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Jin L, Ye H, Yang Y, Liu J, Li R, Zheng H. Treatment of lactational mastitis with Gualou Xiaoyong soup and painless lactation promoting technique: A case series. Medicine (Baltimore) 2023; 102:e36384. [PMID: 38050191 PMCID: PMC10695488 DOI: 10.1097/md.0000000000036384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 11/09/2023] [Indexed: 12/06/2023] Open
Abstract
BACKGROUND Lactational mastitis is a common and frequently disease in clinical practice, characterized by acute inflammation of the mammary ducts and surrounding connective tissues. The main manifestations are damage to the mammary gland acini, edema, and invasion of inflammatory cells. If not treated properly, it may lead to the formation of breast abscesses, or even sepsis, septic shock, and chronic inflammation of the breast, which may cause the disease to persist or recur multiple times, so that the patients suffer extreme pain, and the health of both the mother and child are directly affected. This disease not only causes suffering for women but also may result in the cessation of breastfeeding. Therefore, rapid and effective treatment is particularly important. CASE SUMMARY We report 3 cases of lactation mastitis patients showing good clinical efficacy after being treated with the Chinese medicine Gualou Xiaoyong soup and painless lactation promoting techniques. Gualou Xiaoyong soup combined with painless lactation promotion techniques can significantly reduce and eliminate the clinical symptoms of patients in the short term, and rapidly restore inflammatory indicators such as total white blood cells, neutrophils, C-reactive protein, and procalcitonin to normal levels. The patchy low echo area of the breast under B-ultrasound also disappears quickly. Therefore, we believe that this method is a good way to treat lactational mastitis and is worthy of clinical reference and research. However, this study has certain limitations: this study lacks a large sample of prospective controlled studies. Next, we will continue to collect relevant cases and conduct prospective case randomized controlled clinical studies. CONCLUSION The treatment of lactation mastitis with Gualou Xiaoyong soup and painless lactation promoting techniques can achieve good clinical results.
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Affiliation(s)
- Lihua Jin
- Department of Gynaecology and Obstetrics, The Second Affiliated Hospital of Zhejiang Chinese Medicine University, Hangzhou City, China
| | - Huijun Ye
- Department of Gynaecology and Obstetrics, The Second Affiliated Hospital of Zhejiang Chinese Medicine University, Hangzhou City, China
| | - Yi Yang
- Department of Gynaecology and Obstetrics, The Second Affiliated Hospital of Zhejiang Chinese Medicine University, Hangzhou City, China
| | - Jiali Liu
- Department of Gynaecology and Obstetrics, The Second Affiliated Hospital of Zhejiang Chinese Medicine University, Hangzhou City, China
| | - Ruilan Li
- Department of Gynaecology and Obstetrics, The Second Affiliated Hospital of Zhejiang Chinese Medicine University, Hangzhou City, China
| | - Huiling Zheng
- Department of Gynaecology and Obstetrics, The Second Affiliated Hospital of Zhejiang Chinese Medicine University, Hangzhou City, China
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Babakazo P, Bosonkie M, Mafuta E, Mvuama N, Mapatano MA. Common breastfeeding problems experienced by lactating mothers during the first six months in Kinshasa. PLoS One 2022; 17:e0275477. [PMID: 36223384 PMCID: PMC9555666 DOI: 10.1371/journal.pone.0275477] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 09/18/2022] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Breastfeeding has numerous advantages for infant, mother and society. However, many mothers discontinue breastfeeding due to problems they encounter. This study aimed to identify problems commonly experienced by breastfeeding mothers during the first six months in Kinshasa. METHODS A prospective cohort study was carried out in Kinshasa from October 2012 to July 2013. A total of 422 mother-infant couples were recruited shortly after being discharged from twelve maternity facilities in Kinshasa and followed-up for six months. Interviews were conducted at the mother's house during the first week after birth, and thereafter at monthly intervals for six months. Data included mother's sociodemographic characteristics, the breastfeeding problems she experienced and information on child's feeding. Incidences of breastfeeding problems encountered during different periods were calculated as well as their confidence intervals. RESULTS Cracked or sore nipples, insufficient production of milk and breast engorgement were the most commonly experienced problems by lactating mothers. The problems occurred mainly during the first week (17.1%; CI95% 13.7-21.1) and the rest of the first month (16.2%; CI95% 12.8-20.3). CONCLUSIONS The first month after birth presents the most risk for the occurrence of breastfeeding problems. Mothers should be supported as soon as possible after delivery, to improve their breastfeeding performance and to be informed on how to maintain breast milk supply.
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Affiliation(s)
- Pélagie Babakazo
- Kinshasa School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
- * E-mail: ,
| | - Marc Bosonkie
- Kinshasa School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Eric Mafuta
- Kinshasa School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Nono Mvuama
- Centre Mère et Enfant Barumbu, Kinshasa, Democratic Republic of the Congo
| | - Mala-Ali Mapatano
- Kinshasa School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
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3
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Douglas P. Re-thinking benign inflammation of the lactating breast: A mechanobiological model. WOMEN'S HEALTH (LONDON, ENGLAND) 2022; 18:17455065221075907. [PMID: 35156466 PMCID: PMC8848036 DOI: 10.1177/17455065221075907] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Despite the known benefits of breastfeeding for both infant and mother, clinical support for problems such as inflammation of the lactating breast remains a research frontier. Breast pain associated with inflammation is a common reason for premature weaning. Multiple diagnoses are used for inflammatory conditions of the lactating breast, such as engorgement, blocked ducts, phlegmon, mammary candidiasis, subacute mastitis, mastitis and white spots, which lack agreed or evidence-based aetiology, definitions and treatment. This is the first in a series of three articles which review the research literature concerning benign lactation-related breast inflammation. This article investigates aetiological models. A complex systems perspective is applied to analyse heterogeneous and interdisciplinary evidence elucidating the functional anatomy and physiology of the lactating breast; the mammary immune system, including the human milk microbiome and cellular composition; the effects of mechanical forces during lactation; and the interactions between these. This analysis gives rise to a mechanobiological model of breast inflammation, in which very high intra-alveolar and intra-ductal pressures are hypothesized to strain or rupture the tight junctions between lactocytes and ductal epithelial cells, triggering inflammatory cascades and capillary dilation. Resultant elevation of stromal tension exerts pressure on lactiferous ducts, worsening intraluminal backpressure. Rising leucocyte and epithelial cell counts in the milk and alterations in the milk microbiome are signs that the mammary immune system is recruiting mechanisms to downregulate inflammatory feedback loops. From a complex systems perspective, the key mechanism for the prevention or treatment of breast inflammation is avoidance of excessively high intra-alveolar and intra-ductal pressures, which prevents a critical mass of mechanical strain and rupture of the tight junctions between lactocytes and ductal epithelial cells.
