Correlates of lactation in mothers of very low birth weight infants

Método Mãe-Canguru

Estudo de natureza qualitativa, cujo objetivo é o de identificar o conhecimento que vem sendo produzido e veiculado a respeito do Método Mãe-Canguru (MMC). Foi realizada uma incursão pela literatura, a partir das bases de dados Medline e Lilacs, assim como busca direta aos principais periódicos de enfermagem, durante o período de 1995 a 2004. Foram selecionados 85 artigos, posteriormente catalogados e submetidos à categorização. Após análise dos artigos, foram extraídas quatro categorias sobre a temática. Os resultados levaram à conclusão de que apesar do MMC estar configurando-se como uma mudança paradigmática no cuidado ao recém-nascido, não há total correspondência com a produção teórica, levando a que a prática seja desenvolvida, muitas vezes, sem a devida sustentação teórica. Esta lacuna de conhecimentos dificulta, inclusive, uma adequada avaliação desta prática com relação ao recémnascido e sua família, mas principalmente no que diz respeito à aplicação do MMC junto à equipe neonatal.

Human milk pumping rates of mothers of singletons and mothers of multiples

Rates of breastfeeding are increasing, but the methods by which human milk is fed to infants is not well described. Using a retrospective survey design, the authors collected information about infant feeding from mothers of term, preterm, singleton, and multiple-gestation infants (n=346). Human milk feeding methods were characterized as solely at the breast, pumped only, or a combination. Sixty-eight percent of mothers in the study fed their infants at least some human milk; 77% of these mothers reported pumping milk. There was no difference in the percentage of pumping based on multiple gestation or length of pregnancy. Feeding human milk solely at the breast at early postpartum time points was associated with longer durations of human milk feeding overall. More research is needed to better understand why mothers choose pumping over direct human milk feedings and to evaluate the health outcomes associated with this practice.

Sipping/lapping is a safe alternative feeding method to suckling for preterm infants

AIM

To determine whether sipping/lapping is a safe alternative to suckle bottle-feeding without any hydrostatic pressure, in terms of physiological stability and the relationship between swallowing and respiration. In addition, tongue movement was compared between sipping/lapping and suckling (bottle- and breastfeeding).

METHODS

Eighteen infants (30-35?wk of gestation at birth) were studied while sipping/lapping and suckling a bottle without any hydrostatic pressure at different feeding sessions on the same day of the first oral feeding. The postmenstrual age at the time of study was 34.6+/-0.2 wk. We evaluated the amounts ingested and administration times. The heart rate, O(2) saturation (SpO(2)), and relationship between swallowing and respiration were examined while feeding. Tongue movements were also observed by ultrasonography. Statistical analysis was performed by a paired t-test.

RESULTS

The amounts ingested and intake volume per minute were lower while sipping/lapping compared to suckling. The overall heart rate and SpO(2) showed no statistically significant difference. The frequency of swallows followed by inspiration (27.6+/-0.8% and 31.0+/-1.3%) and swallows followed by expiration (46.4+/-0.9% and 45.4+/-1.4%, sipping and suckling, respectively) also showed no difference. Tongue movements while sipping/lapping differed from those while suckling a bottle or breast.

CONCLUSION

Because physiological parameters and the relationship between swallowing and respiration while sipping/lapping are comparable to those while suckle bottle-feeding without any hydrostatic pressure, sipping/lapping is a safe alternative feeding method to suckle bottle-feeding, even in preterm infants.

Mothers' decisions to change from formula to mothers' milk for very-low-birth-weight infants

OBJECTIVE

The purpose of this study was to examine maternal decisions about providing milk for a very-low-birth-weight (VLBW) infant, when the initial maternal intent was to formula-feed.

DESIGN

Using prospective, purposive sampling, semistructured interviews were conducted with 21 of 23 eligible mothers over a 9-month period. Audio-recorded data were transcribed verbatim, coded, categorized, and subjected to dimensional analysis.

SETTING

The study took place in a 52-bed, tertiary urban neonatal intensive-care unit.

PATIENTS/PARTICIPANTS

Mean maternal age was 26.5 years (range = 18-38), and mean infant birth weight and gestational age were 705.4 g (range = 504-1,310), and 25.8 weeks (range = 23-33), respectively. Of the 21 mothers, 76% were African American or Latina; 62% were low income.

MAIN OUTCOME MEASURES

We evaluated mothers' initial reasons for selecting formula and changing the decision to provide their milk, whether they were made to feel guilty or coerced, the processes of establishing and maintaining lactation, and breastfeeding outcomes at 1-month postbirth.

