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Scime NV, Burke SM. Environmental Scan of Breastfeeding Resources in Canadian NICUs. J Obstet Gynecol Neonatal Nurs 2018; 47:202-213. [PMID: 29425679 DOI: 10.1016/j.jogn.2017.12.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2017] [Indexed: 01/26/2023] Open
Abstract
We conducted an environmental scan using a mixed methods approach to determine the types and frequencies of breastfeeding resources available to mothers of infants in Canadian NICUs. Through interviews with key informants from 29 Level 3 NICUs, we identified six categories of resources: breastfeeding-friendly layout, breastfeeding support personnel, breastfeeding education for mothers, breast pump-related resources, coordination of postdischarge breastfeeding support, and breastfeeding-related policies. Findings from this national study indicate that a wide range of breastfeeding resources were reportedly available in Canadian Level 3 NICUs. NICU professionals are encouraged to connect with other units across Canada to facilitate the exchange of breastfeeding resources and best practices.
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Alexandre-Gouabau MC, Moyon T, Cariou V, Antignac JP, Qannari EM, Croyal M, Soumah M, Guitton Y, David-Sochard A, Billard H, Legrand A, Boscher C, Darmaun D, Rozé JC, Boquien CY. Breast Milk Lipidome Is Associated with Early Growth Trajectory in Preterm Infants. Nutrients 2018; 10:E164. [PMID: 29385065 PMCID: PMC5852740 DOI: 10.3390/nu10020164] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 01/12/2018] [Accepted: 01/12/2018] [Indexed: 12/30/2022] Open
Abstract
Human milk is recommended for feeding preterm infants. The current pilot study aims to determine whether breast-milk lipidome had any impact on the early growth-pattern of preterm infants fed their own mother's milk. A prospective-monocentric-observational birth-cohort was established, enrolling 138 preterm infants, who received their own mother's breast-milk throughout hospital stay. All infants were ranked according to the change in weight Z-score between birth and hospital discharge. Then, we selected infants who experienced "slower" (n = 15, -1.54 ± 0.42 Z-score) or "faster" (n = 11, -0.48 ± 0.19 Z-score) growth; as expected, although groups did not differ regarding gestational age, birth weight Z-score was lower in the "faster-growth" group (0.56 ± 0.72 vs. -1.59 ± 0.96). Liquid chromatography-mass spectrometry lipidomic signatures combined with multivariate analyses made it possible to identify breast-milk lipid species that allowed clear-cut discrimination between groups. Validation of the selected biomarkers was performed using multidimensional statistical, false-discovery-rate and ROC (Receiver Operating Characteristic) tools. Breast-milk associated with faster growth contained more medium-chain saturated fatty acid and sphingomyelin, dihomo-γ-linolenic acid (DGLA)-containing phosphethanolamine, and less oleic acid-containing triglyceride and DGLA-oxylipin. The ability of such biomarkers to predict early-growth was validated in presence of confounding clinical factors but remains to be ascertained in larger cohort studies.
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Affiliation(s)
- Marie-Cécile Alexandre-Gouabau
- Institut National de la Recherche Agronomique (INRA), Unité Mixte de Recherche (UMR) 1280, Physiopathologie des Adaptations Nutritionnelles, Institut des Maladies de L'appareil Digestif (IMAD), Centre de Recherche en Nutrition Humaine Ouest (CRNH), 44093 Nantes, CEDEX 1, France.
| | - Thomas Moyon
- Institut National de la Recherche Agronomique (INRA), Unité Mixte de Recherche (UMR) 1280, Physiopathologie des Adaptations Nutritionnelles, Institut des Maladies de L'appareil Digestif (IMAD), Centre de Recherche en Nutrition Humaine Ouest (CRNH), 44093 Nantes, CEDEX 1, France.
| | - Véronique Cariou
- Statistique, Sensométrie et Chimiométrie (StatSC), Ecole Nationale Vétérinaire, Agroalimentaire et de l'Alimentation Nantes-Atlantique (ONIRIS), Institut National de la Recherche Agronomique (INRA), 44322 Nantes, France.
| | - Jean-Philippe Antignac
- L'Université Nantes Angers Le Mans (LUNAM Université), Ecole Nationale Vétérinaire, Agroalimentaire et de l'Alimentation Nantes-Atlantique (ONIRIS), Laboratoire d'Etude des Résidus et Contaminants dans les Aliments (LABERCA), USC INRA 1329, 44200 Nantes, France.
| | - El Mostafa Qannari
- Statistique, Sensométrie et Chimiométrie (StatSC), Ecole Nationale Vétérinaire, Agroalimentaire et de l'Alimentation Nantes-Atlantique (ONIRIS), Institut National de la Recherche Agronomique (INRA), 44322 Nantes, France.
| | - Mikaël Croyal
- Institut National de la Recherche Agronomique (INRA), Unité Mixte de Recherche (UMR) 1280, Physiopathologie des Adaptations Nutritionnelles, Institut des Maladies de L'appareil Digestif (IMAD), Centre de Recherche en Nutrition Humaine Ouest (CRNH), 44093 Nantes, CEDEX 1, France.
| | - Mohamed Soumah
- Statistique, Sensométrie et Chimiométrie (StatSC), Ecole Nationale Vétérinaire, Agroalimentaire et de l'Alimentation Nantes-Atlantique (ONIRIS), Institut National de la Recherche Agronomique (INRA), 44322 Nantes, France.
| | - Yann Guitton
- L'Université Nantes Angers Le Mans (LUNAM Université), Ecole Nationale Vétérinaire, Agroalimentaire et de l'Alimentation Nantes-Atlantique (ONIRIS), Laboratoire d'Etude des Résidus et Contaminants dans les Aliments (LABERCA), USC INRA 1329, 44200 Nantes, France.
| | - Agnès David-Sochard
- Institut National de la Recherche Agronomique (INRA), Unité Mixte de Recherche (UMR) 1280, Physiopathologie des Adaptations Nutritionnelles, Institut des Maladies de L'appareil Digestif (IMAD), Centre de Recherche en Nutrition Humaine Ouest (CRNH), 44093 Nantes, CEDEX 1, France.
| | - Hélène Billard
- Institut National de la Recherche Agronomique (INRA), Unité Mixte de Recherche (UMR) 1280, Physiopathologie des Adaptations Nutritionnelles, Institut des Maladies de L'appareil Digestif (IMAD), Centre de Recherche en Nutrition Humaine Ouest (CRNH), 44093 Nantes, CEDEX 1, France.
| | - Arnaud Legrand
- Faculté de Médicine de Nantes, Centre Hospitalo-Universitaire Hôtel-Dieu (CHU), 44093 Nantes, France.
| | - Cécile Boscher
- Faculté de Médicine de Nantes, Centre Hospitalo-Universitaire Hôtel-Dieu (CHU), 44093 Nantes, France.
| | - Dominique Darmaun
- Institut National de la Recherche Agronomique (INRA), Unité Mixte de Recherche (UMR) 1280, Physiopathologie des Adaptations Nutritionnelles, Institut des Maladies de L'appareil Digestif (IMAD), Centre de Recherche en Nutrition Humaine Ouest (CRNH), 44093 Nantes, CEDEX 1, France.
- Faculté de Médicine de Nantes, Centre Hospitalo-Universitaire Hôtel-Dieu (CHU), 44093 Nantes, France.
| | - Jean-Christophe Rozé
- Institut National de la Recherche Agronomique (INRA), Unité Mixte de Recherche (UMR) 1280, Physiopathologie des Adaptations Nutritionnelles, Institut des Maladies de L'appareil Digestif (IMAD), Centre de Recherche en Nutrition Humaine Ouest (CRNH), 44093 Nantes, CEDEX 1, France.
- Faculté de Médicine de Nantes, Centre Hospitalo-Universitaire Hôtel-Dieu (CHU), 44093 Nantes, France.
| | - Clair-Yves Boquien
- Institut National de la Recherche Agronomique (INRA), Unité Mixte de Recherche (UMR) 1280, Physiopathologie des Adaptations Nutritionnelles, Institut des Maladies de L'appareil Digestif (IMAD), Centre de Recherche en Nutrition Humaine Ouest (CRNH), 44093 Nantes, CEDEX 1, France.
- European Milk Bank Association (EMBA), 20126 Milan, Italy.
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Martins-Celini FP, Gonçalves-Ferri WA, Aragon DC, Bernichi JP, Calixto C, Sacramento EMF, Santos MA, Martinez FE. Association between type of feeding at discharge from the hospital and nutritional status of very low birth weight preterm infants. Braz J Med Biol Res 2018. [PMID: 29513880 PMCID: PMC5912099 DOI: 10.1590/1414-431x20176540] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The ideal feeding for premature babies has been the source of extensive debate. The aim of this study was to assess the association between type of feeding at discharge and the nutritional status of very low birth weight infants. This was a retrospective cohort of preterm babies with birth weight ≤1500 g, born between January 2006 and December 2013. The infants were divided into 3 groups according to type of feeding at discharge: exclusive breast milk (group 1), mixed feeding (group 2) and exclusive artificial formula (group 3). Frequencies of each group were calculated, as well as mean Z-score differences in weight, length and head circumference. Six hundred and forty-nine newborns were included. The mean weight of groups 1, 2, and 3 was 1338.7, 1104.0, and 1254.7 g, respectively, and their mean gestational age was 31.9, 30, and 31.2 weeks, respectively. The Z-score differences (means±SD) for groups 1, 2, and 3 were: −0.84±0.68, −1.02±0.75, and −0.86±0.71 for weight, −0.21±1.23, −0.52±1.64 and −0.08±1.34 for head circumference, and −1.10±1.18, −1.54±1.37, and −0.97±1.21 for length. A significant difference was observed between groups 2 and 3 in the adjusted Z-score model for length, with no significant differences in anthropometric measurements for the other comparative analyses. Because of its many advantages, breastfeeding should be stimulated within neonatal units since nutritional status was not influenced by the different types of feeding.
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Geddes DT, Chooi K, Nancarrow K, Hepworth AR, Gardner H, Simmer K. Characterisation of sucking dynamics of breastfeeding preterm infants: a cross sectional study. BMC Pregnancy Childbirth 2017; 17:386. [PMID: 29149869 PMCID: PMC5693509 DOI: 10.1186/s12884-017-1574-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 11/06/2017] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Full breastfeeding is the ultimate aim for preterm infants to ensure they receive the full benefits of human milk however, preterm infants face a number of challenges associated with their immaturity and associated morbidities. In order to facilitate oral feeding, it is essential to have a sound knowledge of the sucking dynamics of the breastfed infant. The aim of this study was to measure and describe the sucking dynamics of the preterm breastfeeding infant. METHODS A prospective cross sectional observational study was carried out at King Edward Memorial Hospital, Perth. 38 mothers and their preterm infants (birth gestation age: 23.6-33.3 weeks; corrected gestation age 32.7 to 39.9 weeks) were recruited. Intra-oral vacuum levels, tongue movement and milk intake for a single breastfeed was measured. Statistical analysis employed linear regression and linear mixed effects models. RESULTS Synchronised ultrasound and intra-oral vacuum measurements show that the preterm infant generates vacuum by lowering their tongue in a parallel fashion, without distortion of the nipple/nipple shield. Baseline (B), mean (M) and (P) peak suck burst vacuums weakened over the course of a feed (B: p = 0.015; M: p = 0.018; P: p = 0.044) and mean and peak vacuums were weaker if the mother fed with a nipple shield (M: p = 0.012; P: p = 0.021). Infant milk intakes were higher when infants sucked for longer (p = 0.002), sucked for a greater proportion of the feed (p = 0.002), or had a greater sucking efficiency (p < 0.001). CONCLUSIONS Breastfeeding preterm infants generated intra-oral vacuum in the same manner as term infants. Nipple shields were associated with weaker intra-oral vacuums. However, vacuum strengths were not associated with milk intake rather time spent actively sucking was related to milk volumes. Further research is required to elucidate factors that influence preterm infant milk intake during breastfeeding.