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Affiliation(s)
- Pamela Douglas
- School of Nursing and Midwifery, Griffith University, Brisbane, QLD, Australia.,General Practice Clinical Unit, The University of Queensland, Brisbane, QLD, Australia.,Possums & Co., Brisbane, QLD, Australia
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Hussain NHN, Noor NM, Ismail SB, Zainuddin NA, Sulaiman Z. Metoclopramide for Milk Production in Lactating Women: A Systematic Review and Meta-Analysis. Korean J Fam Med 2021; 42:453-463. [PMID: 34871486 PMCID: PMC8648493 DOI: 10.4082/kjfm.20.0238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Accepted: 12/17/2020] [Indexed: 11/29/2022] Open
Abstract
Background Breastfeeding is recognized as the optimal form of nutrition for the physical and neurological development of infants and is considered the most significant way to prevent child mortality. This study aimed to assess the effectiveness of metoclopramide for enhancing milk production in lactating women. Methods We searched the Cochrane Central Register of Controlled Trials and MEDLINE for randomized controlled trials comparing metoclopramide with a placebo, no treatment, or other galactagogue drugs. We included breastfeeding women with term or preterm infants. Results We retrieved 164 records from our search of the electronic databases and 20 records from other sources. Eight trials involving 342 lactating women that used metoclopramide were included in this review after assessing the eligibility criteria. The meta-analysis of these trials revealed that metoclopramide did not increase the milk volume of the intervention groups compared to that of the control groups. There was a significant increase in the serum concentrations of prolactin when the mothers were administered metoclopramide. No significant adverse events were reported. Conclusion Metoclopramide did not improve milk production in lactating women. Therefore, we do not recommend using metoclopramide to increase milk production in lactating women.
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Affiliation(s)
- Nik Hazlina Nik Hussain
- Women's Health Development Unit, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, Malaysia
| | - Norhayati Mohd Noor
- Department of Family Medicine, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, Malaysia
| | - Shaiful Bahari Ismail
- Department of Family Medicine, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, Malaysia
| | - Nur Amirah Zainuddin
- Women's Health Development Unit, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, Malaysia
| | - Zaharah Sulaiman
- Women's Health Development Unit, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, Malaysia
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5
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Kam RL, Cullinane M, Amir LH. Research Challenges and Considerations in Investigating Rare Exposures Using Breast Hypoplasia as an Example. J Hum Lact 2021; 37:633-638. [PMID: 34382473 DOI: 10.1177/08903344211037620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Renee L Kam
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria, Australia
| | - Meabh Cullinane
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria, Australia
| | - Lisa H Amir
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria, Australia.,Breastfeeding Service, Royal Women's Hospital, Parkville, Victoria, Australia
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Affiliation(s)
- Lisa H Amir
- Breastfeeding Service, Royal Women's Hospital, Parkville, Australia
- Judith Lumley Centre, La Trobe University, Victoria, Australia
| | | | - Jayne R Charlamb
- Division of Breast Health & Breastfeeding Medicine, Department of Obstetrics & Gynecology, SUNY Upstate Medical University, Syracuse, NY, USA
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McBride GM, Stevenson R, Zizzo G, Rumbold AR, Amir LH, Keir AK, Grzeskowiak LE. Use and experiences of galactagogues while breastfeeding among Australian women. PLoS One 2021; 16:e0254049. [PMID: 34197558 PMCID: PMC8248610 DOI: 10.1371/journal.pone.0254049] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 06/19/2021] [Indexed: 02/05/2023] Open
Abstract
Background Galactagogues are substances thought to increase breast milk production, however evidence to support their efficacy and safety remain limited. We undertook a survey among Australian women to examine patterns of use of galactagogues and perceptions regarding their safety and effectiveness. Methods An online, cross-sectional survey was distributed between September and December 2019 via national breastfeeding and preterm birth support organisations, and networks of several research institutions in Australia. Women were eligible to participate if they lived in Australia and were currently/previously breastfeeding. The survey included questions about galactagogue use (including duration and timing), side effects and perceived effectiveness (on a scale of 1 [Not at all effective] to 5 [Extremely effective]). Results Among 1876 respondents, 1120 (60%) reported using one or more galactagogues. Women were 31.5 ± 4.8 years (mean ± standard deviation) at their most recent birth. Sixty-five percent of women were currently breastfeeding at the time of the survey. The most commonly reported galactagogues included lactation cookies (47%), brewer’s yeast (32%), fenugreek (22%) and domperidone (19%). The mean duration of use for each galactagogue ranged from 2 to 20 weeks. Approximately 1 in 6 women reported commencing galactagogues within the first week postpartum. Most women reported receiving recommendations to use herbal/dietary galactagogues from the internet (38%) or friends (25%), whereas pharmaceutical galactagogues were most commonly prescribed by General Practitioners (72%). The perceived effectiveness varied greatly across galactagogues. Perceived effectiveness was highest for domperidone (mean rating of 3.3 compared with 2.0 to 3.0 among other galactagogues). Over 23% of domperidone users reported experiencing multiple side effects, compared to an average of 3% of women taking herbal galactagogues. Conclusions This survey demonstrates that galactagogues use is common in Australia. Further research is needed to generate robust evidence about galactagogues’ efficacy and safety to support evidence-based strategies and improve breastfeeding outcomes.
