Literature review for - Flourish Paediatrics

lactation?
Draft Evidence statement
Draft Grade
Component Rating Notes
No single intervention provides a significant effect in
terms of preventing nipple pain/trauma
D
Evidence Base Satisfactory 2 Systematic reviews (overlap between studies, 15
RCTs and quasi-experimental studies in total) of high
quality.
Consistency
Satisfactory Both reviews concluded that no single pharmacological
or non-pharmacological method offered a significant
effect in the prevention of nipple pain/trauma in
breastfeeding women.
Clinical impact Poor No trial provides sufficient evidence on any intervention
to justify widespread uptake of that intervention.
Generalisability
Applicability
Satisfactory Majority of studies conducted in developed countries,
including Australia
Satisfactory Results are applicable to Australian women
The studies included in the body of evidence statement are shown in the Table below
Page and colleagues reviewed studies that compared education, water compress, breast milk,
warm compress, lanolin, aerosol spray, ointment, firm dressing, tea-bag compress, hydrogel
dressing, breast shells or oral cloxacillin/erythromycin use in the prevention of nipple
pain/trauma. Page and colleagues found warm water compresses prevented nipple pain (one
level II study) and keeping nipples clean and dry prevented cracked nipples (one level II
study). In conclusion there is potential for some interventions to offer beneficial effects in the
prevention of nipple pain/trauma however the evidence for those interventions are limited
(Page, Lockwood et al. 2003).
Morland-Schultz and Hill conducted a review on the prevention and treatment of nipple pain
included 11 trials compared water compress, breast milk, lanolin, collagenase, glycerin gel,
dexpanthenol, vitamin A, tea-bag compress, glycerin gel therapy and breast shells use in the
treatment of nipple pain/trauma(Morland-Schultz and Hill 2005). After assessing the
evidence the authors found no one method showed superior results in the prevention of nipple
pain/trauma and support the finding that proper positioning and correct breastfeeding
technique is the best way to prevent nipple/pain trauma.
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