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Affiliation(s)
- Donna T. Geddes
- School of Molecular Sciences, Faculty of Science M310, The University of Western Australia, Perth, WA 6009 Australia
| | - Kok Chooi
- Centre for Neonatal Research and Education, King Edward Memorial Hospital, Perth, WA Australia
- School of Paediatrics and Child Health, The University of Western Australia, Perth, WA Australia
| | - Kathryn Nancarrow
- Centre for Neonatal Research and Education, King Edward Memorial Hospital, Perth, WA Australia
- School of Paediatrics and Child Health, The University of Western Australia, Perth, WA Australia
| | - Anna R. Hepworth
- School of Molecular Sciences, Faculty of Science M310, The University of Western Australia, Perth, WA 6009 Australia
| | - Hazel Gardner
- School of Molecular Sciences, Faculty of Science M310, The University of Western Australia, Perth, WA 6009 Australia
| | - Karen Simmer
- Centre for Neonatal Research and Education, King Edward Memorial Hospital, Perth, WA Australia
- School of Paediatrics and Child Health, The University of Western Australia, Perth, WA Australia
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Pinchevski-Kadir S, Shust-Barequet S, Zajicek M, Leibovich M, Strauss T, Leibovitch L, Morag I. Direct Feeding at the Breast Is Associated with Breast Milk Feeding Duration among Preterm Infants. Nutrients 2017; 9:E1202. [PMID: 29104257 PMCID: PMC5707674 DOI: 10.3390/nu9111202] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Revised: 10/18/2017] [Accepted: 10/29/2017] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND In spite of high rates of initiating breast milk feeding (BMF) among preterm infants, a significant rate of discontinuation occurs shortly after discharge. AIM To investigate the effect of mode (direct feeding at the breast vs. expressing) and exclusivity (breast milk combined with formula vs. breast milk only) as well as maternal perceptions on the duration of BMF among preterm infants. METHODS The study included mothers whose infants were born before 32 weeks gestation, between January 2012 and August 2015 at Sheba Medical Center (SMC). Perinatal data were collected retrospectively from infants' computerized charts. Mothers were approached >12 months postpartum and were asked to complete a questionnaire. Those who agreed to participate were asked (during their visit to the follow-up clinic or by phone or mail) to complete a questionnaire regarding mode and duration of BMF as well as reasons for its discontinuation. Mothers were also asked about their pre-partum intentions to feed directly at the breast. RESULTS Out of 162 eligible mothers, 131 (80.8%) initiated BMF during their intensive care unit (ICU) hospitalization. Of these, 66 (50.3%) discontinued BMF earlier than six months postpartum. BMF ≥ 6 months was significantly associated with direct feeding at the breast, duration of exclusive BMF, and singleton birth. Regression analysis revealed that direct feeding at the breast (any or only) and duration of BMF exclusivity were the only significant variables associated with BMF duration (Odds ratio (OR) 5.5 and 95% confidence interval (CI) 2.00-15.37; OR 1.5 and 95% CI 1.25-1.88, respectively). Milk supply (inadequate or nonexistent) was the most commonly reported cause for BMF discontinuation <6 months. Direct feeding at the breast was significantly associated with BMF duration and was more common among singletons. CONCLUSIONS Direct feeding at the breast and duration of exclusive BMF are associated with duration of BMF among infants born <32 weeks of gestational age (GA). These findings suggest that targeting these two factors may play a key role in prolonging BMF duration among preterm infants.
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Affiliation(s)
- Shiran Pinchevski-Kadir
- The Edmong and Lily Safra Children Hospital, Chaim Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Ramat Gan 5262000, Israel.
| | - Shir Shust-Barequet
- Rappoport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 3525422, Israel.
| | - Michal Zajicek
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Tel Hashomer, Sackler Faculty of Medicine, Tel Aviv University, Ramat Gan 5262000, Israel.
| | - Mira Leibovich
- Newborn Neonatal Unit, Mayanei Hayeshua Medical Center, Bnei-Brak 5154475, Israel.
| | - Tzipi Strauss
- The Edmong and Lily Safra Children Hospital, Chaim Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Ramat Gan 5262000, Israel.
| | - Leah Leibovitch
- The Edmong and Lily Safra Children Hospital, Chaim Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Ramat Gan 5262000, Israel.
| | - Iris Morag
- The Edmong and Lily Safra Children Hospital, Chaim Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Ramat Gan 5262000, Israel.
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56
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Sipsma HL, Jones K, Nickel NC. Hospital practices to promote breastfeeding: The effect of maternal age. Birth 2017; 44:272-280. [PMID: 28322008 DOI: 10.1111/birt.12284] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 01/27/2017] [Accepted: 01/27/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Breastfeeding rates are disproportionately low among young mothers in the United States. Although the use of hospital practices to promote breastfeeding is widely supported, the extent to which these practices help explain breastfeeding disparities by maternal age is unclear. Accordingly, we aimed to explore how maternal age may affect (1) receipt of hospital practices and (2) associations between these practices and exclusive breastfeeding. METHODS Data were derived from participants (n = 1598) of Listening to Mothers III, a national survey administered to mothers of singleton births in United States hospitals from July 2011 to June 2012. We used multivariable logistic regression models and interaction terms to examine maternal age as an effect modifier. RESULTS Compared with mothers aged 30 and older, mothers aged 18-19 had lower odds of reporting that nurses helped them initiate breastfeeding when ready (OR 0.59 [95% CI 0.35-0.99]), they roomed-in with their baby (OR 0.32 [95% CI 0.19-54]) and they did not receive a pacifier (OR 0.53 [95% CI 0.32-0.90]). Many associations with breastfeeding were stronger among mothers aged 18-19 and 20-24 than mothers aged 25-29 and 30 and older. Additionally, compared with receiving a pacifier, not receiving a pacifier was associated with greater odds of exclusive breastfeeding at 1 week among mothers aged 30 and older (OR 1.47 [95% CI 1.02-2.11]) but lower odds among mothers aged 18-19 (OR 0.26 [95% CI 0.10-0.70]). CONCLUSIONS Hospital practices to promote breastfeeding may be differentially implemented by maternal age. Encouraging teenage mothers to room-in with their babies may be particularly important for reducing breastfeeding disparities. Pacifier use among babies of teenage mothers requires further exploration.
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Affiliation(s)
- Heather L Sipsma
- Center for Interdisciplinary Inquiry and Innovation in Sexual and Reproductive Health, University of Chicago, Chicago, IL, USA.,Department of Public Health, Benedictine University, Lisle, IL, USA
| | - Krista Jones
- Department of Health Systems Science, University of Illinois at Chicago College of Nursing, Urbana, IL, USA
| | - Nathan C Nickel
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.,Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, MB, Canada
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Suberi M, Morag I, Strauss T, Geva R. Feeding Imprinting: The Extreme Test Case of Premature Infants Born With Very Low Birth Weight. Child Dev 2017; 89:1553-1566. [PMID: 28800162 DOI: 10.1111/cdev.12923] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Feeding imprinting, considered a survival-enabling process, is not well understood. Infants born very preterm, who first feed passively, are an effective model for studying feeding imprinting. Retrospective analysis of neonatal intensive care unit (NICU) records of 255 infants (Mgestational age = 29.98 ± 1.64) enabled exploring the notion that direct breastfeeding (DBF) during NICU stay leads to consumption of more mother's milk and earlier NICU discharge. Results showed that DBF before the first bottle feeding is related to shorter transition into oral feeding, a younger age of full oral feeding accomplishment and earlier discharge. Furthermore, the number of DBF meals before first bottle feeding predicts more maternal milk consumption and improved NICU outcomes. Improved performance in response to initial exposure to DBF at the age of budding feeding abilities supports a feeding imprinting hypothesis.
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Wilson E, Edstedt Bonamy AK, Bonet M, Toome L, Rodrigues C, Howell EA, Cuttini M, Zeitlin J. Room for improvement in breast milk feeding after very preterm birth in Europe: Results from the EPICE cohort. MATERNAL AND CHILD NUTRITION 2017; 14. [PMID: 28714111 DOI: 10.1111/mcn.12485] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 05/22/2017] [Accepted: 06/07/2017] [Indexed: 12/01/2022]
Abstract
Breast milk feeding (BMF) is associated with lower neonatal morbidity in the very preterm infant (<32 weeks gestation) and breastfeeding is beneficial for maternal health. Previous studies show large variations in BMF after very preterm birth and recognize the need for targeted breastfeeding support in the neonatal intensive care units (NICU). In a European collaboration project about evidence-based practices after very preterm birth, we examined the association between maternal, obstetric, and infant clinical factors; neonatal and maternal care unit policies; and BMF at discharge from the NICU. In multivariable analyses, covariates associated with feeding at discharge were first investigated as predictors of any BMF and in further analysis as predictors of exclusive or partial BMF. Overall, 58% (3,826/6,592) of the infants received any BMF at discharge, but there were large variations between regions (range 36-80%). Primiparity, administration of antenatal corticosteroids, first enteral feed <24 hr after birth, and mother's own milk at first enteral feed were predictors positively associated with any BMF at discharge. Vaginal delivery, singleton birth, and receiving mother's own milk at first enteral feed were associated with exclusive BMF at discharge. Units with a Baby Friendly Hospital accreditation improved any BMF at discharge; units with protocols for BMF and units using donor milk had higher rates of exclusive BMF at discharge. This study suggests that there is a high potential for improving BMF through policies and support in the NICU.
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Affiliation(s)
- Emilija Wilson
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Anna-Karin Edstedt Bonamy
- Department of Women's and Children's Health, and Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Mercedes Bonet
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé) and Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, Paris, France
| | - Liis Toome
- Department of Neonates and Infants, Tallinn Children's Hospital, Tallinn, and University of Tartu, Tartu, Estonia
| | | | - Elizabeth A Howell
- Departments of Population Health Science & Policy and Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Marina Cuttini
- Research Unit of Perinatal Epidemiology, Clinical Care and Management Innovation Research Area, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Jennifer Zeitlin
- INSERM, Obstetrical, Perinatal and Paediatric Epidemiology Research Team, Centre for Epidemiology and Biostatistics (U1153), Paris-Descartes University, Paris, France
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A Password-Protected Web Site for Mothers Expressing Milk for Their Preterm Infants. Adv Neonatal Care 2017; 17:222-229. [PMID: 27902504 DOI: 10.1097/anc.0000000000000365] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Research has demonstrated that breast milk significantly decreases morbidities that impact length of stay for preterm infants, but there is a need to test interventions to improve breastfeeding outcomes. Since many Americans are using technologies such as the Intranet and smartphones to find health information and manage health, a Web site was developed for mothers who provide breast milk for their preterm hospitalized infants. PURPOSE This study examined the efficacy of a Web site for mothers to educate them about breast milk expression and assist them in monitoring their breast milk supply. METHODS Quantitative and qualitative data were collected from mothers whose preterm infants were hospitalized in a level IV neonatal intensive care unit (NICU) or transitional care unit (TCU) in an urban academic medical center in the Midwest. RESULTS Eighteen mothers participated in evaluation of the Web site. Thirteen mothers consistently logged on to the password-protected Web site (mean [standard deviation] = 13.3 [11.7]) times. Most participants, (69.2%), reported they used the breast milk educational information. Most mothers indicated that using the Web site log helped in tracking their pumping. These findings can be used to direct the design and development of web-based resources for mothers of preterm infants IMPLICATIONS FOR PRACTICE:: NICU and TCU staffs need to examine and establish approaches to actively involve mothers in monitoring the establishment and maintenance of an adequate supply of breast milk to improve neonatal health outcomes. IMPLICATIONS FOR RESEARCH An electronic health application that incorporates the features identified in this study should be developed and tested.