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Affiliation(s)
- Grace M. McBride
- Adelaide Medical School, University of Adelaide, Adelaide, Australia
- The Robinson Research Institute, University of Adelaide, Adelaide, Australia
- South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Robyn Stevenson
- Adelaide Medical School, University of Adelaide, Adelaide, Australia
| | - Gabriella Zizzo
- Adelaide Medical School, University of Adelaide, Adelaide, Australia
| | - Alice R. Rumbold
- Adelaide Medical School, University of Adelaide, Adelaide, Australia
- The Robinson Research Institute, University of Adelaide, Adelaide, Australia
- South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Lisa H. Amir
- Judith Lumley Centre, La Trobe University, Melbourne, Australia
- Breastfeeding Service, Royal Women’s Hospital, Parkville, Australia
| | - Amy K. Keir
- Adelaide Medical School, University of Adelaide, Adelaide, Australia
- The Robinson Research Institute, University of Adelaide, Adelaide, Australia
- South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Luke E. Grzeskowiak
- Adelaide Medical School, University of Adelaide, Adelaide, Australia
- The Robinson Research Institute, University of Adelaide, Adelaide, Australia
- South Australian Health and Medical Research Institute, Adelaide, Australia
- SA Pharmacy, SA Health, Adelaide, Australia
- Flinders Health and Medical Research Institute, Flinders University, Adelaide, Australia
- * E-mail:
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8
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Colombari GC, Mariusso MR, Ercolin LT, Mazzoleni S, Stellini E, Ludovichetti FS. Relationship between Breastfeeding Difficulties, Ankyloglossia, and Frenotomy: A Literature Review. J Contemp Dent Pract 2021; 22:452-461. [PMID: 34267016 DOI: 10.5005/jp-journals-10024-3073] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVE Breastfeeding plays a key role in the development of the baby, in addition to the benefits to the mother and this dyad. Among the possible difficulties in this process, we have ankyloglossia. Some professionals opt for the frenotomy, although the literature is controversial. This paper aims to present how the literature provides subsidies for health professionals' decision and action in the intersection of the themes: breastfeeding, ankyloglossia, and frenotomy. MATERIALS AND METHODS The research on the platforms SciELO and PubMed used the terms: "ankyloglossia," "frenotomy," and "lingual frenulum" and the same ones associated with "breastfeeding." A specific inclusion and exclusion criteria were applied and validated by the American Speech-Language-Hearing Association to reduce any bias in the analysis. In the end, 16 papers were included and, by thematic equivalence, divided into two domains: association between lingual frenulum alteration and breastfeeding and between frenotomy and breastfeeding. RESULTS The literature does not assure that the frenotomy is the "standard conduct" to be adopted in cases of difficulty in breastfeeding and ankyloglossia. CONCLUSION Further studies are needed on the different types of ankyloglossia and their direct influence on the sucking function and lactation difficulties.
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Affiliation(s)
| | | | | | - Sergio Mazzoleni
- Department of Neurosciences, Dentistry Section, University of Padova, Padova, Italy
| | - Edoardo Stellini
- Department of Neurosciences, Dentistry Section, University of Padova, Padova, Italy
| | - Francesco S Ludovichetti
- Department of Neurosciences, Dentistry Section, University of Padova, Padova, Italy, Phone: +39 3408573561, e-mail:
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Jiménez Gómez MI, Meneses Monroy A, Corrillero Martín J, Santana Gutierrez S, Rodríguez Martín R, Girón Daviña PR. Prevalence of Nipple Soreness at 48 Hours Postpartum. Breastfeed Med 2021; 16:325-331. [PMID: 33493005 DOI: 10.1089/bfm.2020.0112] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background: Although most women start breastfeeding after delivery, difficulties often arise. One of the main reasons is nipple soreness, which contributes greatly to early cessation of breastfeeding. A soreness evaluation through validated scales, performed by health care professionals during the first few days, can contribute to improve breastfeeding and support for the mothers. Research Aim: Knowing the prevalence of nipple soreness during breastfeeding at 48 hours postpartum at the Infanta Cristina University Hospital (Madrid, Spain) through a cross-sectional descriptive study. Materials and Methods: The study took place between February and March 2019. A survey of 58 postpartum second day mothers was conducted including the Visual Analogue Scale (VAS) and Lactation Assessment Scale (LATCH) score for breastfeeding assessment. A descriptive analysis of secondary variables and subsequent bivariate inferential was performed for 95% confidence interval (CI). Results: The prevalence of nipple soreness observed is 97% (95% CI = 92-100%). It was found, significantly (p = 0.001), that the higher the score on LATCH, the lower the score on VAS and therefore the less pain. We found a relationship between women who were in skin-to-skin contact with their babies for 2 hours without interruption after birth and a higher pain score (p = 0.046). No other associations were found between VAS and other variables such as parity, type of birth, artificial milk supplements for the newborn, or using a pacifier. Conclusions: The high percentage of nipple soreness detected highlights that breastfeeding can be unpleasant in the first days after delivery. It is important to include in clinical practice the assessment of nipple soreness and the effectiveness of breastfeeding using validated scales.
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Affiliation(s)
| | - Alfonso Meneses Monroy
- Nursing Department, Faculty of Nursing, Physiotherapy and Podiatry, Complutense University of Madrid, Madrid, Spain
| | | | | | - Rocío Rodríguez Martín
- Department of Obstetrics and Maternity, Infanta Cristina University Hospital, Madrid, Spain
| | - Pedro Ramón Girón Daviña
- Statistics and Data Science Department, Faculty of Statistical Studies, Complutense University of Madrid, Madrid, Spain
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Wang Z, Liu Q, Min L, Mao X. The effectiveness of the laid-back position on lactation-related nipple problems and comfort: a meta-analysis. BMC Pregnancy Childbirth 2021; 21:248. [PMID: 33761882 PMCID: PMC7992330 DOI: 10.1186/s12884-021-03714-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 03/15/2021] [Indexed: 01/24/2023] Open
Abstract
Background The importance of breastfeeding for maternal and child health is agreed upon worldwide. However, lactation-related nipple problems are common and are important factors affecting breastfeeding. Multiple studies recommended laid-back breastfeeding, but they are of various levels of quality, and the results are inconclusive. Methods We systematically searched the following twelve databases from inception to January 28,2020: Cochrane Library, EMBASE, Medline, Ovid, PubMed, Web of Science, CINAHL, Scopus, Chinese National Knowledge Infrastructure (CNKI), China Biology Medicine disc (CBM), WanFang, and VIP. All studies regarding laid-back breastfeeding or biological nurturing were considered, regardless of whether they were randomized controlled trials. Two trained investigators independently evaluated the quality of the selected articles and screened the data. All the data were analysed separately using Review Manager Version 5.3 and STATA/SE Version 15.1. Results A total of 12 studies involving 1936 groups of postpartum women and their newborns were included. The results of the meta-analysis showed that nipple pain (RR = 0.24; 95% CI 0.14, 0.40; p < 0.00001), nipple trauma (RR = 0.47; 95% CI 0.29, 0.75; p = 0.002) and correct latching position (RR = 1.22; 95% CI 1.11, 1.33; p < 0.0001) in the experimental groups were all better than those of the control groups, and the differences were statistically significant (p < 0.05), which indicates that the laid-back position has a positive effect on maternal breastfeeding. However, the results of position comfort showed that there was no statistical significance between the two groups (ES = 0.09; 95% CI -0.63, 0.81; p = 0.798). Conclusion Compared with traditional breastfeeding positions, the laid-back position has been proven to be related to a decreased incidence of nipple pain and nipple trauma and is seemingly conducive to the use of the correct latching position. It is suggested that the laid-back position is helpful in solving lactation-related nipple problems and can be recommended as a position for breastfeeding. However, no significant difference in position comfort was found between the two groups based on the current evidence, and further studies are still needed to validate these results due to the limitations of the included studies. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-021-03714-8.
