Breastfeeding Success With the Use of the WHO Syringe Technique for Management of Inverted Nipples in Lactating Women

NCT ID: NCT03529630

Last Updated: 2022-03-02

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

54 participants

Study Classification

INTERVENTIONAL

Study Start Date

2018-06-01

Study Completion Date

2020-07-15

Brief Summary

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Breastfeeding is the ideal infant nutrition recommended by governmental and medical professional organizations. Yet, women with inverted nipples often face difficulties in breastfeeding that ultimately force them to prematurely terminate breastfeeding. This open-label randomized clinical trial aims to investigate the effectiveness of the use of the inverted syringe technique on exclusive breastfeeding success in women with inverted nipples, as compared to standard of care.

Detailed Description

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Breastfeeding is the ideal infant nutrition recommended by governmental and medical professional organizations. Its benefits to infants and their mothers are many including protection from infections, certain malignancies and chronic diseases, as well as improved growth, development, cognition and intelligence for children. Yet, women with inverted nipples often face difficulties in breastfeeding that ultimately force them to prematurely terminate breastfeeding. The main treatment of severely inverted nipples is surgical sectioning of the lactiferous ducts at the expense of breast's function. Several conservative measures have also been used for the less severe (grades 1 and 2) inverted nipples such as application of Hoffman Exercises and Woolwich Breast Shields, which have failed to prove their worth. The modified syringe technique is a conservative means for the correction of inverted nipples that was reported in a single case series of 8 women, with high success rates in infant latching (7/8) and exclusive breastfeeding (6/8). It is a simple, inexpensive, portable, safe, and easily learned method that can be performed by mothers as often as required.

This open-label randomized clinical trial aims to investigate the effectiveness of the use of inverted syringe on the 1-month exclusive breastfeeding rate in women with inverted nipples. We hypothesize that in women with grades 1 and 2 inverted nipples, the use of the modified syringe technique soon after delivery, as opposed to the standard of care, will significantly improve breastfeeding rates at 1 month postpartum. We will recruit 100 healthy women at ≥37 weeks of gestation with grades 1 or 2 inverted nipples from the Women's Health Center and the obstetrics outpatient department at AUBMC. They will be randomly allocated to a control group (standard of care) or to the intervention group (inverted syringe). Data will be collected at baseline (socio-demographic variables, inverted nipple grading) and at 1, 3, and 7 days postpartum about infant feeding method, and adverse events. Mothers will be contacted at 1, 3 and 6 months regarding infant feeding method, maternal satisfaction, infant's weight gain and adverse events. The association between breastfeeding success at 1 month and the use of the inverted syringe will be investigated using multivariate regression models. Findings from this study, if positive, will provide much needed evidence for a safe, affordable, readily available and simple intervention to treat inverted nipples and improve breastfeeding practice among affected women.

Conditions

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Breastfeeding Inverted Nipple

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Inverted syringe

Participants in this arm will use of the inverted syringe before each breastfeeding starting from the first feed after delivery and continued as long as needed by the mother.

Group Type EXPERIMENTAL

Inverted syringe

Intervention Type OTHER

Application of mild suction over the mother's inverted nipple using an inverted syringe before each breastfeeding.

Standard of care

Participants in the control group will receive standard medical care as dictated by their obstetricians. Any advice regarding infant nutrition or treatment of inverted nipples will be left to the primary physician, including possible use of the inverted syringe technique. .

Group Type NO_INTERVENTION

No interventions assigned to this group

Interventions

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Inverted syringe

Application of mild suction over the mother's inverted nipple using an inverted syringe before each breastfeeding.

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

1. Healthy pregnant women in their 37th week of gestation or more with grade 1 or 2 inverted nipples
2. Able to read and write
3. Singleton or twin pregnancy An inverted nipple is defined as a condition in which the nipple is pulled inward into the breast instead of pointing outward, classified according to Han and Hong \[11\].

