JJAM30_268

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1 J. Jpn. Acad. Midwif., Vol. 30, No. 2, , 2016 原著産後早期の褥婦の授乳に影響する乳頭の硬度と長さの検討 Nipple hardness and length in the early stage of postpartum breastfeeding Keiko TERADA 抄録目的 LATCH 対象と方法 LATCH 3 Welch t χ 2 ROC 結果 SD 3.4 mm 11 SD 3.2 mm 13 SD 3.2 mm p.001 LATCH 7.4 SD SD SD 1.7 p.001 LATCH 6.0 SD SD SD 1.7 LATCH LATCH 8 11mm 7mm 4mm 結論 11mm 7mm LATCH LATCH キーワード : Megumi Midwifery Home

2 Abstract Purpose We examined the relationship between the success-rate, as shown by the LATCH score, of breastfeeding mothers who were in the early stages of postpartum and the basic data collected regarding the hardness and length of their nipples. Methods The exam was carried out targeting 394 breastfeeding, Japanese female who had given birth 1-2 days prior. The survey included assessments of nipple hardness, nipple length, and the LATCH score. The nipple hardness was subjectively measured and classified into 3 stages. Nipple length was measured using the same manufactured plastic syringe that was used in previous Thai studies. The cooperating facilities' nursing staffs were provided training in advance of the study. Statistical analysis was performed using Welch's t-test and the χ 2 test. The cut-off for nipple length that leads to successful breastfeeding was calculated using the ROC curve. This study was approved by the Saga University Ethics Committee. Results For this study, 311 (87%) people from 11 facilities cooperated. Compared to the primipara group for the first 1-2 days postpartum, the multipara group's nipples were more flexible. Over all, the average nipple length was 12 (SD 3.4) mm. The average primipara nipple length was 11 (SD 3.2) mm while the nipple length of multipara women was 13 (SD 3.2) mm; thus the multipara group was longer (p<0.001). The overall average LATCH score was 7.4 (SD 1.9) points. The average primipara LATCH score was 6.5 (SD 1.7) points. The average multipara LATCH score was 8.0 (SD 1.7) points. The multipara groups' LATCH score was higher (p<0.001). There is a relationship between the LATCH score and the nipple hardness. Hard is 6.0 (SD 1.8) points. Medium is 7.5 (SD 1.8) points. Soft is 8.2 (SD 1.7) points. As the flexibility increases, so does the LATCH score. In order for the latch score to achieve 8 points or higher, the nipple length cut-off must be 11mm. When compared with the previous studies' decubitus female nipple length cut-off value of 7mm, that is 4mm more than before. Conclusion The flexibility of early postpartum nipples in the multipara group was more flexible and nipple length was longer. When breastfeeding was successful, nipple length was greater than 11 mm, and was longer compared to the Thai women. When nipples were flexible the LATCH Score was higher. Challenges concerning the thorough education on the measuring method of nipple length and LATCH Scores and securing the trust between the determination on measurement of nipple length and LATCH scores remain. Keywords: breastfeeding, nipple areola, nipple hardness, nipple length, cut-off value Ⅰ. 緒言 2010, p , p , p.37 Lawrence, Lawrence, 2005, p , p.20 1 mm LATCH Puapornpong, Raungrongmorakot, Paritakul, et al., 2013, pp.s1-s3 Chanprapaph, Luttarapakul, Siribariruck, et al., 2013, pp J. Jpn. Acad. Midwif., Vol. 30, No. 2,

LATCH Puapornpong, Raungrongmorakot, Paritakul, et al., 2013, pp.s1-s3 Ⅱ. 研究目的 Ⅲ. 用語の定義 1991, p.1838 Puapornpong, Raungrongmorakot, Paritakul, et al. 2013, p.s2 24 B 6736 5 95 364 2011, p.