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Affiliation(s)
- Zhi Wang
- School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Qiuyue Liu
- School of Nursing, North Sichuan Medical College, Nanchong, Sichuan, China
| | - Lihua Min
- Department of Nursing, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, Sichuan, China.
| | - Xiaorong Mao
- Department of Nursing, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, Sichuan, China.
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Bawazir O, Bawazir A, Bawazir R, Bawazir F, Halabi N. Experiences and outcomes of frenotomy in children with ankyloglossia in multiple tertiary centers in Saudi Arabia. J Clin Neonatol 2021. [DOI: 10.4103/jcn.jcn_151_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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12
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Pereira NM, Maresh A. Trends in outpatient intervention for pediatric ankyloglossia. Int J Pediatr Otorhinolaryngol 2020; 138:110386. [PMID: 33152977 DOI: 10.1016/j.ijporl.2020.110386] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 09/12/2020] [Accepted: 09/12/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Anecdotally, there has been an increase in ankyloglossia referrals and frenotomy procedures performed in recent years. Many studies have characterized frenotomy indications and outcomes, but none have quantified how the frequency of referrals and interventions have changed over time in the outpatient setting. This study analyzes temporal trends in the diagnosis and intervention of ankyloglossia in a pediatric otolaryngology practice to further clarify how patterns of management of this condition have changed over time. METHODS This study was a retrospective chart review of patients evaluated for ankyloglossia in an outpatient pediatric otolaryngology clinic between 2008 and 2018. The chi-square test for trend was used to assess yearly changes in the referral numbers, surgical interventions, and procedure indication prevalence proportions of interest. RESULTS Referral numbers and frenotomy procedures increased as a percentage of total office visits from 2008 to 2018 (P = 0.0026, P < 0.0001). The trend in frenotomies was especially pronounced in the 0 to 2-month age group (P < 0.0001) but was not observed in the 2 months to 1-year (P = 0.30) or 1- to 4-year (P = 0.40) age groups. Frenotomy performed for concerns of feeding (P < 0.0001) increased over the study period, but there was no significant increase in procedures performed for speech concerns (P = 0.13). CONCLUSION Significant increases in referrals for frenotomy and number of frenotomy procedures performed are demonstrated, especially in young infants for feeding concerns. It is unlikely representative of a true increase in the incidence of ankyloglossia, but rather the result of cultural and clinical factors driving referrals and intervention.
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Affiliation(s)
- Nicola M Pereira
- Weill Cornell Medical College, 1300 York Ave., New York, NY, USA.
| | - Alison Maresh
- Department of Otolaryngology - Head and Neck Surgery, Weill Cornell Medicine, 1305 York Ave, 5th Floor, New York, NY, USA.
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13
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Kent JC, Ashton E, Hardwick CM, Rea A, Murray K, Geddes DT. Causes of perception of insufficient milk supply in Western Australian mothers. MATERNAL AND CHILD NUTRITION 2020; 17:e13080. [PMID: 32954674 PMCID: PMC7729526 DOI: 10.1111/mcn.13080] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 07/28/2020] [Accepted: 09/02/2020] [Indexed: 01/11/2023]
Abstract
A perception of insufficient milk supply (PIMS) is associated with early discontinuation of breastfeeding. Ideally, an objective measure of milk supply would either dispel or confirm this perception and provide reassurance or guide professional advice. Clinical signs of sufficient milk intake (steady growth, sufficient elimination, infant alertness and breasts feeling full before breastfeeds and soft after breastfeeds) should provide confidence in milk supply. We surveyed 423 mothers in early lactation who had breastfeeding problems to determine the proportion that had PIMS and to determine if the mothers with PIMS relied on these clinical signs or other perceptions of their infants' behaviour as indications of insufficient milk supply. By 3 weeks after birth, we found that the rate of PIMS among mothers with breastfeeding problems was 44%. Supplementary infant formula was being given to 66% of the infants, so the clinical indications were that milk intake was sufficient, but 74% of the mothers with PIMS cited concerns that their infants did not appear satisfied after breastfeeds. After targeted advice from lactation consultants, mothers with PIMS showed positive changes in their perceptions of their milk supply, underlining the value of professional guidance soon after birth. We conclude that an appearance of infant dissatisfaction is the major cause of PIMS in Western Australia.
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Affiliation(s)
- Jacqueline Coral Kent
- School of Molecular Sciences, The University of Western Australia, Crawley, Western Australia, Australia
| | - Elizabeth Ashton
- Breastfeeding Centre of WA, King Edward Memorial Hospital for Women, Subiaco, Western Australia, Australia
| | - Catherine Meria Hardwick
- Breastfeeding Centre of WA, King Edward Memorial Hospital for Women, Subiaco, Western Australia, Australia
| | - Alethea Rea
- College of Science, Engineering and Education, Murdoch University, Murdoch, Western Australia, Australia
| | - Kevin Murray
- Population and Public Health, The University of Western Australia, Crawley, Western Australia, Australia
| | - Donna Tracy Geddes
- School of Molecular Sciences, The University of Western Australia, Crawley, Western Australia, Australia
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14
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Mitchell KB, Johnson HM. Breast Pathology That Contributes to Dysfunction of Human Lactation: a Spotlight on Nipple Blebs. J Mammary Gland Biol Neoplasia 2020; 25:79-83. [PMID: 32495215 DOI: 10.1007/s10911-020-09450-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 05/21/2020] [Indexed: 01/19/2023] Open
Abstract
Nipple blebs are blister-like fibrinous lesions that form on the surface of the nipple during lactation, and can result in orifice obstruction and mastitis. They likely result from superficial extension of underlying ductal plugging, and can present concurrently with hyperlactation and mammary dysbiosis. Despite their prevalence, few formal reports on nipple blebs exist. In this perspective, we review the experience of a breastfeeding medicine practice that receives referrals for patients with nipple blebs, and provide preliminary insight into etiology, management, and outcomes of these lesions.