Exclusion Criteria

1. Women with grade 3 inverted nipples
2. Previous breast surgery affecting the breast anatomy
3. High risk pregnancies
4. Medical conditions that could interfere with breastfeeding such as critical maternal condition
5. Newborns with congenital malformations that may interfere with breastfeeding such as esophageal atresia, cleft lip \&/or palate
6. Women choosing artificial milk as their preferred infant nutrition.
Minimum Eligible Age

18 Years

Maximum Eligible Age

45 Years

Eligible Sex

FEMALE

Accepts Healthy Volunteers

No

Sponsors

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American University of Beirut Medical Center

OTHER

Sponsor Role lead

Responsible Party

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Mona Nabulsi

Professor of Clinical Pediatrics

Responsibility Role PRINCIPAL_INVESTIGATOR

Locations

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American University of Beirut Medical Center

Beirut, , Lebanon

Site Status

Countries

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Lebanon

References

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Binns C, Lee M, Low WY. The Long-Term Public Health Benefits of Breastfeeding. Asia Pac J Public Health. 2016 Jan;28(1):7-14. doi: 10.1177/1010539515624964.

Reference Type BACKGROUND
PMID: 26792873 (View on PubMed)

Victora CG, Horta BL, Loret de Mola C, Quevedo L, Pinheiro RT, Gigante DP, Goncalves H, Barros FC. Association between breastfeeding and intelligence, educational attainment, and income at 30 years of age: a prospective birth cohort study from Brazil. Lancet Glob Health. 2015 Apr;3(4):e199-205. doi: 10.1016/S2214-109X(15)70002-1.

Reference Type BACKGROUND
PMID: 25794674 (View on PubMed)

Victora CG, Bahl R, Barros AJ, Franca GV, Horton S, Krasevec J, Murch S, Sankar MJ, Walker N, Rollins NC; Lancet Breastfeeding Series Group. Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect. Lancet. 2016 Jan 30;387(10017):475-90. doi: 10.1016/S0140-6736(15)01024-7.

Reference Type BACKGROUND
PMID: 26869575 (View on PubMed)

Yan J, Liu L, Zhu Y, Huang G, Wang PP. The association between breastfeeding and childhood obesity: a meta-analysis. BMC Public Health. 2014 Dec 13;14:1267. doi: 10.1186/1471-2458-14-1267.

Reference Type BACKGROUND
PMID: 25495402 (View on PubMed)

Belfort MB, Rifas-Shiman SL, Kleinman KP, Guthrie LB, Bellinger DC, Taveras EM, Gillman MW, Oken E. Infant feeding and childhood cognition at ages 3 and 7 years: Effects of breastfeeding duration and exclusivity. JAMA Pediatr. 2013 Sep;167(9):836-44. doi: 10.1001/jamapediatrics.2013.455.

Reference Type BACKGROUND
PMID: 23896931 (View on PubMed)

Section on Breastfeeding. Breastfeeding and the use of human milk. Pediatrics. 2012 Mar;129(3):e827-41. doi: 10.1542/peds.2011-3552. Epub 2012 Feb 27.

Reference Type BACKGROUND
PMID: 22371471 (View on PubMed)

Kramer MS, Kakuma R. Optimal duration of exclusive breastfeeding. Cochrane Database Syst Rev. 2012 Aug 15;2012(8):CD003517. doi: 10.1002/14651858.CD003517.pub2.

Reference Type BACKGROUND
PMID: 22895934 (View on PubMed)

SKOOG T. An operation for inverted nipples. Br J Plast Surg. 1952 Apr;5(1):65-9. doi: 10.1016/s0007-1226(52)80008-6. No abstract available.

Reference Type BACKGROUND
PMID: 14944774 (View on PubMed)

Terrill PJ, Stapleton MJ. The inverted nipple: to cut the ducts or not? Br J Plast Surg. 1991 Jul;44(5):372-7. doi: 10.1016/0007-1226(91)90152-a.

Reference Type BACKGROUND
PMID: 1873618 (View on PubMed)

Han S, Hong YG. The inverted nipple: its grading and surgical correction. Plast Reconstr Surg. 1999 Aug;104(2):389-95; discussion 396-7. doi: 10.1097/00006534-199908000-00010.