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Abstract
BACKGROUND For very-low-birth-weight (VLBW) infants, breastfeeding may no longer be an immediate option. Mothers often turn to mechanically expressing their milk with a breast pump to provide their infants human milk. Research aim: This study aimed to describe mothers' experiences expressing milk for their VLBW infants in a level 3 neonatal intensive care unit. METHODS Qualitative, phenomenological methods were used to better understand the milk expression experiences of 17 mothers of VLBW infants. In-depth interviews were audio-recorded and transcribed verbatim. Transcripts were analyzed using Colaizzi's seven-step protocol, and themes were identified to illustrate the lived experience of the mothers. RESULTS Five global themes emerged from interviews with mothers. However, this article focuses on one global theme, "I had one job and that was to make milk," and the supporting subthemes: (1) "I was heartbroken," (2) "Pumping is a full-time thing," and (3) "I literally sacrificed nights." CONCLUSION This study provides insight into the complex experience that mothers in the southeastern United States undergo when expressing milk for their VLBW infants.
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Affiliation(s)
- Katherine Bower
- 1 Department of Nutrition, University of Tennessee, Knoxville, Knoxville, TN, USA
| | - Tara Burnette
- 2 Department of Obstetrics and Gynecology, University of Tennessee Medical Center, Knoxville, TN, USA
| | - Daniel Lewis
- 3 Office of Research, University of Tennessee, Knoxville, Knoxville, TN, USA
| | - Courtney Wright
- 1 Department of Nutrition, University of Tennessee, Knoxville, Knoxville, TN, USA
| | - Katie Kavanagh
- 1 Department of Nutrition, University of Tennessee, Knoxville, Knoxville, TN, USA
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61
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Fotiou C, Vlastarakos PV, Bakoula C, Papagaroufalis K, Bakoyannis G, Darviri C, Chrousos G. Parental stress management using relaxation techniques in a neonatal intensive care unit: A randomised controlled trial. Intensive Crit Care Nurs 2017; 32:20-8. [PMID: 26520208 DOI: 10.1016/j.iccn.2015.08.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Revised: 08/19/2015] [Accepted: 08/22/2015] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The objective of this study was to investigate the effect of relaxation techniques on the stress/anxiety of parents with hospitalised premature infants, three months following discharge from the neonatal intensive care unit. STUDY DESIGN A randomised controlled trial was conducted in the neonatal intensive care unit of a tertiary maternity hospital including 59 parents, who were randomised into two groups: 31 in the intervention group and 28 in the control group. Parents in the intervention group practiced three different relaxation techniques, in addition to undergoing the same information-based training courses as did the parents of the control group. DATA COLLECTION Data were collected 10-15 days post delivery and three months post discharge. The assessment measures included the Perceived Stress Scale, the State and Trait Anxiety Inventory 1 and 2 and salivary cortisol levels. RESULTS The psychometric assessment at baseline was comparable between the two groups. The intervention group showed a significant reduction in trait anxiety (p=0.02) compared with the control group three months post discharge. The perceived stress decreased in both groups (p=0.699). No difference in salivary cortisol levels was detected. The multivariate analysis revealed that higher initial stress levels (p<0.001) and university/college education (p=0.003) were associated with higher parental stress, whereas moderate-to-high income satisfaction was associated with lower parental stress (p=0.003). CONCLUSION Further long-term follow-up of families with a neonatal intensive care unit experience could assess more delayed effects of stress management by relaxation techniques.
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Affiliation(s)
- Catherine Fotiou
- Postgraduate Program in Stress Management and Health Promotion, University of Athens, Athens, Greece
| | | | - Chrysa Bakoula
- Second Department of Pediatrics, University of Athens, "P. & A. Kyriakou" Children's Hospital, Athens, Greece
| | | | - George Bakoyannis
- Department of Biostatistics, "Richard M. Fairbanks" School of Public Health, University of Indiana, Indianapolis, IN, USA
| | - Christine Darviri
- Postgraduate Program in Stress Management and Health Promotion, University of Athens, Athens, Greece
| | - George Chrousos
- First Department of Pediatrics, University of Athens, "Aghia Sophia" Children's Hospital, Athens, Greece
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Dritsakou K, Massara P, Skourlis N, Liosis G, Skouroliakou M. Maternal diet and breastfeeding duration of infants after NICU hospitalization in Greece: a cohort study. J Matern Fetal Neonatal Med 2016; 30:2398-2403. [DOI: 10.1080/14767058.2016.1250258] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Kalliopi Dritsakou
- Midwife, Registered Nurse, Departments of Quality Control, Research and Continuing Education, Elena Venizelou Maternity Hospital, Athens, Greece,
| | - Paraskevi Massara
- Department of Nutrition and Dietetics, Harokopeion University of Athens, Greece,
| | - Nikolaos Skourlis
- Department of Nutrition and Dietetics, Harokopeion University of Athens, Greece,
| | - Georgios Liosis
- Neonatologist, Human Milk Bank, NICU, Elena Venizelou Maternity Hospital, Athens, Greece, and
| | - Maria Skouroliakou
- Assistant Professor of Enteral and Parenteral Nutrition, Department of Science of Dietetics-Nutrition, Harokopeion University of Athens, Greece
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63
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Oza-Frank R, Moreland JJ, McNamara K, Geraghty SR, Keim SA. Early Lactation and Infant Feeding Practices Differ by Maternal Gestational Diabetes History. J Hum Lact 2016; 32:658-665. [PMID: 27550377 PMCID: PMC6322208 DOI: 10.1177/0890334416663196] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Detailed data on lactation practices by gestational diabetes mellitus (GDM) history are lacking, precluding potential explanations and targets for interventions to improve lactation intensity and duration and, ultimately, long-term maternal and child health. OBJECTIVE This study aimed to examine breastfeeding practices through 12 months postpartum by GDM history. METHODS Women who delivered a singleton, liveborn infant at The Ohio State University Wexner Medical Center (Columbus, OH), in 2011 completed a postal questionnaire to assess lactation and infant feeding practices and difficulties. Bivariate and multivariate associations between GDM history and lactation and infant feeding practices were examined. RESULTS The sample included 432 women (62% response rate), including 7.9% who had GDM during the index pregnancy. Women with GDM initiated breastfeeding (at-the-breast or pumping) as often as women without any diabetes but were more likely to report introduction of formula within the first 2 days of life (79.4% vs 53.8%, P < .01; adjusted odds ratio: 3.48; 95% confidence interval, 1.47-8.26). Women with GDM initiated pumping 4 days earlier than women without diabetes ( P < .05), which was confirmed in adjusted analyses. There was no difference in the proportion of women reporting breastfeeding difficulty (odds ratio: 2.08; 95% confidence interval, 0.78-5.52). However, there was a trend toward women with GDM reporting more formula feeding and less at-the-breast feeding as strategies to address difficulty compared with women without diabetes. CONCLUSION Additional research is needed to understand why women with GDM engage in different early lactation and infant feeding practices, and how best to promote and sustain breastfeeding among these women.
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Affiliation(s)
- Reena Oza-Frank
- The Research Institute at Nationwide Children’s Hospital, Columbus, OH, USA
- The Ohio State University College of Medicine, Columbus, OH, USA
| | | | - Kelly McNamara
- The Research Institute at Nationwide Children’s Hospital, Columbus, OH, USA
| | | | - Sarah A. Keim
- The Research Institute at Nationwide Children’s Hospital, Columbus, OH, USA
- The Ohio State University College of Medicine, Columbus, OH, USA
- The Ohio State University College of Public Health, Columbus, OH, USA
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64
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Direct-breastfeeding in the neonatal intensive care unit and breastfeeding duration for premature infants. Appl Nurs Res 2016; 32:47-51. [DOI: 10.1016/j.apnr.2016.04.004] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 03/28/2016] [Accepted: 04/05/2016] [Indexed: 11/19/2022]
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65
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Colaizy TT, Bartick MC, Jegier BJ, Green BD, Reinhold AG, Schaefer AJ, Bogen DL, Schwarz EB, Stuebe AM. Impact of Optimized Breastfeeding on the Costs of Necrotizing Enterocolitis in Extremely Low Birthweight Infants. J Pediatr 2016; 175:100-105.e2. [PMID: 27131403 PMCID: PMC5274635 DOI: 10.1016/j.jpeds.2016.03.040] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Revised: 02/01/2016] [Accepted: 03/16/2016] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To estimate risk of necrotizing enterocolitis (NEC) for extremely low birth weight (ELBW) infants as a function of preterm formula (PF) and maternal milk intake and calculate the impact of suboptimal feeding on the incidence and costs of NEC. STUDY DESIGN We used aORs derived from the Glutamine Trial to perform Monte Carlo simulation of a cohort of ELBW infants under current suboptimal feeding practices, compared with a theoretical cohort in which 90% of infants received at least 98% human milk. RESULTS NEC incidence among infants receiving ≥98% human milk was 1.3%; 11.1% among infants fed only PF; and 8.2% among infants fed a mixed diet (P = .002). In adjusted models, compared with infants fed predominantly human milk, we found an increased risk of NEC associated with exclusive PF (aOR = 12.1, 95% CI 1.5, 94.2), or a mixed diet (aOR 8.7, 95% CI 1.2-65.2). In Monte Carlo simulation, current feeding of ELBW infants was associated with 928 excess NEC cases and 121 excess deaths annually, compared with a model in which 90% of infants received ≥98% human milk. These models estimated an annual cost of suboptimal feeding of ELBW infants of $27.1 million (CI $24 million, $30.4 million) in direct medical costs, $563 655 (CI $476 191, $599 069) in indirect nonmedical costs, and $1.5 billion (CI $1.3 billion, $1.6 billion) in cost attributable to premature death. CONCLUSIONS Among ELBW infants, not being fed predominantly human milk is associated with an increased risk of NEC. Efforts to support milk production by mothers of ELBW infants may prevent infant deaths and reduce costs.
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MESH Headings
- Breast Feeding/economics
- Enterocolitis, Necrotizing/economics
- Enterocolitis, Necrotizing/epidemiology
- Enterocolitis, Necrotizing/prevention & control
- Health Care Costs/statistics & numerical data
- Humans
- Infant Formula/economics
- Infant, Extremely Low Birth Weight
- Infant, Newborn
- Infant, Premature
- Infant, Premature, Diseases/economics
- Infant, Premature, Diseases/epidemiology
- Infant, Premature, Diseases/prevention & control
- Milk, Human
- Models, Economic
- Monte Carlo Method
- United States/epidemiology
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Affiliation(s)
- Tarah T Colaizy
- Carver College of Medicine, University of Iowa, Iowa City, IA.
| | - Melissa C Bartick
- Department of Medicine, Cambridge Health Alliance and Harvard Medical School, Cambridge, MA
| | | | - Brittany D Green
- Department of Industrial Engineering, University of Pittsburgh, Pittsburgh, PA
| | | | - Andrew J Schaefer
- Department of Computational and Applied Mathematics, Rice University, Houston, TX
| | - Debra L Bogen
- Department of Pediatrics, University of Pittsburgh, Pittsburgh, PA
| | | | - Alison M Stuebe
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, NC; Carolina Global Breastfeeding Institute, Gillings School of Global Public Health, Chapel Hill, NC
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66
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McKinney CO, Hahn-Holbrook J, Chase-Lansdale PL, Ramey SL, Krohn J, Reed-Vance M, Raju TN, Shalowitz MU. Racial and Ethnic Differences in Breastfeeding. Pediatrics 2016; 138:peds.2015-2388. [PMID: 27405771 PMCID: PMC4960721 DOI: 10.1542/peds.2015-2388] [Citation(s) in RCA: 108] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/11/2016] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Breastfeeding rates differ among racial/ethnic groups in the United States. Our aim was to test whether racial/ethnic disparities in demographic characteristics, hospital use of infant formula, and family history of breastfeeding mediated racial/ethnic gaps in breastfeeding outcomes. METHODS We analyzed data from the Community and Child Health Network study (N = 1636). Breastfeeding initiation, postnatal intent to breastfeed, and breastfeeding duration were assessed postpartum. Hierarchical linear modeling was used to estimate relative odds of breastfeeding initiation, postnatal intent, and duration among racial/ethnic groups and to test the candidate mediators of maternal age, income, household composition, employment, marital status, postpartum depression, preterm birth, smoking, belief that "breast is best," family history of breastfeeding, in-hospital formula introduction, and WIC participation. RESULTS Spanish-speaking Hispanic mothers were most likely to initiate (91%), intend (92%), and maintain (mean duration, 17.1 weeks) breastfeeding, followed by English-speaking Hispanic mothers (initiation 90%, intent 88%; mean duration, 10.4 weeks) and white mothers (initiation 78%, intent 77%; mean duration, 16.5 weeks); black mothers were least likely to initiate (61%), intend (57%), and maintain breastfeeding (mean duration, 6.4 weeks). Demographic variables fully mediated disparities between black and white mothers in intent and initiation, whereas demographic characteristics and in-hospital formula feeding fully mediated breastfeeding duration. Family breastfeeding history and demographic characteristics helped explain the higher breastfeeding rates of Hispanic mothers relative to white and black mothers. CONCLUSIONS Hospitals and policy makers should limit in-hospital formula feeding and consider family history of breastfeeding and demographic characteristics to reduce racial/ethnic breastfeeding disparities.