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Affiliation(s)
- Katrina B Mitchell
- Surgical Oncology, Ridley-Tree Cancer Center, Sansum Clinic, 540 W. Pueblo Street, Santa Barbara, CA, 93105, USA.
| | - Helen M Johnson
- Department of Surgery, Brody School of Medicine, East Carolina University, 600 Moye Boulevard, Greenville, NC, 27834, USA
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15
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Affiliation(s)
- Loretta Anderson
- Evidence in Practice Unit, Mater Misericordiae Limited and The Queensland Centre for Evidence Based Nursing and Midwifery: a Joanna Briggs Institute Centre of Excellence, Brisbane, Australia; Mater Research Institute and School of Nursing, Midwifery and Social Work, University of Queensland, Brisbane, Australia
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Anderson L, Kynoch K, Kildea S, Lee N. Effectiveness of breast massage for the treatment of women with breastfeeding problems. ACTA ACUST UNITED AC 2019; 17:1668-1694. [DOI: 10.11124/jbisrir-2017-003932] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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17
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Grzeskowiak LE, Wlodek ME, Geddes DT. What Evidence Do We Have for Pharmaceutical Galactagogues in the Treatment of Lactation Insufficiency?-A Narrative Review. Nutrients 2019; 11:nu11050974. [PMID: 31035376 PMCID: PMC6567188 DOI: 10.3390/nu11050974] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 04/23/2019] [Accepted: 04/24/2019] [Indexed: 11/23/2022] Open
Abstract
Inadequate breast milk supply is a frequently reported reason for early discontinuation of breastfeeding and represents a critical opportunity for intervening to improve breastfeeding outcomes. For women who continue to experience insufficient milk supply despite the utilisation of non-pharmacological lactation support strategies, pharmacological intervention with medications used to augment lactation, commonly referred to as galactagogues, is common. Galactagogues exert their pharmacological effects through altering the complex hormonal milieu regulating lactation, particularly prolactin and oxytocin. This narrative review provides an appraisal of the existing evidence regarding the efficacy and safety of pharmaceutical treatments for lactation insufficiency to guide their use in clinical practice. The greatest body of evidence surrounds the use of domperidone, with studies demonstrating moderate short-term improvements in breast milk supply. Evidence regarding the efficacy and safety of metoclopramide is less robust, but given that it shares the same mechanism of action as domperidone it may represent a potential treatment alternative where domperidone is unsuitable. Data on remaining interventions such as oxytocin, prolactin and metformin is too limited to support their use in clinical practice. The review provides an overview of key evidence gaps and areas of future research, including the impacts of pharmaceutical galactagogues on breast milk composition and understanding factors contributing to individual treatment response to pharmaceutical galactagogues.
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Affiliation(s)
- Luke E Grzeskowiak
- Adelaide Medical School, Robinson Research Institute, The University of Adelaide, Adelaide, SA 5005, Australia.
- SA Pharmacy, Flinders Medical Centre, SA Health, Bedford Park, Adelaide, SA 5042, Australia.
| | - Mary E Wlodek
- Department of Physiology, The University of Melbourne, Melbourne, VIC 3010, Australia.
| | - Donna T Geddes
- School of Molecular Sciences, The University of Western Australia, Crawley, Perth, WA 6009, Australia.
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18
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The effect of a single irradiation of low-level laser on nipple pain in breastfeeding women: a randomized controlled trial. Lasers Med Sci 2019; 35:63-69. [DOI: 10.1007/s10103-019-02786-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 04/10/2019] [Indexed: 01/25/2023]
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19
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Lebedevs T, Kendrick C. Pharmacological management of common lactation problems. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2019. [DOI: 10.1002/jppr.1561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Tamara Lebedevs
- Pharmacy Department Women and Newborn Health Service King Edward Memorial Hospital Perth Australia
| | - Claire Kendrick
- Pharmacy Department Women and Newborn Health Service King Edward Memorial Hospital Perth Australia
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20
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Lucas R, Bernier K, Perry M, Evans H, Ramesh D, Young E, Walsh S, Starkweather A. Promoting self-management of breast and nipple pain in breastfeeding women: Protocol of a pilot randomized controlled trial. Res Nurs Health 2019; 42:176-188. [PMID: 30835887 DOI: 10.1002/nur.21938] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 01/10/2019] [Accepted: 02/07/2019] [Indexed: 11/05/2022]
Abstract
The majority of women experience pain during breastfeeding initiation with few strategies to manage breast and nipple pain. In fact, women cite breast and nipple pain as among the most common reasons for breastfeeding cessation. To address this important issue, we developed a breastfeeding self-management (BSM) intervention, based on the Individual and Family Self-Management Theory Framework. In this framework, self-management is conceptualized as a process in which women use knowledge, beliefs, and social facilitation to achieve breastfeeding goals. The purpose of this longitudinal pilot randomized controlled trial was to test the feasibility, acceptability, and preliminary efficacy of the BSM intervention with women initiating breastfeeding. Recruitment of 60 women intending to breastfeed occurred within 48 hr of delivery and women were randomized to either the intervention or usual care group. The BSM intervention group received BSM education modules that included information of how to manage breast and nipple pain and self-management support through biweekly texting from the study nurse, and were asked to complete a daily breastfeeding journal. Primary outcomes measured at baseline, 1, 2, and 6 weeks will be used to (a) evaluate feasibility, acceptability, and preliminary efficacy of the BSM intervention, and (b) assess the influence of protective and risk factors of breastfeeding pain (including individual genetic polymorphisms related to pain sensitivity) on process variables for self-management of breastfeeding and breastfeeding pain, and on proximal (breastfeeding pain severity and interference, breastfeeding frequency) and distal outcomes (breastfeeding exclusivity and duration and general well-being).
