Interventions for preventing mastitis after childbirth

Maree A Crepinsek; Emily A Taylor; Keryl Michener; Fiona Stewart

doi:10.1002/14651858.CD007239.pub4

Scolaris Content Display Scolaris Content Display

Contenido relacionado

Ir a:

Revisiones y protocolos relacionados
Respuestas clínicas Cochrane
Guías
Temas

Revisiones y protocolos relacionados

Respuestas clínicas Cochrane

Topics

Temas

Figure 1

Study flow diagram.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Figure 2

Summary of risk of bias assessment of included studies.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Figure 3

Risk of bias judgements

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.1

Comparison 1: Probiotics versus placebo, Outcome 1: Incidence of mastitis within 6 months postpartum

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.2

Comparison 1: Probiotics versus placebo, Outcome 2: Nipple damage within 6 months postpartum

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.3

Comparison 1: Probiotics versus placebo, Outcome 3: Breast pain

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.4

Comparison 1: Probiotics versus placebo, Outcome 4: Number of women with adverse events

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 2.1

Comparison 2: Antibiotics versus topical treatments, Outcome 1: Incidence of mastitis within 6 months postpartum

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 3.1

Comparison 3: Antibiotics versus placebo or usual care, Outcome 1: Incidence of mastitis within 6 months postpartum

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 4.1

Comparison 4: Topical treatments versus breastfeeding advice, Outcome 1: Incidence of mastitis within 6 months postpartum

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 5.1

Comparison 5: Mupirocin ointment versus fusidic acid ointment, Outcome 1: Incidence of mastitis within 6 months postpartum

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 6.1

Comparison 6: Specialist breastfeeding education versus usual care, Outcome 1: Incidence of mastitis within 6 months postpartum

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 6.2

Comparison 6: Specialist breastfeeding education versus usual care, Outcome 2: Breast pain (sore nipples)

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 6.3

Comparison 6: Specialist breastfeeding education versus usual care, Outcome 3: Breast engorgement

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 6.4

Comparison 6: Specialist breastfeeding education versus usual care, Outcome 4: Exclusive breastfeeding

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 7.1

Comparison 7: Hydrothermally processed cereal with anti‐secretory factor‐inducing properties versus standard cereal, Outcome 1: Incidence of mastitis within 6 months postpartum

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 7.2

Comparison 7: Hydrothermally processed cereal with anti‐secretory factor‐inducing properties versus standard cereal, Outcome 2: Recurrence of mastitis within 12 months postpartum

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 8.1

Comparison 8: Acupoint massage versus routine care, Outcome 1: Incidence of mastitis within 6 months postpartum)

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 8.2

Comparison 8: Acupoint massage versus routine care, Outcome 2: Exclusive breastfeeding (at 42 days postpartum)

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 8.3

Comparison 8: Acupoint massage versus routine care, Outcome 3: Breast pain

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 8.4

Comparison 8: Acupoint massage versus routine care, Outcome 4: Breast engorgement

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 8.5

Comparison 8: Acupoint massage versus routine care, Outcome 5: Women's perception of milk supply (moderate or better)

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 9.1

Comparison 9: Breast massage and low frequency pulse treatment versus routine care, Outcome 1: Incidence of mastitis within 6 months postpartum

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 9.2

Comparison 9: Breast massage and low frequency pulse treatment versus routine care, Outcome 2: Exclusive breastfeeding

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 9.3

Comparison 9: Breast massage and low frequency pulse treatment versus routine care, Outcome 3: Any breastfeeding

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 9.4

Comparison 9: Breast massage and low frequency pulse treatment versus routine care, Outcome 4: Women's perception of milk supply (0‐14 scale; higher score = less milk supply)

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 9.5

Comparison 9: Breast massage and low frequency pulse treatment versus routine care, Outcome 5: Cessation of breastfeeding (at end of treatment period)

