Abstract
Objective: To identify the potential risk factors for acute mastitis during lactation comprehensively. Subsequently, to evaluate logistic regression model in predicting the risk of lactational mastitis in Chinese women by applying receiver operating characteristic (ROC) curve.Methods: A case–control study among Chinese women enrolled 652 patients with mastitis and 581 healthy women with breastfeeding experience as control. The retrospective information was obtained by questionnaires that included medical history of pregnancy, delivery, puerperium and breastfeeding behaviors. Univariate analysis and multivariate logistic regression model were performed to investigate the relationship between these factors and the occurrence of lactational mastitis. Using ROC curve to evaluate the prognostic value of these selected indicators in the risk of acute mastitis.Results: The multivariate logistic regression analysis showed that the primiparity (P < 0.001), mastitis in previous breastfeeding (P < 0.001), nipple’s heteroplasia (P < 0.001), cracked nipple (P < 0.001), breast trauma by external force (P = 0.002), lateral position (P = 0.007), breast pump (P = 0.039), nipple sucking (P = 0.007), sleep with sucking (P = 0.007), and tongue-tie (P = 0.013) were risk variables independently and significantly related with mastitis. While vaginal delivery (P = 0.015), clean nipple before breastfeeding (P = 0.015), first contact with child within 1 h (P = 0.027) were protective factors. The ROC analysis demonstrated that the area under the curve of model 2 was 0.8122 (95%CI = 0.7885–0.8360), which stated that the model presented a high sensitivity and specificity.Conclusion: By means of collecting and summarizing the risk factors associated with the occurrence of breast mastitis in Chinese women, we established risk discriminant model to identify and warn the individuals susceptible to acute mastitis early, which will allow practitioners to provide appropriate management advice and effective individual care.
Highlights
Breastfeeding is a natural infant feeding method highly recommended by the World Health Organization (WHO) [1] and the United Nations International Children’s Emergency Fund (UNICEF) to ensure the healthy growth of infants and children throughout the world [2]
The diagnosis was made according to the Academy of Breastfeeding Medicine (ABM) diagnostic criteria for lactational mastitis [6,12], which were defined as self-reported symptoms of tender, hot, swollen, wedge-shaped area of breast, accompanied by one or more of the following [13]: (1) an elevated temperature 38.5◦C or greater, (2) one of the constitutional symptoms of fever, (3) total number of white blood cells and neutrophils increased, WBC > 10.0 × 109/l and NEUT > 7.0 × 109/l, (4) axillary lymph node enlargement
Based on the steps and procedures mentioned in the method, we approached 833 eligible patients who had acute lactational mastitis
Summary
Breastfeeding is a natural infant feeding method highly recommended by the World Health Organization (WHO) [1] and the United Nations International Children’s Emergency Fund (UNICEF) to ensure the healthy growth of infants and children throughout the world [2]. The main reasons leading to failure of breastfeeding are acute mastitis and breast abscess [4]. The reason is that there are no interventions that have been consistently proven effective for preventing mastitis. About 3–11% of acute mastitis are still prone to develop to breast abscess in the case of rapid progression and improper treatment [7]. Mastitis and breast abscess have potential negative impact on infant feeding. Effective managements such as education, counselling and monitoring are essential to control the discomfort and decrease the likelihood of discontinuation of breastfeeding [8]
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