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Affiliation(s)
- Ruth Lucas
- School of Nursing, University of Connecticut, Storrs, Connecticut.,P20 Center for Accelerating Precision Pain Self-Management, School of Nursing, University of Connecticut, Storrs, Connecticut
| | | | - Mallory Perry
- School of Nursing, University of Connecticut, Storrs, Connecticut
| | - Heather Evans
- Family Birthing Center, Manchester Memorial Hospital, Manchester, Connecticut.,Department of Nursing, University of Saint Joseph, West Hartford, Connecticut
| | - Divya Ramesh
- School of Nursing, University of Connecticut, Storrs, Connecticut.,P20 Center for Accelerating Precision Pain Self-Management, School of Nursing, University of Connecticut, Storrs, Connecticut
| | - Erin Young
- School of Nursing, University of Connecticut, Storrs, Connecticut.,P20 Center for Accelerating Precision Pain Self-Management, School of Nursing, University of Connecticut, Storrs, Connecticut
| | - Stephen Walsh
- School of Nursing, University of Connecticut, Storrs, Connecticut.,P20 Center for Accelerating Precision Pain Self-Management, School of Nursing, University of Connecticut, Storrs, Connecticut
| | - Angela Starkweather
- School of Nursing, University of Connecticut, Storrs, Connecticut.,P20 Center for Accelerating Precision Pain Self-Management, School of Nursing, University of Connecticut, Storrs, Connecticut
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21
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Coca KP, Amir LH, Alves MDRDS, Barbieri M, Marcacine KO, Abrão ACF. Measurement tools and intensity of nipple pain among women with or without damaged nipples: A quantitative systematic review. J Adv Nurs 2019; 75:1162-1172. [DOI: 10.1111/jan.13908] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 09/04/2018] [Accepted: 09/20/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Kelly Pereira Coca
- Judith Lumley Centre La Trobe University Melbourne Victoria Australia
- Department of Nursing Woman's Health Universidade Federal de São Paulo São Paulo Brazil
| | - Lisa H. Amir
- Judith Lumley Centre La Trobe University Melbourne Victoria Australia
- Breastfeeding Service Royal Women's Hospital Parkville, Melbourne Victoria Australia
| | | | - Márcia Barbieri
- Department of Nursing Woman's Health Universidade Federal de São Paulo São Paulo Brazil
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22
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Hurst CG, Reno R, Lefmann T. Committing to Breastfeeding in Social Work. SOCIAL WORK 2018; 63:252-260. [PMID: 29718477 DOI: 10.1093/sw/swy028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2017] [Accepted: 12/11/2017] [Indexed: 06/08/2023]
Abstract
This article addresses the importance of breastfeeding for the social work profession. Because breastfeeding is a critical component of maternal and child health, persistent racial and socioeconomic breastfeeding inequality is a social justice issue in need of social work commitment. Even while breastfeeding rates have been increasing in the United States there are some groups of mothers who initiate breastfeeding less frequently or have trouble with sustaining breastfeeding for recommended lengths. These mothers and their babies thus miss out on the ample benefits of this nurturing interaction. Using social work's unique disciplinary perspective and commitment to social justice, the authors place essential understanding of breastfeeding health benefits within the core values of the National Association of Social Work ethical code. The practice context for early breastfeeding intervention with mothers and families is discussed with acknowledgment of the maternal-child health focus at the root of the profession. Recognition of the potential of contemporary social work to advance breastfeeding equity through practice, scholarship, and action positions breastfeeding support activities as integral to meeting the grand challenges of the social work profession.
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Affiliation(s)
- Carol Grace Hurst
- Carol Grace Hurst, PhD, is associate professor and program director of social work, Applied Social Sciences, Eastern Mennonite University, 1200 Park Road, Harrisonburg, VA; e-mail: . Rebecca Reno, PhD, is maternal child health postdoctoral fellow, School of Public Health, University of California, Berkeley. Tess Lefmann, PhD, is assistant professor, Department of Social Work, School of Applied Sciences, University of Mississippi, University
| | - Rebecca Reno
- Carol Grace Hurst, PhD, is associate professor and program director of social work, Applied Social Sciences, Eastern Mennonite University, 1200 Park Road, Harrisonburg, VA; e-mail: . Rebecca Reno, PhD, is maternal child health postdoctoral fellow, School of Public Health, University of California, Berkeley. Tess Lefmann, PhD, is assistant professor, Department of Social Work, School of Applied Sciences, University of Mississippi, University
| | - Tess Lefmann
- Carol Grace Hurst, PhD, is associate professor and program director of social work, Applied Social Sciences, Eastern Mennonite University, 1200 Park Road, Harrisonburg, VA; e-mail: . Rebecca Reno, PhD, is maternal child health postdoctoral fellow, School of Public Health, University of California, Berkeley. Tess Lefmann, PhD, is assistant professor, Department of Social Work, School of Applied Sciences, University of Mississippi, University
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23
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Hughes K, Watson CJ. The Mammary Microenvironment in Mastitis in Humans, Dairy Ruminants, Rabbits and Rodents: A One Health Focus. J Mammary Gland Biol Neoplasia 2018; 23:27-41. [PMID: 29705830 PMCID: PMC5978844 DOI: 10.1007/s10911-018-9395-1] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Accepted: 04/12/2018] [Indexed: 12/18/2022] Open
Abstract
The One Health concept promotes integrated evaluation of human, animal, and environmental health questions to expedite advances benefiting all species. A recognition of the multi-species impact of mastitis as a painful condition with welfare implications leads us to suggest that mastitis is an ideal target for a One Health approach. In this review, we will evaluate the role of the mammary microenvironment in mastitis in humans, ruminants and rabbits, where appropriate also drawing on studies utilising laboratory animal models. We will examine subclinical mastitis, clinical lactational mastitis, and involution-associated, or dry period, mastitis, highlighting important anatomical and immunological species differences. We will synthesise knowledge gained across different species, comparing and contrasting disease presentation. Subclinical mastitis (SCM) is characterised by elevated Na/K ratio, and increased milk IL-8 concentrations. SCM affecting the breastfeeding mother may result in modulation of infant mucosal immune system development, whilst in ruminants notable milk production losses may ensue. In the case of clinical lactational mastitis, we will focus on mastitis caused by Staphylococcus aureus and Escherichia coli. Understanding of the pathogenesis of involution-associated mastitis requires characterization of the structural and molecular changes occurring during involution and we will review these changes across species. We speculate that milk accumulation may act as a nidus for infection, and that the involution 'wound healing phenotype' may render the tissue susceptible to bacterial infection. We will discuss the impact of concurrent pregnancy and a 'parallel pregnancy and involution signature' during bovine mammary involution.
