S5. Hewat et al.3838 Hewat RJ, Ellis DJ. A comparison of the effectiveness of two methods of nipple care. Birth. 1987; 14 (1): 41-5. 1987, Canada |
Evaluate whether breast milk or colostrum, applied to the nipples after breastfeeding, is superior to hydrated lanolin in preventing nipple pain and trauma |
Randomized clinical trial with 23 primiparous women evaluated until the 10th day postpartum. G1 (n=10) applied expressed breast milk or colostrum on the right nipple and lanolin on the left after each feeding. G2 (n=13) reversed the procedure. Each participant was her own control. |
All the women experienced nipple trauma. There was a positive and significant correlation between nipple trauma and engorgement (r=0.43; p<0.02). |
Low |
Breast milk was not superior to lanolin in the prevention or reduction of nipple trauma in the first 10 days postpartum. |
S6. Centuori et al.3030 Centuori S, Burmaz T, Ronfani L, Fragiacomo M, Quintero S, Pavan C, et al. Nipple care, sore nipples, and breast-feeding: a randomized trial. J Hum Lact. 1999;15(2):125-30. 1999, Italy |
Determine whether the duration of breastfeeding and the incidence of nipple trauma and pain are affected by the use of ointments and creams. |
Randomized clinical trial with 219 postpartum women followed-up in four moments until the third month postpartum. CG (n=96): followed hospital routines. EG (n=123): did not use physical, chemical, and mechanical methods in nipple care. |
There was no difference between the two groups regarding breast and nipple problems. Bottle and pacifier use were associated with nipple trauma (p<0.05) after hospital discharge and two weeks postpartum. |
Moderate |
Special cleaning with distilled water and sterile gauze, and the use of creams and spray on the nipples proved to be unnecessary. |
S7. Api et al.2525 Api M, Sivri D, Api O, Görgen H, Çetin A, Yayla M. Prevention of Nipple Cracks With Guaiazulene Versus Breast Milk in Nursing Mother: A Randomized, Controlled, Double-Blind Trial. J Turkish German Gynecol Assoc. 2005; 6 (4): 279-84. 2005, Turkey |
Evaluate the effectiveness of guaiazulene cream compared to breast milk in the prevention of nipple pain and trauma during breastfeeding. |
Randomized, controlled, double-blind clinical trial with women of vaginal delivery in the puerperium. EG (n=76): used guaiazulene ointment 0.05% after each feeding. Breast cleaning was recommended before feeding CG (n=77): used breast milk after each feeding. The women were evaluated 15 and 30 days after delivery for nipple pain and trauma. |
The total incidence of nipple trauma was 31.4% at 30 days postpartum, 18.4% in EG and 44.2% in CG (p= 0.001, RR = 0.42, CI95%=0.24-0.71). |
High |
The application of guaiazulene was effective to reduce nipple trauma. |
S8. Melli et al.2323 Melli MS, Rashidi MR, Nokhoodchi A, Tagavi S, Farzadi L, Sadaghat K, Tahmasebi Z, Kazemi AM. A randomized trial of peppermint gel, lanolin ointment, and placebo gel to prevent nipple crack in primiparous breastfeeding women. Med Sci Monit. 2007; 13 (9). 2007, Iran |
Investigate the preventive effect of peppermint gel on nipple trauma, compared to modified lanolin and placebo |
Double-blind randomized clinical trial with 216 primiparous women evaluated on days 4, 7, 14, and 42 postpartum. G1 (n=72): purified lanolin G2 (n=72): peppermint gel. G3 (n=72): placebo gel. The intervention was applied to the areola and nipple after each feeding and cleaned before the next feeding. All the women received guidelines on breastfeeding prior to breastfeeding. |
Nipple trauma was less common when using peppermint gel (3.8%) than when using lanolin ointment (6.9%) or placebo (22.6%) (p=0.01), on the 14th day postpartum. The relative risk of trauma in the lanolin group (RR= 2.41, CI95%=1.20-3.01) was higher than in the peppermint group (RR=1.85, CI95%=1.64-3.10). |
High |
Peppermint gel formulated as a natural remedy was effective in preventing nipple trauma. The application of the gel was suggested as prophylaxis for nipple trauma with proper instruction at the start of breastfeeding. |
S9. Melli et al.2424 Melli MS, Rashidi MR, Delazar A, Madarek E, Maher MHK, Ghasemzadeh A, Sadaghat K, Tahmasebi Z. Effect of peppermint water on prevention of nipple cracks in lactating primiparous women: a randomized controlled trial. Int Breastfeed J. 2007; 2 (7). 2007, Iran |
