The effectiveness on health education to prevent nipple trauma from breastfeeding: a systematic review

Abstract Objectives: to analyze the effectiveness on health education to prevent nipple trauma in breastfeeding compared to other interventions. Methods: systematic literature review was carried out in January 2019, according to PRISMA recommendations. The searches were conducted in Cinahl, PubMed, Web of Science, Scopus, and in the references cited in the selected articles. The studies were assessed for quality and level of evidence according to the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE). Results: twelve studies were selected, all conducted at the maternities. The interventions were classified in two categories: health education on breastfeeding and the use of nipple covers. Health education on breastfeeding presents a moderate level of evidence on the prevention of nipple trauma. There is a moderate to high level of evidence on the positive effects of guaiazulene, gel or peppermint water applied in the postpartum period to prevent nipple trauma. Conclusion: health education on breastfeeding with clinical demonstration is an important strategy to prevent nipple trauma and requires more than one educational approach. The use of nipple covers requires some consideration, since they must be removed prior to breastfeeding. All interventions were conducted in the postpartum period, which points out for the necessity of clinical research to prevent nipple trauma in prenatal care.

摘要 目的：分析母乳喂养健康教育相较于其他干预措施，在预防乳头损伤方面的有效性。
方法：本研究于2019年1月按照系统评价与Meta分析优先报告条目（PRISMA）规范开展系统文献综述。检索范围涵盖Cinahl、PubMed、Web of Science、Scopus四大数据库，并对纳入文献的参考文献进行回溯检索。依据推荐分级、评估、制定与评价（GRADE）标准，对纳入研究的质量与证据等级进行评定。
结果：共纳入12项研究，全部在产科病房开展。干预措施分为两类：母乳喂养健康教育与乳头保护罩（nipple covers）使用。母乳喂养健康教育在预防乳头损伤领域的证据等级为中等。产后阶段应用愈创蓝油烃、凝胶或薄荷水以预防乳头损伤，其相关证据等级为中至高。
结论：结合临床演示的母乳喂养健康教育是预防乳头损伤的重要策略，且需采用多元教育方式。使用乳头保护罩需谨慎，因其需在哺乳前取下。所有干预措施均在产后阶段开展，这提示亟需开展产前阶段预防乳头损伤的临床研究。