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Affiliation(s)
- Katherine Hughes
- Department of Veterinary Medicine, University of Cambridge, Madingley Road, Cambridge, CB3 0ES, UK.
| | - Christine J Watson
- Department of Pathology, University of Cambridge, Tennis Court Road, Cambridge, CB2 1QP, UK
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Billington J, Yardley I, Upadhyaya M. Long-term efficacy of a tongue tie service in improving breast feeding rates: A prospective study. J Pediatr Surg 2018; 53:286-288. [PMID: 29248165 DOI: 10.1016/j.jpedsurg.2017.11.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Accepted: 11/08/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Breast feeding rates in England at 3months of age are approximately 17% for exclusive breast-feeding and 55% for breast-feeds supplemented with formula. Tongue-tie (TT) in infants is cited as a significant cause of difficulty with maintaining breast-feeding. Early treatment and support can improve breast-feeding and allow infants to benefit from the many long-term benefits of breast-feeding. Our aim was to determine BF rates in infants 3months after attending our tongue-tie clinic (TTC). METHODS Institutional ethical approval and study approval were obtained. Patients attending the TTC from May to July 2016 were included. Telephone contact was made 3months postprocedure to establish current behaviour. Symptom resolution was recorded as complete resolution (CR), moderate resolution (MoR), or minimal resolution (MiR). Feeding pattern was either exclusively BF or combined breast and formula feeds or exclusively formula fed. RESULTS 100 infants were included with complete follow-up data on 87 (87% response rate). Median age at release of TT was 17 (2-88) days without any recurrence. Status at 3months was CR (n=70, 80%); MoR (n=13, 15%), and MiR (n=4, 5%). 43 (49%) were exclusively BF, 36 (41%) were supplementing BF with some formula (2/3 by choice and 1/3 owing to insufficient milk production), and 8 (10%) were using only formula milk (7 by choice and 2 owing to ongoing feeding difficulties). Of the 17 mothers still experiencing symptoms, 5 were exclusively breast-feeding, and 8 were persisting with combined feeds. CONCLUSION Infants attending our tongue-tie clinic achieved both higher exclusive breastfeeding and combined breast and bottle-feeding when compared to national breast-feeding data at 3months of age. This can facilitate the achievement of long-term breastfeeding, exposing infants and mothers to many of the associated benefits. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- Jennifer Billington
- Department of Paediatric Surgery, Evelina Children's Hospital, Westminster Bridge Road, London, UK
| | - Iain Yardley
- Department of Paediatric Surgery, Evelina Children's Hospital, Westminster Bridge Road, London, UK.
| | - Manasvi Upadhyaya
- Department of Paediatric Surgery, Evelina Children's Hospital, Westminster Bridge Road, London, UK
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Anderson L, Kynoch K, Kildea S. Effectiveness of breast massage in the treatment of women with breastfeeding problems. ACTA ACUST UNITED AC 2016; 14:19-25. [DOI: 10.11124/jbisrir-2016-003058] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Amir LH, Griffin L, Cullinane M, Garland SM. Probiotics and mastitis: evidence-based marketing? Int Breastfeed J 2016; 11:19. [PMID: 27446229 PMCID: PMC4955247 DOI: 10.1186/s13006-016-0078-5] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Accepted: 07/04/2016] [Indexed: 11/25/2022] Open
Abstract
Probiotics are defined as live micro-organisms, which when administered in adequate amounts, confer health benefits on the host. Scientists have isolated various strains of Lactobacilli from human milk (such as Lactobacillus fermentum and Lactobacillus salivarius), and the presence of these organisms is thought to be protective against breast infections, or mastitis. Trials of probiotics for treating mastitis in dairy cows have had mixed results: some successful and others unsuccessful. To date, only one trial of probiotics to treat mastitis in women and one trial to prevent mastitis have been published. Although trials of probiotics to prevent mastitis in breastfeeding women are still in progress, health professionals in Australia are receiving marketing of these products. High quality randomised controlled trials are needed to assess the effectiveness of probiotics for the prevention and/or treatment of mastitis.
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Affiliation(s)
- Lisa H Amir
- Judith Lumley Centre, La Trobe University, Melbourne, VIC Australia
| | - Laura Griffin
- La Trobe Law School, La Trobe University, Bundoora, VIC Australia
| | - Meabh Cullinane
- Judith Lumley Centre, La Trobe University, Melbourne, VIC Australia
| | - Suzanne M Garland
- Department of Microbiology and Infectious Diseases, Western Pacific Regional HPV Reference Laboratory, Royal Women's Hospital, Parkville, VIC Australia ; Department of Infectious Diseases and Microbiology, Murdoch Childrens Research Institute, Melbourne, Australia ; Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, VIC Australia
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Logan C, Zittel T, Striebel S, Reister F, Brenner H, Rothenbacher D, Genuneit J. Changing Societal and Lifestyle Factors and Breastfeeding Patterns Over Time. Pediatrics 2016; 137:peds.2015-4473. [PMID: 27244822 DOI: 10.1542/peds.2015-4473] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/10/2016] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Breastfeeding is an important determinant of early infant immune function and potentially future health. Although numerous studies have reported rising breastfeeding initiation rates and duration, few longitudinally investigated the impact of shifting societal and lifestyle factors on breastfeeding patterns in developed nations. METHODS The Ulm Birth Cohort Study (UBCS) and Ulm SPATZ Health Study (SPATZ) cohorts consist of newborns and their mothers recruited, respectively, from 2000 to 2001 and 2012 to 2013 at the University Medical Center Ulm, Germany. Cox proportional hazards models were used to estimate crude and mutually adjusted hazard ratios for study effect (time trend) and individual risk factors on noninitiation and duration of predominant and total breastfeeding. RESULTS Compared with UBCS mothers, SPATZ mothers had lower cessation rates of both predominant breastfeeding by 4 months and total breastfeeding by 6 months: hazard ratio (95% confidence interval) 0.79 (0.67-0.93) and 0.71 (0.60-0.82), respectively. However, this crude time trend was limited to mothers with higher educational achievement. Similar time trend effects were observed among less educated mothers only after adjustment for early cessation risk factors. Mutually adjusted hazard ratios for individual risk factors were similar in both studies: low education, high BMI, smoking within 6 weeks of delivery, and cesarean delivery were associated with early breastfeeding cessation beginning at 6 weeks. In addition, actively abstaining from drinking alcohol was associated with lower rates of early cessation. CONCLUSIONS Our results suggest widening socioeconomic disparity in breastfeeding and potentially subsequent child health, which may require new targeted interventions.