Ir a la figura de la revisiónAbrir en una pestaña nueva

Summary of findings 1. Probiotics compared to placebo for preventing mastitis after childbirth

Outcomes	*Anticipated absolute effects^ (95% CI)**		Relative effect (95% CI)	№ of participants (studies)	Certainty of the evidence (GRADE)	Comments
Probiotics compared to placebo for preventing mastitis after childbirth
Patient or population: postpartum breastfeeding women Setting: obstetric outpatient clinic Intervention: probiotics Comparison: placebo
Outcomes	Risk with placebo	Risk with probiotics	Relative effect (95% CI)	№ of participants (studies)	Certainty of the evidence (GRADE)	Comments
Incidence of mastitis within 6 months postpartum	Study population		RR 0.51 (0.35 to 0.75)	399 (2 RCTs)	⊕⊕⊝⊝ LOW ¹
Incidence of mastitis within 6 months postpartum	293 per 1000	149 per 1000 (102 to 220)	RR 0.51 (0.35 to 0.75)	399 (2 RCTs)	⊕⊕⊝⊝ LOW ¹
Recurrence of mastitis within 12 months postpartum	Not reported
Breast abscess within 6 months postpartum	Not reported
Nipple damage within 6 months postpartum	Study population		RR 0.33 (0.11 to 1.01)	424 (1 RCT)	⊕⊝⊝⊝ VERY LOW ^{1 2}
Nipple damage within 6 months postpartum	59 per 1000	19 per 1000 (6 to 59)	RR 0.33 (0.11 to 1.01)	424 (1 RCT)	⊕⊝⊝⊝ VERY LOW ^{1 2}
Duration of any breastfeeding	Not reported
Breast pain	Study population		RR 0.81 (0.64 to 1.01)	335 (2 RCTs)	⊕⊕⊝⊝ LOW^{3 4}
Breast pain	522 per 1000	423 per 1000 (334 to 527)	RR 0.81 (0.64 to 1.01)	335 (2 RCTs)	⊕⊕⊝⊝ LOW^{3 4}
Number of women with adverse events	In one trial no women in either the probiotics group or the placebo group experienced adverse events			108 (1 RCT)	⊕⊕⊝⊝ LOW ⁵
*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; RR: Risk ratio; OR: Odds ratio;
GRADE Working Group grades of evidence High certainty: We are very confident that the true effect lies close to that of the estimate of the effect Moderate certainty: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different Low certainty: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect Very low certainty: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect
¹ Downgraded two levels due to risk of bias: unclear allocation concealment, high risk of reporting bias, and missing data ² Downgraded one level for indirectness: measured as number of women using topical treatment for nipple cracks ³ Downgraded one level due to risk of bias: unclear allocation concealment and high risk of selective reporting ⁴ Downgraded one level for imprecision: 95% confidence interval is consistent with possible benefit and possible harm ⁵ Downgraded two levels for imprecision: few participants and no events

Summary of findings 1. Probiotics compared to placebo for preventing mastitis after childbirth

Ir a la tabla de la revisión

Summary of findings 2. Antibiotics compared to usual care or placebo for preventing mastitis after childbirth

Outcomes	*Anticipated absolute effects^ (95% CI)**		Relative effect (95% CI)	№ of participants (studies)	Certainty of the evidence (GRADE)	Comments
Antibiotics compared to usual care or placebo for preventing mastitis after childbirth
Patient or population: postpartum breastfeeding women Setting: obstetric outpatient clinic Intervention: antibiotics Comparison: usual care or placebo
Outcomes	Risk with usual care or placebo	Risk with antibiotics	Relative effect (95% CI)	№ of participants (studies)	Certainty of the evidence (GRADE)	Comments
Incidence of mastitis within 6 months postpartum	Study population		RR 0.37 (0.10 to 1.34)	429 (3 RCTs)	⊕⊕⊝⊝ LOW ¹
Incidence of mastitis within 6 months postpartum	37 per 1000	14 per 1000 (4 to 49)	RR 0.37 (0.10 to 1.34)	429 (3 RCTs)	⊕⊕⊝⊝ LOW ¹
Recurrence of mastitis within 12 months postpartum	Not reported
Breast abscess within 6 months postpartum	Not reported
Nipple damage within 6 months postpartum	Not reported
Duration of any breastfeeding	Not reported
Breast pain	Not reported
Number of women with adverse effects	Not reported
*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; RR: Risk ratio; OR: Odds ratio;
GRADE Working Group grades of evidence High certainty: We are very confident that the true effect lies close to that of the estimate of the effect Moderate certainty: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different Low certainty: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect Very low certainty: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect
¹ Downgraded two levels due to imprecision: low event rate and wide 95% CIs indicating the true effect may be either appreciable benefit or harm

