Ana Cristina Freitas de Vilhena Abrão

Factors associated with nipple trauma in the maternity unit

OBJECTIVE To identify factors associated with nipple trauma in women breastfeeding exclusively in a maternity unit. METHODS This was a case-control study that recruited 146 recently-delivered mothers in rooming-in wards: 73 cases, defined as women with nipple trauma, and 73 controls, defined as women free from this pathology. Women breastfeeding exclusively were tested daily for a diagnosis of nipple injury, identified using a magnifying glass. Sociodemographic, obstetric and neonatal variables were studied. A logistic regression model was used for statistical analysis. RESULTS Cases and controls proved to be comparable in terms of their sociodemographic variables, although the women with nipple trauma were more likely not to be living with a partner. The following variables were found to be factors associated with nipple trauma: primiparity (OR 3.16; 95%CI 1.19-8.42), not living with a partner (OR 3.25; 95%CI 1.18-8.93), turgid and/or engorged breasts (OR 12.31; 95%CI 4.48-33.78), semi-protruding and/or malformed nipples (OR 4.69; 95%CI 1.50-14.62), and depigmentation of nipples (OR 13.98; 95%CI 4.43-44.06). CONCLUSION Primiparity, not living with a partner, turgid and/or engorged breasts, semi-protruding and/or malformed nipples, and depigmentated nipples are associated with nipple trauma.

A posição de amamentar determina o aparecimento do trauma mamilar

The aim of the study was to identify the breast feeding position and holding variables related to nipple trauma. This case-control study assessed the onset of nipple trauma among women hospitalized at a University Hospital in the city of São Paulo, in 2004 and 2005. Subjects were puerperae diagnosed with unilateral or bilateral nipple trauma. Data analysis was performed using chi-square, Students t, and odds ratio tests (CI = 95%) and correspondence analysis. Participants were 146 puerperal women and their newborns, being 73 cases and 73 controls. Statistically significant position and holding variables for causing lesions were the following: newborns with their necks bent/contorted, chin away from the breast and lip-related defect (turned inward). Trauma prevention at the beginning of breast feeding is crucial for continuing this practice. Following adequate positioning is decisive for establishing effective and prolonged breast feeding.The aim of the study was to identify the breast feeding position and holding variables related to nipple trauma. This case-control study assessed the onset of nipple trauma among women hospitalized at a University Hospital in the city of Sao Paulo, in 2004 and 2005. Subjects were puerperae diagnosed with unilateral or bilateral nipple trauma. Data analysis was performed using chi-square, Students t, and odds ratio tests (CI= 95%) and correspondence analysis. Participants were 146 puerperal women and their newborns, being 73 cases and 73 controls. Statistically significant position and holding variables for causing lesions were the following: newborns with their necks bent/contorted, chin away from the breast and lip-related defect (turned inward). Trauma prevention at the beginning of breast feeding is crucial for continuing this practice. Following adequate positioning is decisive for establishing effective and prolonged breast feeding.

Padrão de aleitamento materno no primeiro mês de vida em mulheres submetidas a cirurgia de redução de mamas e implantes