RESULTS

Mothers initially chose formula because they had no breastfeeding role models and were fearful of pain and lifestyle modifications. They changed this decision after the nurse or physician talked with them about the health benefits for their infant. Of the 21 women, all denied feeling pressured, coerced, or guilty about the decision change, and all identified rewards to themselves and their infants. All mothers provided milk for greater than or equal to 30 days, 19 went on to feed at breast, and 2 became certified breastfeeding peer counselors for the Rush Mothers' Milk Club.

CONCLUSION

These findings underscore the role of nurses and physicians in providing evidence-based information about mothers' milk and indicate that sharing this knowledge does not make mothers of VLBW infants feel pressured, coerced, or guilty.

A population-based study of exclusive breastfeeding in Icelandic women: is there a relationship with depressive symptoms and parenting stress?

This study investigated whether postpartum depressive symptoms and parenting stress are related to exclusive breastfeeding in mothers at 2-3 months postpartum. Data were collected from 734 Icelandic mothers postpartum. Parenting stress, depressive symptoms, feeding methods and demographical data were assessed by self-administered questionnaires. A high level of maternal education increased the likelihood of exclusive breastfeeding whereas lower maternal education, high levels of depressive symptoms, twins and single motherhood reduced the likelihood of exclusive breastfeeding. It is concluded that depressive symptoms are related to lower levels of exclusive breastfeeding and that exclusive breastfeeding becomes more likely with higher level of maternal education.

Efficiency of breastfeeding as compared to bottle-feeding in very low birth weight (VLBW, <1.5 kg) infants

OBJECTIVES

To examine feeding efficiency and correlates of feeding behaviors in breastfeeding as compared with bottle-feeding VLBW infants at 35 weeks corrected age (CA, postmenstrual plus chronologic age).

STUDY DESIGN

In all, 105 singleton VLBW infants underwent a standardized feeding observation, of whom 35 were observed breastfeeding and 70 bottle-feeding. Intake, efficiency, and feeding behaviors were compared, and effects of infant and maternal factors were examined.

RESULTS

Breastfeeding as compared with bottle-feeding infants took in smaller volumes (median 6.5 vs 30.5 ml, p<0.001), fed less efficiently (median 0.6 vs 2.2 ml/min, p<0.001), and spent less time with sucking bursts (mean 33 vs 55%, p<0.001). For breastfed infants, birth and neonatal factors and prior maternal breastfeeding experience were not associated with feeding efficiency or behaviors.

CONCLUSION

Feeding performance of breastfeeding compared with bottle-feeding VLBW infants at 35 weeks CA is worrisome, and lactation intervention is needed for discharge planning.

Effect of bottles, cups, and dummies on breast feeding in preterm infants: a randomised controlled trial

OBJECTIVE

To determine the effect of artificial teats (bottle and dummy) and cups on breast feeding in preterm infants.

DESIGN

Randomised controlled trial.

SETTING

Two large tertiary hospitals, 54 peripheral hospitals.

PARTICIPANTS

319 preterm infants (born at 23-33 weeks' gestation) randomly assigned to one of four groups: cup/no dummy (n = 89), cup/dummy (n = 72), bottle/no dummy (n = 73), bottle/dummy (n = 85). Women with singleton or twin infants < 34 weeks' gestation who wanted to breastfeed were eligible to participate.

INTERVENTIONS

Cup or bottle feeding occurred when the mother was unable to be present to breast feed. Infants randomised to the dummy groups received a dummy on entry into the trial.

MAIN OUTCOME MEASURES

Full breast feeding (compared with partial and none) and any breast feeding (compared with none) on discharge home.

SECONDARY OUTCOMES

prevalence of breast feeding at three and six months after discharge and length of hospital stay.

RESULTS

303 infants (and 278 mothers) were included in the intention to treat analysis. There were no significant differences for any of the study outcomes according to use of a dummy. Infants randomised to cup feeds were more likely to be fully breast fed on discharge home (odds ratio 1.73, 95% confidence interval 1.04 to 2.88, P = 0.03), but had a longer length of stay (hazard ratio 0.71, 0.55 to 0.92, P = 0.01).

CONCLUSIONS

Dummies do not affect breast feeding in preterm infants. Cup feeding significantly increases the likelihood that the baby will be fully breast fed at discharge home, but has no effect on any breast feeding and increases the length of hospital stay.

Designing the neonatal intensive care unit for optimal family involvement

The design of a new neonatal intensive care unit provides an opportunity to ensure that the new facility best meets the needs of the infants and families whom the unit serves. In design planning,administrators, staff, family members, and the architect must work together in a self-education process that entails examining current design standards, exploring exemplary facilities at other institutions,defining the priorities and needs of infants, families, and staff, and deciding how to respond to them. The involvement of family members in this important work can help ensure that the facility is responsive to families and supports the family as the primary caregiver and decision maker for the infant. Such an environment will lead to improved health and developmental outcomes for infants and greater family and staff satisfaction.