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Affiliation(s)
- Chelsea O. McKinney
- NorthShore University HealthSystem Department of Pediatrics and Research Institute, Evanston, Illinois
| | | | | | - Sharon L. Ramey
- Virginia Tech Carilion Research Institute, Virginia Tech, Roanoke, Virginia
| | - Julie Krohn
- Lake County Health Department and Community Health Center, Waukegan, Illinois
| | | | - Tonse N.K. Raju
- Pregnancy and Perinatology Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Rockville, Maryland; and
| | - Madeleine U. Shalowitz
- NorthShore University HealthSystem Department of Pediatrics and Research Institute, Evanston, Illinois;,Department of Pediatrics, University of Chicago, Pritzker School of Medicine, Chicago, Illinois
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67
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Ziadi M, Héon M, Aita M. A Critical Review of Interventions Supporting Transition from Gavage to Direct Breastfeeding in Hospitalized Preterm Infants. ACTA ACUST UNITED AC 2016. [DOI: 10.1053/j.nainr.2016.03.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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68
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Lamounier JA. Breastfeeding in preterm infants: public health policy in primary care. REVISTA PAULISTA DE PEDIATRIA (ENGLISH EDITION) 2016. [PMID: 27068609 PMCID: PMC4917261 DOI: 10.1016/j.rppede.2016.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
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69
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Niela-Vilén H, Axelin A, Melender HL, Löyttyniemi E, Salanterä S. Breastfeeding preterm infants - a randomized controlled trial of the effectiveness of an Internet-based peer-support group. J Adv Nurs 2016; 72:2495-507. [DOI: 10.1111/jan.12993] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2016] [Indexed: 11/29/2022]
Affiliation(s)
| | - Anna Axelin
- Department of Nursing Science; University of Turku; Finland
| | | | | | - Sanna Salanterä
- Department of Nursing Science; University of Turku; Finland
- Turku University Hospital; Finland
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70
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Niela-Vilén H, Melender HL, Axelin A, Löyttyniemi E, Salanterä S. Predictors of Breastfeeding Initiation and Frequency for Preterm Infants in the NICU. J Obstet Gynecol Neonatal Nurs 2016; 45:346-58. [DOI: 10.1016/j.jogn.2016.01.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/01/2016] [Indexed: 10/22/2022] Open
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71
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Pierro J, Abulaimoun B, Roth P, Blau J. Factors Associated with Supplemental Formula Feeding of Breastfeeding Infants During Postpartum Hospital Stay. Breastfeed Med 2016; 11:196-202. [PMID: 27027901 DOI: 10.1089/bfm.2015.0091] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To determine reasons potentially amenable to interventions that mothers choose to supplement breastfeeding with formula in the immediate postpartum period. STUDY DESIGN We distributed surveys to all mothers in the postpartum unit who delivered a live newborn on day of maternal discharge to assess feeding behaviors during their inpatient admission. We evaluated, when applicable, their reasons for supplementation and examined cultural and demographic information to uncover trends for formula use and potential areas for provider intervention. RESULTS Seven hundred twelve of 1,400 mothers responded, of which 478 (65%) reported supplementing breastfeeding with formula (BF+F). The most common reasons for formula supplementation were perception of inadequate milk supply (36.4%), desire for sleep (35.4%), and a plan to breast and bottle feed (35.2%). Exclusive breastfeeding (EBF) was associated with primiparous status (OR 1.95; 95% CI 1.3-3.0), higher education level (OR 2.6; 95% CI 1.7-3.9), and having been breastfed as an infant (OR 1.54; 95% CI 1-2.37). Mothers who experienced skin-to-skin contact also had higher rates of EBF (29.5% versus 19.9%). Factors associated with exclusive formula feeding included single marital status, birth of mother in the United States, Catholic religion, multiparity, and cesarean delivery. Religious and cultural factors also played important roles in maternal feeding behaviors. CONCLUSION Clinicians can anticipate risk factors for formula use in mothers who plan to breastfeed and tailor counseling appropriately to increase EBF rates.
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Affiliation(s)
- Joanna Pierro
- Division of Neonatology, Department of Pediatrics, Staten Island University Hospital , Staten Island, New York
| | - Bdair Abulaimoun
- Division of Neonatology, Department of Pediatrics, Staten Island University Hospital , Staten Island, New York
| | - Philip Roth
- Division of Neonatology, Department of Pediatrics, Staten Island University Hospital , Staten Island, New York
| | - Jonathan Blau
- Division of Neonatology, Department of Pediatrics, Staten Island University Hospital , Staten Island, New York
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72
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Lee SY, Jang GJ. Prevalence and Predictors of Exclusive Breastfeeding in Late Preterm Infants at 12 Weeks. CHILD HEALTH NURSING RESEARCH 2016. [DOI: 10.4094/chnr.2016.22.2.79] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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73
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Lamounier JA. [Breastfeeding in preterm infants: public health policy in primary care]. REVISTA PAULISTA DE PEDIATRIA 2016; 34:137-8. [PMID: 27068609 DOI: 10.1016/j.rpped.2016.03.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Indexed: 12/01/2022]
Affiliation(s)
- Joel Alves Lamounier
- Departamento de Medicina, Universidade Federal de São João Del Rei (UFSJ), São João del Rei, MG, Brasil.
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74
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Cricco-Lizza R. Infant Feeding Beliefs and Day-to-Day Feeding Practices of NICU Nurses. J Pediatr Nurs 2016; 31:e91-8. [PMID: 26601732 PMCID: PMC4769936 DOI: 10.1016/j.pedn.2015.10.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Revised: 10/16/2015] [Accepted: 10/17/2015] [Indexed: 10/22/2022]
Abstract
UNLABELLED The purpose is to examine the infant feeding beliefs and day-to-day feeding practices of NICU nurses with the goal of identifying ways to improve breastfeeding promotion. DESIGN AND METHODS An ethnographic approach incorporated 14 months of participant observation and interviewing. General informants consisted of 114 purposively selected NICU nurses from a northeastern, level-IV NICU, pediatric hospital. From this group, 18 nurses served as key informants. There was an average of 13 interactions with each key informant and 3.5 with each general informant. Audio taped interviews and observational field notes were gathered for descriptions of beliefs and practices. Data were coded and analyzed for patterns and themes with the aid of NUD*IST. RESULTS 1. The nurses identified health benefits of breastfeeding, but spoke in greater detail and with more emotion about day-to-day challenges of breastfeeding in the NICU. 2. Formula feeding evoked less emotion and most nurses viewed it as safe and convenient. 3. Despite infant feeding challenges in the NICU, nurses who had breastfeeding continuing education and/or some positive experiences with breastfeeding: identified evidence based breastfeeding benefits for mothers and babies; emphasized the health-based differences between breast milk and formula; and were more committed to working through difficulties with breastfeeding. CONCLUSIONS Breastfeeding promotion interventions should include every NICU nurse and incorporate both evidence-based and affective components to overcome day-to-day feeding practice challenges. PRACTICE IMPLICATIONS Breastfeeding promotion interventions must address conflicting and emotionally evocative infant feeding beliefs of NICU nurses. Effective interventions must be integrated within the realities of bedside feeding practices.
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75
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Simmer K, Kok C, Nancarrow K, Hepworth AR, Geddes DT. Novel feeding system to promote establishment of breastfeeds after preterm birth: a randomized controlled trial. J Perinatol 2016; 36:210-5. [PMID: 26658121 PMCID: PMC4770056 DOI: 10.1038/jp.2015.184] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Revised: 08/31/2015] [Accepted: 10/02/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVE We aimed to determine if a novel feeding system where milk only flowed when the preterm infant created a vacuum would influence time to full oral feeds, the length of stay (LOS) in hospital and breastfeeding at discharge. STUDY DESIGN This was a randomized controlled trial in the tertiary neonatal intensive care unit at King Edward Memorial Hospital, Perth, Australia. Eligibility criteria were: preterm infants of gestational age 25 to 34 weeks receiving >75% human milk by gastric tube. Infants were randomly assigned to being fed with a novel teat (NT) or conventional teat (CT). Intention to treat analysis was performed. RESULT Time to full suck feeds was not different between groups. LOS was shorter (mean: 2.5 days; P=0.026) and less formula was fed at discharge in the NT group (P=0.036). CONCLUSION Use of a NT that releases milk when the infant applies vacuum while establishing breastfeeding reduces duration of hospitalization of preterm infants.
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Affiliation(s)
- K Simmer
- Centre for Neonatal Research and Education, School of Pediatrics and Child Health, King Edward Memorial Hospital, Perth, WA, Australia
- School of Paediatrics and Child Health, Faculty of Medicine, Dentistry and Health Sciences, The University of Western Australia, Perth, WA, Australia
| | - C Kok
- Centre for Neonatal Research and Education, School of Pediatrics and Child Health, King Edward Memorial Hospital, Perth, WA, Australia
- School of Paediatrics and Child Health, Faculty of Medicine, Dentistry and Health Sciences, The University of Western Australia, Perth, WA, Australia
| | - K Nancarrow
- Centre for Neonatal Research and Education, School of Pediatrics and Child Health, King Edward Memorial Hospital, Perth, WA, Australia
- School of Paediatrics and Child Health, Faculty of Medicine, Dentistry and Health Sciences, The University of Western Australia, Perth, WA, Australia
| | - A R Hepworth
- School of Chemistry and Biochemistry, Faculty of Science, The University of Western Australia, Perth, WA, Australia
| | - D T Geddes
- School of Chemistry and Biochemistry, Faculty of Science, The University of Western Australia, Perth, WA, Australia
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76
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Sharp JA, Lefèvre C, Watt A, Nicholas KR. Analysis of human breast milk cells: gene expression profiles during pregnancy, lactation, involution, and mastitic infection. Funct Integr Genomics 2016; 16:297-321. [PMID: 26909879 DOI: 10.1007/s10142-016-0485-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2015] [Revised: 02/04/2016] [Accepted: 02/09/2016] [Indexed: 12/22/2022]
Abstract
The molecular processes underlying human milk production and the effects of mastitic infection are largely unknown because of limitations in obtaining tissue samples. Determination of gene expression in normal lactating women would be a significant step toward understanding why some women display poor lactation outcomes. Here, we demonstrate the utility of RNA obtained directly from human milk cells to detect mammary epithelial cell (MEC)-specific gene expression. Milk cell RNA was collected from five time points (24 h prepartum during the colostrum period, midlactation, two involutions, and during a bout of mastitis) in addition to an involution series comprising three time points. Gene expression profiles were determined by use of human Affymetrix arrays. Milk cells collected during milk production showed that the most highly expressed genes were involved in milk synthesis (e.g., CEL, OLAH, FOLR1, BTN1A1, and ARG2), while milk cells collected during involution showed a significant downregulation of milk synthesis genes and activation of involution associated genes (e.g., STAT3, NF-kB, IRF5, and IRF7). Milk cells collected during mastitic infection revealed regulation of a unique set of genes specific to this disease state, while maintaining regulation of milk synthesis genes. Use of conventional epithelial cell markers was used to determine the population of MECs within each sample. This paper is the first to describe the milk cell transcriptome across the human lactation cycle and during mastitic infection, providing valuable insight into gene expression of the human mammary gland.