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Affiliation(s)
- Chad Logan
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Tatjana Zittel
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Stefanie Striebel
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Frank Reister
- Department of Gynecology and Obstetrics, University Medical Center Ulm, Ulm, Germany; and
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany
| | | | - Jon Genuneit
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
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Cullinane M, Amir LH, Donath SM, Garland SM, Tabrizi SN, Payne MS, Bennett CM. Determinants of mastitis in women in the CASTLE study: a cohort study. BMC FAMILY PRACTICE 2015; 16:181. [PMID: 26674724 PMCID: PMC4681172 DOI: 10.1186/s12875-015-0396-5] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 12/09/2015] [Indexed: 11/10/2022]
Abstract
BACKGROUND Mastitis is an acute, debilitating condition that occurs in approximately 20 % of breastfeeding women who experience a red, painful breast with fever. This paper describes the factors correlated with mastitis and investigates the presence of Staphylococcus aureus in women who participated in the CASTLE (Candida and Staphylococcus Transmission: Longitudinal Evaluation) study. The CASTLE study was a prospective cohort study which recruited nulliparous women in late pregnancy in two maternity hospitals in Melbourne, Australia in 2009-2011. METHODS Women completed questionnaires at recruitment and six time-points in the first eight weeks postpartum. Postpartum questionnaires asked about incidences of mastitis, nipple damage, milk supply, expressing practices and breastfeeding problems. Nasal and nipple swabs were collected from mothers and babies, as well as breast milk samples. All samples were cultured for S. aureus. "Time at risk" of mastitis was defined as days between birth and first occurrence of mastitis (for women who developed mastitis) and days between birth and the last study time-point (for women who did not develop mastitis). Risk factors for incidence of mastitis occurring during the time at risk (Incident Rate Ratios [IRR]) were investigated using a discrete version of the multivariable proportional hazards regression model. RESULTS Twenty percent (70/346) of participants developed mastitis. Women had an increased risk of developing mastitis if they reported nipple damage (IRR 2.17, 95 % CI 1.21, 3.91), over-supply of breast milk (IRR 2.60, 95 % CI 1.58, 4.29), nipple shield use (IRR 2.93, 95 % CI 1.72, 5.01) or expressing several times a day (IRR 1.64, 95 % CI 1.01, 2.68). The presence of S. aureus on the nipple (IRR 1.72, 95 % CI 1.04, 2.85) or in milk (IRR 1.78, 95 % CI 1.08, 2.92) also increased the risk of developing mastitis. CONCLUSIONS Nipple damage, over-supply of breast milk, use of nipple shields and the presence of S. aureus on the nipple or in breast milk increased the mastitis risk in our prospective cohort study sample. Reducing nipple damage may help reduce maternal breast infections.
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Affiliation(s)
- Meabh Cullinane
- Judith Lumley Centre (formerly Mother & Child Health Research), La Trobe University, Melbourne, VIC, 3000, Australia.
| | - Lisa H Amir
- Judith Lumley Centre (formerly Mother & Child Health Research), La Trobe University, Melbourne, VIC, 3000, Australia.
| | - Susan M Donath
- Murdoch Childrens Research Institute, The Royal Children's Hospital, Parkville, VIC, 3052, Australia. .,University of Melbourne Department of Paediatrics, The Royal Children's Hospital, Parkville, VIC, 3052, Australia.
| | - Suzanne M Garland
- Murdoch Childrens Research Institute, The Royal Children's Hospital, Parkville, VIC, 3052, Australia. .,Women's Centre for Infectious Diseases, Royal Women's Hospital, Parkville, VIC, 3052, Australia. .,University of Melbourne Department of Obstetrics and Gynaecology, The Royal Women's Hospital, Parkville, VIC, 3052, Australia.
| | - Sepehr N Tabrizi
- Murdoch Childrens Research Institute, The Royal Children's Hospital, Parkville, VIC, 3052, Australia. .,Women's Centre for Infectious Diseases, Royal Women's Hospital, Parkville, VIC, 3052, Australia. .,University of Melbourne Department of Obstetrics and Gynaecology, The Royal Women's Hospital, Parkville, VIC, 3052, Australia.
| | - Matthew S Payne
- School of Women's and Infants' Health, University of Western Australia, Crawley, WA, Australia.
| | - Catherine M Bennett
- Centre for Population Health Research, Deakin University, Burwood, VIC, 3125, Australia.
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Nipple Pain in Breastfeeding Mothers: Incidence, Causes and Treatments. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 12:12247-63. [PMID: 26426034 PMCID: PMC4626966 DOI: 10.3390/ijerph121012247] [Citation(s) in RCA: 85] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Revised: 09/10/2015] [Accepted: 09/23/2015] [Indexed: 11/17/2022]
Abstract
Background: Persistent nipple pain is one of the most common reasons given by mothers for ceasing exclusive breastfeeding. We aimed to determine the frequency of nipple pain as a reason for consultation, the most common attributed aetiologies, and the effectiveness of the advice and treatment given. Methods: All consultations at the Breast Feeding Centre of Western Australia (WA) were audited over two six-month periods in 2011 (n = 469) and 2014 (n = 708). Attributed cause(s) of nipple pain, microbiology results, treatment(s) advised, and resolution of pain were recorded. Results: Nipple pain was one of the reasons for consultation in 36% of cases. The most common attributed cause of nipple pain was incorrect positioning and attachment, followed by tongue tie, infection, palatal anomaly, flat or inverted nipples, mastitis, and vasospasm. Advice included correction of positioning and attachment, use of a nipple shield, resting the nipples and expressing breastmilk, frenotomy, oral antibiotics, topical treatments, and cold or warm compresses. Pain was resolving or resolved in 57% of cases after 18 days (range 2–110). Conclusion: The multiple attributed causes of nipple pain, possibly as a result of a cascade of events, suggests that effective early lactation management for prevention of nipple pain and early diagnosis and effective treatment are crucial to avoid early weaning.
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Amir LH. It's time for pharmacists to increase their support for breastfeeding. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2015. [DOI: 10.1002/jppr.1072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Lisa H. Amir
- Judith Lumley Centre; La Trobe University; Melbourne Australia
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