The effect of prenatal consultation with a neonatologist on human milk feeding in preterm infants

OBJECTIVE

To study the effect of prenatal consultation (PC) with a neonatologist on the incidence and duration of human milk feeding (HMF) in preterm infants.

DESIGN/METHODS

A retrospective matched case-control study was preformed at a perinatal centre. Study infants were preterm infants (23-35 wk) whose mothers had received PC emphasizing the importance of HMF. Control infants were matched by birthweight, gestational age and multiplicity.

RESULTS

Each group included 29 mothers and 46 preterm infants. Mean gestational age was 30.1 +/- 3 wk in both groups. Mean birthweight was 1329 +/- 489 (PC) and 1334 +/- 441 g (control). PC infants received HMF for significantly longer, both in the hospital and after discharge (hospital: PC 37 +/- 34 d vs control 15 +/- 19 d, p = 0.001; discharge PC 60 +/- 57 d vs control 21 +/- 32 d; p = 0.0001). No significant difference in neonatal morbidity was detected between the groups.

CONCLUSIONS

PC is associated with significantly longer HMF in preterm infants, both in hospital and after discharge.

Incidence and correlates of breast milk feeding in hospitalized preterm infants

The majority of epidemiological studies of breast feeding have been conducted in healthy, fullterm infant samples. Little is known about the incidence and correlates of breast milk feeding in preterm infants, particularly in those born outside of metropolitan areas. Therefore, hospital medical charts of 151 consecutively admitted preterm infants (</=34 weeks gestational age), in the US, were reviewed and daily feeding, maternal demographic, pregnancy, and infant medical condition information was recorded. About half of the preterm infant sample was fed breast milk, receiving at least one breast milk feeding per day for 44% of their hospital stay. Although maternal demographic variables were important predictors of breast milk feeding, perinatal medical condition of the infant played a unique role in feeding practices in preterm infants. Specific interventions could be targeted to families with preterm infants to modestly increase population breast feeding rates.

Initiation of breastfeeding among mothers of very low birth weight infants

OBJECTIVE

To examine factors that predict the initiation of expressed milk feedings and the transition to direct breastfeedings among mothers of very low birth weight (VLBW) infants.

METHODS

The sample consists of 361 mother-infant pairs enrolled in a follow-up study of children aged 6 to 8 years who were born weighing <1501 g in 1 of 5 hospitals between 1991-1993. Chart review at birth provided data on neonatal characteristics and demographic factors at delivery were obtained by postpartum maternal interview. Information regarding infant feeding practices was obtained at follow-up.

RESULTS

In this study, 60% of mothers initiated expressed milk feedings for their VLBW infants. However, the duration of these feedings was brief with 52% of infants receiving 1 to 3 months or less of human milk feedings. Greater educational attainment, private insurance, and breastfeeding experience were each independently associated with the decision to provide expressed milk feedings. Only 27% of mothers reported directly breastfeeding their VLBW infants. The transition from expressed milk feedings to direct breastfeedings was positively associated with sociodemographic factors including maternal age, insurance status, and breastfeeding experience as well as the length of hospitalization, an indicator of infant health.

CONCLUSIONS

Sociodemographic factors were associated with both the decision to initiate expressed milk feedings and the transition to direct breastfeedings. However, factors relating to infant health only influenced the transition to direct breastfeedings. Intervention programs need to consider the sociodemographic factors that influence infant feeding decisions as well as specific challenges encountered by mothers of VLBW infants.

Neurodevelopmental care in the NICU

Neurodevelopmental care, which is any NICU intervention undertaken to improve neurodevelopmental outcome, includes NICU design, nursing routines, nursing care plans, management of pain, feeding methods and, most importantly, encouraging parental involvement with their NICU infant. Recognition that sensory stimulation can overwhelm preterm infants and increase physiologic signs of stress led to attempts to reduce sensory input. More recent approaches judiciously add back soothing sensory input (e.g., therapeutic touch, soft music). Circadian light/dark cycles and physical activity improve preterm growth. Attention to infant positioning and handling affects physiologic variables and joint mobility, if not functional motor abilities. A highly organized system of care for NICU infants is Als' NIDCAP (i.e., Neonatal Individualized Developmental Care and Assessment Program). Although NIDCAP may reduce need for respiratory support and hospital length of stay, it does not significantly influence neurodevelopmental outcome at 2-3 years. Pain management includes benign interventions (e.g., nonnutritive sucking, oral glucose), but the prolonged use of narcotics must be balanced against the consequences of sedation and dependency. The foremost challenge for NICUs remains parent disenfranchisement. Kangaroo care, which involves parent/infant skin-to-skin contact, improves preterm growth, decreases nosocomial infections and may shorten hospital length of stay. A great deal of work needs to be done to identify and demonstrate efficacy of specific interventions and changes that humanize the NICU, encourage parental involvement, support infant development and optimize preterm neurodevelopmental outcomes.