Summary of findings 2. Antibiotics compared to usual care or placebo for preventing mastitis after childbirth

Ir a la tabla de la revisión

Summary of findings 3. Antibiotics compared to topical treatments for preventing mastitis after childbirth

Outcomes	*Anticipated absolute effects^ (95% CI)**		Relative effect (95% CI)	№ of participants (studies)	Certainty of the evidence (GRADE)	Comments
Antibiotics compared to topical treatments for preventing mastitis after childbirth
Patient or population: postpartum breastfeeding women Setting: obstetric outpatient clinic Intervention: antibiotics Comparison: topical treatments
Outcomes	Risk with topical treatments	Risk with antibiotics	Relative effect (95% CI)	№ of participants (studies)	Certainty of the evidence (GRADE)	Comments
Incidence of mastitis within 6 months postpartum ‐ Antibiotics versus fusidic acid ointment	Study population		RR 0.22 (0.03 to 1.81)	36 (1 RCT)	⊕⊕⊝⊝ LOW ¹
	235 per 1000	52 per 1000 (7 to 426)	RR 0.22 (0.03 to 1.81)	36 (1 RCT)	⊕⊕⊝⊝ LOW ¹
Incidence of mastitis within 6 months postpartum ‐ Antibiotics versus mupirocin ointment	Study population		RR 0.44 (0.05 to 3.89)	44 (1 RCT)	⊕⊕⊝⊝ LOW ¹
	120 per 1000	53 per 1000 (6 to 467)	RR 0.44 (0.05 to 3.89)	44 (1 RCT)	⊕⊕⊝⊝ LOW ¹
Recurrence of mastitis within 12 months postpartum	Not reported
Breast abscess within 6 months postpartum	Not reported
Nipple damage within 6 months postpartum	Not reported
Duration of any breastfeeding	Not reported
Breast pain	Not reported
Number of women with adverse effects	Not reported
¹ Downgraded two levels due to imprecision: single small trial with wide 95% CIs, indicating that the true effect may be either appreciable benefit or harm

Summary of findings 3. Antibiotics compared to topical treatments for preventing mastitis after childbirth

Ir a la tabla de la revisión

Summary of findings 4. Topical treatments compared to breastfeeding advice for preventing mastitis after childbirth

