Interventions for preventing mastitis after childbirth

Maree A Crepinsek; Linda Crowe; Keryl Michener; Neil A Smart

doi:10.1002/14651858.CD007239.pub3

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Figure 1

Summary of quality assessment of included studies. Methodological quality graph: review authors' judgements about each methodological quality item presented as percentages across all included studies.

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Figure 2

Methodological quality summary: review authors' judgements about each methodological quality item for each included study.

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Analysis 1.1

Comparison 1 Antibiotic versus no antibiotic, Outcome 1 Mastitis.

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Analysis 2.1

Comparison 2 Breastfeeding education (specialist) versus usual care, Outcome 1 Mastitis.

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Analysis 2.2

Comparison 2 Breastfeeding education (specialist) versus usual care, Outcome 2 Sore nipples.

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Analysis 2.3

Comparison 2 Breastfeeding education (specialist) versus usual care, Outcome 3 Breast engorgement.

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Analysis 2.4

Comparison 2 Breastfeeding education (specialist) versus usual care, Outcome 4 Exclusive breastfeeding.

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Analysis 2.5

Comparison 2 Breastfeeding education (specialist) versus usual care, Outcome 5 Breastfeeding problems, mean per mother.

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Analysis 3.1

Comparison 3 Anti‐secretory factor in cereal versus standard cereal, Outcome 1 Mastitis.

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Analysis 3.2

Comparison 3 Anti‐secretory factor in cereal versus standard cereal, Outcome 2 Mastitis recurrence.

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Analysis 4.1

Comparison 4 Mupirocin ointment versus breastfeeding advice alone, Outcome 1 Mastitis.

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Analysis 5.1

Comparison 5 Fusidic acid ointment versus breastfeeding advice alone, Outcome 1 Mastitis.

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Analysis 6.1

Comparison 6 Mupirocin ointment+BF advice versus fusidic acid ointment+BF advice, Outcome 1 Mastitis.

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Comparison 1. Antibiotic versus no antibiotic

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Mastitis Show forest plot	3		Risk Ratio (M‐H, Fixed, 95% CI)	Subtotals only

1.1 Antibiotic versus no antibiotic	3	471	Risk Ratio (M‐H, Fixed, 95% CI)	0.43 [0.11, 1.61]
1.2 Antibiotic versus placebo	2	387	Risk Ratio (M‐H, Fixed, 95% CI)	1.01 [0.15, 6.68]
1.3 Antibiotic versus mupirocin	1	44	Risk Ratio (M‐H, Fixed, 95% CI)	0.44 [0.05, 3.89]
1.4 Antibiotic versus fusidic acid	1	36	Risk Ratio (M‐H, Fixed, 95% CI)	0.22 [0.03, 1.81]
1.5 Antibiotic versus breastfeeding advice	1	42	Risk Ratio (M‐H, Fixed, 95% CI)	0.17 [0.02, 1.28]

Comparison 1. Antibiotic versus no antibiotic

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Comparison 2. Breastfeeding education (specialist) versus usual care

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Mastitis Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Subtotals only

1.1 at hospital discharge	1	211	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
1.2 at 7 days	1	210	Risk Ratio (M‐H, Fixed, 95% CI)	3.75 [0.35, 40.70]
1.3 at 30 days	1	203	Risk Ratio (M‐H, Fixed, 95% CI)	0.93 [0.17, 4.95]
2 Sore nipples Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Subtotals only

2.1 at hospital discharge	1	211	Risk Ratio (M‐H, Fixed, 95% CI)	0.99 [0.72, 1.36]
2.2 at 7 days	1	210	Risk Ratio (M‐H, Fixed, 95% CI)	0.90 [0.66, 1.22]
2.3 at 30 days	1	203	Risk Ratio (M‐H, Fixed, 95% CI)	0.93 [0.36, 2.37]
3 Breast engorgement Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Subtotals only

3.1 at hospital discharge	1	211	Risk Ratio (M‐H, Fixed, 95% CI)	0.61 [0.03, 14.87]
3.2 at 7 days	1	210	Risk Ratio (M‐H, Fixed, 95% CI)	1.04 [0.71, 1.53]
3.3 at 30 days	1	203	Risk Ratio (M‐H, Fixed, 95% CI)	1.04 [0.73, 1.49]
4 Exclusive breastfeeding Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Subtotals only

4.1 at 7 days	1	210	Risk Ratio (M‐H, Fixed, 95% CI)	1.03 [0.90, 1.18]
4.2 at 30 days	1	203	Risk Ratio (M‐H, Fixed, 95% CI)	0.88 [0.68, 1.14]
5 Breastfeeding problems, mean per mother Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

5.1 at hospital discharge	1	211	Mean Difference (IV, Fixed, 95% CI)	0.20 [‐0.27, 0.67]
5.2 at 30 days	1	211	Mean Difference (IV, Fixed, 95% CI)	‐0.20 [‐0.61, 0.21]

Comparison 2. Breastfeeding education (specialist) versus usual care

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Comparison 3. Anti‐secretory factor in cereal versus standard cereal

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Mastitis Show forest plot	1	29	Risk Ratio (M‐H, Fixed, 95% CI)	0.24 [0.03, 1.72]

2 Mastitis recurrence Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Subtotals only

2.1 First recurrence	1	29	Risk Ratio (M‐H, Fixed, 95% CI)	0.20 [0.01, 3.51]
2.2 Second recurrence	1	29	Risk Ratio (M‐H, Fixed, 95% CI)	0.46 [0.02, 10.45]

Comparison 3. Anti‐secretory factor in cereal versus standard cereal

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Comparison 4. Mupirocin ointment versus breastfeeding advice alone

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Mastitis Show forest plot	1	48	Risk Ratio (M‐H, Fixed, 95% CI)	0.39 [0.12, 1.35]

Comparison 4. Mupirocin ointment versus breastfeeding advice alone

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Comparison 5. Fusidic acid ointment versus breastfeeding advice alone

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Mastitis Show forest plot	1	40	Risk Ratio (M‐H, Fixed, 95% CI)	0.77 [0.27, 2.22]

Comparison 5. Fusidic acid ointment versus breastfeeding advice alone

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Comparison 6. Mupirocin ointment+BF advice versus fusidic acid ointment+BF advice

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Mastitis Show forest plot	1	42	Risk Ratio (M‐H, Fixed, 95% CI)	0.51 [0.13, 2.00]

Comparison 6. Mupirocin ointment+BF advice versus fusidic acid ointment+BF advice

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