Literature review for - Flourish Paediatrics

Studies used to make evidence statement for nipple variation
Reference Alexander et al. 1992 Alexander & Campbell 1997 Vogel et al. 1999
Type of study RCT Cross-sectional Cohort
Level of evidence II (intervention) IV (aetiology) II (aetiology)
Definition of
breastfeeding
Not stated Not stated Full breastfeeding is defined as infants
receiving breastmilk with or without
supplements of
water or juice, but without formula,
Intervention/
comparator
Breast shells vs. Hoffman’s exercises
vs breast shells and Hoffman’s
exercises vs. no treatment
Prevalence of inverted or nonprotractile
nipples
other milk or solids
Presence of inverted nipples
N
96 women. Follow up at 6 weeks was
100%
Randomly allocated to 4 treatment
groups
Breast shells= 24
Hoffman’s exercises= 24
Shells & exercises= 24
Control= 24
3006 women 350 mothers. Follow up at 1 yr was
95%
Population/study
information
Women were recruited
at 25- 35 weeks in a singleton
pregnancy with at least one inverted
or non-protractile
nipple. Recruitment occurred in
Southampton over 23
Sample consisted of women intending
to breastfeed who were examined in
antenatal clinics in Hants, UK between
1987-9.
Trained observers conducted a ‘pinch
Sample consisted of women who
delivered a normal term infant at North
Shore Hospital, Auckland in 1996.
Mothers were interviewed in the
immediate postpartum
169