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Affiliation(s)
- Julie A Sharp
- Institute for Frontier Materials, Deakin University, Geelong, VIC, 3216, Australia. .,Department of Anatomy and Developmental Biology, Monash University, Clayton, VIC, 3800, Australia.
| | - Christophe Lefèvre
- Division of Bioinformatics, Walter and Eliza Hall Medical Research Institute, Melbourne, 3000, Australia
| | - Ashalyn Watt
- Institute for Frontier Materials, Deakin University, Geelong, VIC, 3216, Australia
| | - Kevin R Nicholas
- Department of Anatomy and Developmental Biology, Monash University, Clayton, VIC, 3800, Australia
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77
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Kair LR, Colaizy TT. Breastfeeding Continuation Among Late Preterm Infants: Barriers, Facilitators, and Any Association With NICU Admission? Hosp Pediatr 2016; 6:261-8. [PMID: 27048247 DOI: 10.1542/hpeds.2015-0172] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND OBJECTIVES Late preterm birth (at 34-36 6/7 weeks' gestation) is a risk factor for early breastfeeding cessation. The objective of this study was to determine barriers to and facilitators of breastfeeding continuation among late preterm infants (LPI) and to compare the barriers faced by LPI admitted to the well nursery versus the NICU. METHODS The SAS Complex Survey was used to perform multivariable logistic regression analysis by using data from the Centers for Disease Control and Prevention's Pregnancy Risk Assessment Monitoring System. Data from 3 states (Illinois, Maine, and Vermont) for the years 2004 to 2008 were used. RESULTS A total of 2530 mothers of LPI were surveyed. Odds of breastfeeding initiation were similar among LPI admitted to the NICU versus the well nursery (adjusted odds ratio, 1.24 [95% confidence interval, 0.88-1.73]; P = .209). Odds of breastfeeding for ≥ 10 weeks were no different between LPI admitted to the NICU versus those admitted to the well-nursery (adjusted odds ratio, 1.02 [95% confidence interval, 0.73-1.43]; P = .904). Factors associated with increased odds of breastfeeding for ≥ 10 weeks among LPI were higher maternal education, mother being married, and normal maternal BMI. Regardless of NICU admission, the top reasons cited by mothers of LPI for early breastfeeding discontinuation were perceived inadequate milk supply and nursing difficulties. CONCLUSIONS Among LPIs, NICU admission was not associated with early breastfeeding cessation. Mothers of LPIs with lower odds of sustaining breastfeeding for at least 10 weeks were single mothers, those with a high school education only, and those who were obese. Breastfeeding support should be enhanced for LPIs and should address perceived maternal milk supply concerns and nursing difficulties.
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Affiliation(s)
- Laura R Kair
- Department of Pediatrics, University of Iowa Stead Family, Carver College of Medicine, Iowa City, Iowa, 52242, USA.
| | - Tarah T Colaizy
- Department of Pediatrics, University of Iowa Stead Family, Carver College of Medicine, Iowa City, Iowa, 52242, USA
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78
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Preterm Infants' Mothers' Experiences With Milk Expression and Breastfeeding: An Integrative Review. Adv Neonatal Care 2015; 15:394-406. [PMID: 26536173 DOI: 10.1097/anc.0000000000000232] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Preterm infants' mothers face several challenges when providing critical breast milk for their infants; therefore, sensitive and evidence-based counseling and support are needed. However, a general view of the experiences preterm infants' mothers can face during their infants' hospitalization and after discharge is lacking. PURPOSE The aim of this integrative review was to explore practical and emotional experiences of preterm infants' mothers with respect to breast milk expression and breastfeeding, from the birth of the preterm infant, during the neonatal intensive care unit (NICU) stay, and postdischarge until the cessation of breastfeeding. METHODS/SEARCH STRATEGY A systematic literature search from MEDLINE, CINAHL, PsycInfo, and Cochrane databases were performed. The search resulted in 20 qualitative and 3 quantitative studies. The data were analyzed by thematic analysis. FINDINGS Coping was the central theme in mothers' experiences. The benefits of breast milk served both as a supportive factor and an obstructive factor for the mothers, and breastfeeding was used to rebuild connection and motherhood. Simultaneously, the mothers needed to cope with new demands, interfering NICU environment, demanding expressing, and difficulties with breastfeeding. IMPLICATIONS FOR PRACTICE Expressing and breastfeeding are important for the mothers to contribute to their infants' care and to rebuild the interrupted connection. Evidence-based and sensitive informational and practical counseling are vital for the mothers. Intensive emotional support is important during encountered problems and during cessation. IMPLICATIONS FOR RESEARCH Future research is needed about mothers' experiences using supplementation methods, test-weighing, exploring experiences of mothers of late-preterm infants, and the validity of the concept of coping with this phenomenon.
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79
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Briere CE, McGrath JM, Cong X, Brownell E, Cusson R. Direct-Breastfeeding Premature Infants in the Neonatal Intensive Care Unit. J Hum Lact 2015; 31:386-92. [PMID: 25900843 DOI: 10.1177/0890334415581798] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Accepted: 03/20/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND The neonatal intensive care unit (NICU) presents challenges for breastfeeding, especially with feeding directly at the breast (direct-breastfeeding). OBJECTIVES The objectives of this study were to describe the characteristics of direct-breastfeeding and identify factors that are associated with direct-breastfeeding in the NICU. METHODS A retrospective chart review of 88 infants born < 34 weeks gestational age whose mothers provided human milk was conducted. Analyses included chi-square and logistic regression models. RESULTS Of infants who received human milk at the time of their first oral feeding, 59% received their first oral feeding at breast and 33% of mothers had a specific breastfeeding goal. Mothers who breastfed ≥ 1 direct-breastfeed per day were more likely to have a breastfeeding goal (odds ratio [OR] = 11.13; 95% confidence interval [CI], 1.43-86.88) and be older (OR = 1.33; 95% CI, 1.03-1.72). Their infants had more days between the first breastfeed and introduction of a bottle (OR = 1.56; 95% CI, 1.11-2.17) and had shorter lengths of stay (OR = 0.9; 95% CI, 0.9-0.97). Mothers were more likely to provide direct-breastfeeding at discharge if they were non-Hispanic (OR = 0.05; 95% CI, < 0.01-0.60), were primiparous (OR = 0.06; 95% CI, 0.01-0.45), had a specific breastfeeding goal (OR = 13.79; 95% CI, 1.99-95.80), and their infant had a shorter length of stay (OR = 0.94; 95% CI, 0.90-0.98). CONCLUSION Mothers should be supported to breastfeed before using bottles in the NICU. In addition, goal setting is important for prenatal care providers to discuss with all mothers early in pregnancy, especially those at high risk for premature delivery.
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Affiliation(s)
- Carrie-Ellen Briere
- School of Nursing, University of Connecticut, Storrs, CT, USA Institute for Nursing Research and Evidence Based Practice, Connecticut Children's Medical Center, Hartford, CT, USA
| | - Jacqueline M McGrath
- School of Nursing, University of Connecticut, Storrs, CT, USA Institute for Nursing Research and Evidence Based Practice, Connecticut Children's Medical Center, Hartford, CT, USA
| | - Xiaomei Cong
- School of Nursing, University of Connecticut, Storrs, CT, USA
| | - Elizabeth Brownell
- Division of Neonatology, Connecticut Children's Medical Center, Hartford, CT, USA University of Connecticut School of Medicine, Storrs, CT, USA
| | - Regina Cusson
- School of Nursing, University of Connecticut, Storrs, CT, USA
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80
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Fabiyi C, Rankin K, Norr K, Yoder JC, Vasa R, White-Traut R. The Association of Low Social Support with Breast Milk Expression in Low-Income Mother-Preterm Infant Dyads. J Hum Lact 2015; 31:490-7. [PMID: 25975943 DOI: 10.1177/0890334415586199] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Accepted: 04/18/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND Premature infants benefit from receiving expressed breast milk (BM), but expressing breast milk is difficult for new mothers. Little is known about mothers' social support and BM expression during the premature infant's hospital stay. OBJECTIVE We examined whether low maternal social support was associated with breast milk expression initiation and low breast milk expression among low-income mothers of premature infants. METHODS Maternal intake interview data and daily infant data on proportion of nutrition from BM during hospitalization were analyzed from a larger randomized trial testing a developmental intervention on 181 mother-premature infant dyads with at least 2 of 10 social-environmental risks. Multivariable modified Poisson regression was used to examine the relationship between social support (Personal Resources Questionnaire 2000; dichotomized as low for lowest quartile), initiation (any breast milk expressed vs none), and low breast milk expression (if BM was < 30% of infant total milk/formula intake during hospitalization). RESULTS Breast milk expression was initiated by 70.2% of mothers, and 32.3% of those mothers had low breast milk expression. In adjusted multivariable analyses, social support did not relate to the initiation of breast milk expression but was significantly associated with low breast milk expression among mothers who initiated (adjusted relative risk = 1.57; 95% confidence interval, 1.00-2.47). CONCLUSION Low social support was not associated with initiation but was associated with low breast milk expression during hospitalization. Interventions to enhance social support for mothers of premature infants, especially those reporting low social support from family and friends, may increase in-hospital expression and long-term breastfeeding.
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Affiliation(s)
- Camille Fabiyi
- Section of Family Planning and Contraception Research, Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL, USA Women, Children and Family Health Science, College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
| | - Kristin Rankin
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, IL, USA
| | - Kathleen Norr
- Women, Children and Family Health Science, College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
| | - Joseph C Yoder
- Women, Children and Family Health Science, College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
| | - Rohitkumar Vasa
- Mercy Hospital and Medical Center, Chicago, IL, USA Department of Pediatrics, University of Chicago, Chicago, IL, USA
| | - Rosemary White-Traut
- Women, Children and Family Health Science, College of Nursing, University of Illinois at Chicago, Chicago, IL, USA Children's Hospital of Wisconsin, Children's Research Institute, Milwaukee, WI, USA
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81
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Hoban R, Bigger H, Patel AL, Rossman B, Fogg LF, Meier P. Goals for Human Milk Feeding in Mothers of Very Low Birth Weight Infants: How Do Goals Change and Are They Achieved During the NICU Hospitalization? Breastfeed Med 2015; 10:305-11. [PMID: 26110439 PMCID: PMC4523097 DOI: 10.1089/bfm.2015.0047] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Little is known about human milk (HM) feeding goals for mothers of very low birth weight (VLBW) (<1,500 g birth weight) infants, especially for black mothers, for whom rates of VLBW birth are higher and lactation rates lower. This study examined the establishment, modification, and achievement of HM feeding goals during neonatal intensive care unit (NICU) hospitalization for mothers of VLBW infants and the influence of maternal race and income. MATERIALS AND METHODS A prospective cohort study measured maternal HM feeding goals (exclusive [EHM], partial, none) predelivery and during three time intervals: day of life (DOL) 1-14, 15-28, and 29-72. Goal achievement compared the goal for the time interval with the proportion of HM feedings received by the infant. Goal establishment, modification, and achievement were examined using chi-squared and contingency tables. RESULTS Three hundred fifty-two mother-infant dyads (53% black; 70% low-income; mean birth weight, 1,048 g) were studied. Predelivery, 55% of mothers planned to provide EHM; fewer black and low-income mothers chose EHM. During DOL 1-14, 63% of mothers chose EHM, and predelivery racial differences disappeared. Only 10% of mothers chose exclusive at-breast EHM feedings. EHM feeding goals decreased during NICU hospitalization, especially for black mothers. Whereas most mothers met their HM feeding goals initially, achievement rates declined during hospitalization. Mothers' EHM goal achievement was not influenced by race or income. CONCLUSIONS Mothers changed their predelivery HM feeding goals after birth of a VLBW infant. Longitudinally, HM feeding goals and achievement reflected less HM use, highlighting the need to target lactation maintenance in this population.