Outcomes	*Anticipated absolute effects^ (95% CI)**		Relative effect (95% CI)	№ of participants (studies)	Certainty of the evidence (GRADE)	Comments
Topical treatments compared to breastfeeding advice for preventing mastitis after childbirth
Patient or population: postpartum breastfeeding women Setting: obstetric outpatient clinic Intervention: topical treatments Comparison: breastfeeding advice
Outcomes	Risk with breastfeeding advice	Risk with topical treatments	Relative effect (95% CI)	№ of participants (studies)	Certainty of the evidence (GRADE)	Comments
Incidence of mastitis within 6 months postpartum ‐ Fusidic acid ointment versus breastfeeding advice	Study population		RR 0.77 (0.27 to 2.22)	40 (1 RCT)	⊕⊕⊝⊝ LOW ¹
	304 per 1000	234 per 1000 (82 to 676)	RR 0.77 (0.27 to 2.22)	40 (1 RCT)	⊕⊕⊝⊝ LOW ¹
Incidence of mastitis within 6 months postpartum ‐ Mupirocin ointment versus breastfeeding advice	Study population		RR 0.39 (0.12 to 1.35)	48 (1 RCT)	⊕⊕⊝⊝ LOW ¹
	304 per 1000	119 per 1000 (37 to 411)	RR 0.39 (0.12 to 1.35)	48 (1 RCT)	⊕⊕⊝⊝ LOW ¹
Recurrence of mastitis within 12 months postpartum	Not reported
Breast abscess within 6 months postpartum	Not reported
Nipple damage within 6 months postpartum	Not reported
Duration of any breastfeeding	Not reported
Breast pain	Not reported
Number of women with adverse events	Not reported
*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; RR: Risk ratio; OR: Odds ratio;
GRADE Working Group grades of evidence High certainty: We are very confident that the true effect lies close to that of the estimate of the effect Moderate certainty: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different Low certainty: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect Very low certainty: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect
¹ Downgraded two levels due to imprecision: single small trial with wide 95% CIs, indicating that the true effect may be either appreciable benefit or harm

Summary of findings 4. Topical treatments compared to breastfeeding advice for preventing mastitis after childbirth

Ir a la tabla de la revisión

Summary of findings 5. Mupirocin ointment compared to fusidic acid ointment for preventing mastitis after childbirth

Outcomes	*Anticipated absolute effects^ (95% CI)**		Relative effect (95% CI)	№ of participants (studies)	Certainty of the evidence (GRADE)	Comments
Mupirocin ointment compared to fusidic acid ointment for preventing mastitis after childbirth
Patient or population: postpartum breastfeeding women Setting: obstetric outpatient clinic Intervention: Mupirocin ointment Comparison: fusidic acid ointment
Outcomes	Risk with fusidic acid ointment	Risk with Mupirocin ointment	Relative effect (95% CI)	№ of participants (studies)	Certainty of the evidence (GRADE)	Comments
Incidence of mastitis within 6 months postpartum	Study population		RR 0.51 (0.13 to 2.00)	42 (1 RCT)	⊕⊕⊝⊝ LOW ¹
Incidence of mastitis within 6 months postpartum	235 per 1000	120 per 1000 (31 to 471)	RR 0.51 (0.13 to 2.00)	42 (1 RCT)	⊕⊕⊝⊝ LOW ¹
Recurrence of mastitis within 12 months postpartum	Not reported
Breast abscess within 6 months postpartum	Not reported
Nipple damage within 6 months postpartum	Not reported
Duration of any breastfeeding	Not reported
Breast pain	Not reported
Number of women with adverse events	Not reported
*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; RR: Risk ratio; OR: Odds ratio;
GRADE Working Group grades of evidence High certainty: We are very confident that the true effect lies close to that of the estimate of the effect Moderate certainty: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different Low certainty: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect Very low certainty: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect
¹ Downgraded two levels due to imprecision: single small trial with wide 95% CIs, indicating that the true effect may be either appreciable benefit or harm

Summary of findings 5. Mupirocin ointment compared to fusidic acid ointment for preventing mastitis after childbirth

Ir a la tabla de la revisión

Summary of findings 6. Specialist breastfeeding education compared to usual care for preventing mastitis after childbirth