Evaluate the effectiveness of a topical preparation of peppermint water in comparison with expressed breast milk for the prevention of nipple trauma in nursing primiparous women. |
Randomized clinical trial with 196 women, followed-up in three visits or phone calls within 14 days and one phone call within the sixth week postpartum. EG (n=98): application of peppermint water after each feeding. CG (n=98): application of breast milk after each feeding. All mothers received standardized breastfeeding education with demonstrations before starting breastfeeding. |
The occurrence of nipple trauma was lower in the group using peppermint water (p<0.01) EG=7%, CG=23%. In the EG, trauma occurred on the 7th day postpartum (6.2 ± 1.9) and in the CG, on the 4th day postpartum (3.8 ± 0.9). Peppermint water reduced the risk of trauma compared to the other group (RR=3.6, CI95%=2.9, 4.3). |
Moderate |
Peppermint water was effective in preventing nipple pain and trauma compared with breast milk. |
S10. Atan e Sirin.2727 Atan SÜ, Sirin A. Prevention of nipple problems in primipara breastfeeding mothers: A pilot study. Healthmed. 2012; 6 (12): 4258-66. 2012, Turkey |
Compare the effectiveness of breast milk, warm wet compress, and tea compress in the prevention of nipple problems in primiparous women. |
Experimental study with 105 primiparous women. G1 (n=35): tea compress G2 (n=35): warm wet compress G3 (n=35): breast milk Health education on the benefits and success of breastfeeding was provided, together with a brochure to support this education. Visits on the 5th and 14th day postpartum. |
The highest rate of nipple trauma (34.3%) occurred on the 3rd day postpartum. On the 6th and 7th days postpartum, fewer nipple problems were identified in the warm wet compress group (p>0.023). On the 14th day postpartum, there was no significant difference between the groups, p=609 (G1=54.3%, G2=42.9%, and G3=49.5%). |
Low |
Midwives and nurses can teach mothers in the hospital about warm wet compresses to prevent nipple pain and trauma and continue the practice after discharge. |
S11. Thabet et al.2626 Thabet HA, Mourad MA, Alahadal AM, Alsenany S, Alsaif A. Prevention of Nipple Cracks with Peppermint Water versus Breast Milk in Lactating Primiparous Women. Life Science J. 2013;10(4): 2010-7. Disponível em: http://www.lifesciencesite.com/lsj/life1004/266_21318life1004_2010_2017.pdf. http://www.lifesciencesite.com/lsj/life1...
2013, Saudi Arabia |
Compare the effect of peppermint water compared to breast milk for the prevention of nipple injuries. |
Experimental study with 150 primiparous women breastfeeding after vaginal delivery with 38 or more weeks of gestation, from the 1st to the 14th day postpartum. G1(n=50): peppermint water applied after each feeding with a gauze on the nipples and areolas after washing the nipples with water. G2 (n=50): expressed breast milk after each feeding. CG (n=50): nipples were kept clean and dry. All the women received comprehensive hospital education on breastfeeding before the start of breastfeeding. |
Women in the peppermint water group were more prone to intact nipples and areolas at 15 and 30 days (88% and 92%) than women in the breast milk group (60% and 64%) and CG (44% and 40%) (p<0.001). |
Low |
Peppermint water was more effective in preventing nipple trauma and pain than breast milk. Proper instructions at the beginning of the breastfeeding program are required. |
S12. Cordero et al.4040 Cordero MJA, Villar NM, Barrilao RG, Cortés MEC, López AM. Application of Extra Virgin Olive Oil to Prevent Nipple Cracking in Lactating Women. Worldviews on Evid Based Nurs. 2015; 12 (6): 364-9. 2015, Cuba |
Evaluate the effectiveness of extra virgin olive oil (EVOO) in the relief and prevention of sore nipples in nursing mothers compared to the use of breast milk. |
Experimental, prospective, randomized trial with 300 nursing mothers. G1 (n=150): EVOO on the nipple after each feeding G2 (n=150): drops of milk after each feeding. Clinical evaluations were performed in the first two weeks of treatment and after the first month of breastfeeding. |
The occurrence of nipple trauma in the EVOO group: 2.7%. In the group that used breast milk: 44.0%. Nipple trauma was related to poor posture during feeding (p<0.001) |
Low |
EVOO was important in the prevention of nipple trauma, with a positive result even with inadequate posture during feeding. |