trauma and/or pain. In one study, peppermint water was more effective than breast milk in preventing nipple cracks and in another study nipple crack was less in women using peppermint compared with those who used lanolin ointment or placebo. Conclusion: As each study used a special medicinal plant in this review, judgement about the definitive efficacy of these remedies needs further precise studies.
... This soreness usually occurs between days 3 and 7 postpartum and in some mothers may persist to 6 weeks after delivery . The occurrence rate of nipple soreness and nipple pain during breastfeeding is 11-96% (Marrazzu et al., 2015). ...
... Currently, moisture is used for healing wounds, because moist environment creates epithelization, proliferation and epithelial migration on the surface of the wound during healing time. Current guidelines recommend the use of purified lanolin ointment and breast milk in the treatment of nipple fissures, based on moist wound healing principles (Marrazzu et al., 2015). However, effectiveness of these treatments is controversial (Marrazzu et al., 2015;Cadwell et al., 2004). ...
... Current guidelines recommend the use of purified lanolin ointment and breast milk in the treatment of nipple fissures, based on moist wound healing principles (Marrazzu et al., 2015). However, effectiveness of these treatments is controversial (Marrazzu et al., 2015;Cadwell et al., 2004). Furthermore, healing time in breast milk-treated mothers is longer compared to other treatments (As̕ adi et al., 2016). ...
Objective
Painful nipple fissure is a troublesome problem for breastfeeding mothers. This study was conducted to evaluate the effect of saqez (Pistacia atlantica) ointment on the improvement of nipple fissure in breastfeeding women during one-month follow-up.
Materials and Methods
This randomized controlled clinical trial was conducted on 100 eligible women who visited the selected health centers affiliated to Shahid Beheshti University of Medical Sciences, Tehran, Iran, from July 2015 to December 2015 during their postpartum period. A total of 100 subjects were randomly divided into two equal groups of 50 women grouped as saqez ointment group and breast milk group, and followed-up for one month. Both groups received face-to-face instructions on breastfeeding techniques. For severity of nipple fissure, Storr scale and to measure the intensity of pain, visual analog scale (VAS) were used.
Results
The results showed that the two groups were matched in terms of demographic and obstetric characteristics. Mean of nipple fissure severity in ointment group (42.62) was lower than that of the control group (48.02), that was significantly different between the two groups (p=0.047). In addition, Mean nipple pain intensity in ointment group (40.57) was lower than that of the control group (49.81), but there was no significant difference between the two groups (p=0.056).
Conclusion
The present study showed that saqez ointment was more effective than breast milk in healing and controlling nipple fissures during one-month follow-up, without resulting in any side effects.
... Treating nipple fissure trauma quickly is an important factor in establishing successful breastfeeding and preventing complications such as mastitis or abscesses. Topical creams, solutions or sprays, exposing nipple to dry heat or UV light, air drying, pre-or postnatal breastfeeding education, nipple shells, hydrogel, adhesive polyethylene film wraps and distilled water are some of the widely-used available treatments and prevention options for nipple fissures (8). ...
... Silver cover creates a barrier that accelerates wound healing and reduces the risk of infection. A study involving 40 women with symptomatic nipple fissures found that silver cups led to a more rapid resolution of painful symptoms, bleeding, and nipple fissures compared to applying only breast milk (8). The preventive effect of silver cups on nipple fissures is also significant. ...
Objectives: Breastfeeding, which is the ideal feeding method for babies, has many benefits for both babies and mothers. However, nipple problems during breastfeeding can cause early weaning. One of the methods used for nipple care is the use of silver nipple cups. In this study, we aimed to evaluate the experiences of breastfeeding mothers using silver cups for nipple care. Methods: Mothers contacted via social media were asked to participate in a structured survey consisting of 33 questions related to breastfeeding, nipple care and silver cups use. Results: A total number of 298 women were assessed with a structured questionnaire. There was no significant difference between mothers using and not using silver cups regarding their demographic features, breastfeeding starting time, frequency, duration and pumping. Ninthy three percent (n=290) of mothers used at least one method for nipple care. The first three commonly used methods for nipple care were lanoline (52,2%), breastmilk (51,2%) and silver cups (49,8%). It was reported by 36,6% (n=109) of mothers that they have not experienced any nipple problems. Among the 147 mothers who had used silver cups 89,9% (132) claimed that this method was effective for them. There was no difference between the frequency of nipple fissures in mothers using silver cups when compared to mothers who did not use it. Conclusion: Nipple fissure is one of the most common causes of early cessation of breastfeeding. Mothers use many methods for nipple care. Silver cups is one of the methods preferred by mothers in the prevention of nipple fissures and it is reported to be beneficial.
... Breastfeeding problems, including nipple fissures, constitute a major postpartum challenge. Given breastfeeding as the ideal method of feeding babies and providing them with all the nutrients they need to grow (3), necessary measures should be adopted to solve the associated problems and prolong and effectively maintain exclusive breastfeeding (4). With a reported prevalence of 34 -96%, nipple fissures are a major cause of the early cessation of breastfeeding (5). ...
... Treating nipple fissures is challenging (6) given that nipple is constantly traumatized by the baby's sucking (7) and the lesion can be infected through its contact with the mother's skin flora and the baby's oral flora. Shortening the wound healing can thus greatly help with its improvement (4). ...
Context: As a prevalent problem on the first days of childbirth, nipple fissures can cause pain and discomfort and lead to the early cessation of breastfeeding. Effectively treating this complication is therefore crucial. This systematic review investigated the effects of herbal medicines on the treatment of nipple fissures.
Methods: Keywords such as “treatment”, “nipple fissure”, “fissure”, “medicinal plants”, “sore nipple” and “herbal ingredients” were used individually and in combination to extract relevant articles published by March 2020 from English databases, i.e. Science Direct, PubMed, Scopus and Google Scholar. The Persian equivalents of these keywords were used for extracting articles from Google Scholar, SID and Magiran. The selected articles were qualitatively evaluated using the checklist issued by Consolidated Standard of Reporting Trials (CONSORT) in 2017.
Results: Out of 132 articles retrieved, 10 eligible ones were included in this study. Investigating the full text of the articles found herbal medicines such as purslane, aloe vera, olive oil, frankincense, pistacia atlantica, curcumin and ziziphus jujuba effective in treating nipple fissures.
Conclusions: Given the effects of herbal medicines on treating nipple fissures, it is recommended that comprehensive studies be conducted on different forms and doses of these compounds.
... [1] Breastfeeding cessation causes infant's deprivation of the benefits of breast milk. [2] Accordingly, nipple trauma is the main reason for early breastfeeding cessation, [3] in which mother experiences pain as well as bleeding at the start, during, and between breastfeeding. [4] Also, nipple fissure may have a harmful effect on milk production, [5] and its highest prevalence is between 3 and 7 days after delivery. ...
... [18] On the other hand, the exclusion criteria included the followings: mother's sensitivity to yarrow and honey, lack of proper treatment for up to 7 days, the impossibility of communication on days of study, postpartum fever, incidence of mastitis, bottle feeding, and the use of topical creams and analgesics. [3,5,18] In the breast milk group, breastfeeding women were asked to put a few drops of milk on their breast twice a day, after finishing the breastfeeding. [5] In the group of yarrow using, breastfeeding women were asked to wash their breasts with boiled yarrow (30 g yarrow in 1 L water for 10 min) twice a day after finishing the breastfeeding. ...
Background:
Nipple fissure is a common problem among breastfeeding women, which can lead to early cessation of breastfeeding. Because of the lack of effective treatment and given the approved efficacy of honey and yarrow on sore healing, this study was conducted to evaluate and compare the effects of yarrow, honey, and breast milk on the treatment of nipple fissure.
Materials and methods:
This study was a three-group clinical trial, and sampling was conducted at Sina breastfeeding counseling center from September 2016 to March 2018 in Sirjan, Iran, using a target-based method. The sample size consisted of 150 individuals who were randomly assigned into three groups as topical use of yarrow, the mountain honey, and breast milk after obtaining the written informed consent. The correct method of breastfeeding and using materials were instructed to these three groups on the 1st, 3rd, and 7th days, where the Storr scale was completed by the researcher.
Results:
Friedman test showed that, in these three groups of yarrow (χ2 = 92.19, df = 2, p < 0.001), honey (χ2 = 93.29, df = 2, p < 0.001), and breast milk (χ2 = 90.51, df = 2, p < 0.001)); severity of fissure had a significant reduction. Nevertheless, Kruskal-Wallis test revealed no significant difference among the severity of fissure scores in these three groups (p > 0.05).
Conclusions:
Use of honey, yarrow, and breast milk can be recommended to women in breastfeeding counseling and pharmaceutical companies can be advised to use honey and yarrow in the preparation of anti-fissure creams.
... Therefore, prevention and treatment of nipple trauma during the early postpartum period are essential for successful breastfeeding (11) . Over the years, various methods have been used for prevention and treatment of nipple trauma, and although several studies have been conducted to validate the effectiveness of these methods, there is no consensus on the most effective strategies in the resolution or reduction of nipple pain (11,17,18) . To improve breastfeeding duration and exclusivity rates and to address one of the most common difficulties encountered by breastfeeding women systematically, a good understanding of nipple pain and a corresponding effective treatment is needed (12) . ...