Outcomes	*Anticipated absolute effects^ (95% CI)**		Relative effect (95% CI)	№ of participants (studies)	Certainty of the evidence (GRADE)	Comments
Specialist breastfeeding education compared to usual care for preventing mastitis after childbirth
Patient or population: postpartum breastfeeding women Setting: obstetric outpatient clinic Intervention: specialist breastfeeding education Comparison: usual care
Outcomes	Risk with usual care	Risk with specialist breastfeeding education	Relative effect (95% CI)	№ of participants (studies)	Certainty of the evidence (GRADE)	Comments
Incidence of mastitis within 6 months postpartum	Study population		RR 0.93 (0.17 to 4.95)	203 (1 RCT)	⊕⊕⊝⊝ LOW ¹	This outcome was measured at 30 days postpartum
Incidence of mastitis within 6 months postpartum	30 per 1000	28 per 1000 (5 to 150)	RR 0.93 (0.17 to 4.95)	203 (1 RCT)	⊕⊕⊝⊝ LOW ¹	This outcome was measured at 30 days postpartum
Recurrence of mastitis within 12 months postpartum	Not reported
Breast abscess within 6 months postpartum	Not reported
Nipple damage within 6 months postpartum	Not reported
Duration of any breastfeeding	Not reported
Breast pain (sore nipples)	Study population		RR 0.93 (0.36 to 2.37)	203 (1 RCT)	⊕⊕⊝⊝ LOW ¹
Breast pain (sore nipples)	91 per 1000	85 per 1000 (33 to 215)	RR 0.93 (0.36 to 2.37)	203 (1 RCT)	⊕⊕⊝⊝ LOW ¹
Number of women with adverse events	Not reported
*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; RR: Risk ratio; OR: Odds ratio;
GRADE Working Group grades of evidence High certainty: We are very confident that the true effect lies close to that of the estimate of the effect Moderate certainty: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different Low certainty: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect Very low certainty: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect
¹ Downgraded two levels due to imprecision: single small trial with wide 95% CIs, indicating that the true effect may be either appreciable benefit or harm

Summary of findings 6. Specialist breastfeeding education compared to usual care for preventing mastitis after childbirth

Ir a la tabla de la revisión

Summary of findings 7. Hydrothermally processed cereal with anti‐secretory factor‐inducing properties versus standard cereal standard cereal for preventing mastitis after childbirth

Outcomes	*Anticipated absolute effects^ (95% CI)**		Relative effect (95% CI)	№ of participants (studies)	Certainty of the evidence (GRADE)	Comments
Anti‐secretory factor‐inducing cereal compared to standard cereal for preventing mastitis after childbirth
Patient or population: postpartum breastfeeding women Setting: obstetric outpatient clinic Intervention: anti‐secretory factor‐inducing cereal Comparison: standard cereal
Outcomes	Risk with standard cereal	Risk with anti‐secretory factor‐inducing cereal	Relative effect (95% CI)	№ of participants (studies)	Certainty of the evidence (GRADE)	Comments
Incidence of mastitis within 6 months postpartum	Study population		RR 0.24 (0.03 to 1.72)	29 (1 RCT)	⊕⊕⊝⊝ LOW ¹
Incidence of mastitis within 6 months postpartum	353 per 1000	85 per 1000 (11 to 607)	RR 0.24 (0.03 to 1.72)	29 (1 RCT)	⊕⊕⊝⊝ LOW ¹
Recurrence of mastitis within 12 months postpartum	Study population		RR 0.39 (0.03 to 4.57)	7 (1 RCT)	⊕⊕⊝⊝ LOW ¹
Recurrence of mastitis within 12 months postpartum	667 per 1000	260 per 1000 (20 to 1000)	RR 0.39 (0.03 to 4.57)	7 (1 RCT)	⊕⊕⊝⊝ LOW ¹
Breast abscess within 6 months postpartum	Not reported
Nipple damage within 6 months postpartum	Not reported
Duration of any breastfeeding	Not reported
Breast pain	Not reported
Number of women with adverse events	Not reported
*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; RR: Risk ratio; OR: Odds ratio;
GRADE Working Group grades of evidence High certainty: We are very confident that the true effect lies close to that of the estimate of the effect Moderate certainty: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different Low certainty: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect Very low certainty: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect
¹ Downgraded two levels for imprecision: few participants and wide 95% CIs indicating the true effect may be either appreciable benefit or harm