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Affiliation(s)
- Rebecca Hoban
- 1 Section of Neonatology, Department of Pediatrics, Rush University Medical Center , Chicago, Illinois.,2 Department of Women, Children, and Family Nursing, Rush University Medical Center , Chicago, Illinois
| | - Harold Bigger
- 1 Section of Neonatology, Department of Pediatrics, Rush University Medical Center , Chicago, Illinois
| | - Aloka L Patel
- 1 Section of Neonatology, Department of Pediatrics, Rush University Medical Center , Chicago, Illinois.,2 Department of Women, Children, and Family Nursing, Rush University Medical Center , Chicago, Illinois
| | - Beverly Rossman
- 2 Department of Women, Children, and Family Nursing, Rush University Medical Center , Chicago, Illinois
| | - Louis F Fogg
- 2 Department of Women, Children, and Family Nursing, Rush University Medical Center , Chicago, Illinois
| | - Paula Meier
- 1 Section of Neonatology, Department of Pediatrics, Rush University Medical Center , Chicago, Illinois.,2 Department of Women, Children, and Family Nursing, Rush University Medical Center , Chicago, Illinois
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82
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Giles EL, Holmes M, McColl E, Sniehotta FF, Adams JM. Acceptability of financial incentives for breastfeeding: thematic analysis of readers' comments to UK online news reports. BMC Pregnancy Childbirth 2015; 15:116. [PMID: 25982305 PMCID: PMC4475305 DOI: 10.1186/s12884-015-0549-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Accepted: 05/05/2015] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Whilst it is recommended that babies are breastfed exclusively for the first six months, many mothers do not maintain breastfeeding for this length of time. Previous research confirms that women and midwives value financial incentives for breastfeeding, but limited research has explored the wider acceptability of these interventions to the general public. This paper examines opinion towards financial incentives for breastfeeding using reader responses to UK on-line media coverage of a study undertaken in this area. METHODS This study used netnography to undertake a thematic analysis of 3,373 reader comments posted in response to thirteen articles, published in November 2013, which reported findings from a feasibility study of financial incentives for breastfeeding. All articles were published on one of six UK news websites that achieved a monthly audience of at least five million viewers across laptop and desktop computers and mobile devices during April-May 2013. RESULTS Nine analytical themes were identified, with a majority view that financial incentives for breastfeeding are unacceptable. These themes cover a range of opinions: from negligent parents unable to take responsibility for their own actions; through to psychologically vulnerable members of society who should be protected from coercion and manipulation; to capable and responsible women who can, and should be allowed to, make their own decisions. Many views focused on the immediate costs of the intervention, concluding that this was something that was currently unaffordable to fund (e.g. by the NHS). Others contrasted the value of the incentive against other 'costs' of breastfeeding. There was some consideration of the issue of cost-effectiveness and cost-saving, where the potential future benefit from initial investment was identified. Many commenters identified that financial incentives do not address the many structural and cultural barriers to breastfeeding. CONCLUSIONS Overall, those commenting on the on-line UK news articles viewed financial incentives for breastfeeding as unacceptable and that alternative, structural, interventions were likely to be more effective. Further consideration of how best to conduct internet-based qualitative research to elicit opinion towards public health issues is required.
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Affiliation(s)
- Emma L Giles
- Health and Social Care Institute, Teesside University, Middlesbrough, North Yorkshire, TS1 3BA, UK.
| | - Matthew Holmes
- The Medical School, Newcastle University, Framlington Place, NE2 4HH, Newcastle upon Tyne, Tyne and Wear, UK.
| | - Elaine McColl
- Institute of Health & Society, Newcastle Clinical Trials Unit, The Medical School, Newcastle University, 4th Floor, William Leech Building, Framlington Place, NE2 4HH, Newcastle upon Tyne, Tyne and Wear, UK.
| | - Falko F Sniehotta
- Health and Social Care Institute, Teesside University, Middlesbrough, North Yorkshire, TS1 3BA, UK.
| | - Jean M Adams
- Centre for Diet and Activity Research, MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Level 3 Institute of Metabolic Science, Addenbrooke's Treatment Centre, Cambridge Biomedical Campus, Cambridge, CB2 0SL, UK.
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83
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Quinlivan J, Kua S, Gibson R, McPhee A, Makrides MM. Can we identify women who initiate and then prematurely cease breastfeeding? An Australian multicentre cohort study. Int Breastfeed J 2015; 10:16. [PMID: 25941535 PMCID: PMC4418044 DOI: 10.1186/s13006-015-0040-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Accepted: 03/15/2015] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Health authorities recommend 6 months of fully breastfeeding and continuation of breastfeeding for at least a year. Many women initiate breastfeeding in hospital but discontinue before the six-month period, and therefore do not optimise the public health benefits. The aim of this study was to determine whether these women could be identified at hospital discharge, to enable targeted interventions. METHODS A secondary analysis of women who intended to breastfeed and were enrolled in a large randomised trial was undertaken. Women were enrolled in the antenatal period and antenatal, delivery and six month postnatal questionnaires were completed. Univariate and multivariate analyses were undertaken to determine the variables associated with early cessation of breastfeeding within six months, compared to women who continued to breastfeed. RESULTS Of 2148 women who initiated breastfeeding in hospital, 877 continued to breastfed either partially (N = 262) or fully (N = 615) until six months postpartum and 1271 ceased breastfeeding early. Median breastfeeding duration in women who ceased early was 3(+6) weeks (IQR 1(+1) to 11(+2) weeks). In multivariate analysis, factors that were significantly associated with early cessation of breastfeeding were maternal factors of lower education (less than 12 years of schooling, no completion of further education), smoking (pre-pregnancy or during pregnancy), and newborn factors of preterm birth and low birthweight (all p < 0.01). These variables correctly identify 83% of women. CONCLUSION We can identify women who initiate and then prematurely discontinue breastfeeding prior to hospital discharge. Evaluation of additional interventions to support longer duration of breastfeeding in women at risk of ceasing prematurely is needed.
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Affiliation(s)
- Julie Quinlivan
- />Institute for Health Research, University of Notre Dame Australia, Fremantle, 6160 WA Australia
| | - Sonia Kua
- />King Edward Memorial Hospital, Subiaco, 6008 WA Australia
| | - Robert Gibson
- />Women’s and Children’s Health Research Institute, Adelaide, 5000 SA Australia
| | - Andrew McPhee
- />Women’s and Children’s Health Research Institute, Adelaide, 5000 SA Australia
| | - Maria M Makrides
- />Women’s and Children’s Health Research Institute, Adelaide, 5000 SA Australia
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84
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Sharp M, Campbell C, Chiffings D, Simmer K, French N. Improvement in long-term breastfeeding for very preterm infants. Breastfeed Med 2015; 10:145-9. [PMID: 25786115 DOI: 10.1089/bfm.2014.0117] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION The extensive health benefits of breastfeeding preterm infants for both mother and infant have been widely reported. However, establishing and maintaining breastfeeding for very preterm (VP) infants remain challenging. The aim of this study was to examine changes in breastfeeding of VP infants over time. SUBJECTS AND METHODS Breastfeeding questionnaires were administered to two cohorts of parents of VP infants (<32 weeks) cared for at the tertiary perinatal or surgical neonatal unit in Western Australia. Of these, 488 infants were included in cohort 1 (C1) (births from January 1, 1990 to June 30, 1992) and 253 in cohort 2 (C2) (from January 1, 2011 to September 14, 2012). RESULTS More mothers (96.8%) initiated breastfeeding in C2 compared with those in C1 (65.6%) (p<0.001). Additionally, 41.4% of mothers in C2 breastfed for more than 6 months, relative to 25.8% in C1 (p<0.001). The benefits of breastfeeding were endorsed by more women in C2 (45.8%) compared with C1 (11.4%) (p<0.01). Reasons for stopping feeding remained largely consistent. CONCLUSIONS Significant improvements were evident in the initiation and duration of breastfeeding of the VP infant over time. This improvement was associated with attitudinal shifts in mothers about the benefits of breastfeeding.
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Affiliation(s)
- Mary Sharp
- UWA Centre for Neonatal Education and Research , School of Paediatrics and Child Health, Perth, Western Australia, Australia; Neonatal Clinical Care Unit , King Edward Memorial Hospital, Subiaco, Western Australia, Australia
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85
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Ak J, Lakshmanagowda PB, G C M P, Goturu J. Impact of music therapy on breast milk secretion in mothers of premature newborns. J Clin Diagn Res 2015; 9:CC04-6. [PMID: 26023551 DOI: 10.7860/jcdr/2015/11642.5776] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2014] [Accepted: 03/04/2015] [Indexed: 11/24/2022]
Abstract
INTRODUCTION The promotion of breastfeeding is a simple and efficient strategy in reducing morbidity and mortality in neonates worldwide. Milk from the mother of a Preterm New Born (PTNB) infant contains a higher concentration of nutrients and energy than that produced by mothers of a full-term infant. Studies have shown that music therapy can reduce maternal anxiety, helping mothers cope with the hospitalization of their newborns in Neonatal Intensive Care Unit (NICU). OBJECTIVE To evaluate the impact of music therapy on amount of breast milk secretion among mothers of premature newborns by reducing maternal stress. MATERIALS AND METHODS Mothers of premature babies who were admitted to NICU at a tertiary health care centre were included as subjects. Mothers of premature infants were enrolled in the study once they came to NICU to express breast milk from Dec 2012 to May 2013. Each subject was assessed for 4 sessions on MT (Music Therapy) and 4 sessions on NMT (No Music Therapy) over 4 days. Breast milk was expressed using breast milk pump and quantity was measured for two sessions each day once at 11.00am and other at 4.00pm. Raga malkauns and yaman by flute was used for music therapy. MT was administered for 4 sessions in a randomized manner during the study period of 30mins (15mins prior to and 15mins during Breast milk amount). To assess the psychological stress, PSS questionnaire was administered on day 1 and day 4 of MT. Mother's saliva was collected to estimate salivary cortisol level on the last day of study during the sessions with MT and NMT. RESULTS Music therapy was associated with a significant reduction in stress level as shown by improved PSS score and reduced salivary cortisol. Subjects who received music therapy had significant increase (p-value- 0.033) in breast milk expression when compared to mothers who didn't. CONCLUSION Music therapy can be easily used in the breast milk expression room as a method to increase breast milk secretion in mothers who are stressed because of their neonates being admitted in NICU.
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Affiliation(s)
- Jayamala Ak
- Assistant Professor, Department of Physiology, Sri Venkateshwaraa Medical College Hospital & Research Centre , Puducherry, India
| | | | - Pradeep G C M
- Associate Professor (Neonatologist), Department of Paediatrics, M S Ramaiah Medical College & Hospital , Bangalore, India
| | - Jaisri Goturu
- Professor, Department of Physiology, M S Ramaiah Medical College & Hospital , Bangalore, India
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86
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Healthy late preterm infants and supplementary artificial milk feeds: Effects on breast feeding and associated clinical parameters. Midwifery 2015; 31:426-31. [DOI: 10.1016/j.midw.2014.12.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Revised: 11/26/2014] [Accepted: 12/22/2014] [Indexed: 11/18/2022]
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87
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Altuntas N, Kocak M, Akkurt S, Razi HC, Kislal MF. LATCH scores and milk intake in preterm and term infants: a prospective comparative study. Breastfeed Med 2015; 10:96-101. [PMID: 25548967 DOI: 10.1089/bfm.2014.0042] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES We aimed to detect the breastmilk intake in preterm and term infants and to determine if the LATCH scoring system (latch; audible swallowing; type of nipple; comfort [breast/nipple]; hold [positioning]) could be helpful to denote that infants have taken enough breastmilk according to their postnatal age and weight. MATERIALS AND METHODS Sixty-six breastfeeding sessions were monitored and scored simultaneously by using the LATCH scoring system. The weight of the 66 infants (33 preterm, 33 term) was measured before and after a breastfeeding session, and thereby milk intake by breastfeeding was determined. The expected amount of milk volume that infants should receive for each feeding session was calculated according to the postnatal age and weight. The breastmilk intake by breastfeeding was compared with LATCH scores and the expected milk volume for each feeding. RESULTS We observed that 25 term infants (75.8%) took 100% of the expected milk volume for each feeding session, compared with two preterm infants (2.1%) (p=0.009). The median LATCH scores were 7.0 (minimum-maximum=5-9) in preterm babies and 9 (minimum-maximum=7-10) in term babies (p<0.0001). Term babies could consume 95.4% of the expected milk volume for each feeding session, whereas this ratio was only 45% in preterm babies. In each group, babies receiving a score of ≥7 took at least 50% of the expected milk volume for each feeding session. In each group, higher LATCH scores were associated with higher median intake, but the minimum and maximum intake for each LATCH score revealed marked variability. CONCLUSIONS High LATCH scores (7-10) may be helpful to determine that infants take at least 50% of the expected breastmilk volume for each feeding in both preterm and term infants. However, LATCH scores cannot substitute for test weights in premature infants because of variability in minimum and maximum milk intake per LATCH score.
