Healthcare quality in breastfeeding: implementation of the nipple trauma index

Cirico, Michelli Oliveira Vani; Shimoda, Gilcéria Tochika; Oliveira, Rebeca Nunes Guedes de

doi:10.1590/1983-1447.2016.04.60546

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Sumário

Original Papers • Rev. Gaúcha Enferm. (Online) 37 (4) • 2016 • https://doi.org/10.1590/1983-1447.2016.04.60546 copy

Healthcare quality in breastfeeding: implementation of the nipple trauma index

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective

assess the efficacy of the Nipple Trauma Indicator Instrument implemented in the rooming-in facility t of a university teaching hospital as a healthcare quality indicator.

Method

exploratory, descriptive, retrospective study, with analysis of the Nipple Trauma Indicator tool of 1,691 mothers admitted in rooming-In from June to November 2012. Data were presented as absolute frequencies and percentages and statistical tests were administered.

Results

the mean rate of nipple trauma was 55.5%. The most frequent trauma was excoriation (62,2%) and the main cause was incorrect attachment of the newborn (44%). Maternal and neonatal factors associated with nipple trauma are also presented.

Conclusion

the Nipple Trauma Indicator provides a picture of breastfeeding healthcare, contributing to the construction of this quality indicator.

Breast feeding; Nipples; Wounds and injuries; Quality indicators, health care

Possible causes of nipple trauma	n	%
Total	1042	100
Infant’s incorrect mouth attachment	459	44,0
Frequent sucking of the newborn	247	23,7
Strong suckling of the newborn	107	10,3
Use of breast pump	11	1,1
Other causes *	218	20,9

		Presence of nipple trauma				P-value

		Yes		No

Variables		N	%	N	%
Age group	Adolescents (<19 years)	152	63,9	86	36,1	0,001
Age group	Adult (≥19 us)	776	54,1	658	45,9	0,001

Parity	Primiparous	498	60,2	323	39,8	0,000
	Delivered the second child	278	53,1	246	46,9
	Had more than three children	159	48	172	52,0

Skin color	White	396	62,6	237	37,4	0,000
	Brown	462	52,4	429	47,6
	Yellow	1	50,0	1	50,0
	Black	47	40,2	70	59,8

Areola and nipple area color	Pink	45	70,3	19	29,7	0,000
	Light brown	173	37,4	289	62,6
	Dark brown	531	53,4	463	46,6
	Black	41	36,0	73	64,0

Preterm newborn?	Yes	26	32,9	53	67,1	0,000
Preterm newborn?	No	570	58,6	402	41,4	0,000

Newborn remained in the rooming-in facility	Yes, during all assessments	788	57,8	575	42,2	0,000
	Yes, during part of the assessed moments	86	43,2	113	56,8
	No, the newborn remained in the Neonatal Unit	25	24,0	79	76,0
	No, newborn remained in the Neonatal Intensive Care Unit	4	66,7	2	33,3

Have you had trauma before?	Yes	225	57,0	163	42,7	0,000
Have you had trauma before?	No	163	42,7	219	57,3	0,000

Improper sucking pattern	Yes	491	70,1	209	29,9	0,000
Improper sucking pattern	No	404	47,4	448	52,6	0,000

Type of nipple		Trauma in the left nipple (p= 0.000)		Total	Trauma in the right nipple (p= 0.000)		Total
Type of nipple		no	yes	Total	no	yes	Total
inverted	n	7	13	20	6	7	13
inverted	%	35.0%	65.0%	100%	46.2%	53.8%	100%
flat	n	29	56	85	38	44	82
flat	%	34.1%	65.9%	100%	46.3%	53.7%	100%
pseudo-inverted	n	13	25	38	10	20	30
pseudo-inverted	%	34.2%	65.8%	100%	33.3%	66.7%	100%
Semi-protruding	n	174	244	418	185	233	418
Semi-protruding	%	41.6%	58.4%	100%	44.3%	55.7%	100%
Protruding	n	587	514	1101	626	492	1118
Protruding	%	53.3%	46.7%	100%	56.0%	44.0%	100%

Total	n	810	852	1662	865	796	1661
Total	%	48.7%	51.3%	100%	52.1%	47.9%	100%

Universidade Federal do Rio Grande do Sul. Escola de Enfermagem Rua São Manoel, 963 -Campus da Saúde , 90.620-110 - Porto Alegre - RS - Brasil, Fone: (55 51) 3308-5242 / Fax: (55 51) 3308-5436 - Porto Alegre - RS - Brazil
E-mail: revista@enf.ufrgs.br

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[1] Corresponding author: Michelli Oliveira Vani Cirico E-mail: vani@usp.br