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