OBJETIVO: Descrever o padrao de aleitamento materno no primeiro mes de vida da crianca em mulheres que se submeteram a dois tipos de cirurgias mamarias - reducao e implante - e comparar com o padrao praticado por mulheres que nao se submeteram as cirurgias. METODOS: Coorte prospectiva controlada com 25 mulheres submetidas a cirurgia redutora, 24 a cirurgia de implante e 25 sem cirurgia de mama, que tiveram seus filhos no Hospital Israelita Albert Einstein, Sao Paulo (SP). Os dados foram coletados por meio de avaliacoes realizadas entre 48 e 72 horas, entre os quinto e setimo dias e 30 dias apos o parto. Para analise dos dados, usaram-se os testes qui-quadrado, exato de Fisher, curva de Kaplan-Meier e regressao de Cox. RESULTADOS: A probabilidade de uma crianca estar em aleitamento exclusivo no final do primeiro mes de vida foi de 29% em mulheres com cirurgia redutora e 54% nas com cirurgia de implante, e 80% nas mulheres sem cirurgia. A probabilidade do aleitamento misto estar presente neste mesmo periodo foi de 68% entre maes com cirurgia de reducao, 32% com cirurgia de implante e apenas 16% entre as mulheres sem cirurgia mamaria. O risco de uma crianca estar em aleitamento nao exclusivo foi cinco vezes maior entre maes do grupo submetido a reducao, quando comparado aquelas do grupo sem cirurgia (p = 0,002). Para o grupo de mulheres com implante, o risco de uma crianca estar em aleitamento nao exclusivo foi 2,6 vezes aquele observado entre criancas cujas maes fazem parte do grupo sem cirurgia (p = 0,075). CONCLUSAO: A cirurgia redutora de mama e de implante refletiu em menor taxa de aleitamento materno exclusivo no primeiro mes de vida da crianca.

An evaluation of the effect ov lanolin in healing nipple injuries

Objective: To evaluate the effect of anhydrous lanolin-based ointment in the process of healing nipple injuries. Methods: This is a descriptive experimental study was performed in two Maternity Hospitals in Sao Paulo. The random sample consisted of 50 puerperium women with nipple injuries, hospitalized in the period of June 2002 to July 2003. Participants were randomly assigned into control and experimental groups, by the means of a draw. Statistical analysis was performed using Qui-square, Student’s t test, and ANOVA (a at 5%).Results: The size of the injury in the control group reduced in 0.41 ± 0.11 cm (right breast) and 0.29 ± 0.06 cm (left breast) compared to the experimental group, from the first to the second evaluation (p < 0.001), showing to be statistically significant. Conclusion: The lanolin is effective in treating nipple injuries.OBJETIVO: Avaliar o efeito da pomada a base de lanolina anidrica na cicatrizacao de lesoes mamilares apresentadas por puerperas internadas em duas maternidades do Municipio de Sao Paulo. METODOS: Estudo experimental descritivo realizado em duas maternidades do Municipio de Sao Paulo. A amostra aleatoria foi constituida de 50 puerperas com trauma mamilar internadas no periodo de junho de 2002 a julho de 2003. A amostra foi composta por meio de sorteio aleatorio, distribuida entre os grupos controle e experimental. Utilizou-se testes Qui-quadrado, t de Student e ANOVA (a of 5%). RESULTADOS: Observou-se uma diferenca na diminuicao do tamanho da lesao mamilar de 0,41 ± 0,11 cm (mama direita) e 0,29 ± 0,06 cm (mama esquerda) nas puerperas do grupo experimental para o grupo controle, da primeira para a segunda avaliacao (p < 0,001), mostrando ser estatisticamente significativa. CONCLUSAO: A lanolina foi favoravel no tratamento das lesoes mamilares.

Does breast feeding position influence the onset of nipple trauma

The aim of the study was to identify the breast feeding position and holding variables related to nipple trauma. This case-control study assessed the onset of nipple trauma among women hospitalized at a University Hospital in the city of São Paulo, in 2004 and 2005. Subjects were puerperae diagnosed with unilateral or bilateral nipple trauma. Data analysis was performed using chi-square, Students t, and odds ratio tests (CI = 95%) and correspondence analysis. Participants were 146 puerperal women and their newborns, being 73 cases and 73 controls. Statistically significant position and holding variables for causing lesions were the following: newborns with their necks bent/contorted, chin away from the breast and lip-related defect (turned inward). Trauma prevention at the beginning of breast feeding is crucial for continuing this practice. Following adequate positioning is decisive for establishing effective and prolonged breast feeding.The aim of the study was to identify the breast feeding position and holding variables related to nipple trauma. This case-control study assessed the onset of nipple trauma among women hospitalized at a University Hospital in the city of Sao Paulo, in 2004 and 2005. Subjects were puerperae diagnosed with unilateral or bilateral nipple trauma. Data analysis was performed using chi-square, Students t, and odds ratio tests (CI= 95%) and correspondence analysis. Participants were 146 puerperal women and their newborns, being 73 cases and 73 controls. Statistically significant position and holding variables for causing lesions were the following: newborns with their necks bent/contorted, chin away from the breast and lip-related defect (turned inward). Trauma prevention at the beginning of breast feeding is crucial for continuing this practice. Following adequate positioning is decisive for establishing effective and prolonged breast feeding.