Summary of findings 7. Hydrothermally processed cereal with anti‐secretory factor‐inducing properties versus standard cereal standard cereal for preventing mastitis after childbirth

Ir a la tabla de la revisión

Summary of findings 8. Acupoint massage compared to routine care for preventing mastitis after childbirth

Outcomes	*Anticipated absolute effects^ (95% CI)**		Relative effect (95% CI)	№ of participants (studies)	Certainty of the evidence (GRADE)	Comments
Acupoint massage compared to routine care for preventing mastitis after childbirth
Patient or population: postpartum breastfeeding women Setting: obstetric outpatient clinic Intervention: acupoint massage Comparison: routine care
Outcomes	Risk with routine care	Risk with acupoint massage	Relative effect (95% CI)	№ of participants (studies)	Certainty of the evidence (GRADE)	Comments
Incidence of mastitis within 6 months postpartum)	Study population		RR 0.38 (0.19 to 0.78)	400 (1 RCT)	⊕⊕⊕⊝ MODERATE ¹
Incidence of mastitis within 6 months postpartum)	130 per 1000	49 per 1000 (25 to 101)	RR 0.38 (0.19 to 0.78)	400 (1 RCT)	⊕⊕⊕⊝ MODERATE ¹
Recurrence of mastitis within 12 months postpartum	Not reported
Breast abscess within 6 months postpartum	Not reported
Nipple damage within 6 months postpartum	Not reported
Duration of any breastfeeding	Not reported
Breast pain	Study population		RR 0.13 (0.07 to 0.23)	400 (1 RCT)	⊕⊕⊕⊝ MODERATE ¹
Breast pain	400 per 1000	52 per 1000 (28 to 92)	RR 0.13 (0.07 to 0.23)	400 (1 RCT)	⊕⊕⊕⊝ MODERATE ¹
Number of women with adverse events	Not reported
*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; RR: Risk ratio; OR: Odds ratio;
GRADE Working Group grades of evidence High certainty: We are very confident that the true effect lies close to that of the estimate of the effect Moderate certainty: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different Low certainty: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect Very low certainty: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect
¹ Downgraded one level due to unclear risk of bias across most domains

Summary of findings 8. Acupoint massage compared to routine care for preventing mastitis after childbirth

Ir a la tabla de la revisión

Summary of findings 9. Breast massage and low frequency pulse treatment compared to routine care for preventing mastitis after childbirth

Outcomes	*Anticipated absolute effects^ (95% CI)**		Relative effect (95% CI)	№ of participants (studies)	Certainty of the evidence (GRADE)	Comments
Breast message and low frequency pulse treatment compared to routine care for preventing mastitis after childbirth
Patient or population: postpartum breastfeeding women Setting: obstetric outpatient clinic Intervention: breast message and low frequency pulse treatment Comparison: routine care
Outcomes	Risk with routine care	Risk with breast message and low frequency pulse treatment	Relative effect (95% CI)	№ of participants (studies)	Certainty of the evidence (GRADE)	Comments
Incidence of mastitis within 6 months postpartum	Study population		RR 0.03 (0.00 to 0.21)	300 (1 RCT)	⊕⊕⊝⊝ LOW ^{1 2}
Incidence of mastitis within 6 months postpartum	233 per 1000	7 per 1000 (0 to 49)	RR 0.03 (0.00 to 0.21)	300 (1 RCT)	⊕⊕⊝⊝ LOW ^{1 2}
Recurrence of mastitis within 12 months postpartum	Not reported
Breast abscess within 6 months postpartum	Not reported
Nipple damage within 6 months postpartum	Not reported
Duration of any breastfeeding	Not reported for either the duration of exclusive or any breastfeeding
Breast pain	Not reported
Number of women with adverse events	Not reported
*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; RR: Risk ratio; OR: Odds ratio;
GRADE Working Group grades of evidence High certainty: We are very confident that the true effect lies close to that of the estimate of the effect Moderate certainty: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different Low certainty: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect Very low certainty: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect
¹ Downgraded one level due to unclear risk of selection, performance and detection bias ² Downgraded one level for imprecision: few events