Reference Type BACKGROUND
PMID: 10654681 (View on PubMed)

Alexander JM, Grant AM, Campbell MJ. Randomised controlled trial of breast shells and Hoffman's exercises for inverted and non-protractile nipples. BMJ. 1992 Apr 18;304(6833):1030-2. doi: 10.1136/bmj.304.6833.1030.

Reference Type BACKGROUND
PMID: 1586788 (View on PubMed)

McGeorge DD. The "Niplette": an instrument for the non-surgical correction of inverted nipples. Br J Plast Surg. 1994 Jan;47(1):46-9. doi: 10.1016/0007-1226(94)90117-1.

Reference Type BACKGROUND
PMID: 8124566 (View on PubMed)

Chakrabarti K, Basu S. Management of flat or inverted nipples with simple rubber bands. Breastfeed Med. 2011 Aug;6(4):215-9. doi: 10.1089/bfm.2010.0028. Epub 2011 Jan 8.

Reference Type BACKGROUND
PMID: 21214390 (View on PubMed)

Kesaree N, Banapurmath CR, Banapurmath S, Shamanur K. Treatment of inverted nipples using a disposable syringe. J Hum Lact. 1993 Mar;9(1):27-9. doi: 10.1177/089033449300900127.

Reference Type BACKGROUND
PMID: 8489719 (View on PubMed)

Chan AW, Tetzlaff JM, Altman DG, Laupacis A, Gotzsche PC, Krleza-Jeric K, Hrobjartsson A, Mann H, Dickersin K, Berlin JA, Dore CJ, Parulekar WR, Summerskill WS, Groves T, Schulz KF, Sox HC, Rockhold FW, Rennie D, Moher D. SPIRIT 2013 statement: defining standard protocol items for clinical trials. Ann Intern Med. 2013 Feb 5;158(3):200-7. doi: 10.7326/0003-4819-158-3-201302050-00583.

Reference Type BACKGROUND
PMID: 23295957 (View on PubMed)

Leff EW, Jefferis SC, Gagne MP. The development of the Maternal Breastfeeding Evaluation Scale. J Hum Lact. 1994 Jun;10(2):105-11. doi: 10.1177/089033449401000217.

Reference Type BACKGROUND
PMID: 7619250 (View on PubMed)

Riordan JM, Woodley G, Heaton K. Testing validity and reliability of an instrument which measures maternal evaluation of breastfeeding. J Hum Lact. 1994 Dec;10(4):231-5. doi: 10.1177/089033449401000416.

Reference Type BACKGROUND
PMID: 7619277 (View on PubMed)

Hill PD, Aldag JC, Hekel B, Riner G, Bloomfield P. Maternal Postpartum Quality of Life Questionnaire. J Nurs Meas. 2006 Winter;14(3):205-20. doi: 10.1891/jnm-v14i3a005.

Reference Type BACKGROUND
PMID: 17278340 (View on PubMed)

Nabulsi M, Hamadeh H, Tamim H, Kabakian T, Charafeddine L, Yehya N, Sinno D, Sidani S. A complex breastfeeding promotion and support intervention in a developing country: study protocol for a randomized clinical trial. BMC Public Health. 2014 Jan 15;14:36. doi: 10.1186/1471-2458-14-36.

Reference Type BACKGROUND
PMID: 24428951 (View on PubMed)

Nabulsi M, Ghanem R, Smaili H, Khalil A. The inverted syringe technique for management of inverted nipples in breastfeeding women: a pilot randomized controlled trial. Int Breastfeed J. 2022 Feb 5;17(1):9. doi: 10.1186/s13006-022-00452-1.

Reference Type DERIVED
PMID: 35123525 (View on PubMed)

Nabulsi M, Ghanem R, Abou-Jaoude M, Khalil A. Breastfeeding success with the use of the inverted syringe technique for management of inverted nipples in lactating women: a study protocol for a randomized controlled trial. Trials. 2019 Dec 16;20(1):737. doi: 10.1186/s13063-019-3880-8.

Reference Type DERIVED
PMID: 31842992 (View on PubMed)

Other Identifiers

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PED.MN.15

Identifier Type: -

Identifier Source: org_study_id

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