... In the present study, it was observed that breast milk also decreased the mean score of nipple pain, trauma and soreness over the four time periods of intervention, where the ANOVA repeated measures showed a significant difference in comparison of the four time periods of intervention. The efficacy of breast milk may be due to the breast milk have healing elements such as antibodies, anti-inflammatory, anti-microbial substances and epidermal growth factor which may potentially promote the growth and repair of skin cells (18) . This current finding is similar to the finding of the study of Mohammad et al, (2005) (45) who found that breast milk was more effective in managing nipple soreness than lanoline in relation to healing time. ...
Nipple trauma occurs in 29-76% of breastfeeding mothers within the first postpartum week which causes pain and discomfort for the mothers to continue breastfeeding. Aim of the study: Compare the effect of breast milk, peppermint water and breast shell on treatment of traumatic nipple in puerperal lactating mothers. Research design: A quasi-experimental research design was utilized. Settings: The study was conducted in postnatal clinics at Abu EL-Matamer Central Hospital and Housh Issa Central Hospital affiliated to Ministry of Health in El-Beheira Governorate. Subjects: Convenient sample of 120 puerperal lactating mothers with nipple trauma diagnosed in their first postpartum week were selected according to eligibility criteria. The selected subjects were randomly divided into three equal study groups. Tools of data collection: Five tools were used for data collection namely: A structured interview schedule; breast feeding observation checklist; visual analogue pain intensity scale; nipple soreness rating and nipple trauma score. Results: Findings demonstrate that the mean score of nipple pain, nipple soreness and nipple trauma were significantly decreased among the breast milk, peppermint water, and breast shell groups in the seventh and fourteenth day of intervention. There were a statistically significant difference between the three groups in favor of the peppermint water group in relation to nipple pain, nipple soreness and nipple trauma in the seventh and fourteenth days of intervention. Conclusion: The study concluded that peppermint water treatment was more effective in nipple trauma healing and pain relief than breast milk and breast shell treatment.
... The indirect healing effect of the silver is attributed to create a humid environment at the wound surface and eventually the duplication and migration of the epithelial cells in the affected site [29]. Marrazzu et al (2015) has investigated the effect of the silver cap on the nipple pain heal and reduction. After the participants were randomly grouped in two, the intervention and control group, then were recommended a standard care (personal hygiene protection and nipple care) along with rubbing the breast milk after each breastfeeding around the fissure. ...
... The silver cap has some advantages: it is washable, it can be reused, and it has no effect on the breast milk odor and taste. The silver cap was more effective in Marrazzu et al (2015) study in the nipple fissure pain relief and treatment, but the small sample size of his study can have an effect on the results and can increase false positive results risk [30]. In the Coca (2016) study the low level laser had a significant effect on the nipple pain relief, but its high cost makes problems using this type of treatment for everyone [28]. ...
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.
... Over the years, various methods have been used for prevention and treatment of nipple trauma, and although several studies have been conducted to validate the effectiveness of these methods, [3][4][5][6][7][8][9] there is no consensus on the most effective strategies. Some methodological issues have been addressed, such as the small number of subjects 9 as well as the lack of a standardized definition of nipple trauma. ...
... The characteristics of observed changes in the nipple skin were determined and examined with reference to previously defined characteristics. 5,10 Signs of nipple trauma were then anatomically classified, and the number of signs for each postpartum day was counted. If more than one sign was observed on a nipple, each sign was counted as an independent sign and therefore 776 images were taken for the analyses. ...
Objective:
To objectively describe changes to nipple skin and classify signs of nipple trauma in breastfeeding women during postpartum week 1.
Methods:
This study was conducted in two phases. Phase 1 was an observational prospective study of breastfeeding mothers in which data were obtained from photographs and digital images of nipple skin and analyzed to anatomically classify signs of nipple trauma. In Phase 2, the reliability of signs identified in Phase 1 was verified with the cooperation of eight clinical midwives.
Results:
A total of 776 images of 50 breastfeeding mothers were obtained daily. The signs of nipple trauma included erythema, swelling, blistering, fissure, and scabbing. Purpura and peeling were identified only with photographic image analysis. Scabbing and blistering were classified as damage to the dermis, and erythema and swelling as damage to the epidermis, based on anatomical evidence and the mothers' subjective experiences of pain intensity. Erythema and swelling were observed from day 0, with erythema most frequently observed. For inter-rater reliability of the five signs of nipple trauma, Kendall's coefficient of concordance ranged from 0.46 (moderate) to 0.85 (almost perfect). Reliability was high for fissure, substantial for blistering and scabbing, and moderate for erythema and swelling.
Conclusions:
Image analysis revealed five signs of nipple trauma. Erythema and swelling were the most frequently observed signs during postpartum week 1. However, the agreement rate was lower than that for other signs, suggesting the possibility of conflicting interpretations in clinical evaluation.
... 1,2 Hence, breastfeeding is recommended during the first six months of life by the World Health Organization (WHO) and paediatrics societies. 3 However, mothers often encounter problems during the onset of lactation, especially nipple pain, which can occur in 11% to 96% of cases 4 and affect breastfeeding and exclusive breastfeeding duration rates. 3 In Switzerland, 95% of women initiate breastfeeding during their stay in hospital. ...
... This confirms the conclusions of guidelines. 4,5 However, the rate of nipple pain remained high on the first day when compared to Henderson 12 (30% versus 8%). This can be due to delayed support of breastfeeding either in the delivery room (not included in this project) or on arrival at the postnatal unit. ...
Introduction:
Breast milk represents the optimal nutrition for a child and is recommended during the first six months. However, nipple pain often occurs during the onset of lactation and may affect breastfeeding and exclusive breastfeeding duration rates. Multiple treatments are available in the postpartum units of the Lausanne University Hospital (CHUV, Lausanne, Switzerland) and are used empirically, according to caregiver preferences.
Objectives:
The aim of this project is to implement a care plan for nipple pain according to best recommendations and evidence-based studies.
Methods:
The project was developed using the Joanna Briggs Institute framework and Practical Application of Clinical Evidence System (JBI-PACES). Five audit criteria were used in pre- and post-audits to observe any changes in compliance with the recommendations. The Getting Research into Practice (GRiP) was used between audits to identify stakeholders, barriers and facilitators of the project.
Results:
Compliance in four criteria improved, with no increase in pain experienced by breastfeeding mothers. More women received adequate information (from 47% to 64%) and support (from 47% to 58%). Each item under criteria 2 (adequate information) and 3 (adequate support) showed improvement. The adequate management of nipple pain also increased from 8% to 31%. However, it remains an important issue to consider.
Conclusions:
Despite the limitations associated with small samples, the results of this project show that implementation of best practice is possible, even though it involved the withdrawal of unnecessary treatment. Another evaluation is necessary in the future to consolidate and improve these results.
... 21,29 Breast shields, a vented plastic dome whose base has an opening for the maternal nipple, has been used with or without lanolin to protect the nipple from rubbing against the maternal bra and promote air flow for healing. 31 Another form of shield is a nonvented dome composed of trilaminate silver. Silver ions are a natural antibiotic and have emerged as an alternative to antibiotic treatment. ...
... Silver ions are a natural antibiotic and have emerged as an alternative to antibiotic treatment. 31 Mothers place the cap on the breast between feedings. One pilot study found mothers experience a significant decrease in maternal pain within 7 days of a nipple fissure compared with no treatment. ...
... Otro método que se describe como competente en el artículo de Marrazzu, es el uso de pezoneras de plata, las cuales ofrecen una acción antibacteriana eficaz y a la vez cumplirían una función cicatrizante y disminución de dolor (20). Por otro lado, en relación al uso de pezoneras de silicona junto a la aplicación de gotas de leche extraída, determinó que potenciaba su efectividad (12), sin embargo, Medina sostiene que el uso no disminuye el dolor asociado a grietas del pezón e incluso aumenta las lesiones por roce (19). ...
Objetivo: Describir el manejo actual recomendado a los profesionales de la salud para el tratamiento de las grietas en el pezón asociadas a la lactancia materna basado en la evidencia científica. Material y métodos: Revisión de la literatura en diferentes bases de datos tales como Pubmed, Embase, Lilacs, entre otras. Aplicando filtros y criterios de selección, se obtuvieron 15 artículos en esta síntesis de evidencia. Resultados: Las grietas del pezón se observan generalmente entre el tercer y el séptimo día después del parto y pueden continuar hasta por seis semanas, posicionándose como el segundo factor de abandono de la lactancia materna. En cuanto al origen, se ha demostrado que la posición y el acople incorrecto se consideran las causas más comunes que generan las grietas del pezón. No existe un único método para la prevención o tratamiento de las grietas en el pezón. Conclusión: No se recomienda un tratamiento estándar para las grietas del pezón, sino que este dependerá del tipo de lesión. De acuerdo a esta revisión y evaluación de los artículos, la leche materna se considerará eficaz solo si el pezón está enrojecido y no hay pérdida de continuidad de la piel, si ese es el caso se recomienda mantener la zona limpia evitando la humedad para favorecer la cicatrización del tejido.