Summary of findings 9. Breast massage and low frequency pulse treatment compared to routine care for preventing mastitis after childbirth

Ir a la tabla de la revisión

Comparison 1. Probiotics versus placebo

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1.1 Incidence of mastitis within 6 months postpartum Show forest plot	2	399	Risk Ratio (M‐H, Fixed, 95% CI)	0.51 [0.35, 0.75]

1.2 Nipple damage within 6 months postpartum Show forest plot	1	424	Risk Ratio (M‐H, Fixed, 95% CI)	0.33 [0.11, 1.01]

1.3 Breast pain Show forest plot	2	335	Risk Ratio (M‐H, Fixed, 95% CI)	0.81 [0.64, 1.01]

1.4 Number of women with adverse events Show forest plot	1	108	Risk Ratio (M‐H, Fixed, 95% CI)	Not estimable

Comparison 1. Probiotics versus placebo

Ir a la tabla de la revisión

Comparison 2. Antibiotics versus topical treatments

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
2.1 Incidence of mastitis within 6 months postpartum Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Subtotals only

2.1.1 Antibiotics versus fusidic acid ointment	1	36	Risk Ratio (M‐H, Fixed, 95% CI)	0.22 [0.03, 1.81]
2.1.2 Antibiotics versus mupirocin ointment	1	44	Risk Ratio (M‐H, Fixed, 95% CI)	0.44 [0.05, 3.89]

Comparison 2. Antibiotics versus topical treatments

Ir a la tabla de la revisión

Comparison 3. Antibiotics versus placebo or usual care

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
3.1 Incidence of mastitis within 6 months postpartum Show forest plot	3	429	Risk Ratio (M‐H, Fixed, 95% CI)	0.37 [0.10, 1.34]

Comparison 3. Antibiotics versus placebo or usual care

Ir a la tabla de la revisión

Comparison 4. Topical treatments versus breastfeeding advice

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
4.1 Incidence of mastitis within 6 months postpartum Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Subtotals only

4.1.1 Fusidic acid ointment versus breastfeeding advice	1	40	Risk Ratio (M‐H, Fixed, 95% CI)	0.77 [0.27, 2.22]
4.1.2 Mupirocin ointment versus breastfeeding advice	1	48	Risk Ratio (M‐H, Fixed, 95% CI)	0.39 [0.12, 1.35]

Comparison 4. Topical treatments versus breastfeeding advice

Ir a la tabla de la revisión

Comparison 5. Mupirocin ointment versus fusidic acid ointment

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
5.1 Incidence of mastitis within 6 months postpartum Show forest plot	1	42	Risk Ratio (M‐H, Fixed, 95% CI)	0.51 [0.13, 2.00]

Comparison 5. Mupirocin ointment versus fusidic acid ointment

Ir a la tabla de la revisión

Comparison 6. Specialist breastfeeding education versus usual care

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
6.1 Incidence of mastitis within 6 months postpartum Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Subtotals only

6.1.1 At hospital discharge	1	211	Risk Ratio (M‐H, Fixed, 95% CI)	Not estimable
6.1.2 At 7 days	1	210	Risk Ratio (M‐H, Fixed, 95% CI)	3.75 [0.35, 40.70]
6.1.3 At 30 days	1	203	Risk Ratio (M‐H, Fixed, 95% CI)	0.93 [0.17, 4.95]
6.2 Breast pain (sore nipples) Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Subtotals only

6.2.1 At hospital discharge	1	211	Risk Ratio (M‐H, Fixed, 95% CI)	0.99 [0.72, 1.36]
6.2.2 At 7 days	1	210	Risk Ratio (M‐H, Fixed, 95% CI)	0.90 [0.66, 1.22]
6.2.3 At 30 days	1	203	Risk Ratio (M‐H, Fixed, 95% CI)	0.93 [0.36, 2.37]
6.3 Breast engorgement Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Subtotals only