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Affiliation(s)
- Nilgun Altuntas
- 1 Division of Neonatology, Department of Pediatrics, Kecioren Training and Research Hospital , Ankara, Turkey
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88
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Demirci JR, Happ MB, Bogen DL, Albrecht SA, Cohen SM. Weighing worth against uncertain work: the interplay of exhaustion, ambiguity, hope and disappointment in mothers breastfeeding late preterm infants. MATERNAL & CHILD NUTRITION 2015; 11:59-72. [PMID: 23020593 PMCID: PMC3535546 DOI: 10.1111/j.1740-8709.2012.00463.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Poor breastfeeding outcomes among late preterm infants (LPIs) have been attributed to inadequate breast milk transfer stemming from physiological immaturities. However, breastfeeding is more than a biological phenomenon, and it is unclear how mothers of LPIs manage other factors that may also impact the breastfeeding course. Using grounded theory methods and incorporating serial post-partum interviews with several novel data collection techniques, we examined breastfeeding establishment over a 6-8-week-period among 10 late preterm mother-infant dyads recruited from a maternity hospital in Pittsburgh, Pennsylvania, USA. We found that breastfeeding in the LPI population was a fluctuating, cascade-like progression of trial and error, influenced by a host of contextual factors and events and culminating with breastfeeding continuation (with or without future caveats for duration or exclusivity of breastfeeding) or cessation. The trajectory was explained by the basic psychosocial process Weighing Worth against Uncertain Work, which encompassed the tension among breastfeeding motivation, the intensity of breastfeeding work and the ambiguity surrounding infant behaviour and feeding cues. Several sub-processes were also identified: Playing the Game, Letting Him Be the Judge vs. Accommodating Both of Us and Questioning Worth vs. Holding out Hope. If valid, our theoretical model indicates a need for earlier, more extensive and more qualified breastfeeding support for mothers of LPIs that emphasizes the connection between prematurity and observed feeding behaviours.
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Affiliation(s)
- Jill Radtke Demirci
- Children's Hospital of Pittsburgh/UPMC, General Academic PediatricsUniversity of Pittsburgh School of MedicinePittsburghPennsylvaniaUSA
| | - Mary Beth Happ
- University of Pittsburgh School of NursingPittsburghPennsylvaniaUSA
| | - Debra L. Bogen
- Children's Hospital of Pittsburgh/UPMC, General Academic PediatricsUniversity of Pittsburgh School of MedicinePittsburghPennsylvaniaUSA
| | | | - Susan M. Cohen
- University of Pittsburgh School of NursingPittsburghPennsylvaniaUSA
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Davanzo R, Strajn T, Kennedy J, Crocetta A, De Cunto A. From tube to breast: the bridging role of semi-demand breastfeeding. J Hum Lact 2014; 30:405-9. [PMID: 25172892 DOI: 10.1177/0890334414548697] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Determination of the optimal timing of breastfeeding initiation for preterm infants is still a challenge for health professionals. Often unjustified delays and restrictions of breastfeeding occur due to non-evidence-based current opinions about preterm infants' feeding capacity. Semi-demand feeding has been proposed for preterm infants during the transition from scheduled to full demand feeding, to promote the establishment of self-regulated oral feeding. Although semi-demand feeding has been shown to be safe and effective in reducing time to reaching oral feeding, the implementation of this feeding pattern for preterm infants in the neonatal intensive care unit (NICU) is still limited. We developed a protocol for the application of semi-demand feeding in preterm infants based on the existing knowledge of preterm infant neurodevelopment and NICU organization and staff experience. The protocol's aim is to attain successful transition from tube feeding to breastfeeding. In this article, we describe the protocol used in the neonatal unit of the Maternal and Child Health Institute of Trieste, a third level care center in northeastern Italy.
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Affiliation(s)
- Riccardo Davanzo
- Department of Perinatal Medicine, Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
| | - Tamara Strajn
- Department of Perinatal Medicine, Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
| | - Jacqueline Kennedy
- Department of Perinatal Medicine, Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
| | - Anna Crocetta
- Department of Perinatal Medicine, Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
| | - Angela De Cunto
- Department of Perinatal Medicine, Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
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Mulready-Ward C, Sackoff J. Outcomes and factors associated with breastfeeding for <8 weeks among preterm infants: findings from 6 states and NYC, 2004-2007. Matern Child Health J 2014; 17:1648-57. [PMID: 23108740 DOI: 10.1007/s10995-012-1178-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
To examine breastfeeding outcomes and factors associated with breastfeeding <8 weeks among preterm infants. Pregnancy Risk Assessment Monitoring System (PRAMS) data for seven sites from 2004 to 2007 were used. Logistic regression was used to identify correlates of short breastfeeding duration among preterm infants. Among preterm infants, short breastfeeding duration (<8 weeks) was associated with maternal age ≤19 years (OR 1.75; 95 % CI: 1.22, 2.50), infant birth weight between 1,500 and 2,499 g (OR 1.29; 95 % CI: 1.01, 1.65), maternal obesity (OR 1.52; 95 % CI: 1.17, 1.98), smoking (OR 2.61; 95 % CI: 1.87, 3.63), and hypertension (OR 1.34; 95 % CI: 1.06, 1.69). Receiving a phone number for breastfeeding help (OR 0.59; 95 % CI: 0.44, 0.78) and not receiving a gift pack with formula (OR 0.64; 95 % CI: 0.47, 0.87) were associated with decreased odds of short duration. Speaking with a provider about breastfeeding prenatally was associated with increased odds of short duration (OR 1.75; 95 % CI: 1.33, 2.30). These findings strengthen the hypothesis that infant and maternal health are determinants of breastfeeding preterm infants and suggest a need to provide additional support to smokers, obese and hypertensive women, and mothers of infants with birth weights between 1,500 and 2,499 g, to help them sustain breastfeeding. Support from hospitals, such as providing a telephone number for breastfeeding help, and not providing a gift pack with formula, can also make a difference. These practices should be adopted by hospitals.
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Affiliation(s)
- Candace Mulready-Ward
- NYC Department of Health and Mental Hygiene, Bureau of Maternal, Infant and Reproductive Health, New York, NY, USA,
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91
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Unger S, Gibbins S, Zupancic J, O’Connor DL. DoMINO: Donor milk for improved neurodevelopmental outcomes. BMC Pediatr 2014; 14:123. [PMID: 24884424 PMCID: PMC4032387 DOI: 10.1186/1471-2431-14-123] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2014] [Accepted: 05/01/2014] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Provision of mother's own milk is the optimal way to feed infants, including very low birth weight infants (VLBW, <1500 g). Importantly for VLBW infants, who are at elevated risk of neurologic sequelae, mother's own milk has been shown to enhance neurocognitive development. Unfortunately, the majority of mothers of VLBW infants are unable to provide an adequate supply of milk and thus supplementation with formula or donor milk is necessary. Given the association between mother's own milk and neurodevelopment, it is important to ascertain whether provision of human donor milk as a supplement may yield superior neurodevelopmental outcomes compared to formula.Our primary hypothesis is that VLBW infants fed pasteurized donor milk compared to preterm formula as a supplement to mother's own milk for 90 days or until hospital discharge, whichever comes first, will have an improved cognitive outcome as measured at 18 months corrected age on the Bayley Scales of Infant Development, 3(rd) ed. Secondary hypotheses are that the use of pasteurized donor milk will: (1) reduce a composite of death and serious morbidity; (2) support growth; and (3) improve language and motor development. Exploratory research questions include: Will use of pasteurized donor milk: (1) influence feeding tolerance and nutrient intake (2) have an acceptable cost effectiveness from a comprehensive societal perspective? METHODS/DESIGN DoMINO is a multi-centre, intent-to-treat, double blinded, randomized control trial. VLBW infants (n = 363) were randomized within four days of birth to either (1) pasteurized donor milk or (2) preterm formula whenever mother's own milk was unavailable. Study recruitment began in October 2010 and was completed in December 2012. The 90 day feeding intervention is complete and long-term follow-up is underway. DISCUSSION Preterm birth and its complications are a leading cause long-term morbidity among Canadian children. Strategies to mitigate this risk are urgently required. As mother's own milk has been shown to improve neurodevelopment, it is essential to ascertain whether pasteurized donor milk will confer the same advantage over formula without undue risks and at acceptable costs. Knowledge translation from this trial will be pivotal in setting donor milk policy in Canada and beyond. TRIAL REGISTRATION ISRCTN35317141; Registered 10 August 2010.
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Affiliation(s)
- Sharon Unger
- Mount Sinai Hospital and the University of Toronto, 600 University Avenue, 19-231, Toronto, Ontario, M5G 1X5, Canada
| | - Sharyn Gibbins
- Trillium Health Partners, 2200 Eglinton Ave West, Mississauga, Ontario, L5M 2 N1, Canada
| | - John Zupancic
- Beth Israel Deaconess Med Center, Neonatology, Rose 318 330 Brookline Ave, Boston, MA 02215, USA
| | - Deborah L O’Connor
- University of Toronto and The Hospital for Sick Children, 327 Fitzgerald Building, 150 College Street, Toronto, Ontario, M5S 3E2, Canada
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92
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Gower S, Bartu A, Ilett KF, Doherty D, McLaurin R, Hamilton D. The wellbeing of infants exposed to buprenorphine via breast milk at 4 weeks of age. J Hum Lact 2014; 30:217-23. [PMID: 24399105 DOI: 10.1177/0890334413517748] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Buprenorphine has been available in Australia since 2000 as an alternative pharmacotherapy to methadone for the treatment of opioid dependence. However, there is little information in the literature regarding the effect of buprenorphine on the wellbeing of infants exposed to buprenorphine via breast milk, following discharge from hospital. OBJECTIVE The aim of the present study was to examine the wellbeing of infants exposed to buprenorphine via breast milk up to 4 weeks postnatally. METHODS Approximately 4 weeks after birth, information on the feeding and sleeping patterns, skin color, infant elimination patterns and hydration, and Neonatal Abstinence Scores of infants (n = 7) exposed to buprenorphine via breast milk was collected via both observation and documentation. RESULTS Infants were progressing well, with normal sleep patterns and skin color, and 2 mothers had minor concerns regarding infant elimination patterns. Four infants were exclusively breastfed and 3 were receiving a supplement, with a range of 260 to 700 mL of formula over 24 hours. The sleep patterns following feeding ranged from 1.55 to 3.33 hours, with a median of 2.12 hours. CONCLUSION No adverse effects were detected in infants exposed to buprenorphine via breast milk up to 4 weeks postnatally. Further research using larger samples to assess possible developmental effects over longer periods of time is required.
