DISCUSSION
nipple pain, nipple damages, breasts, Nipple damages, literatureNipple pain, pain, Nipple pain, nipple damage
PRESSURE ULCER, PRESSURE ULCER, BACTERIAL INFECTIONS, COMPLICATIONS
The nipple pain score found in the first two postpartum days during feedings is moderate, and the compromised area of nipple damage is more than 25% of the nipple surface. Women’s pain score during BF and the moment of occurrence of nipple damage did not affect nipple damage degree.This study presents a new theme in the literature by assessing the degree of nipple damage using NTS based on photographic images, comparing nipple damage size and nipple pain score associated with BF. The importance of exploring these approaches stands out in the implementation of differential clinical approaches that promote tissue regeneration of nipple damage and thus favor EBF duration.There is a limit to classifying the nipple damage type, associated with the postpartum period of occurrence and nipple damage degree, which lead the professional to a different interpretation, generating conducts that are sometimes generalized and not based on scientific evidence.Nipple damages can be classified according to their postpartum period, i.e., according to the period in which they appear. They can occur from infants’ first contact with the breast, with the main associated and determining cause being inadequate latch-on and positioning during BFInitial nipple damage can occur in one or both nipples. In this study, the majority of nipple damages occurred on both nipples, a condition that translates into an even greater challenge for women to maintain breast supply.Nipple pain score reported during BF by women was assessed individually between breasts and, in both the right and left breasts, moderate intensity was reported, corresponding to 4 and 5, respectively. This data is consistent with the available literatureNipple pain score during BF may have repercussions on other situations experienced by BF women and lead to interruption of BF, such as a reduction in milk ejection reflex as a result of reduction or limitation of supply from the damaged breast, which has an impact on the suckling pressure, which may contribute to nipple damage worsening and persistence, in addition to predisposing to occurrence of complications, such as local fungal and bacterial infections, disseminated to the breastThe mean size of nipple damages in this study were 8.3 mm in the right breast and 8.8 mm in the left breast, with variations between 2 mm and 23 mm. Establishing nipple damage size in order to assess tissue healing based on the proposed treatments and guidelines represents a challenge for practice. It was considered that the parameters usually used to characterize this evolution, such as area of damage, amount of exudate and appearance of pressure ulcer (Pressure Ulcer Scale for Healing (PUSH))Efforts to standardize nipple damage assessment considering their peculiarities have been explored. Recently published, the The tissue impairment degree measured using NTS revealed scores attributed to all scores, demonstrating variations related to the depth and extent of nipple damages observed between the first 48 hours postpartum.Identifying nipple damage degree is fundamental for establishing clinical management. NTS used to assess nipple damages proved to be valid, accurate and easy to apply, with potential for use in practice, demonstrated by the high agreement degree among evaluators in this study and in a study with a similar themeIn this study, nipple damages classified as NTS 2 had a higher nipple pain score than those classified as NTS 3, revealing that pain intensity should be valued, regardless of nipple damage size. Considering the findings, it is recommended that the moment of onset of nipple damage be considered, i.e., initial, late or persistent, since there is variation between related causes.The advancement of classification and associations with the various characteristics of the damage will bring great benefit to BF women with this condition, contributing to direction of care during the lactation phase. Health education for BF women focused on appropriate BF techniques performed in the postpartum period continues to be important in preventing nipple damage; however, assertive treatment according to damage specifications can reduce early cessation rates