유방울혈

Treatments for breast engorgement during lactation (Review), 2010

Mangesi L, Dowswell T

Main results

We included eight studies with 744 women. Trials examined a range of different treatments for breast engorgement: acupuncture (two studies), cabbage leaves (two studies), cold gel packs (one study), pharmacological treatments (two studies) and ultrasound (one study). For several interventions (ultrasound, cabbage leaves, and oxytocin) there was no statistically significant evidence that interventions were associated with amore rapid resolution of symptoms; in these studies women tended to have improvements in pain and other symptoms over time whether or not they received active treatment. There was evidence from one study that, compared with women receiving routine care, women receiving acupuncture had greater improvements in symptoms in the days following treatment, although there was no evidence of a difference between groups by six days, and the study did not have sufficient power to detect meaningful differences for other outcomes (such as breast abscess). A study examining protease complex reported findings favouring intervention groups although it is more than 40 years since the study was carried out, and we are not aware that this preparation is used in current practice. A study looking at cold packs suggested that the application of cold does not cause harm, and may be associated with improvements in symptoms, although differences between control and intervention groups at baseline mean that results are difficult to interpret.

Acupuncture to treat breast engorgement: two studies with 293 women

Primary and secondary outcomes
Two studies examined the effects of acupuncture on breast engorgement(Kvist 2004; Kvist 2007). In both studies there were three treatment groups: advice and usual care (which might include the use of oxytocin nasal spray at the discretion of the midwife); advice and acupuncture (excluding the SP6 acu-point); and advice and acupuncture including the SP6 point. Results for resolution of symptoms were very similar for women in the two acupuncture groups in the Kvist 2007 study, and we have combined them in the data tables. 
We were not able to include data from the Kvist 2004 study in analyses because results were not set out separately for the three randomised groups in the published report and were not available from the author.
Neither study provided information on the review’s primary outcomes(cessation of breastfeeding and mastitis). The number of women prescribed antibiotics may represent a proxy measure of mastitis; results from Kvist 2007 show that, while women in the acupuncture group were less likely to be prescribed antibiotics, the difference between the acupuncture and control group was not statistically significant.
The number of women with breast abscess was reported in Kvist 2007; women in the acupuncture group were less likely to have abscess compared to women receiving routine care, but the difference between groups did not reach statistical significance (risk ratio (RR) 0.20. 95% confidence interval (CI) 0.04 to 1.01, P =0.05).

Non pre-specified outcomes
The amount of time taken for symptoms to resolve was reported by Kvist 2007. Findings favoured the acupuncture group, with fewer women having symptoms at three, four, and five days after commencement of treatment; at four and five days the differences between groups reached statistical significance (RR 0.82, 95% CI 0.69 to 0.96) and (RR 0.84, 95% CI 0.70 to 0.99) respectively. The difference between groups for the numbers of women with symptoms lasting more than six days was not statistically significant.
In the Kvist 2004 study it was reported that at three days after the start of treatment there were no significant differences between groups for severity of symptoms or for satisfaction with breastfeeding.

Cabbage leaves to treat breast engorgement: two studies with 62 women

Primary and secondary outcomes
Two studies by the same author examined cabbage leaves to reduce symptoms of breast engorgement, and collected information on pre- and post-treatment pain scores in randomised groups. In both studies breasts rather than women were randomised, and results were not reported in a way that allowed us to enter data into RevMan 2008. In a study comparing cabbage leaves and gel packs (Roberts 1995a) it was reported that women in both groups had reductions in pain scores following treatment, but that there were no significant differences between groups (data not shown). In a second study comparing chilled versus room temperature cabbage leaves, again authors reported that both groups had less pain following treatment, but that there was no difference between the randomised groups for post-treatment pain scores (Roberts 1995)(data not shown).

Cold packs for breast engorgement: one study with 88 women

Primary and secondary outcomes
In a non-blinded study women who had had caesarean deliveries and who developed symptoms of breast engorgement were randomised to treatment and control groups (breast-shaped cold packs worn in a halter versus routine care) (Robson 1990). Women in the intervention group seemed to experience a reduction in pain intensity at post-test. The author reported a decrease in mean pain intensity score from 1.84 (standard deviation (SD) 0.65) to 1.23 (SD 0.68) compared with an increase in the control group from 1.50 (SD 0.71) to 1.79 (SD 0.72). However, the differences between groups at baseline, and the failure to observe randomisation(women with “heightened distress” were moved into the control group), make results difficult to interpret.

Agreements and disagreements with other studies or reviews

Clinical practice guidelines in the UK (NICE 2006) broadly agree with this review concluding that cabbage leaves and cold packs may be helpful for symptom relief, but that evidence on the effectiveness of these interventions is not strong. In the absence of evidence from trials the guidelines recommend breast massage,
continued breastfeeding and analgesia for symptom relief.

A randomised-controlled trial in Sweden of acupuncture and care interventions for the relief of inflammatory symptoms of the breast during lactation, 2007

Linda J. Kvist, MScN, RM, RGN (Care Development Manager and Postgraduate Student), Marie Louise Hall-Lord, PhD, RN (Associate Professor), Hakan Rydhstroem, PhD, MD (Associate Professor), Bodil Wilde Larsson, PhD, RN (Professor)

to further compare acupuncture and care interventions for the relief of inflammatory symptoms of the breast during lactation

The hypothesis tested is that acupuncture treatment will hasten recovery from inflammatory symptoms of the breast during lactation.

group 1: essential care and the use of oxytocin spray as deemed necessary by the midwife;
group 2: essential care and treatment by acupuncture needles placed at HT 3 and GB 21;
group 3: essential care and treatment by acupuncture needles placed at HT 3, GB 21 and SP 6.

