Literature review for - Flourish Paediatrics

In a cohort of 280 mother-infant pairs in California 8% of mothers were diagnosed as having
a flat or inverted nipple. The diagnosis was made by a lactation consultant (Dewey,
Nommsen-Rivers et al. 2003).
Effect of Nipple Variation on Breastfeeding Outcomes
No evidence base was developed for the effect of nipple variation on breastfeeding outcomes
due to the lack of quality studies.
(Vogel, Hutchison et al. 1999) cohort revealed that inverted nipples were associated with a
shorter duration of breastfeeding; multivariate RR 2.02 (1.26, 3.23). The cohort study
conducted by (Dewey, Nommsen-Rivers et al. 2003) found a significant association between
flat or inverted nipples and suboptimal infant breastfeeding behaviour (according to the
IBFAT tool) on day 7 postpartum RR=6.57 (3.16-8.88). Flat or inverted nipples were also
associated with delayed onset of lactation on day 0 RR = 2.26 (1.08-3.56).
A cohort study in Iran aimed to determine the association between presence of maternal
breast variation (such as flat nipple, inverted nipple, large breast or/and large nipple) and
infants weight gain in the first 7 days postpartum. The researchers found that the mean weight
of neonates born to mothers without breast variations (53 ± 154.4 g) was significantly larger
than the mean difference of neonates' weight in the control group (-162 ± 125.5 g). In
response to their finding the authors concluded breast variation in first-time mothers acts as
an important barrier to weight gain among breastfed neonates in the early days of life
(Vazirinejad, Darakhshan et al. 2009).
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