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Affiliation(s)
- Shelley Gower
- 1School of Nursing and Midwifery, Curtin University, Bentley, Perth, WA, Australia
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93
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Niela-Vilén H, Axelin A, Melender HL, Salanterä S. Aiming to be a breastfeeding mother in a neonatal intensive care unit and at home: a thematic analysis of peer-support group discussion in social media. MATERNAL AND CHILD NUTRITION 2014; 11:712-26. [PMID: 24521232 DOI: 10.1111/mcn.12108] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Preterm infants are usually breastfed less than full-term infants, and successful breastfeeding requires a supportive environment and special efforts from their mothers. A breastfeeding peer-support group, utilising social media, was developed for these mothers in order to support them in this challenge. Mothers were able to discuss breastfeeding and share experiences. The purpose of this study was to describe the perceptions of breastfeeding mothers of preterm infants based on the postings in peer-support group discussions in social media. The actively participating mothers (n = 22) had given birth <35 gestational weeks. They were recruited from one university hospital in Finland. The social media postings (n = 305) were analysed using thematic analysis. A description of the process of breastfeeding a preterm infant from the point of view of a mother was created. The process consisted of three main themes: the breastfeeding paradox in hospital, the 'reality check' of breastfeeding at home and the breastfeeding experience as part of being a mother. The mothers encountered paradoxical elements in the support received in hospital; discharge was promoted at the expense of breastfeeding and pumping breast milk was emphasised over breastfeeding. After the infant's discharge, the over-optimistic expectations of mothers often met with reality - mothers did not have the knowledge or skills to manage breastfeeding at home. Successful breastfeeding was an empowering experience for the mothers, whereas unsuccessful breastfeeding induced feelings of disappointment. Therefore, the mothers of preterm infants need evidence-based breastfeeding counselling and systematic support in a neonatal intensive care unit (NICU) and at home.
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Affiliation(s)
| | - Anna Axelin
- Department of Nursing Science, University of Turku, Turku, Finland
| | - Hanna-Leena Melender
- VAMK University of Applied Sciences, Health care and Social Services, Vaasa, Finland
| | - Sanna Salanterä
- Department of Nursing Science, University of Turku, Turku, Finland.,Hospital District of South-West Finland, Turku, Finland
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94
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Lawn JE, Davidge R, Paul VK, Xylander SV, de Graft Johnson J, Costello A, Kinney MV, Segre J, Molyneux L. Born too soon: care for the preterm baby. Reprod Health 2013; 10 Suppl 1:S5. [PMID: 24625233 PMCID: PMC3828583 DOI: 10.1186/1742-4755-10-s1-s5] [Citation(s) in RCA: 143] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
As part of a supplement entitled “Born Too Soon”, this paper focuses on care of the preterm newborn. An estimated 15 million babies are born preterm, and the survival gap between those born in high and low income countries is widening, with one million deaths a year due to direct complications of preterm birth, and around one million more where preterm birth is a risk factor, especially amongst those who are also growth restricted. Most premature babies (>80%) are between 32 and 37 weeks of gestation, and many die needlessly for lack of simple care. We outline a series of packages of care that build on essential care for every newborn comprising support for immediate and exclusive breastfeeding, thermal care, and hygienic cord and skin care. For babies who do not breathe at birth, rapid neonatal resuscitation is crucial. Extra care for small babies, including Kangaroo Mother Care, and feeding support, can halve mortality in babies weighing <2000 g. Case management of newborns with signs of infection, safe oxygen management and supportive care for those with respiratory complications, and care for those with significant jaundice are all critical, and are especially dependent on competent nursing care. Neonatal intensive care units in high income settings are de-intensifying care, for example increasing use of continuous positive airway pressure (CPAP) and this makes comprehensive preterm care more transferable. For health systems in low and middle income settings with increasing facility births, district hospitals are the key frontier for improving obstetric and neonatal care, and some large scale programmes now include specific newborn care strategies. However there are still around 50 million births outside facilities, hence home visits for mothers and newborns, as well as women’s groups are crucial for reaching these families, often the poorest. A fundamental challenge is improving programmatic tracking data for coverage and quality, and measuring disability-free survival. The power of parent’s voices has been important in high-income countries in bringing attention to preterm newborns, but is still missing from the most affected countries.
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Affiliation(s)
- Joy E Lawn
- MARCH, London School Hygiene & Tropical Medicine, UK
- Saving Newborn Lives, Save the Children, Cape Town, South Africa
| | - Ruth Davidge
- Kwa-Zulu Natal Dept. of Health, Pietermartizburg, South Africa
- NNASA-Neonatal Nurses Association of Southern Africa, Durban, South Africa
- Congress of International Neonatal Nurses (COINN
| | - Vinod K Paul
- All India Institute for Medical Sciences, New Delhi, India
| | | | | | | | - Mary V Kinney
- Saving Newborn Lives, Save the Children, Cape Town, South Africa
| | - Joel Segre
- Consultant to Bill & Melinda Gates Foundation, Seattle, WA, USA
| | - Liz Molyneux
- Queen Elizabeth Hospital, College of Medicine, Blantyre, Malawi
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95
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Alves E, Rodrigues C, Fraga S, Barros H, Silva S. Parents' views on factors that help or hinder breast milk supply in neonatal care units: systematic review. Arch Dis Child Fetal Neonatal Ed 2013; 98:F511-7. [PMID: 23867708 DOI: 10.1136/archdischild-2013-304029] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To synthesise what is known about the parents' views on factors that help or hinder breast milk supply during their infants' hospitalisation in neonatal intensive care units (NICU). METHODS A systematic search of PubMed, ISI WoK, PsycINFO and SciELO, targeting studies presenting original empirical data that examined parents' perspectives regarding breast milk supply experiences in NICU, was performed. Based on content analysis, three independent researchers synthesised the findings of seven studies. Categories of facilitators and barriers were identified using quotations stated in the studies: parents' breast milk supply experience; parents-professionals relationships; characteristics of the NICU; and parents' social background and expectations. RESULTS The studies, five qualitative and two mixed methods, were published between 1994 and 2011. With heterogeneous study designs, fathers' perspectives were analysed in one article. Only one study defined breastfeeding. According to parents' perspectives, successful breast milk supply in NICU depends on coherent and accurate knowledge about its techniques and benefits, reinforcement of mothers' motivation and alignment between NICU's routines and parents' needs. Parents perceived issues related to their own current breast milk supply experience, simultaneously, as main facilitators and barriers. Parents-professionals relationship constituted the second group of facilitators, but the fourth of barriers. The characteristics of the NICU were more relevant as a barrier than as a facilitator. CONCLUSIONS Although parents' perspectives are grounded on individual child-focused experiences, their emphasis on learning and motivation guided by short-term goals opens room to the collective intervention of experts. This may facilitate the engagement of mothers, fathers and health professionals on family-centred care.
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Affiliation(s)
- Elisabete Alves
- Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, , Porto, Portugal
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96
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Meier PP, Engstrom JL, Rossman B. Breastfeeding peer counselors as direct lactation care providers in the neonatal intensive care unit. J Hum Lact 2013; 29:313-22. [PMID: 23563112 DOI: 10.1177/0890334413482184] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
In 2005, the Level III neonatal intensive care unit (NICU) at Rush University Medical Center initiated a demonstration project employing breastfeeding peer counselors, former parents of NICU infants, as direct lactation care providers who worked collaboratively with the NICU nurses. This article describes the conceptualization, implementation, and evaluation of this program and provides templates for other NICUs that wish to incorporate breastfeeding peer counselors with the goal of providing quality, evidence-based lactation care.
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Affiliation(s)
- Paula P Meier
- Rush University Medical Center, Chicago, IL 60612, USA.
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97
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Hurst N, Engebretson J, Mahoney JS. Providing mother's own milk in the context of the NICU: a paradoxical experience. J Hum Lact 2013; 29:366-73. [PMID: 23635469 DOI: 10.1177/0890334413485640] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Mothers of very preterm infants continue to face challenges related to providing their expressed breast milk in the neonatal intensive care unit (NICU). OBJECTIVE This qualitative study sought to understand the experience of mothers of hospitalized very preterm infants related to their daily pumping routine during the NICU stay. METHODS Fourteen women who were pumping breast milk for their hospitalized infants were interviewed. Sequential, semistructured, audiotaped individual interviews were conducted at 2 different time points: within 2 weeks following delivery when the mothers were pumping only, and 4 to 6 weeks once breastfeeding had been initiated. RESULTS The central themes found were: becoming a "mother-interrupted" and negotiating a paradoxical experience of separation and connection. Unique to these findings were the paradoxical view of the pump as both a wedge and a link to their infants, the intense dislike the mothers had for the tasks required to provide their expressed breast milk, and diversionary tactics used during pumping sessions. CONCLUSION The complexity of thoughts, actions, and behaviors revealed in the mothers' narrative accounts provides a guide to direct future breastfeeding interventions and management.
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Affiliation(s)
- Nancy Hurst
- Texas Children's Hospital, Houston, TX 77030, USA.
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98
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O'Connor DL, Unger S. Post-discharge nutrition of the breastfed preterm infant. Semin Fetal Neonatal Med 2013; 18:124-128. [PMID: 23706724 DOI: 10.1016/j.siny.2013.05.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Provision of mother's own milk is the optimal way to nourish infants, including the preterm infant. The importance of mother's own milk during initial hospitalization to improve feeding tolerance, reduce serious infection and necrotizing enterocolitis is well appreciated. As a result, there has been a culture shift in neonatology such that breastfeeding is now encouraged and the majority of mothers of preterm infants attempt to express breastmilk. While more can be done during the hospital stay, nutrient intakes and growth are monitored and lactation support is provided. After hospital discharge, however, nutrient intakes and growth are frequently not monitored in a coordinated fashion and lactation support is often inaccessible. Few data are available to guide the clinician on the best approach to supporting the breastfed infant after discharge and expert guidance is frequently non-existent. This review provides evidence for a 'proactive' rather than a 'reactive' approach to supporting the breastfed preterm infant after discharge in terms of breastfeeding promotion, resolving acquired nutrient deficits, normalizing feeding and promoting optimal growth.
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Affiliation(s)
- Deborah L O'Connor
- Department of Nutritional Sciences, University of Toronto, Professional Practice and Research Institute, The Hospital for Sick Children, Room 8511C, 555 University Avenue, Toronto M5G 1X8, Canada.
| | - Sharon Unger
- Department of Pediatrics, University of Toronto, Department of Neonatology, Mount Sinai Hospital, Toronto, Canada
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99
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Demirci JR, Sereika SM, Bogen D. Prevalence and predictors of early breastfeeding among late preterm mother-infant dyads. Breastfeed Med 2013; 8. [PMID: 23199304 PMCID: PMC3663454 DOI: 10.1089/bfm.2012.0075] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Although late preterm infants (LPIs), at 34(0/7)-36(6/7) weeks of gestation, are reported to have suboptimal rates of breastfeeding, there is a lack of quantitative evidence describing this trend. This study examined the prevalence of breastfeeding initiation and factors associated with breastfeeding non-initiation within a Pennsylvania population-based cohort of late preterm mother-infant dyads. SUBJECTS AND METHODS Descriptive statistics and odds ratios were used to assess and compare breastfeeding initiation rates in 2003-2009 among LPI mothers (n=62,451) and their infants (n=68,886) with moderately preterm (n=17,325) and term (n=870,034) infants. Binary logistic regression was used to determine the association of system/provider, sociodemographic, and medical factors with breastfeeding non-initiation in late preterm mother-infant dyads for the year 2009 (n=7,012). RESULTS Although LPI breastfeeding initiation in Pennsylvania increased significantly from 2003 (54%) to 2009 (61.8%) (p<0.001), the 2009 prevalence remained well below rates in term infant populations and national standards. The regression model indicated that interactions involving sociodemographic variables, including marital status, age, race/ethnicity, education, parity, Women, Infants and Children Program participation, and smoking status were among the most significant factors associated with LPI breastfeeding non-initiation (p<0.05). The univariate results were similar to those reported in preterm and term populations. CONCLUSIONS Our data suggest that certain, unexpected demographic groups in the late preterm population be prioritized for further analysis and possibly greater breastfeeding support. More research is indicated to understand the effect of modifiable psychosocial factors on LPI breastfeeding initiation.
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Affiliation(s)
- Jill Radtke Demirci
- General Academic Pediatrics, University of Pittsburgh School of Medicine , Children's Hospital of Pittsburgh, Pittsburgh, PA 15213, USA.
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Myers D, Rubarth LB. Facilitating breastfeeding in the neonatal intensive care unit: identifying barriers. Neonatal Netw 2013; 32:206-212. [PMID: 23666192 DOI: 10.1891/0730-0832.32.3.206] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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