... Visual breast reports on days 0 and 15 indicated that by the end of day 15, the intervention group improved better than the control group. 17 Few studies have examined the effectiveness of VCO on human nipple fissures. Given the lesion's high prevalence, its direct impact on premature breastfeeding cessation, and the lack of an appropriate and definitive method to prevent and treat it, the present study was conducted to determine the impact of VCO on nipple fissure and pain induced by breastfeeding. ...
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.
... The latter included an unspecified fit and hold intervention by an IBCLC and topical application of expressed breast milk. No changes between groups were detected at day 2, but more rapid resolution of symptoms was reported with silver cap at days 7 and 15. 145 This study is methodologically weak because one popularly applied fit and hold intervention has been demonstrated to worsen nipple pain fourfold and it is not clear which approach the IBCLCs used; also, application of expressed breast milk only without advice concerning prevention of adherence of the nipple wound to breast pad risks exacerbation of epithelial damage. A total of 1151 breastfeeding Canadian women with damage to one or both nipples were randomized into APNO and lanolin application groups. ...
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.
... Sistem pengelompokan nyeri dibagi menjadi 4 tingkat yaitu, 0 merepresentasikan tidak adanya nyeri, 1-3 untuk mewakili rasa nyeri ringan, 4-6 mewakili rasa nyeri sedang, dan 7-10 mewakili rasa nyeri berat. 15 Nyeri akibat TN menyebabkan pasien kesulitan dalam menjalankan kegiatan sehari-hari. 16 Usia dan jenis kelamin merupakan faktor risiko utama yang tidak dapat diubah yang mempengaruhi nyeri. ...
Pendahuluan: Trigeminal neuralgia (TN) merupakan kondisi yang digambarkan sebagai nyeri hebat seperti tersilet pada satu sisi wajah pada distribusi area saraf ke lima. Nyeri ini dapat mengganggu aktivitas sehari-hari pasien. Rasa nyeri merupakan fenomena subjektif yang dapat dipengaruhi oleh banyak faktor, seperti usia dan jenis kelamin. Tujuan: Mengetahui pengaruh usia dan jenis kelamin terhadap skala nyeri pasien Trigeminal Neuralgia. Metode: Data diambil dari rekam medik pasien pada periode Januari 2017 hingga Juni 2019 di RSUD Dr. Soetomo Surabaya, RS PHC Surabaya, dan RSUD Bangil Pasuruan berdasarkan kriteria inklusi dan eksklusi yang telah ditetapkan. Hasil: TN banyak ditemukan pada kelompok usia 36-64 tahun (55,55%) dan jenis kelamin perempuan (66,67%). Tidak didapatkan hubungan pengaruh usia dan jenis kelamin terhadap skala nyeri pasien (p > 0.05). Kesimpulan: Usia dan jenis kelamin merupakan faktor yang tidak dapat diubah dalam mempengaruhi nyeri. Usia dan jenis kelamin mempengaruhi nyeri melalui perubahan anatomi, hormonal, dan psikologis. Tidak ada hubungan antara usia dan jenis kelamin pada skala nyeri pasien dengan TN.
... Seven publications used previously developed instruments, namely: NTS (10) (Nipple Trauma Score), Three-point Scale for Nipple Damage (11) , NAS (12) (Nipple Attribute Score), NTI (13) (Nipple Trauma Index), the four-point scale for the assessment of erythema and fissure (14) and the six-point scale for nipple damage (15) . Other publications, not included in this review, bring: the assessment scale for nipple damage (16) , the nipple damage severity scale (17) , the pain, bleeding and severity score scale (18) and the Nipple Trauma Indicator Instrument (2) . However, only one of these studies (10) has a validation process and several authors (11)(12)(13)(15)(16) have adapted an assessment pattern arising from other injuries (19) , not specifically from NALs. ...
Objectives:
to construct and validate a classification of nipple and areola complex lesions resulting from breastfeeding, according to content and appearance.
Methods:
this is a methodological study, developed in four stages: operational definition, instrument construction, content and appearance validation. The Delphi technique and a Likert-type scale were used to validate content and appearance, through the participation of ten and sixteen judges, respectively. For analysis, Content Validity Index and Kappa Coefficient were applied.
Results:
Content Validity Index obtained an overall value of 0.93 and, for appearance, 0.94. Kappa values ranged between 0.46 and 1. The high rates of agreement among judges demonstrated the quality of the proposed content validity.
Conclusions:
the Nipple and Areola Complex Lesions Classification Instrument developed obtained acceptable values of its indexes, proving to be valid in terms of content and appearance.
... . ﻣﺎدران ﻣﻮﻓﻘﯿﺖ ﺷﯿﺮدﻫﯽ ﺑﺮای ،ﺻﺤﯿﺢ اﻃﻼﻋﺎت ﺑﻪ ﻧﯿﺎز آﻣﯿﺰ اﻋﺘﻤﺎدﺑﻪ ﻣﻬﺎرت ﮐﺴﺐ و آراﻣﺶ ،ﻧﻔﺲ زﻧﺎن ،ﻃﺮﻓﯽ از .دارﻧﺪ ﻻزم ﻫﺎی ﻧﺨﺴﺖ ﺑﻪ ﻣﺎدر ﺷﯿﺮ ﺑﺎ ﺗﻐﺬﯾﻪ ﺑﺮای زا ﺑﺎ ﮐﺎﻓﯽ ﺗﺠﺮﺑﻪ ﻋﺪم دﻟﯿﻞ ﻫﺴﺘﻨﺪ ﻣﻮاﺟﻪ ﺑﯿﺸﺘﺮی ﻣﺸﮑﻼت [12,13] اﺳﺖ ﻣﻤﻜﻦ ﻛﻪ آﻧﺠﺎﯾﯽ از . [14] آ . ...
Aims Although the body of nursing mothers naturally produces milk, breastfeeding technique
should be learned and it needs teaching. Regarding the education in successful lactation process,
this search was performed with the aim of investigating the effect of teaching breastfeeding
technique on breastfeeding position in primiparous women.
Materials & Methods In this semi–experimental study with pre-test post-test design with
control group, which was conducted in 2016, 74 primiparous women referring to health
centers in Hamadan were selected by multistage random cluster sampling method and
randomly assigned to experimental and control groups. After completing demographic
questionnaire for all samples, in days 3-5, 10, and 15 after childbirth, experimental group
received teaching breastfeeding technique and control group received common educations
and Bristol Breastfeeding Assessment Checklist in these days for sample was completed by
researcher. The data were analyzed by 20 SPSS software, using independent t-test.
Findings After the first stage of education, there was a significant difference between control
and experimental groups in the sucking stage (p
... Для местного лечения в клинической практике хорошо себя зарекомендовали и широко используются мази на основе 100% ланолина, декспантенола, которые служат защитным барьером, увлажняют кожу соска и способствуют ускорению эпителизации ткани [16]. В медицинской литературе встреча-ются и такие нетрадиционные методы лечения, как использование серебряных колпачков, компрессов из чайных пакетиков или горячей воды [17,18]. Однако Кохрейновский систематических обзор способов лечения болей и трещин сосков с целью поиска наиболее эффективного метода не выявил достоверных различий в ускорении заживления или уменьшении болезненности трещин [19]. ...
Mastitis is one of the most common pyoinflammatory processes that occur in the postpartum. The mastitis incidence varies from 0.5% to 33%. Due to lack of standard algorithms, approaches to diagnosis and treatment of lactational mastitis vary between pediatricians and obstetrician-gynecologists. Plugged ducts is the basic factor that predisposes a woman to plugged milk ducts, which can lead to mastitis. Unfortunately, frequently prescribed antibacterial treatment has an adverse effect on human milk microbiota and creates subtherapeutic drug concentration in milk, which leads to antibiotic resistance in infants. Effective expression of breast milk is a key method to prevent and fight mastitis and plugged ducts. Recommendations for preferred method of breast milk expression require a personalized approach, the first of which depends on the assessment of breast nipples condition. According to some reports, 80–90% of breast-feeding women develop soreness and cracked nipples, which cause delayed or missed breastfeeding. Teaching correct breast-feeding techniques can prevent the chain of these adverse events: cracked nipples – plugged duct – lactation mastitis. Ideally, a healthy mature infant with active sucking reflex, who is breastfed effectively with a good technique, may perfectly ensure a problem-free lactation period.
... In addition, Mamare ® is a similar product to Silver Cap ® , but made of polyacrylamide as the matrix and glycerol for helping the healing process. 10 The present work proposes the development and characterization (physical-chemical and biological) of a breast protector composite using a material with tissue repair properties and a moisturizing compound aligned with a low-cost procedure, aiming not only to relieve pain but also to heal the nipple fissures caused by breastfeeding. ...
