الفهرس 
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Abstract
B
reast milk is an extremely complex, dynamic and highly variable biofluid. Human breast milk provides critical nutrients and bioactive compounds which support growth and immune development during infancy. The discovery of growth factors, cytokines and a heterogeneous population of cells including stem cells, probiotic bacteria in human milk has led researchers’ to increased interest in human breast milk as a natural medicine. The newborn’s skin is thin, fragile, sensitive and presents a deficient epidermal barrier. Newborns may present mechanical, chemical, thermal and infectious skin lesions. The most common injuries are caused by pressure, friction, shear, adhesive removal, incontinence, chemical irritants.
Adhesive-related skin injury (ARSI) is a skin abnormality complication that persists for more than 30 minutes after tape removal. Classification of ARSI includes mechanical injuries such as epidermal stripping, tension injury or blistering and skin tears. Medical Adhesive-related skin injury are associated with risk of infection, skin injury, delayed healing, decreased quality of life, increased treatment costs and pain. Preventing newborns from feeling pain is essential because repeated exposure to pain can cause neurodevelopmental impairment.
There have been a number of reports on the topical application of human milk as an effective treatment for diaper rash, atopic eczema, diaper dermatitis and umbilical cord separation. Human breast milk is an easily accessible and anti-infective agent that can be easily used in developing and developed countries.
Aim of the Work:
The aim of this work was to assess the efficacy of breast milk in treatment of ARSI.
Material and methods:
The study performed on neonates admitted to Ain Shams Hospital NICUs and El-Galaa Teaching Hospital NICUs. Patients enrolled in the study after consideration of inclusion and exclusion criteria and obtained informed consent from the parents or caregivers.
Inclusion criteria:
1. Neonates admitted to the NICU ≥ 36 weeks of gestational age and > 5 days of their neonatal age (to unify using mature maternal breast milk).
2. Neonates with the diagnosis of adhesive related skin injury
Exclusion criteria:
1. Congenital skin diseases.
2. Unavailable maternal breast milk.
3. Hemodynamically unstable neonates.
Sample size:
Community department of faculty of medicine Ain Shams University determined that sample size of 15 neonates in each group will be needed. Sample size was calculated using PAss11 program for sample size calculation, setting power at 90% and alpha error at 0.05 and according to a previous research done by (Seifi et al., 2017) on effectiveness of breast milk on diaper dermatitis it is estimated that proportion of neonates with no lesion after 5 days in intervention group = 80% and in control group = 27%.
Sample randomization:
Thirty nine lesions of the ARSI were enrolled in the study and randomly assigned to one of the two therapeutic modalities according to a predetermined schedule generated from random numbers based on a computer generated randomised sequence.
All lesions of ARSI were numbered and then divided into two groups. Breast milk group and Routine care group.
Results:
The study included 39 lesions of ARSI from 29 neonates (12 males and 17 females), they divided to breast milk group that enrolled 14 neonates with 20 lesions and routine care group that enrolled 15 neonates with 19 lesions, their gestational age ranged between 36 and 40 weeks and their age were from 5 to 28 days old. When we compared the skin sore score of ARSI before and after treatment between breast milk group and control group there were no statistical significant difference between both groups.In breast milk group, there was statistically significant reduction in the skin sore score after treatment when compared with before treatment, this reduction was comparable to the reduction of skin sore score in the control group with no statistical significant difference between both groups.
Conclusion:
In conclusion, breast milk was found to be as effective as the routine care in treatment of the ARSI.
RECOMMENDATIONS
A
sample size of larger number could lead to more precise results.