Breastfeeding Outcomes in Mothers with Retracted Nipples in the Immediate Postnatal Period: A Prospective Observational Study.

Objective: To evaluate immediate postnatal breastfeeding outcomes in mothers with retracted nipples managed with syringing and optimal lactation support, and to compare with outcomes in mothers without nipple deformity. Methods: In this prospective cohort study, all mothers admitted in the postnatal ward of a tertiary hospital were examined for nipple deformities, and mothers with retracted nipples were compared to those without nipple deformities for LATCH score, milk transfer, need for formula supplementation, direct breastfeeding (DBF), exclusive breastfeeding (EBF), breastfeeding problems and neonatal complications during hospital stay. Those with retracted nipples were routinely advised the syringing technique and provided additional lactation support. Results: Among screened mothers, the prevalence of retracted nipples was 12.5% (55/439), mostly grade 1 (24/55, 43.6%) and present bilaterally (45/55, 81.8%). Of these, 47 mothers with retracted nipples were compared with 47 matched controls. There were significant differences in LATCH score [mean (standard deviation) 6.6 (1.5) versus 8.5 (0.6); p < 0.001], milk transfer [mL; median (interquartile range) 10 (10-15) versus 17.5 (10-25); p < 0.001], and DBF rates [25/47 (53.2%) versus 42/47 (89.4%); p < 0.001] in mothers with and without retracted nipples, respectively. However, the need for formula supplementation, EBF rate, breastfeeding problems, and neonatal complications were similar in the two groups. Conclusion: A notable proportion of mothers have retracted nipples, which hinders DBF significantly in the immediate postnatal period. However, with optimal lactation support, most mothers with retracted nipples can achieve EBF without complications.