6.3.1 At hospital discharge	1	211	Risk Ratio (M‐H, Fixed, 95% CI)	0.61 [0.03, 14.87]
6.3.2 At 7 days	1	210	Risk Ratio (M‐H, Fixed, 95% CI)	1.04 [0.71, 1.53]
6.3.3 At 30 days	1	203	Risk Ratio (M‐H, Fixed, 95% CI)	1.04 [0.73, 1.49]
6.4 Exclusive breastfeeding Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Subtotals only

6.4.1 At 7 days	1	210	Risk Ratio (M‐H, Fixed, 95% CI)	1.03 [0.90, 1.18]
6.4.2 At 30 days	1	203	Risk Ratio (M‐H, Fixed, 95% CI)	0.88 [0.68, 1.14]

Comparison 6. Specialist breastfeeding education versus usual care

Ir a la tabla de la revisión

Comparison 7. Hydrothermally processed cereal with anti‐secretory factor‐inducing properties versus standard cereal

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
7.1 Incidence of mastitis within 6 months postpartum Show forest plot	1	29	Risk Ratio (M‐H, Fixed, 95% CI)	0.24 [0.03, 1.72]

7.2 Recurrence of mastitis within 12 months postpartum Show forest plot	1	7	Risk Ratio (M‐H, Fixed, 95% CI)	0.39 [0.03, 4.57]

Comparison 7. Hydrothermally processed cereal with anti‐secretory factor‐inducing properties versus standard cereal

Ir a la tabla de la revisión

Comparison 8. Acupoint massage versus routine care

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
8.1 Incidence of mastitis within 6 months postpartum) Show forest plot	1	400	Risk Ratio (M‐H, Fixed, 95% CI)	0.38 [0.19, 0.78]

8.2 Exclusive breastfeeding (at 42 days postpartum) Show forest plot	1	400	Risk Ratio (M‐H, Fixed, 95% CI)	1.90 [1.58, 2.29]

8.3 Breast pain Show forest plot	1	400	Risk Ratio (M‐H, Fixed, 95% CI)	0.12 [0.07, 0.23]

8.4 Breast engorgement Show forest plot	1	400	Risk Ratio (M‐H, Fixed, 95% CI)	0.49 [0.37, 0.65]

8.5 Women's perception of milk supply (moderate or better) Show forest plot	1	400	Risk Ratio (M‐H, Fixed, 95% CI)	1.26 [1.13, 1.40]

Comparison 8. Acupoint massage versus routine care

Ir a la tabla de la revisión

Comparison 9. Breast massage and low frequency pulse treatment versus routine care

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
9.1 Incidence of mastitis within 6 months postpartum Show forest plot	1	300	Risk Ratio (M‐H, Fixed, 95% CI)	0.03 [0.00, 0.21]

9.2 Exclusive breastfeeding Show forest plot	1	300	Risk Ratio (M‐H, Fixed, 95% CI)	2.65 [1.74, 4.05]

9.3 Any breastfeeding Show forest plot	1	300	Risk Ratio (M‐H, Fixed, 95% CI)	1.83 [1.57, 2.12]

9.4 Women's perception of milk supply (0‐14 scale; higher score = less milk supply) Show forest plot	1	300	Mean Difference (IV, Fixed, 95% CI)	‐5.55 [‐5.90, ‐5.20]

9.5 Cessation of breastfeeding (at end of treatment period) Show forest plot	1	300	Risk Ratio (M‐H, Fixed, 95% CI)	0.03 [0.01, 0.12]

Comparison 9. Breast massage and low frequency pulse treatment versus routine care

Ir a la tabla de la revisión

The Cochrane Library

Scolaris Language Selector Scolaris Language Selector

Idioma de la Revisión Cochrane

Idioma de la web

Scolaris Content Language Banner Portlet Scolaris Content Language Banner Portlet