3 LATCH Puapornpong, Raungrongmorakot, Paritakul, et al., 2013, pp.s1-s3 Ⅱ. 研究目的 Ⅲ. 用語の定義 1991, p.1838 Puapornpong, Raungrongmorakot, Paritakul, et al. 2013, p.s2 24 B , p 調査内容 LATCH , p mm 1 Puapornpong, Raungrongmorakot, Paritakul, et al. 2013, p.s2 Puapornpong. P Ⅳ. 研究方法 1. 研究デザイン 2. 研究対象施設と研究対象者 A B 写真 1 乳頭長の測定方法

4 mm LATCH LATCH LATCH Jensen, Wallace, Kelsay 1994, pp LATCH L Latch A Audible T Type C Comfort H Hold help L A T C H LATCH LATCH 2008 Puapornpong, Raungrongmorakot, Paritakul, et al., 2013, pp.s1-s3 LATCH LATCH LATCH 4. 調査手順 1 2 LATCH 5. 倫理的配慮分析方法 5 LATCH 2 Welch t 3 Kruskal Wallis χ 2 LATCH Receiver Operating Characteristic curve ROC 2011, pp LATCH 8 7 ROC ROC ROC AUC J. Jpn. Acad. Midwif., Vol. 30, No. 2,

5 LATCH Puapornpong, Raungrongmorakot, Paritakul, et al. 2013, p.s2 LATCH LATCH A Riordan, Bibb, Miller, et al., 2001, p.23 LATCH H 3 LATCH 1 LATCH 6 5% IBM SPSS Statistics 21 Ⅴ. 結果 1. 研究対象者の属性 n= g vs. n= vs vs vs vs 乳頭の硬度と乳頭長 1 n= n=322 vs vs vs vs p< mm mm mm p< LATCH スコア LATCH LATCH LATCH LATCH p< LATCH p<.001 LATCH 5 n=295 2 LATCH 5 T 0 1 C H 0 表 1 初経別の乳頭の硬度と乳頭長と LATCH スコア乳頭の硬さ n=322 初産群経産群検定 χ <.001 n=331 Mean mm Welch t SD <.001 LATCH n=330 Mean Welch t SD <

6 表 2 LATCHスコア項目ごとの初経別の平均点と得点ごとの乳頭長の平均値初経別の平均点得点ごとの乳頭長の平均値 Mean( 点 )±SD Mean(mm)±SD n=295 初産群経産群 0 点 1 点 2 点 L mm mm mm A mm mm mm T mm 7 2.1mm mm C mm mm mm H mm mm mm 10mm LATCH vs. A vs H vs A vs L T C 2 H LATCH 5 Cronbach α LATCHスコアによる乳頭長のカットオフ値 LATCH LATCH 8 ROC AUC 11mm AUC= % mm LATCH 7 10mm 65.2 LATCH 8 11mm 61.1% AUC LATCHスコア低得点群の特徴 LATCH p<.001 vs vs vs p<.001 vs vs p< mm mm p<.001 Ⅵ. 考察 1. 研究対象者の特徴乳頭の硬度と乳頭長について 1991, p.1838 J. Jpn. Acad. Midwif., Vol. 30, No. 2,

7 3 VAS mm 9mm Sanuki, Fukuma, Uchida, 2009, p mm mm Thanaboonyawat, Chanprepaph, Lattalapkul, et al., 2013, p.481 2mm 2008, p.110 Thanaboonyawat, Chanprepaph, Lattalapkul, et al. 2013, p.481 teat 3.LATCH スコアについて 1 2 LATCH LATCH 9 Kumar, Mooney, Wieser, et al., 2006, p.395 Riordan, Bibb, Miller, et al. 2001, p LATCH 8 Puapornpong, Raungrongmorakot, Mahasitthiwat.et al. 2014, p.2 LATCH mm LATCH LATCH 5 0 A H H LATCH Kumar, Mooney, Wieser, et al., 2006, p.395; Riordan, Bibb, Miller, et al., 2001, p.23 LATCH Küçükoğlu, Çelebioğlu, 2014, p.55 LATCH LATCH 5 Cronbach α 0.57 Küçükoğlu, Çelebioğlu 2014, p A 4 α 0.56 LATCH T LATCH 2010, p LATCH LATCH 4.LATCHスコアによる乳頭長のカットオフ値 11mm AUC