Utilização do diagnóstico de enfermagem segundo a classificação da NANDA, para a sistematização da assistência de enfermagem em aleitamento materno

The present study aimed at describing the reformulated instrument used in the puerperal woman nursing consultation based on the identified diagnoses classification according to the Taxonomy-I reviewed by NANDA, and the identification of the most frequent nursing diagnoses concerning maternal breastfeeding, based on the reformulated instrument. The diagnoses found as being over 50% were: knowledge deficit (100%); sleep pattern disturbance (75%), altered sexuality patterns (75%), ineffective breastfeeding (66,6%) and impaired physical mobility (66,6%).En este estudio se describe el proceso de reformulacion de un guia de evaluacion de puerperas, utilizado en la consulta de enfermeria, teniendo como referencia la clasificacion de los diagnosticos de enfermeria de la Taxonomia I-revisada por la Asociacion Norteamericana de Enfermeria (NANDA). Tambien son determinados los diagnosticos de enfermeria relacionados con la lactancia materna, que fueron calificados con porcentajes superiores a 50%, a partir de la aplicacion de la guia reformulada. Ellos son: deficit de conocimiento (100,0%), cambios en el patron del sueno (75,0%), cambios en el patron de sexualidad (75,0%), lactancia ineficaz (66,6%) y movilidad fisica disminuida.

Injuries Resulted From Breastfeeding: A New Approach To A Known Problem

This study aimed at analyzing nipple trauma resulted from breastfeeding based on dermatological approach. Two integrative reviews of literature were conducted, the first related to definitions, classification and evaluation methods of nipple trauma and another about validation studies related to this theme. In the first part were included 20 studies and only one third defined nipple trauma, more than half did not defined the nipple’s injuries reported, and each author showed a particular way to assess the injuries, without consensus. In the second integrative review, no validation study or algorithm related to nipple trauma resulted from breastfeeding was found. This fact demonstrated that the nipple’s injuries mentioned in the first review did not go through validation studies, justifying the lack of consensus identified as far as definition, classification and assessment methods of nipple trauma.This study aimed at analyzing nipple trauma resulted from breastfeeding based on dermatological approach. Two integrative reviews of literature were conducted, the first related to definitions, classification and evaluation methods of nipple trauma and another about validation studies related to this theme. In the first part were included 20 studies and only one third defined nipple trauma, more than half did not defined the nipples injuries reported, and each author showed a particular way to assess the injuries, without consensus. In the second integrative review, no validation study or algorithm related to nipple trauma resulted from breastfeeding was found. This fact demonstrated that the nipples injuries mentioned in the first review did not go through validation studies, justifying the lack of consensus identified as far as definition, classification and assessment methods of nipple trauma.