Background
Nipple pain is the second most common reason for early weaning, exceeded only by the insufficient milk supply. Nipple fissures can bring other problems, acting also as a portal for bacteria and leading to mastitis. This work proposes the breast protector composite development using materials with tissue repair and moisturizing properties, aligned with a low‐cost procedure, aiming not only to relieve pain, but also to heal the nipple fissures caused by breastfeeding.
Materials and methods
For the dressings, production was used Natural Latex extracted from the rubber tree and glycerol. The Samples were evaluated chemically and physically by the techniques of Scanning Electron Microscopy, Fourier transform infrared spectroscopy, mechanical traction, and contact angle. The samples were also biologically evaluated by the hemolytic and cytotoxic activity assays.
Results
From the physical‐chemical assays, the matrix with glycerol has high pore density; the natural latex and glycerol do not covalently interact, indicating that the glycerol can be released; the glycerol addition makes the matrix more elastic but fragile, and increase the wettability. From the biological assays, both materials showed no hemolytic effects; and the cytotoxicity results showed that glycerol did not present cytotoxicity in the fibroblasts, but show a dose‐dependent influence in the keratinocytes.
Conclusion
The material developed for application in breast fissures has mechanical properties similar to those found for materials for dermal applications, present high wettability and pore density. Furthermore, the material showed no cytolytic activity and the tests with skin cell cultures demonstrated the biocompatibility.
... It can also prevent cell damage by inhibiting the electron transport process and facilitating nutrient absorption, nu- cleic acid production, and ATPase activity (53). Marrazzu et al. evaluated the effects of a silver-impregnated medical cap and concluded that the cap could relieve the painful symptoms of nipple fissures more effectively than the stan- dard care (24). A study on ointments containing lanolin, an oily colorless agent comprising lana wool and oleum oil, identified appropriate breastfeeding as the most impor- tant factor to treat sore nipples. ...
... Most breastfeeding women experience a transient period of nipple pain especially during the first early postpartum period that is expected to resolve within the first 10 days 16 . Incidence of nipple pain varied between 11% and 96% of breastfeeding women and up to one-third of mothers' experience these symptoms may change to alternate methods of infant nutrition within the first 6 postnatal weeks, if the pain persists 17 . Nipple pain interferes with the breastfeeding women' general activity, sleep pattern and mood status and reduces duration of breastfeeding or lead to early weaning and cessation of breastfeeding 18 . ...
Nipple pain is a common problem among breastfeeding women. Aim of the study was to evaluate the effect of breast milk on nipple pain among early puerperal lactating women. A quasi experimental research design was utilized. This study was conducted at Abu El-Saud Center for obstetrics and Gynecology in Aga City at Dakahlia Governorate. A purposive sampling technique was used to select a total number of 92 lactating women. Eligible women were assigned randomly into two equal groups; each group involved 46 lactating women. The control group followed the routine care while the intervention group was asked to express their breast milk and utilize some milk drops to lubricate the nipples and areolas after each feeding and let the nipple to be dried with air, in addition to, receiving the same routine care. Two tools were utilized for data collection, the first tool was a structured interview schedule and the second tool was a numeric rating scale to assess the intensity of nipple pain. Results: The findings of this study revealed that the intensity of nipple pain in the intervention group was significantly lower than the routine care group (p <0.001) post intervention. Conclusion: Expressed breast milk can be used as a lubricant on nipple to manage nipple pain among early lactating women. Recommendation: Raising awareness of obstetricians' doctors and nurses about the utilization of expressed breast milk to alleviate nipple pain among early lactating women.
... The sample size was calculated based on the results of previous studies [18] and considering a possible dropout rate of 10% to 15% throughout the follow-up period. For a 95% confidence interval, 80% test power, and a = 0.05, it was determined that 50 women would be needed for each group (total: 100 participants). ...
Introduction:
Poor positioning of the child in relation to the breast and improper suckling are the main causes of nipple fissure. Treatment options for nipple fissures include drug therapy with antifungal and antibiotics, topical applications of lanolin, glycerin gel, creams and lotions, the milk itself, hot compresses, and silicone nipple shields. Studies involving light-emitting diode (LED) therapy have demonstrated anti-inflammatory properties, the enhancement of the wound repair process, and the control of pain. As it does not cause discomfort, is relatively inexpensive and may impede the discontinuation of breastfeeding, phototherapy could be a viable option for the treatment of nipple fissures.
Aim:
The principal objective of the proposed study is to evaluate the effectiveness of LED therapy for the treatment of nipple fissures in postpartum mothers.
Materials and methods:
One hundred patients treated with a medical diagnosis of bilateral nipple trauma classified as nipple fissures or cracks will participate in the study, randomized into 2 groups: The control group will receive orientation regarding breast care and adequate breastfeeding techniques. The experimental group will receive the same orientation and phototherapy sessions using a device developed especially for the treatment of nipple trauma. Both groups will be followed up for 6 consecutive weeks.
Background
Nipple trauma and pain pose a challenge, leading to premature discontinuation of breastfeeding. Moisturizing therapies, including lanolin and hydrogel dressings, have been proposed for nipple trauma and pain management. Despite the availability of multiple approaches, evidence for moisturizing therapy is lacking.
Research Aim
This review aimed to determine the efficacy of moisturizing therapy in treating nipple trauma and nipple pain in lactating women.
Methods
A systematic review based on the PRISMA-P guidelines was conducted. Seven databases were systematically searched and screened, and 24 studies were analyzed. The interventions were categorized as high, moderate, or low, based on their moisturization levels. Sample characteristics, interventions, and outcomes were examined.
Results
A total of 21 interventions were identified: high moisturization (two types), moderate moisturization (12 types), and low moisturization (seven types). Hydrogel dressings, lanolin, and breast milk are commonly used interventions. Although intervention and effectiveness evaluation methods differed between studies and could not be compared, results in 10 (41%) of the studies demonstrated that one intervention with more moistening was more effective. Of the three studies categorized as including high moistening interventions, two (66%) supported their effectiveness compared to low moistening interventions; however, two of the three studies were judged to be at high risk of bias, and some reported adverse events.
Conclusions
Moisturization interventions show promise for treating nipple trauma and pain more than drying nipples or using breast milk, but high moisturization needs cautious use due to few rigorous trials and the presence of reported risks. Methodological challenges and the lack of robust trials hinder evidence synthesis and robust conclusions.
Abstract in Japanese
背景： 乳頭損傷や乳頭痛は産褥早期に授乳を断念する要因である。その対処法として、ラノリンやハイドロジェルドレッシングによる保湿療法が提案されている。しかし、乳頭損傷や乳頭痛に対する保湿療法の効果に関する検討は不足している。 目的： 本システマティックレビューは、授乳中の乳頭損傷と乳頭痛の治療における保湿の有効性を検討することを目的とした。 方法： PRISMA-Pガイドラインに基づく系統的レビューを実施した。7つのデータベースを用いて、体系的に検索とスクリーニングを行い、最終的に24件の文献を対象とした。介入方法を保湿レベルに基づいて高保湿、中保湿、低保湿に分類し、サンプル特性や、介入、および結果について検討した。 結果： 高保湿（2種類）、中保湿（12種類）、低保湿（7種類）の合計21種類の介入が特定された。ハイドロジェルドレッシング、ラノリン、母乳の塗布が一般的な介入として使用されていた。介入および効果の測定方法は研究間で異なり、結果の統合は困難であったが、10件（41％）でより高い保湿の介入が効果的であるとされていた。高保湿に分類された3件のうち2件（66％）が低保湿の介入と比較して効果的であるとされたが、2件（66％）はバイアスリスクが高いと判定された文献であり、有害事象の報告もあった。 結論： 保湿療法は乾燥や母乳の塗布と比較して乳頭損傷や乳頭痛の対処法として有望であるが、高保湿の対処法には厳密な無作為化比較試験の不足と有害事象の報告があり、慎重な検討が必要である。堅牢な実験研究の不足と方法論的な課題が、結果の統合とエビデンスの確立の妨げとなっている。 Back translated by Katsumi Mizuno, PhD, MD, IBCLC
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.
Introduction
Histopathological examination of interstitial lung diseases is important to assist diagnosis when the results of clinical assessment, laboratory investigations, high-resolution computed tomographic imaging, and pulmonary function testing do not allow making a confident diagnosis of a certain type or stage of interstitial lung disease.
Patients and methods
A total of 20 patients were enrolled in the study at Chest Medicine Department, Mansoura University Hospital, Mansoura, Egypt. A written informed consent for thoracoscope and tissue sampling was obtained from all patients. The patients were divided into two groups: group I underwent medical thoracoscope and group II underwent mini-thoracoscope.
