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Liu C, Pan M, Lu X, Gao Y, Xu J, Chen X. Breastfeeding Barriers for Preterm Infants in Neonatal Intensive Care Unit Environments: A Systematic Assessment and Meta-Analysis. Breastfeed Med 2024; 19:505-514. [PMID: 38666420 DOI: 10.1089/bfm.2024.0041] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/20/2024]
Abstract
Background: Breast milk is vital for the growth and development of preterm infants. However, in Neonatal Intensive Care Units (NICUs), mothers often encounter significant challenges in breastfeeding. Objective: This study aims to systematically evaluate the barriers to breastfeeding in NICUs, thereby providing evidence-based support for clinical practices. Methods: A comprehensive search was conducted in the Cochrane Library, PubMed, Web of Science, Embase, and Scopus databases, up to September 2023. Meta-analysis was performed using Stata 15.0, applying fixed or random effects models to calculate odds ratios (OR) and their 95% confidence intervals (CI). Study quality was assessed using the Newcastle-Ottawa Scale for cases and cohorts and the Agency for Healthcare Research and Quality standards for cross-sectional studies. Heterogeneity was evaluated using Cochran's chi-squared test (Cochran's Q) and I2 statistics, and publication bias was assessed through funnel plots and symmetry tests. Results: A total of 32 studies were included, encompassing 96,053 preterm infants. The main barriers to breastfeeding in preterm infants included: low gestational age (OR = 1.36, 95% CI: 1.06-1.75), lower maternal education (OR = 1.64, 95% CI: 1.39-1.93), insufficient breast milk (OR = 2.09, 95% CI: 1.39-1.93), multiple births (OR = 1.615, 95% CI: 1.18-2.210), smoking (OR = 2.906, 95% CI: 2.239-3.771), and single motherhood (OR = 1.439, 95% CI: 1.251-1.654). Conclusion: This study underscores the need for individualized breastfeeding support strategies in NICUs, taking into account the diverse backgrounds of mothers. Future research should focus on unraveling the underlying mechanisms affecting breastfeeding in preterm infants, with the goal of enhancing breastfeeding rates and improving developmental outcomes.
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Affiliation(s)
- Chuntian Liu
- School of Nursing, Wenzhou Medical University School of Nursing, Wenzhou, China
- Cixi Institute of Biomedical Engineering, Wenzhou Medical University Cixi Institute of Biomedical Engineering, Cixi, China
| | - Mengqing Pan
- Department of Neonatology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xiaoyu Lu
- Department of Neonatology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Ying Gao
- Department of Neonatology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Jianhong Xu
- Affiliated Cixi Hospital, Wenzhou Medical University, Cixi, Zhejiang, China
| | - Xiaochun Chen
- Department of Neonatology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
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Ramos da Silva E, Ferreira Feitosa AL, Trevizani Depolli G, Rufino da Silva Costa P, Pacheco da Silva MG. Analysis of Colostrum Therapy Administration Protocols in Newborns: An Integrative Review. Breastfeed Med 2022; 17:380-392. [PMID: 35133878 DOI: 10.1089/bfm.2021.0340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Objective: The present study aims to describe the clinical protocols used for administration of colostrum therapy in newborns. Methods: An integrative review was carried out in the following databases: Medline, Cumulative Index to Nursing and Allied Health Literature, Web of Science, Embase, Scientific Electronic Library Online (SciELO), Scopus, Latin American and Caribbean Health Sciences Literature (LILACS), and LIVIVO, using a combination of controlled terms in English, such as "Infant, Newborn," "Colostrum," and "Administration, Oral" associated with the entry terms and keywords. The selection of studies was carried out by reading titles and abstracts, through the Rayyan program to apply inclusion and exclusion criteria, and then reading them in full. Results: Five thousand eight hundred eighty-four studies were found in the databases; 15 studies were included in this review based on the inclusion and exclusion criteria. The selected articles presented variations in terms of cutoff criteria regarding gestational age and weight classification, in addition to the diversification between the beginning and the end of the application of colostrum therapy. In contrast, there was a predominance of the site of administration, type of colostrum used, and time to offer maternal colostrum. Conclusions: The studies present differences in terms of clinical parameters for standardizing the procedure. Therefore, this study can contribute to the generalized implementation of colostrum therapy in neonatal units through creation of a standard operating procedure based on systematization of the analyzed studies.