8 Puapornpong, Raungrongmorakot, Paritakul, et al. 2013, p.s2 LATCH 8 7mm AUC mm 65.2 Puapornpong, Raungrongmorakot, Paritakul, et al. 2013, p.s2 LATCH LATCH LATCH 11 Puapornpong, Raungrongmorakot, Paritakul, et al., 2013, p.s2 1 2 LATCH LATCH LATCH LATCH 3 LATCH 8 11mm AUC LATCH 10mm 謝辞 11 ICM 5.LATCHスコア低得点群の特徴 7 10mm 6. 臨床への応用と本研究の限界と課題 LATCH Ⅶ. 結論 1 12mm 11mm 13mm 文献 2008 p.110. Chanprapaph, P., Luttarapakul, J., Siribarir uck, S., Boonyawanichkul, S. (2013). Outcome of Non-protractile Nipple Correction with Breast Cups in Pregnant Women: A Randomized Controlled Trial. Breastfeeding Medicine, 8(4), Jensen,D., Wallace,S., Kelsay,P. (1994). LATCH: A Breastfeeding Charting System and Documentation Tool. Journal of Obstetric, Gynecologic, and Neonatal Nursing, 23(1), tokusyu/syussyo06/index.html geppo/nengai14/index.html J. Jpn. Acad. Midwif., Vol. 30, No. 2,

9 Küçükoğlu, S., Çelebioğlu, A (2014). Effect of Natural-Feeding Education on Successful Exclusive Breast-Feeding and Breast-Feeding Self-Efficacy of Low-Birth-Weight Infants. Iranian Journal of Pediatrics, 24 (1), Kumar, S, P., Mooney, R., Wieser, L, J., Havstand, S (2006). The LATCH Scoring System and Prediction of Breastfeeding Duration. Journal of Human Lactation, 22(4), Lawrence, RA. & Lawrence, RM (2005). Anatomy of the human breast. A Guido for Medical Profession 6 th eds. (pp.48-52). Philadelphia: Elsevier Mosby (12), pp p (2) Puapornpong, P., Raungrongmorakot, K., Mahasitthiwat, V., Ketsuwan, S. (2014). Comparisons of the Latching on between Newborns with Tongue-Tie and Normal Newborns. Journal of the Medical Association of Thailand, 97(3), 1-5. Puapornpong, P., Raungrongmorakot, K., Paritakul, P., Ketsuwan, S., Wongin, S. (2013). Nipple Length and its Relation to Success in Breastfeeding. Journal of the Medical Association of Thailand, 96 (Suppl.1), S1-S4. Riordan, J., Bibb, D., Miller, M., Rawlins, T., (2001). Predicting Breastfeeding Duration Using the LATCH Breastfeeding Assessment Tool, Journal of Human Lactation, 17(1), Sanuki. J Fukuma. E, Uchida. Y (2009). Morphologic Study of Nipple-Areola Complex in 600 Breasts. Aesthetic Plastic Surgery, 33, (1) Thanaboonyawat, I.,Chanprepaph, P, Lattalapkul, J, Rongluen, S (2013). Pilot study of Normal Development of Nipples during Pregnancy. Journal of Human Lactation, 29 (4), (1) pp

Ⅱ. 用語の操作的定義 Ⅲ. 対象と方法 1. 対象 WAM NET 2. 調査期間 : 3. 調査方法 4. 調査内容 5. 分析方法 FisherMann-Whitney U Kruskal-Wallis SPSS. for Windows 6. 倫理的配慮 Vol. No.

Ⅱ. 用語の操作的定義 Ⅲ. 対象と方法 1. 対象 WAM NET 2. 調査期間 : 3. 調査方法 4. 調査内容 5. 分析方法 FisherMann-Whitney U Kruskal-Wallis SPSS. for Windows 6. 倫理的配慮 Vol. No. 研究報告 The Relation Between the Manager s Administrative Abilities Including Business Activities in Visiting Nursing Stations and the Station s Financial Profits Chisato Fujii Akiko Akama Mariko Ohtake Ikuko