Literature review for - Flourish Paediatrics

shield was 47 g compared to the group with a nipple shield with a transfer of 27 g. Results for
another study revealed that the ‘‘Mexican hat’’ nipple shield severely impaired milk transfer
with a mean volume of 19.5 g compared to a mean volume of 46.4 g in the group without a
nipple shield. The thin latex shield also reduced milk transfer to a mean of 29.9 g, but it was
not significantly different than milk transfer of 38.4 g in the group not using nipple shield.
This nonrandomized study was limited by its small sample size. The third study found
subjects expressed significantly more breastmilk during pumping sessions with no nipple
shield in place compared to pumping with a nipple shield. (McKechnie and Eglash 2010)
note that lactating women generally do not use a breast pump with a nipple shield in place
therefore findings from this study cannot be generalised to all areas of clinical practice.
(McKechnie and Eglash 2010 concluded that larger studies are required to evaluate the effect
of nipple shields on maternal hormonal patterns, infant suckling response as well as longterm
outcomes such as milk supply, infant weight gain, and duration of lactation.
Eight studies were extracted to assess mother’s experiences using a nipple shield. The studies
indicated that mothers had positive experiences using a nipple shield, with the majority of
mothers maintaining breastfeeding after discontinuing nipple shield use. The authors note that
the studies had small sample sizes, limited follow-up time, and poor statistical measures
therefore precaution should be taken when interpreting their results.
Nipple shields are commonly used as an intervention for flat/ inverted nipples but the
author’s did not find a positive association between nipple shield use in this population and
breastfeeding duration.
In summary the authors remark that attempts to achieve successful breastfeeding should be
made prior to the introduction of a nipple shield. Health professions should follow mothers
using a nipple shield to aid them transition away from nipple shield use, monitor
breastfeeding outcomes and screen for problems that may occur with their use such as poor
milk supply(McKechnie and Eglash 2010).
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