Results
The biopsy size ranges from 3 to 9 mm, with a mean±SD of 6.2±1.4 mm in group I and 3.9±0.88 mm in group II. Fever was common in group I (50%) than group II (20%). Surgical emphysema was higher in group I, with a median (range) of 3 (2–3) and median (range) in group II was 1 (1–2). Bleeding was reported in most cases for each group, with median (range) of 1.5 (1–2) in group I and 1 (0–1) in group II. No cases were complicated with severe bleeding in both groups. Pain scoring was higher in group I with median (range) of 2 (0–3) and 1 (1–2) in group II. Only two cases in group I were complicated with persistent air leak more than or equal to 7 days. There is a statistically significant difference regarding bleeding, pain, and surgical emphysema ( P =0.010, 0.044, 0.013). Diagnostic yield is 100% in both groups. Nonspecific interstitial pneumonia was the most common diagnosis in group I (40%) and in group II (60%), followed by usual interstitial pneumonia in three (30%) cases in group I and four (40%) cases in group II. The least common diagnosis is broncholites obliterans organising pneumonia (BOOP), pulmonary alveolar proteinosis (PAP), and mucoid adenocarcinoma, which were encountered in 10% each in group I.
Conclusion
Lung biopsy can be performed with less invasive maneuver by mini-thoracoscopy, leading to decrease complications with good diagnostics.
Background
Nipple fissures are frequent complaints of breastfeeding mothers. Many treatments have been used to treat this problem. However, low-risk methods are more useful for treatment.
Objective
This study aimed to investigate the effect of consulting correct techniques of breastfeeding on the treatment of fissures on the nipple in primiparous mothers referred to Hamadan healthcare centers during 2017.
Methods
This is a clinical trial study that was conducted on two groups comprised of 74 primiparous mothers who were admitted to Hamadan health centers in 2017. They were randomly assigned to two groups of treatment and control. After completing the demographic questionnaire, the intervention group received breastfeeding consultation 3-5, 10, and 15 days after birth, and the control group received routine training like applying a little expressed milk on nipples. Storr and Bristol Scales were completed by the researcher before and one week after the last consultation session. Data were analyzed using SPSS software version 20, and the significance level was considered 0.05.
Results
The results showed that the mean score of the Bristol checklist in the intervention group after counseling was significantly increased (p<0.05), and there were also more people in the intervention group with improvement in their nipple fissures (66.7% vs. 37.9% at the score of zero).
Conclusion
Multi-session and face-to-face correct techniques of breastfeeding counselling can help nipple fissure healing in nursing mothers.
Background
Nipple fissure is a common problem in breastfeeding women, and the main reason for the early discontinuation of breastfeeding.
Objective
To determine the effect of Saqez (Pistacia atlantica) ointment on the treatment of nipple fissure and nipple pain in breastfeeding women.
Methods
This randomized clinical trial was conducted on 100 subjects admitted to the health centers in Tehran, Iran from mid-July to mid-November 2015. The subjects were randomly divided into two equal groups of 50 for the Saqez ointment group and the control group. The subjects were divided into the two groups through random allocation in Excel. The subjects were monitored on day 1, 3 and 7. Data were analyzed in SAS using the Cumulative Logit model and in SPSS-21 using Mann-Whitney, independent-samples t-test, the Chi square and Fisher’s exact test.
Results
No significant differences were observed between the two groups in terms of their demographic and fertility characteristics. The Cumulative Logit model showed that high levels of nipple fissure and pain were significantly less frequent in the Saqez group compared to the control group (p<0.001). There was about 83% reduction in the severity of fissure and 85 %in the severity of pain in the Saqez group compared to the control group (p<0.001).
Conclusion
Saqez ointment is more effective in the treatment of nipple fissures and pain than breast milk. As this study was done for the first time, judgment about the conclusive efficacy of Saqez ointment on the nipple fissure, needs further similar studies.
Trial registration
The trial was registered at the Iranian Registry of Clinical Trials (http://www.irct.ir) with the Irct ID: IRCT2015080723535N1.
Funding
The authors received no financial support for the research, authorship, and/or publication of this article.
Introduction: Nipple fissure is one of the most common problems in breastfeeding women and the main reason for the early discontinuation of breastfeeding. Due to the importance of breastfeeding, the present study was performed with aim to review the clinical trials conducted on the treatment of sore nipple and nipple pain in breastfeeding women. Methods: In this systematic review, all local databases were searched with the keywords of “sore nipple” and “clinical trial” and databases of Google Scholar, PubMed, ProQuest, Scopus, Science Direct and Medline with the keywords of “sore nipple” and “clinical trial” were searched to November 2015 with no time and language limitations. All the articles were reviewed based on the Jadad scale and those scoring ≥3 were selected. The results were reported qualitatively. Results: A total of 14 articles meeting the inclusion criteria were ultimately examined. Among the treatments examined in these studies, Lanolin along with a nipple shield, Aloevera gel, menthol essence and warm compress led to more decrease in severity of pain and the fastest recovery of sore nipples. Conclusion: Lanolin along with a nipple shield, Aloevera gel, menthol essence and warm compress are the most effective treatments for sore nipples. Nevertheless, a definitive judgment about the effectiveness of these interventions requires more accurate studies with adequate sample sizes. Studies conducted on sore nipples and their treatment are scattered and drawing conclusions about the interventions is not possible due to the limited number of studies. © 2016, Mashhad University of Medical Sciences. All rights reserved.
Breastfeeding is widely acknowledged to be the best and most complete form of nutrition for healthy infants born at term and is associated with numerous benefits in terms of infants' health, growth, immunity and development. However, breastfeeding problems often result in early weaning. Standardized treatment recommendations for breastfeeding-related diseases are necessary to optimize the care offered to breastfeeding women. Evidence and consensus based guidelines for the treatment of puerperal mastitis, sore nipples, engorgement and blocked ducts were developed on the initiative of the National Breastfeeding Committee. These guidelines were developed in accordance with the criteria set up by the Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF), the Association of Scientific Medical Societies in Germany. The recommendations were drawn up by an interdisciplinary group of experts and were based on a systematic search and evaluation of the literature but also took clinical experience into account. Additionally good clinical practice (GCP) in terms of expert opinion was formulated in cases where scientific investigations could not be performed or were not aimed for. This article presents a summary of the recommendations of the S3-guidelines.
Background:
Nipple pain and damage are common in the early postpartum period and are associated with early cessation of breastfeeding and comorbidities such as depression, anxiety, and mastitis. The incidence of nipple vasospasm has not been reported previously. This article describes nipple pain and damage prospectively in first-time mothers and explores the relationship between method of birth and nipple pain and/or damage.
Subjects and methods:
A prospective cohort of 360 primiparous women was recruited in Melbourne, Australia, in the interval 2009-2011, and after birth participants were followed up six times. The women completed a questionnaire about breastfeeding practices and problems at each time point. Pain scores were graphically represented using spaghetti plots to display each woman's experience of pain over the 8 weeks of the study.
Results:
After birth, before they were discharged home from hospital, 79% (250/317) of the women in this study reported nipple pain. Over the 8 weeks of the study 58% (198/336) of women reported nipple damage, and 23% (73/323) reported vasospasm. At 8 weeks postpartum 8% (27/340) of women continued to report nipple damage, and 20% (68/340) were still experiencing nipple pain. Ninety-four percent (320/340) of the women were breastfeeding at the end of the study, and there was no correlation between method of birth and nipple pain and/or damage.
Conclusions:
Nipple pain is a common problem for new mothers in Australia and often persists for several weeks. Further studies are needed to establish the most effective means of preventing and treating breastfeeding problems in the postnatal period.
Background:
Infants with latch-on problems cause stress for parents and staff, often resulting in early termination of breastfeeding. Healthy newborns experiencing skin-to-skin contact at birth are pre-programmed to find the mother's breast. This study investigates if skin-to-skin contact between mothers with older infants having severe latching on problems would resolve the problem.
Methods:
Mother-infant pairs with severe latch-on problems, that were not resolved during screening procedures at two maternity hospitals in Stockholm 1998-2004, were randomly assigned to skin-to-skin contact (experimental group) or not (control group) during breastfeeding. Breastfeeding counseling was given to both groups according to a standard model. Participants were unaware of their treatment group. Objectives were to compare treatment groups concerning the proportion of infants regularly latching on, the time from intervention to regular latching on and maternal emotions and pain before and during breastfeeding.
Results:
On hundred and three mother-infant pairs with severe latch-on problems 1-16 weeks postpartum were randomly assigned and analyzed. There was no significant difference between the groups in the proportion of infants starting regular latching-on (75% experimental group, vs. 86% control group). Experimental group infants, who latched on, had a significantly shorter median time from start of intervention to regular latching on than control infants, 2.0 weeks (Q1 = 1.0, Q3 = 3.7) vs. 4.7 weeks (Q1 = 2.0, Q3 = 8.0), (p-value = 0.020). However, more infants in the experimental group (94%), with a history of "strong reaction" during "hands-on latch intervention", latched-on within 3 weeks compared to 33% in the control infants (Fisher Exact test p-value = 0.0001). Mothers in the experimental group (n = 53) had a more positive breastfeeding experience according to the Breastfeeding Emotional Scale during the intervention than mothers in the control group (n = 50) (p-value = 0.022).
