Efeito da lanolina anidra comparado ao leite materno combinado à concha de proteção para tratamento da dor e do trauma mamilar em lactantes: ensaio clínico randomizado
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2013-04-30
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Universidade Federal de Goiás
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INTRODUCTION: Women often experience nipple trauma when they start
breastfeeding, and this is one of the predictive factors of early weaning. There is no
sufficient evidence to date supporting one best treatment for nipple trauma.
OBJECTIVE: Assess the effect of lanolin anhydrous in the treatment of nipple pain,
compared to mother’s breast milk combined with nipple protection shells during
breastfeeding. METHOD: Randomized clinical trial, controlled with 100 puerperal
women with nipple trauma, who had delivered at a public maternity hospital of
Goiânia, Goiás, Brazil. Fifty women were randomized to group 1 and 50 to group 2.
In group 1, a total of 97 breasts with nipple trauma were treated with lanolin
anhydrous, and in group 2, 95 breasts with nipple trauma were treated with breast
milk combined with nipple protection shells, and followed for up to 10 days. Both
groups received educational instructions regarding breastfeeding. The outcome
variables were: nipple trauma healing – determined by the Nipple Trauma Score
(NTS) and pain in the nipple-areolar region – determined by a numerical pain scale.
The research proposal was approved by the Research Ethics Committee of the
University Hospital at Federal University of Goiás, and was recorded on the Brazilian
Record System of Clinical Trials. Data analysis was performed using chi-square test,
Fisher’s Exact Test and ANOVA MR, with significance at p<0.05. RESULTS: In the
baseline assessment, the groups were homogenous in terms of sociodemographic,
obstetrical and neonatal characteristics. The onset of nipple trauma was on the 2nd
day postpartum, in average. Intervention was initiated on the 2nd day of nipple
trauma. There was a variation of traumas, with the crust being the most frequent.
Nipple depigmentation improved with time, with a difference between the groups on
day 7 (p=0.013) and 10 (p=0.001). There was no difference between groups for the
NTS before the intervention (p=0.642). The analysis of variance over time (ANOVA
MR) indicated lower NTS in group 2 with a difference between the groups on days 3
(p=0.026), 5 (p=0.004), 7 (p<0.001) and 10 (p<0.001) of follow-up. Regarding the
intensity of pain in the nipple-areolar region, a 5.5 mean was found for group 1 and
5.8 for group 2, on day 1, with no difference between the groups. The intensity of
pain was smaller in group 2 compared to group 1 on days 5 (p=0.001), 7 (p<0.001)
and 10 (p<0.001). CONCLUSION: Compared to lanolin anhydrous, breast milk
combined with nipple protection shells proved more effective in reducing pain and
healing nipple trauma in breastfeeding puerperal women.
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VIEIRA, F. Efeito da lanolina anidra comparado ao leite materno combinado à concha de proteção para tratamento da dor e do trauma mamilar em lactantes: ensaio clínico randomizado. 2013. 170 f. Tese (Doutorado em Enfermagem) - Universidade Federal de Goiás, Goiânia, 2013.