To help standardise treatments, the midwives were asked to adhere to the following instructions. It was essential that all the participants expressed the sensation of De Qi. If the sensation occurred directly after insertion of the needle, no further manipulation should be carried out. If De Qi did not occur spontaneously, the point should be stimulated by rotation of the needles clockwise to 180° for 30 seconds. This was to be repeated as necessary after 15 mins. Re-positioning of the needle should be carried out if De Qi still did not occur. All treatments were to be terminated after a maximum of 30 mins. A battery-driven acupuncture point localiser was used in conjunction with manual palpation of the points. Marco Polo stainless steel needles with copper handles, gauge 0.25 mm and length 25 mm were used. Insertion was made between 3–5 mm depths, depending on the individual's amount of subcutaneous fat. Needles of gauge 0.2 mm and length 13 mm were available for use for mothers with very little subcutaneous fat. The midwives were at liberty to give daily acupuncture treatments for as long as they and the mothers deemed this necessary.

항생제 처방 비율이 통계적으로 유의성은 없게 나왔으나 의미 있는 감소를 보임.

The role of bacteria in lactational mastitis and some considerations of the use of antibiotic treatment, 2008

Linda J Kvist, Bodil Wilde Larsson, Marie Louise Hall-Lord, Anita Steen and Claes Schalén

Abstract
Background: The role of bacterial pathogens in lactational mastitis remains unclear. The objective of this study was to compare bacterial species in breast milk of women with mastitis and of healthy breast milk donors and to evaluate the use of antibiotic therapy, the symptoms of mastitis, number of health care contacts, occurrence of breast abscess, damaged nipples and recurrent symptoms in relation to bacterial counts.

Methods: In this descriptive study, breast milk from 192 women with mastitis (referred to as cases) and 466 breast milk donors (referred to as controls) was examined bacteriologically and compared using analytical  statistics. Statistical analyses were also carried out to test for relationships between bacteriological content and clinical symptoms as measured on scales, prescription of antibiotics, the number of care contacts, occurrence of breast abscess and recurring symptoms.

Results: Five main bacterial species were found in both cases and controls: coagulase negative staphylococci (CNS), viridans streptococci, Staphylococcus aureus (S. aureus), Group B streptococci (GBS) and Enterococcus faecalis. More women with mastitis had S. aureus and GBS in their breast milk than those without symptoms, although 31% of healthy women harboured S. aureus and 10% had GBS. There were no significant correlations between bacterial counts and the symptoms of mastitis as measured on scales. There were no differences in bacterial counts between those prescribed and not prescribed antibiotics or those with and without breast abscess. GBS in breast milk was associated with increased health care contacts (p = 0.02). Women with ≥ 10^7 cfu/L CNS or viridans streptococci in their breast milk had increased odds for damaged nipples (p = 0.003).

Conclusion:  Many healthy breastfeeding women have potentially pathogenic bacteria in their breast milk. Increasing bacterial counts did not affect the clinical manifestation of mastitis; thus bacterial counts in breast milk may be of limited value in the decision to treat with antibiotics as results from bacterial culture of breast milk may be difficult to interpret. These results suggest that the division of mastitis into infective or non-infective forms may not be practically feasible. Daily follow-up to measure the subsidence of symptoms can help detect those in need of antibiotics.


세균 수, 종류와
1) 유선염의 증상,
2) 항생제 처방 유무,
3) 농양의 유무,
4) 증상의 재발 정도
와는 관계없음.

Antibiotics for mastitis in breastfeeding women, 2009

Shayesteh Jahanfar, Chirk-Jenn Ng, Cheong Lieng Teng

One small trial (n = 25) compared amoxicillin with cephradine and found no significant difference between the two antibiotics in terms of symptom relief and abscess formation.
Older study compared breast emptying alone as 'supportive therapy' versus antibiotic therapy plus supportive therapy, and no therapy. The findings of the latter study suggested faster clearance of symptoms for women using antibiotics, although the study design was problematic.

Interventions for preventing mastitis after childbirth, 2010

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

We searched the Cochrane Pregnancy and Childbirth Group’s Trials Register (November 2009), CENTRAL (The Cochrane Library 2009, Issue 4), MEDLINE (1950 to November 2009), EMBASE (1974 to November 2009), CINAHL (1981 to November 2009), MIDIRS (1971 to November 2009), IPA (1970 to November 2009), AMED (1985 to November 2009) and LILACS (1982 to November 2009).

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).

Occurrence of lactational mastitis and medical management: A prospective cohort study in Glasgow, 2008

Jane A Scott, Michele Robertson, Julie Fitzpatrick, Christopher Knight and Sally Mulholland.

A longitudinal study of 420 breastfeeding women was undertaken in Glasgow in 2004/05.

In total,
74 women (18%) experienced at least one episode of mastitis.
More than one half of initial episodes (53%) occurred within the first four weeks postpartum.
One in ten women (6/57) were inappropriately advised to either stop breastfeeding from the affected breast or to discontinue breastfeeding altogether.