Efficacy and Safety of Topical Application of Breast Milk Compared with Lanolin for Reducing Nipple Cracks and Pain in Breastfeeding Mothers: A Systematic Review and Meta-Analysis of Randomized Clinical Trials

BACKGROUND: Nipple cracks and pain are common issues that affect the exclusivity and continuity of breastfeeding. There is a lack of consensus regarding whether breast milk or lanolin is more effective for managing these problems. This study aimed to evaluate the efficacy and safety of topical application of breast milk compared with lanolin in reducing nipple cracks and pain in breastfeeding mothers. METHODS: A systematic review with meta-analysis was conducted. Randomized controlled trials (RCTs) comparing breast milk and lanolin for the treatment of nipple cracks and pain were included. Two independent reviewers performed data extraction and risk of bias assessment. Meta-analyses were conducted using a random-effects model, and the certainty of the evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) methodology. RESULTS: Four RCTs with 711 participants were included. There were no significant differences between the application of breast milk and lanolin in reducing nipple cracks (mean difference [MD]: -0.43; 95% confidence interval [CI]: -1.12 to 0.25) or pain (MD: 0.13; 95% CI: -3.20 to 3.46). The certainty of the evidence was rated as very low due to risk of bias, inconsistency, and imprecision. CONCLUSION: There is very low-certainty evidence about whether topical breast milk differs from lanolin in reducing nipple cracks or nipple pain among breastfeeding mothers. Further well-designed RCTs with standardized protocols and outcome definitions are needed to establish the comparative effectiveness and safety of these interventions.