A review of breastfeeding training intervention studies that evaluate staff knowledge outcomes in NICU

Impact of introducing a lactation consultant into a neonatal unit

AIM

Benefits of mothers' own milk (MOM) for premature and sick neonates are well documented. To increase access, many neonatal units have a lactation consultant (LC) on staff. This study aimed to assess the impact of a permanent LC on (i) maternal access to LC support; (ii) staff confidence in providing Breast Feeding (BF) education and (iii) provision of MOM.

METHODS

Study included a staff survey and chart audit. Questions provided feedback on access to lactation support and meeting maternal needs. Audit data included: gestational age, birthweight, intention to breastfeed, documentation of LC appointment, provision of MOM at 12 hours, days 3, 7, 28 and discharge. Student's t-tests were used for numerical data and chi-squared tests for categorical variables.

RESULTS

Ninety-one staff surveys were returned, (pre 35/75 (47%), post 56/85 (66%) with staff reporting organising an LC appointment was significantly easier (P < 0.0001). Staff perceived maternal lactation needs and confidence to breastfeed post-discharge had significantly improved post-LC. The chart audit showed a significant increase in maternal access to LC appointments (15% vs. 80%; P < 0.01), breast pump education by day 3 (65% vs. 81%; P < 0.01), and an increase in MOM provision by 12 h (46% vs. 61%; P < 0.01) post-LC but not at days 7, 28 or discharge.

CONCLUSION

A dedicated LC increases staff and maternal access to lactation education and support, improving provision of early MOM. Further research is required to assess the effect of LCs in improving breastfeeding rates in neonatal units.

Promoting Breastfeeding and Lactation Among Mothers of Premature Newborns in a Hospital in China

OBJECTIVE

To promote breastfeeding and lactation in mothers separated from their premature infants admitted to the NICU in a hospital in China.

DESIGN

For this evidence-based practice project we used a mixed method of survey measures and interviews and were guided by the Joanna Briggs Institute Practical Application of Clinical Evidence System and Getting Research Into Practice framework.

SETTING/LOCAL PROBLEM

Obstetric unit of a Women and Children's Hospital in China from September 2017 to August 2018. Before the project, the partial breastfeeding rate in the hospital was 17.9%, and the exclusive breastfeeding rate of premature infants was 1.8%; these rates were much lower than the national breastfeeding rate in the country.

PARTICIPANTS

Seventeen nurses and 70 mothers of premature infants.

INTERVENTION/MEASUREMENTS

The project included three phases: (a) finding the best evidence to promote breastfeeding in the literature and identifying the gaps between best practice and current practice, (b) implementing best practice strategies, and (c) comparing pre- and postintervention outcomes. Based on the evidence in the literature and the barriers, strategies were implemented in practice to promote breastfeeding and lactation among women separated from their preterm newborns. Chi-square and t tests were performed to compare the pre-/postintervention differences.

RESULTS

Partial breastfeeding rates increased from 17.9% to 52.7%, and exclusive breastfeeding rates increased from 1.8% to 4.1%. Compliance with breastfeeding guidelines and measures of maternal lactation volume both improved significantly.

CONCLUSION

Promoting breastfeeding and lactation among mothers of premature infants requires not only scientific knowledge but also a caring environment and family-centered practice.

Barriers to Providing Mother's Own Milk to Extremely Preterm Infants in the NICU

BACKGROUND

Mothers' own milk (MOM) has more than nutritional benefits for extremely preterm infants (<28 weeks). However, mothers encounter barriers that make it difficult to provide their own milk to their extremely preterm infants.

PURPOSE

The aim of this study was to describe and understand the experiences of mothers of extremely preterm infants regarding barriers to providing their own milk during infant hospital stay in the neonatal intensive care unit (NICU).

METHODS

This study followed a qualitative, interpretative design using Gadamer's hermeneutic approach and included 15 in-depth semistructured interviews. The data were analyzed using a modified form of the steps described by Fleming.

RESULTS

Fifteen mothers of extremely preterm infants participated in the study. The following themes were extracted from the data analysis: (1) "unexpected and unusual lactation," including the subthemes "the extremely preterm birth and the decision to provide MOM," "the battle to produce milk," and "my job was to make milk"; and (2) "providing MOM to a tiny infant in an unknown technological environment," with the subthemes "the limitations of providing MOM in the NICU" and "the difficulties of having an extremely preterm infant."

IMPLICATIONS FOR PRACTICE

To provide MOM to an extremely preterm infant, there is a need for informational and practical counseling by neonatal nurses educated in breastfeeding according to mothers' requirements and emotional needs.

IMPLICATIONS FOR RESEARCH

Future research may analyze the parents' and neonatal nurses' experience about facilitators to improve MOM provision and the influence of women's sociodemographic characteristics in providing MOM to the extremely preterm infants.