Conclusions:
Skin-to-skin contact during breastfeeding seems to immediately enhance maternal positive feelings and shorten the time it takes to resolve severe latch-on problems in the infants who started to latch. An underlying mechanism may be that skin-to-skin contact with the mother during breastfeeding may calm infants with earlier strong reaction to "hands on latch intervention" and relieve the stress which may have blocked the infant's inborn biological program to find the breast and latch on.
Trial registration:
Karolinska Clinical Trial Registration number CT20100055.
Dermatological photography is used as a supplement to dermatological examination with the function of providing additional knowledge and information. Its quality depends on the expertise of the photographer-dermatologist in recording the relevant elements present. Therefore, the dermatologist should know basic principles of photography and the journal editors should ensure that the articles have high-quality images. This article suggests criteria to improve the quality of photographs submitted to journals for publication.
Silver is used widely in wound dressings and medical devices as a broad-spectrum antibiotic. Metallic silver and most inorganic silver compounds ionise in moisture, body fluids, and secretions to release biologically active Ag(+). The ion is absorbed into the systemic circulation from the diet and drinking water, by inhalation and through intraparenteral administration. Percutaneous absorption of Ag(+) through intact or damaged skin is low. Ag(+) binds strongly to metallothionein, albumins, and macroglobulins and is metabolised to all tissues other than the brain and the central nervous system. Silver sulphide or silver selenide precipitates, bound lysosomally in soft tissues, are inert and not associated with an irreversible toxic change. Argyria and argyrosis are the principle effects associated with heavy deposition of insoluble silver precipitates in the dermis and cornea/conjunctiva. Whilst these changes may be profoundly disfiguring and persistent, they are not associated with pathological damage in any tissue. The present paper discusses the mechanisms of absorption and metabolism of silver in the human body, presumed mechanisms of argyria and argyrosis, and the elimination of silver-protein complexes in the bile and urine. Minimum blood silver levels consistent with early signs of argyria or argyrosis are not known. Silver allergy does occur but the extent of the problem is not known. Reference values for silver exposure are discussed.
Painful and/or damaged nipples associated with breastfeeding are common and represent a challenge for both the persons experiencing nipple pain and/or trauma and for those providing treatment. However, evidence-based data has been insufficient to demonstrably minimize these common reasons for failure to initiate or continue successful breastfeeding. The aim of this study was to evaluate the efficacy of specific-grade highly purified anhydrous (HPA) lanolin versus expressed breastmilk (EBM) for the treatment of painful and damaged nipples associated with breastfeeding in a prospective controlled clinical trial evaluating 84 lactating mothers. Nipple trauma and healing rates were rated by the Nipple Trauma Score. Nipple pain intensity was assessed on a visual analog scale. Outcome parameters were in favor of the HPA lanolin group, reaching statistical significance for healing rates, nipple trauma and nipple pain. In our study, we found HPA lanolin more effective than EBM, inducing faster healing of nipple trauma (absolute risk reduction of 0.43) and reducing nipple pain (absolute risk reduction of 0.61 on day 3). We concluded that HPA lanolin, combined with breastfeeding education, was more effective than EBM, combined with breastfeeding education, in reducing nipple pain and promoting healing of nipple trauma.
Silver has been used extensively throughout recorded history for a variety of medical purposes.
A review of the literature in English was undertaken, primarily using PUBMED, to identify the medical uses of silver before the clinical introduction of antibiotics in the 1940s.
Silver has been used for at least six millennia to prevent microbial infections. It has been effective against almost all organisms tested and has been used to treat numerous infections and noninfectious conditions, sometimes with striking success. Silver also has played an important role in the development of radiology and in improving wound healing.
Silver was the most important antimicrobial agent available before the introduction of antibiotics.
Jane Scott and colleagues have recently published a paper in the International Breastfeeding Journal showing that health professionals are still giving harmful advice to women with mastitis. We see the management of mastitis as an illustration of health professionals' management of wider breastfeeding issues. If health professionals don't know how to manage this common problem, how can they be expected to manage less common conditions such as a breast abscess or nipple/breast candidiasis? There is an urgent need for more clinical research into breastfeeding problems and to improve the education of health professionals to enable them to promote breastfeeding and support breastfeeding women.
To compare the effect of rubbing breast milk versus lanolin in the treatment of symptoms of sore nipples.
We carried out this randomized clinical trial on 225 mothers with sore nipples in the Neonatal Intensive Care Unit of Imam Reza Hospital in Mashhad, Iran from April 2001 for 2 years. We randomly divided the patients into 3 groups. The first group rubbed the hind milk on their nipples at the end of each breast-feeding session, and the second group used lanolin locally on the nipple 3 times a day, and cleaned the nipple with a wet cloth before infant feeding. The third group did not use anything (control group). We corrected the breast-feeding technique of all mothers throughout the study. After the first visit, we reexamined the patient on the third, fifth, seventh and tenth days. We obtained information with interviewing and physical examination by using a questionnaire. We based the sore nipple improvement on absence of irritation according to mothers opinions. We analyzed the obtained information using the SPSS version 11.5 software, and the used tests were Chi-Square test, Mann-Whitney test, and Kruskal-Wallis test.
The first group (breast milk users) included 78 patients, the second group (lanolin users) included 74 patients, and the third group (control group) included 73 patients. The 3 groups were similar in gravidity, delivery method, pre-delivery breast feeding education, the beginning time of the first breast feeding, prior success breast feeding experiences, detergent agents usage for nipples, use of formula, and pacifier. Clinical manifestations, such as appearance time of symptoms, irritation and breast wound were not significantly different. The healing time was different in these 3 groups (p=0.038) according to the mean ranking in the groups. The healing time in the lanolin group was longer than the breast milk group (p=0.029) and the control group (p=0.028). No side effects were noted during the study.
This study suggests that, due to the better healing of the sore nipple with breast milk, its availability, without payment and side effect, breast milk is recommended for the treatment of sore nipples.
Bactericidal actions of the silver ion on Escherichia coli as a model microorganism were studied using energy-filtering transmission electron microscopy (EFTEM), two-dimensional electrophoresis
(2-DE), and matrix-assisted laser desorption ionization-time-of-flight mass spectrometry (MALDI-TOF MS). EFTEM observations
demonstrated that the silver ion readily infiltrates the interior of E. coli, contrary to the early hypothesis that it resides initially in the cell membrane area. Furthermore, 2-DE and MALDI-TOF MS
indicated that the expression of a ribosomal subunit protein as well as that of some other enzymes and proteins is affected
by the silver ion. The present results demonstrate for the first time that one of the major bactericidal functions of the
silver ion is its interaction with the ribosome and the ensuing inhibition in expression of the enzymes and proteins essential
to ATP production.
Nipple pain and damage in breastfeeding mothers are common causes of premature breastfeeding cessation. Peppermint water is popularly used for the prevention of nipple cracks in the North West of Iran. The aim of this study was to determine the effectiveness of peppermint water in the prevention of nipple cracks during breastfeeding in comparison with the application of expressed breast milk (EBM).
One hundred and ninety-six primiparous breastfeeding women who gave birth between February and May 2005 in a teaching hospital in Tabriz, Iran, were randomized to receive either peppermint water or EBM. Each woman was followed for up to three visits or telephone calls within 14 days and then by telephone call at week six postpartum.
Women who were randomized to receive peppermint water were less likely to experience nipple and areola cracks (9%) compared to women using EBM (27%; p < 0.01). Women who used the peppermint water on a daily basis were less likely to have a cracked nipple than women who did not use peppermint water (relative risk 3.6, 95%CI: 2.9, 4.3). Nipple pain in the peppermint water group was lower than the expressed breast milk group (OR 5.6, 95% CI: 2.2, 14.6; p < 0.005).
This study suggests that peppermint water is effective in the prevention of nipple pain and damage. Further studies are needed to assess the usefulness of peppermint water in conjunction with correct breastfeeding techniques.
To identify the most effective interventions to treat nipple trauma in breastfeeding mothers.
Systematic literature review using the PICO strategy. The search was conducted on the electronic information systems Medline-PubMed, Latin American and Caribbean Health Sciences Literature (LILACS), Scientific Electronic Library Online (SciELO), World Health Organization Library Information System (WHOLIS), Cochrane, ScienceDirect (Elsevier), Embase, and Cumulative Index to Nursing and Allied Health Literature (CINAHL), using standardized and unstandardized descriptors. Studies were selected if they were controlled or uncontrolled randomized clinical trials written in English, Portuguese, or Spanish. Two reviewers evaluated the studies independently using a guide, and in case there were disagreements, a third reviewer was called on to reach a consensus. Of the 496 studies located, five were included.
The treatments investigated were lanolin, lanolin in association with breast protection shells, breast milk, hydrogel, adhesive polyethylene film dressings, a spray containing chlorhexidine with alcohol, and distilled water. All the groups in every study received breastfeeding education. The best outcomes for the treatment of nipple trauma used lanolin (recommendation B, evidence level 2) and breast milk (recommendation B, evidence level 2). Although one clinical study was found with positive outcomes resulting from treatment using a spray containing alcohol and chlorhexidine 0.2% (recommendation B, evidence level 2), this treatment modality should be further investigated since literature is not in favor of using antiseptic substances in skin wound treatment.
