Postupci za sprečavanje mastitisa (upale dojke) nakon poroda
Abstract
Background
Despite the health benefits of breastfeeding, initiation and duration rates continue to fall short of international guidelines. Many factors influence a woman's decision to wean; the main reason cited for weaning is associated with lactation complications, such as mastitis.
Objectives
To assess the effects of preventive strategies for mastitis and the subsequent effect on breastfeeding duration.
Search methods
We searched the Cochrane Pregnancy and Childbirth Group’s Trials Register (8 August 2012).
Selection criteria
We included randomised controlled trials of interventions for preventing mastitis in postpartum breastfeeding women.
Data collection and analysis
We independently identified relevant studies and assessed the trial quality. We contacted trial authors for missing data and information as appropriate.
Main results
We included five trials (involving 960 women). In three trials of 471 women, we found no significant differences in the incidence of mastitis between use of antibiotics and no antibiotics (risk ratio (RR) 0.43; 95% confidence interval (CI) 0.11 to 1.61; or in one trial of 99 women comparing two doses (RR 0.38; 95% CI 0.02 to 9.18). We found no significant differences for mastitis in three trials of specialist breastfeeding education with usual care (one trial); anti‐secretory factor cereal (one trial); and mupirocin, fusidic acid ointment or breastfeeding advice (one trial).
Generally we found no differences in any of the trials for breastfeeding initiation or duration; or symptoms of mastitis.
Authors' conclusions
There was insufficient evidence to show effectiveness of any of the interventions, including breastfeeding education, pharmacological treatments and alternative therapies, regarding the occurrence of mastitis or breastfeeding exclusivity and duration. While studies reported the incidence of mastitis, they all used different interventions. Caution needs to be applied when considering the findings of this review as the conclusion is based on studies, often with small sample sizes. An urgent need for further adequately powered research is needed into this area to conclusively determine the effectiveness of these interventions.
PICOs
Laički sažetak
Postupci za sprečavanje mastitisa (upale dojke) nakon poroda
Zdravstveni autoriteti i Svjetska zdravstvena organizacija preporučuju hranjenje novorođenčadi i dojenčadi isključivo majčinim mlijekom do navršenih šest mjeseci života. Dojenje nudi brojne prednosti za dijete, uključujući bolju prehranu i zaštitu od bolesti poput gastroenteritisa, respiratornih infekcija, upale uha, upale mokraćnih putova, alergija i šećerne bolesti. Dojenje također omogućuje uštede i dobro je za zdravlje majke. Mastitis (upala dojke) je značajna komplikacija dojenja i može dovesti do prestanka dojenja. Bradavica postane bolna, a dojke osjetljive i otečene. Ako nastane ragada na bradavici, može doći do upale dojke, koja izaziva simptome poput gripe. Loše postavljanje djeteta na dojci kao i nedovoljno pražnjenje dojke tijekom podoja može pridonijeti pojavi mastitisa. Važno je istražiti preventivne mjere za očuvanje i povećanje isključivosti i trajanja dojenja.
Ovaj sustavni pregled je pronašao pet randomiziranih kontroliranih pokusa s ukupno 960 žena. Proučili su različite preventivne mjere uključujući obuku o dojenju, uzimanje antibiotika, primjenu masti i uzimanja žitarica s anti‐sekretornim čimbenikom. Na temelju ovih ograničenih dokaza zaključujemo da niti jedna intervencija nije smanjila učestalost upale dojki niti je dovela do promjene u isključivosti ili trajanju dojenja. Općenito su istraživanja bila loše kvalitete, s ograničenim podatcima, što naglašava potrebu za kvalitetnijim istraživanjima iz ovog područja.
