Uso de sulpirida como galactagogo para mães de recém-nascidos prematuros de muito baixo peso

Abstract

Introduction: Lactation of mothers of premature infants is unique. Unexpected early delivery, abrupt separation between mother and child, and specificities of the premature newborn are situations that make this period challenging for all those involved in promoting breastfeeding, so important for the child's survival and development. Faced with this, numerous alternatives are used to assist in this process. The use of galactagogues is one of them, in which the puerperas use drugs that act in the central nervous system in order to rise the levels of prolactin and, consequently, to increase the milk production. Objective: To investigate the use of the drug sulpiride as an aid in the promotion and maintenance of lactation in mothers of very low birth weight preterm infants admitted to the Neonatal Intensive Care Unit of a large private hospital in the city of Porto Alegre, Rio Grande do Sul. Methods: A retrospective cross-sectional study included mothers of very low birth weight preterm infants who remained at the Neonatal Intensive Care Unit for at least 30 days, who underwent mechanical extraction of milk during the hospitalization of their children. HIV seropositive mothers, those with health problems and those who spontaneously chose not to breastfeed were excluded. The data were obtained from the routinely performed records in the milk collection sector and consisted in the volume of milk obtained daily by mechanical exhaustion, daily number of drains, use and dose of drugs as lactation aids and possible side effects of these drugs. For the mothers who started sulpiride therapy after the seventh day postpartum, the volume of mechanically extracted milk was evaluated for three consecutive days before the start of therapy and, later, on the third, fifth and seventh day. Results: The study included 68 women who completed the inclusion and exclusion criteria. Their mean age was 34.5±4.2 years (minimum 18 and maximum 43 years), 98.5% were white and 65% had complete or incomplete higher education. Sixty-two (91.2%) nursing mothers took sulpiride; 17 associated other adjuvant drugs in the ejection or production of milk, 15 of which used nasal spray oxytocin. There was no difference in the volume of depleted milk comparing the mothers who used only sulpiride and the mothers who used oxytocin or a galactagogue drug besides sulpiride (p=1,000). No side effects have been reported, in either the mothers or the newborns, which might be associated with sulpiride during the investigated period. Thirty mothers initiated the use of sulpiride after the seventh day postpartum. Among these, the median daily volume of milk extracted prior to the use of sulpiride was 34 ml (interquartile range 18.3-71.7) and after sulpiride was 54 ml (interquartile range 28.8-89.9) (p=0.001). The mean number of pumping sessions performed daily at pre-sulpiride was 2.13±0.80 times, and post-sulpiride was 2.02±0.83 times (p=0.194). The group that started with sulpiride after the 14th day postpartum presented a trend towards a higher volume of milk, but the difference was not significant (p=0.158). There was a significant increase in the volume of mechanically collected milk only in the group that started sulpiride after the 14th day (p=0.002). In the group that started between seven and 14 days, the difference was not significant (p=0.117). Regarding the dosage of sulpiride used, there was no significant difference in the increase in the volume of milk in relation to the dose of one, two or three tablets Conclusion: Sulpiride was frequently used as an adjunct to lactation in the studied mothers. There was a significant increase in the volume of mechanically depleted milk, comparing the volume obtained before the use of any galactagogue drug with that obtained after treatment with sulpiride, in the mothers who started using the drug after the seventh day postpartum, particularly in those who started sulpiride after the 14th day postpartum. However, the volume of breast milk obtained both before and after therapy was low in comparison to published reports and with the volume associated with subsequent maintenance of breastfeeding in preterm infants. The mean number of daily mechanical pumping sessions of the breasts was very low compared to the current recommendations. The dosage of sulpiride was that indicated in published studies. There was no difference in the volume of milk extracted in relation to the dose of sulpiride. There were other drugs associated with sulpiride, mainly nasal oxytocin, and no difference was observed in the volume of milk between mothers who used sulpiride alone and those who used other drugs. No side effects that could be attributed to the use of sulpiride were observed in either the mothers or the newborns.