Considering the treatments investigated, the most favorable evidence indicates the use of lanolin alone or in association with breast protection shells and breast milk expressed and rubbed into the nipple and areola after each feeding session. However, the results obtained in this review are inconclusive, indicating the need for further studies in order to clarify the action of breast milk and lanolin on the damaged tissues, as well as studies involving samples representative of the number needed to treat.
This study provides evidence for nursing practice, thus contributing to the improvement of lactating mothers with nipple trauma care and, consequently, improving the rates of successful breastfeeding as well as the quality of life of breastfeeding mothers.
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: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.
The use of unidimensional pain scales such as the Numerical Rating Scale (NRS), Verbal Rating Scale (VRS), or Visual Analogue Scale (VAS) is recommended for assessment of pain intensity (PI). A literature review of studies specifically comparing the NRS, VRS, and/or VAS for unidimensional self-report of PI was performed as part of the work of the European Palliative Care Research Collaborative on pain assessment.
To investigate the use and performance of unidimensional pain scales, with specific emphasis on the NRSs.
A systematic search was performed, including citations through April 2010. All abstracts were evaluated by two persons according to specified criteria.
Fifty-four of 239 papers were included. Postoperative PI was most frequently studied; six studies were in cancer. Eight versions of the NRS (NRS-6 to NRS-101) were used in 37 studies; a total of 41 NRSs were tested. Twenty-four different descriptors (15 for the NRSs) were used to anchor the extremes. When compared with the VAS and VRS, NRSs had better compliance in 15 of 19 studies reporting this, and were the recommended tool in 11 studies on the basis of higher compliance rates, better responsiveness and ease of use, and good applicability relative to VAS/VRS. Twenty-nine studies gave no preference. Many studies showed wide distributions of NRS scores within each category of the VRSs. Overall, NRS and VAS scores corresponded, with a few exceptions of systematically higher VAS scores.
NRSs are applicable for unidimensional assessment of PI in most settings. Whether the variability in anchors and response options directly influences the numerical scores needs to be empirically tested. This will aid in the work toward a consensus-based, standardized measure.
This paper is a systematic review with the objective of determining the effectiveness of silver-releasing dressing in the management of infected chronic wounds.
Chronic wounds exhibit increased bacterial burdens which not only result in a negative physical impact on patients, impairing their quality of life, but also increase treatment costs. Silver dressings are wound products designed to control and inhibit infection and provide a wound environment conducive to healing. However, there is limited evidence on their effectiveness in doing so.
A systematic review of literature from 1950-May 2007 was conducted using the PubMed, CINAHL, Cochrane, MEDLINE, British Nursing Index, EBSCO Host, OCLC, Proquest and PsychInfo databases. The review included randomised or non-randomised control trials, published in English or non-English, of silver-releasing dressings in infected chronic wounds.
Of the over 1957 potentially releasing studies examined, 14 pertinent articles involving 1285 participants were identified. Almost all the participants reported one or more statistically significant outcomes. The main points to emerge from this review of studies are that silver-releasing dressings show positive effects on infected chronic wounds. The quality of the trials was limited by the potential for bias associated with inadequate concealment, no detailed description of the outcome measurement and no reported intention-to-treat analysis. Moreover, problems existed in some studies with confounding factors.
The review clearly highlights the need for well-designed, methodologically standardised outcome measurement research into the effectiveness of silver-releasing dressings. It also points to the need for a comprehensive assessment of wound bed status in further studies.
This review strengthens the case for the use of silver dressings when managing infected chronic wounds. They appear more effective and are tolerated well by patients. However, their use should be accompanied by a comprehensive wound assessment.
The inhibitory and bactericidal concentrations of electrically generated silver ions were 10 to 100 times lower than for silver
sulfadiazine. Effects on normal mammalian cells were minimal.
We have measured growth factor concentrations in human milk from mothers of term and premature infants to identify any adaptive responses to premature delivery. Measurements included concentrations of epidermal growth factor and insulin and the growth-promoting activity of milk in vitro, estimated by the stimulation of rats of protein accumulation in cultured human fibroblasts. Compared with women delivering at full-term, mothers of premature infants produced milk containing higher concentrations of epidermal growth factor and increased growth-promoting activity in vitro, changes which were probably maintained throughout lactation. The anabolic effect of human milk in cultured human fibroblasts could be attributed partially but not entirely to epidermal growth factor, suggesting that the concentrations of additional growth factors were also increased following premature delivery. Insulin did not contribute to the extra growth-promoting activity; premature delivery depressed the insulin concentration significantly on the first two days of lactation and, thereafter, milk from mothers of term or premature infants contained similar amounts of insulin. Growth factor concentrations were also measured in cow's milk-based formulae. These formulae contained low concentrations of epidermal growth factor and insulin and reduced growth-promoting activity compared with human milk. Changes in milk growth factor concentrations may occur as a compensatory mechanism to accelerate growth and development in pre-term infants, and if so, it follows that premature infants could benefit more from their own mother's milk than from pooled human milk or from cow's milk-based formulae.
This study was designed to evaluate whether maintenance of a moist environment on the nipple skin during the first week of breast-feeding would improve damaged nipple skin condition, as indicated by the presence of eschar, erythema, and fissures, and reduce pain. Fifty White women applied a polyethylene film dressing with a perimeter adhesive system to a randomly determined nipple. The dressing was present at all times except during feeding. Subjects were assessed every 48 hours (four times) over 7 days. Serial photographic slides were obtained and assessed for skin characteristics. Nipple pain was self-rated with a verbal descriptor scale. Use of an occlusive film dressing on nipple skin during the first week of breast-feeding appeared to have limited influence on improvement in damaged skin condition. Summary scores indicated significant reduction in the amount of eschar on the surface of the nipple. There were no differences in erythema intensity or fissure severity. Use of a dressing significantly reduced nipple pain during the study period.
To document skin changes in the nipple during the 1st week of breastfeeding and to explore the relationship of such changes to pain.
Longitudinal descriptive study. Subjects were visited four times during the 1st week of breastfeeding.
Convenience sample of 20 Caucasian women.
Hospital and home.
Observed skin characteristics of the nipple included erythema, edema, fissures, blisters, inflamed areas, eschar, white patches, dark patches, yellow patches, peeling, pus, and ecchymosis. Subject-rated nipple pain.
Skin changes were identified and quantified. Changes were visible in 100% (20) of the sample, and 65% (13) had severe skin damage; 90% (18) of the subjects reported pain. Some correlations between skin characteristics and pain were statistically significant, but not clinically meaningful. Skin damage was concentrated on the tip of the nipple.
The data chronicle skin changes and their relationship to nipple pain during the 1st week of breastfeeding. Normal neonatal sucking appears to induce a suction wound on the skin of the nipples of many breastfeeding women that may account for pain experienced at the onset of lactation.
Nipple soreness is one reason why breastfeeding women wean their infants. This study examined the effectiveness of three topical agents--USP-modified lanolin, warm water compresses, and expressed breast milk with air drying--in alleviating nipple pain, and if early predictors of breastfeeding at six weeks could be determined.
One hundred seventy-seven breastfeeding, primiparous women were randomly assigned to one of four groups. All women received education about breastfeeding technique. Numeric rating scales were used to discriminate levels of pain intensity, pain affect, and strength of sucking on day 1. Participants were interviewed by telephone on postpartum days 4, 7, and 14, and during week 6 using the same scales.
No significant differences were found among groups for pain intensity, pain affect, or duration of breastfeeding. Results of a logistic regression indicated that older mothers and those who were exclusively breastfeeding (no supplemental feeding) were most likely to be breastfeeding six weeks postpartum. Raw scores supported the use of warm compresses.
Further investigation is required into ways of supporting young mothers and how caregivers provide support to breastfeeding mothers in the early weeks after childbirth.
Nipple soreness and nipple trauma have long been associated with breastfeeding, and persist despite the many clinical advancements in the field of lactation. Management of nipple wounds has been approached in a variety of ways over the years in an attempt to treat and resolve this problem. Incorporating the scientific principles of modern wound care management can provide additional effective treatment options. Wounds are characterized by depth and extent of tissue destruction, regardless of their location on the body. Current wound treatment methods employ the use of moisture to aid healing. A moist environment is critical for epithelization, the proliferation and migration of epithelial cells across the surface of a wound during healing. Nipple wounds also heal by this process. Using a particular type of wound dressing, a hydrogel sheet wound covering, on a nipple wound offers several advantages. These dressings help maintain a moist environment, decrease the chance of bacterial infection, are easy to use, and provide immediate pain relief.
Sore nipples in breast-feeding mothers are a common cause of premature weaning, and are difficult to treat owing to recurrent trauma and exposure to the infant's oral flora.
To compare the safety and efficacy of a hydrogel moist wound dressing (Elasto-gel, Southwest Technologies Inc, Baltimore, Md) with the use of breast shells and lanolin cream in the treatment of maternal sore nipples associated with breast-feeding.
