Initial nipple damages in breastfeeding women: analysis of photographic images and clinical associations

Camargo, Bárbara Tideman Sartorio; Sañudo, Adriana; Kusahara, Denise Miyuki; Coca, Kelly Pereira

doi:10.1590/0034-7167-2022-0773

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Revista Brasileira de Enfermagem

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ORIGINAL ARTICLE • Rev. Bras. Enferm. 77 (1) • 2024 • https://doi.org/10.1590/0034-7167-2022-0773 copy

Initial nipple damages in breastfeeding women: analysis of photographic images and clinical associations

Lesiones tempranas del pezón derivadas de la lactancia materna: análisis de imágenes fotográficas y asociaciones clínicas

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

to analyze the initial nipple damage degree by breastfeeding practice and to associate findings with clinical manifestations of breastfeeding women.

Methods:

a retrospective, cross-sectional study with primary data and photographic images database from two randomized clinical trials. Photographic images were analyzed by two independent evaluators using the Nipple Trauma Score. For analysis, the chi-square, Mann-Whitney tests and Kappa coefficient were applied.

Results:

115 breastfeeding women and their respective 186 photographic images were analyzed. The degree of agreement of evaluators using the Nipple Trauma Score was 93.6%. The nipple pain score during breastfeeding was moderate and compromised more than 25% of the nipple surface area.

Conclusions:

assistance to breastfeeding women should prioritize nipple pain intensity instead of the nipple damage size.

Descriptors:
Nipples; Pain; Wounds and Injuries; Breast Feeding; Clinical Decision-Making

Nipple Trauma Score (NTS)
Score	Characteristics
0	Não há mudança visível na pele do mamilo
1	Eritema ou edema ou ambos
2	Dano superficial com ou sem crosta formada em menos de 25% da superfície do mamilo
3	Dano superficial com ou sem crosta formada em mais de 25% da superfície do mamilo
4	Lesão com espessura parcial com ou sem crosta formada em menos de 25% da superfície do mamilo
5	Lesão com espessura parcial com ou sem crosta formada em mais de 25% da superfície do mamilo

Variables	Total
Woman characteristics
Age (years)
Median (p25-p75)	26 (21-31)
Parity (n= 115) n (%)
Primiparous	60 (52.2)
Multiparous	55 (47.8)
Condition of the breasts (n=115) n (%)
Soft	106 (92.1)
Turgid/engorged	9 (7.8)
Nipple damage side (n=115) n (%)
One nipple	24 (20.9)
Both nipples	91 (79.1)
Nipple damage characteristic
Inclusion postpartum day (n=186) n (%)
1^st postpartum day	119 (64)
2^nd postpartum day	67 (36)

Dependent variables	P50	P25-P75
Nipple pain score (VAS^* * VAS= Visual Analog Scale; )
Right breast (n= 90)	5	0-8
Left breast (n= 96)	5	1.5-8
Nipple damage size (mm)
Right breast (n= 90)	8	5-10
Left breast (n= 96)	9	7-11

Variáveis dependentes	n	Median (P25-P75)	p value
Nipple damage size (mm)			< 0.001^A
NTS 2^* * NTS 2= score assigned to nipple damage degree comprised between scores 0-2;	32	5 (4-5)
NTS 3^ NTS 3= score assigned to nipple damage degree comprised between scores 3-5;	154	9 (7-11)
Nipple pain score (VAS^* ***** VAS= Visual Analog Scale; A= Mann-Whitney test; B= chi-square test. )			0.055^A
NTS 2^* * NTS 2= score assigned to nipple damage degree comprised between scores 0-2;	32	7 (4.5-8)
NTS 3^ NTS 3= score assigned to nipple damage degree comprised between scores 3-5;	154	5 (0-7)
Postpartum inclusion day (1^st or 2^nd day)			0.551^B
NTS 2^* * NTS 2= score assigned to nipple damage degree comprised between scores 0-2;	32	1 (1-2)
NTS 3^ NTS 3= score assigned to nipple damage degree comprised between scores 3-5;	154	1 (1-2)

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[1] Corresponding author: Kelly Pereira Coca, E-mail: kcoca@unifesp.br