Nível de dor, regeneração tecidual e carga microbiana: estudo multifásico com lesões mamilares decorrentes da amamentação
Data
2024-07-17
Autores
Camargo, Bárbara Tideman Sartorio 
Orientadores
Coca, Kelly Pereira
Tipo
Tese de doutorado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Introdução: Lesões mamilares persistentes são um desafio para a assistência e continuidade do aleitamento materno, uma vez que estão susceptíveis à colonização por microrganismos. O uso da Polihexanida Biguanida a 0,1% (PHMB) e da Terapia Fotodinâmica com Azul de Metileno a 0,01% (PDT-MB) são modalidades terapêuticas possíveis e já exploradas na prática clínica, porém ainda sem validação com lactantes. Objetivo: Explorar o nível de dor e comprometimento tecidual das lesões mamilares de lactantes e analisar o uso de tratamentos PHMB e PDT-MB na carga microbiana de lesões mamilares persistentes. Métodos: Estudo multifásico com vistas de determinar um protocolo de tratamento para as lesões mamilares decorrentes da amamentação com a PDT-MB, associada ou não à PHMB, dividido em quatro fases, com diferentes métodos: 1) transversal descritivo, com análise post-hoc; 2) transversal descritivo; 3) longitudinal descritivo; e 4) ensaio clínico piloto randômico, duplo-cego, controlado. Foi conduzido em um ambulatório de aleitamento materno de São Paulo, com amostra composta por puérperas com lesão mamilar (uni ou bilateral), que persiste por 7-10 dias ou mais, em aleitamento materno diretamente na mama. As variáveis de desfecho foram nível de dor, regeneração tecidual e carga microbiana. Resultados: Lesões mamilares precoces apresentaram grau de comprometimento da epiderme, superior a 25% da superfície do mamilo, enquanto as persistentes um grau de comprometimento da derme, superior a 25% da superfície do mamilo, cujas mulheres apresentam nível de dor moderado e nível intenso, respectivamente. Os tratamentos PHMB e PDT-MB reduziram a carga microbiana de lesões mamilares persistentes. Conclusão: Lesões mamilares precoces se diferenciam de persistentes, indicando o agravamento do quadro conforme a manutenção da lesão. Nos casos clínicos analisados, observou-se regeneração tecidual e a redução da carga microbiana. Estudos sobre a eficácia da intervenção a partir dos protocolos propostos podem comprovar sua viabilidade clínica.
Introduction: Persistent nipple injuries are a challenge for breastfeeding care and continuity, as they are susceptible to colonization by microorganisms. The use of 0.1% Polyhexanide Biguanide (PHMB) and Photodynamic Therapy with Methylene Blue (PDT-MB) are possible therapeutic modalities already explored in clinical practice, but still without validation in breastfeeding women. Objective: To explore the level of pain and tissue impairment of nipple injuries in breastfeeding women and analyze the use of PHMB and PDT-MB treatments on the microbial load of persistent nipple injuries. Methods: Multi-phase study aimed at determining a treatment protocol for nipple injuries resulting from breastfeeding with PDT-MB, associated or not with PHMB, divided into four phases, with different methods: 1) descriptive cross-sectional, with post-hoc analysis; 2) descriptive transversal; 3) descriptive longitudinal; and 4) randomized, double-blind, controlled pilot clinical trial. It was conducted in a breastfeeding clinic in São Paulo, with a sample composed of postpartum women with nipple injuries (uni or bilateral), which persisted for 7-10 days or more, breastfeeding directly from the breast. The outcome variables were pain level, tissue regeneration and microbial load. Results: Early nipple injuries had a degree of involvement of the epidermis, greater than 25% of the nipple surface, while persistent ones had a degree of involvement of the dermis, greater than 25% of the nipple surface, with women presenting a moderate level of pain and an intense level, respectively. PHMB and PDT- MB treatments reduced the microbial load of persistent nipple injuries. Conclusion: Early nipple injuries differ from persistent ones, indicating the worsening of the condition as the injury persists. In the analyzed clinic cases, tissue regeneration and a reduction in microbial load were observed. Studies on the effectiveness of the intervention based on the proposed protocols can prove its clinical feasibility.
Introduction: Persistent nipple injuries are a challenge for breastfeeding care and continuity, as they are susceptible to colonization by microorganisms. The use of 0.1% Polyhexanide Biguanide (PHMB) and Photodynamic Therapy with Methylene Blue (PDT-MB) are possible therapeutic modalities already explored in clinical practice, but still without validation in breastfeeding women. Objective: To explore the level of pain and tissue impairment of nipple injuries in breastfeeding women and analyze the use of PHMB and PDT-MB treatments on the microbial load of persistent nipple injuries. Methods: Multi-phase study aimed at determining a treatment protocol for nipple injuries resulting from breastfeeding with PDT-MB, associated or not with PHMB, divided into four phases, with different methods: 1) descriptive cross-sectional, with post-hoc analysis; 2) descriptive transversal; 3) descriptive longitudinal; and 4) randomized, double-blind, controlled pilot clinical trial. It was conducted in a breastfeeding clinic in São Paulo, with a sample composed of postpartum women with nipple injuries (uni or bilateral), which persisted for 7-10 days or more, breastfeeding directly from the breast. The outcome variables were pain level, tissue regeneration and microbial load. Results: Early nipple injuries had a degree of involvement of the epidermis, greater than 25% of the nipple surface, while persistent ones had a degree of involvement of the dermis, greater than 25% of the nipple surface, with women presenting a moderate level of pain and an intense level, respectively. PHMB and PDT- MB treatments reduced the microbial load of persistent nipple injuries. Conclusion: Early nipple injuries differ from persistent ones, indicating the worsening of the condition as the injury persists. In the analyzed clinic cases, tissue regeneration and a reduction in microbial load were observed. Studies on the effectiveness of the intervention based on the proposed protocols can prove its clinical feasibility.
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Citação
CAMARGO, Bárbara Tideman Sartorio. Nível de dor, regeneração tecidual e carga microbiana: estudo multifásico com lesões mamilares decorrentes da amamentação. 2024. 173 f. Tese (Doutorado em Enfermagem) - Escola Paulista de Enfermagem, Universidade Federal de São Paulo, São Paulo, 2024.