Randomized controlled trial comparing the above treatments for sore nipples. Patients were seen for a maximum of 3 follow-up visits within 10 days, or until the resolution of symptoms.
The Maternal-Infant Lactation Center at the Mercy Hospital of Pittsburgh, Pittsburgh, Pa, a tertiary care teaching hospital in inner-city Pittsburgh.
A referred sample of 42 breast-feeding women who presented to the Maternal-Infant Lactation Center for the treatment of sore nipples. All patients with breast infection or chronic unrelated pain conditions were excluded from the study.
After informed consent, patients were randomized to receive either a hydrogel wound dressing or breast shells and lanolin. All patients underwent a history, physical examination of the infant and the mother's breasts, assessment of breast-feeding technique, and breast-feeding instruction.
The degree of pain on self-report questionnaires and the change in scores for physical examination, breast-feeding technique, and pain behaviors during breast-feeding.
Although both treatments, in association with instruction in breast-feeding technique, were effective, greater improvement was seen in the group using breast shells and lanolin. This reached statistical significance for physician-rated healing (P<.01) and self-reported pain (P<.05). There were significantly more infections in the dressing group (P<.05), which resulted in early discontinuation of the study.
Prevention of sore nipples by teaching proper technique on the initiation of breast-feeding should be instituted. For those cases in which sore nipples do develop, breast shells and lanolin in association with instruction in breast-feeding technique are more effective than moist wound dressings. Lanolin and shells should remain first-line therapy.
Antiseptics and disinfectants are extensively used in hospitals and other health care settings for a variety of topical and hard-surface applications. A wide variety of active chemical agents (biocides) are found in these products, many of which have been used for hundreds of years, including alcohols, phenols, iodine, and chlorine. Most of these active agents demonstrate broad-spectrum antimicrobial activity; however, little is known about the mode of action of these agents in comparison to antibiotics. This review considers what is known about the mode of action and spectrum of activity of antiseptics and disinfectants. The widespread use of these products has prompted some speculation on the development of microbial resistance, in particular whether antibiotic resistance is induced by antiseptics or disinfectants. Known mechanisms of microbial resistance (both intrinsic and acquired) to biocides are reviewed, with emphasis on the clinical implications of these reports.
This article identifies problems and conditions that contribute to nipple pain during lactation and that may lead to early cessation or noninitiation of breastfeeding. Signs and symptoms of poor latch-on and positioning, oral anomalies, and suckling disorders are reviewed. Diagnosis and treatment of infectious agents that may cause nipple pain are presented. Comfort measures for sore nipples and current treatment recommendations for nipple wound healing are discussed. Suggestions are made for incorporating in-depth breastfeeding content into midwifery education programs.
WHERE there is a superficial wound in the skin, new epidermis covers the denuded area by migration from the hair follicles and sweat gland ducts within the wound and from the surface epidermis at the wound edges. It has been found that epithelization is retarded by the dry scab which normally covers a superficial wound, and if the formation of the scab is prevented, the rate of epithelization is markedly increased.
Unlabelled:
The aim of the study was to assess the efficacy and side effects of purified lanolin (Lansinoh) in the prophylactics and treatment of sore nipples. Fifty-seven women aged 20-35 years have been treated - 41 (72%) with phototype III-IV and 16 (28%) with phototype I-II. Thirty-seven (65%) of them were primiparous and 20 (35%) were multiparous. Pre-delivery preparation of the breast has been performed in 16 (28%) of the women. Two groups of patients were formed: I gr. - 10 women (17,5%) with no complaints applying the preparation with preventive aim and II gr. - 47 (82,5%) women with sore nipples of different severity. Therapeutic efficacy was assessed according to the nipple attribute score. In the first group of patients due to the application of Lansinoh the skin remained smooth and elastic and breast-feeding was not disturbed. In the II group Lansinoh lead to a statistically significant difference in the nipple attribute score before and after treatment. The improvement was most pronounced in patients with light and moderate forms of inflammation, in women with phototype III-IV, in multipara and in patients with pre-delivery preparation of the breast.
Conclusion:
Lansinoh is purified lanolin suitable for prophylactics and treatment of sore nipples.
This review aims to explore the research available relating to three commonly used pain rating scales, the Visual Analogue Scale, the Verbal Rating Scale and the Numerical Rating Scale. The review provides information needed to understand the main properties of the scales.
Data generated from pain-rating scales can be easily misunderstood. This review can help clinicians to understand the main features of these tools and thus use them effectively.
A MedLine review via PubMed was carried out with no restriction of age of papers retrieved. Papers were examined for methodological soundness before being included. The search terms initially included pain rating scales, pain measurement, Visual Analogue Scale, VAS, Verbal Rating Scale, VRS, Numerical/numeric Rating Scale, NRS. The reference lists of retrieved articles were used to generate more papers and search terms. Only English Language papers were examined.
All three pain-rating scales are valid, reliable and appropriate for use in clinical practice, although the Visual Analogue Scale has more practical difficulties than the Verbal Rating Scale or the Numerical Rating Scale. For general purposes the Numerical Rating Scale has good sensitivity and generates data that can be statistically analysed for audit purposes. Patients who seek a sensitive pain-rating scale would probably choose this one. For simplicity patients prefer the Verbal Rating Scale, but it lacks sensitivity and the data it produces can be misunderstood.
In order to use pain-rating scales well clinicians need to appreciate the potential for error within the tools, and the potential they have to provide the required information. Interpretation of the data from a pain-rating scale is not as straightforward as it might first appear.
To review the literature on nipple pain and to delineate effective strategies for the prevention and treatment of nipple pain in breastfeeding mothers.
Computerized searches on MEDLINE, Pre-MEDLINE, CINAHL, and the Cochrane Library.
Articles from indexed journals relevant to the objective were reviewed from January 1983 to April 2004. Preference was given to research-based studies in English.
Data were extracted and organized under two headings: prevention of nipple pain or trauma and treatment of nipple pain or trauma. The Critical Appraisal Form by J. Briggs was used to extract the data from research-based articles.
The health benefits of breastfeeding for mother and infant are well documented; however, nipple pain is a common reason reported by women for the early termination of breastfeeding. Several studies have compared various treatments for either the prevention of or treatment for nipple pain. These treatments include warm water compresses, tea bag compresses, heat, application of expressed mother's milk, lanolin, vitamin A, collagenase, dexpanthenol, hydrogel therapy, glycerin gel therapy, moist occlusive dressing, education regarding proper latch-on and positioning, and no treatment.
No one topical agent showed superior results in the relief of nipple discomfort. The most important factor in decreasing the incidence of nipple pain is the provision of education in relation to proper breastfeeding technique and latch-on as well as anticipatory guidance regarding the high incidence of early postpartum nipple pain.
This prospective, randomized study compared protocols of care using either AQUACEL Ag Hydrofiber (ConvaTec, a Bristol-Myers Squibb company, Skillman, NJ) dressing with silver (n = 42) or silver sulfadiazine (n = 42) for up to 21 days in the management of partial-thickness burns covering 5% to 40% body surface area (BSA). AQUACEL Ag dressing was associated with less pain and anxiety during dressing changes, less burning and stinging during wear, fewer dressing changes, less nursing time, and fewer procedural medications. Silver sulfadiazine was associated with greater flexibility and ease of movement. Adverse events, including infection, were comparable between treatment groups. The AQUACEL Ag dressing protocol tended to have lower total treatment costs (Dollars 1040 vs. Dollars 1180) and a greater rate of re-epithelialization (73.8% vs 60.0%), resulting in cost-effectiveness per burn healed of Dollars 1,409.06 for AQUACEL Ag dressing and Dollars 1,967.95 for silver sulfadiazine. A protocol of care with AQUACEL(R) Ag provided clinical and economic benefits compared with silver sulfadiazine in patients with partial-thickness burns.
Dressings have a part to play in the management of wounds; whether they are sutured or open, usually chronic wounds of many aetiologies which are healing by secondary intention. They traditionally provide a moist wound environment, but this property has been extended through simple to complex, active dressings which can handle excessive exudate, aid in debridement, and promote disorganised, stalled healing. The control of infection remains a major challenge. Inappropriate antibiotic use risks allergy, toxicity and most importantly resistance, which is much reduced by the use of topical antiseptics (such as povidone iodine and chlorhexidine). The definition of what is an antimicrobial and the recognition of infection has proven difficult. Although silver has been recognised for centuries to inhibit infection its use in wound care is relatively recent. Evidence of the efficacy of the growing number of silver dressings in clinical trials, judged by the criteria of the Cochrane Collaboration, is lacking, but there are good indications for the use of silver dressings, to remove or reduce an increasing bioburden in burns and open wounds healing by secondary intention, or to act as a barrier against cross contamination of resistant organisms such as MRSA. More laboratory, and clinical data in particular, are needed to prove the value of the many silver dressings which are now available. Some confusion persists over the measurement of toxicity and antibacterial activity but all dressings provide an antibacterial action, involving several methods of delivery. Nanocrystalline technology appears to give the highest, sustained release of silver to a wound without clear risk of toxicity.