Estado nutricional e qualidade da dieta de nutrizes em amamentação exclusiva

Abstract Objective: Identifying the nutritional status, dietary intake and diet quality of nursing mothers on exclusive breastfeeding. Methods: Cross-sectional study carried out with nursing mothers on exclusive breastfeeding from day 28 postpartum. Standardized instruments were used, and body mass index, food consumption and diet quality were evaluated.Results: The nursing mothers were overweight, presented energy consumption below the recommended and adequate percentage of macronutrients, except for protein, which was elevated. The diet was classified as “needs improvement” according to the Healthy Eating Index (HEI).Conclusion: The results show that the overweight associated with a diet of poor quality indicated possible deficiencies of micronutrients. Resumo Objetivo: Identificar o estado nutricional, o consumo alimentar e a qualidade da dieta de nutrizes em amamentacao exclusiva. Metodos: Estudo transversal realizado com nutrizes em aleitamento exclusivo a partir do 28o dia pos-parto. Foram utilizados instrumentos padronizados e foram avaliados o indice de massa corporal, consumo alimentar e qualidade da dieta. Resultados: As nutrizes apresentaram sobrepeso, consumo energetico abaixo do recomendado, porcentagens de macronutrientes adequadas exceto para proteina, que foi elevada. A dieta foi classificada como “precisando de melhorias”, conforme o Indice de Alimentacao Saudavel. Conclusao: Os resultados mostraram que o sobrepeso associado a uma qualidade inadequada da dieta, indicou possiveis carencias de micronutrientes.

[Baby-Friendly Hospital: prevalence of exclusive breastfeeding at 6 months and intervening factors].

The objective of this research was to identify the pattern of exclusive breastfeeding (EBF) in the first 6 months of infants born in a Baby-Friendly Hospital and the factors that contribute to early weaning. This was a prospective cohort study with 261 mothers and children. The data were analyzed via the construction of a Kaplan-Meier survival curve, and the log-rank test was used for the univariate analysis. A multivariate analysis was performed using the Cox proportional-hazards regression model. During the 6 months, the percentage of mothers who practiced EBF for 30, 90, 120, 150 and 180 days was 75%, 52%, 33%, 19% and 5.7%, respectively. In the multivariate analysis, the variables that conferred a risk for early weaning were the hospital and the occurrence of a follow-up visit due to mammary complication, improper positioning and the association of both of these factors. The Baby-Friendly Hospital Initiative favored EBF.The objective of this research was to identify the pattern of exclusive breastfeeding (EBF) in the first 6 months of infants born in a Baby-Friendly Hospital and the factors that contribute to early weaning. This was a prospective cohort study with 261 mothers and children. The data were analyzed via the construction of a Kaplan-Meier survival curve, and the log-rank test was used for the univariate analysis. A multivariate analysis was performed using the Cox proportional-hazards regression model. During the 6 months, the percentage of mothers who practiced EBF for 30, 90, 120, 150 and 180 days was 75%, 52%, 33%, 19% and 5.7%, respectively. In the multivariate analysis, the variables that conferred a risk for early weaning were the hospital and the occurrence of a follow-up visit due to mammary complication, improper positioning and the association of both of these factors. The Baby-Friendly Hospital Initiative favored EBF.

Breastfeeding pattern in the first month of life in women submitted to breast reduction and augmentation.

OBJECTIVE To describe the breastfeeding pattern in the first month of life in women submitted to two types of surgery - breast reduction and augmentation - and to compare it with the pattern exhibited by women who had no surgery. METHODS Controlled prospective cohort with 25 women submitted to reduction surgery, 24 submitted to augmentation surgery and 25 with no breast surgery, who gave birth at Hospital Israelita Albert Einstein, São Paulo, Brazil. The data were obtained from assessments carried out 48 to 72 hours, between the 5th and 7th days, and 30 days after delivery. The following tests were used for data analysis: chi-square test, Fishers exact test, Kaplan-Meier curve and Cox regression. RESULTS The probability of an infant being on exclusive breastfeeding at the end of the first month of life was 29% in women with reduction surgery, 54% in those with augmentation surgery, and 80% in women who had no surgery. The probability of mixed breastfeeding being adopted during this same period amounted to 68% among women with reduction surgery, 32% in those with augmentation surgery, and only 16% among those without any breast surgery. The risk of an infant being on non-exclusive breastfeeding was five times greater in women submitted to reduction surgery when compared to those women with no surgery (p = 0.002). Among women with augmentation surgery, the risk of an infant being on non-exclusive breastfeeding was 2.6 times greater than that observed in infants whose mothers had no breast surgery (p = 0.075). CONCLUSION Breast reduction and augmentation surgeries led to lower rates of exclusive breastfeeding in the first month of life.