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CIOCHETTO CR, BOLZAN GDP, WEINMANN ARM. Influence of Kangaroo Mother Care on breastfeeding, the introduction of complementary feeding and diet quality in the first year of life. REV NUTR 2022. [DOI: 10.1590/1678-9865202235e220054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
ABSTRACT Objective To assess the influence of Kangaroo Mother Care on breastfeeding rates in preterm neonates, both at hospital discharge and throughout the first year of life, as well as its relation with the time of introduction of early complementary feeding and diet quality. Methods Observational, prospective and analytical longitudinal study conducted in a public hospital in southern Brazil. The study included 46 preterm neonates, who were admitted to a Kangaroo Neonatal Intermediate Care Unit or Conventional Neonatal Intermediate Care Unit. Results The frequency of exclusive breastfeeding at hospital discharge was higher in preterm neonates of Kangaroo Neonatal Intermediate Care Unit (p<0.001), and at four months of corrected age, 35% of them continued on exclusive breastfeeding (p=0.029), as compared to infants in Conventional Neonatal Intermediate Care Unit. However, at six and 12 months, no difference was found in breastfeeding rates between the participating groups. At four months of corrected age, approximately 45% of the breastfeeding infants in both groups were already on complementary feeding. At 12 months of corrected age, consumption of ultra-processed foods was 38.9% in infants from the Kangaroo Neonatal Intermediate Care Unit and 70% in infants from the Conventional Neonatal Intermediate Care Unit (p=0.054), and no significant differences were found. Conclusion The Kangaroo Mother Care fostered exclusive breastfeeding at hospital discharge and at 4 months of corrected age. On the other hand, with regard to the early introduction of complementary feeding, Kangaroo Mother Care was not protective, and a high rate of consumption of processed foods by infants was found.
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Belin CHS, Sarmento RA, Refosco LF, Bernardi JR. Description of a Nutrition Screening and Assessment Tool and Associations with Clinical Outcomes in Preterm Newborns. Nutr Clin Pract 2021; 36:1252-1261. [PMID: 33410545 DOI: 10.1002/ncp.10618] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Preterm newborns have higher nutrition risk and mortality. Nutrition risk screening enables early intervention. This article evaluates a nutrition screening tool in a neonatal intensive care unit (NICU). METHOD Retrospective longitudinal study of preterm newborns (aged <37 weeks) in a NICU in Brazil from May 2018 to January 2019. Weight, length, and head circumference (HC) were analyzed. Nutrition screening was defined by care levels (CLs). Outcomes analyzed were bronchopulmonary dysplasia (BPD), peri-intraventricular hemorrhage (PIVH), retinopathy of prematurity (ROP), late sepsis, length of stay, mortality, and time receiving enteral and parenteral nutrition. RESULTS Data on 110 newborns were studied, with median gestational age 34 (31-35) weeks, mean weight 1914.92 g (±657.7), length 42.2 cm (±4.45), and HC 29.9 cm (±2.97). Most (82.7%) of them were adequate for gestational age. Screening classifications were 41.8% (n = 46) at CL 2, 41.8% (n = 46) at CL 3, and 16.4% (n = 18) at CL 4. CL 3 and CL 4 patients had higher frequencies of BPD (P = .003), ROP (P = .027), and PIVH (P = .006) and longer enteral time (P < .001) and length of stay (P < .001). All mortality occurred in CL 4 patients (P < .001). CONCLUSIONS CL 3 and CL 4 patients had more BPD, ROP, PIVH, and mortality and longer enteral nutrition. Hospital stay was longer for CL ≥3 than CL 2 patients. Patients classified as CL 3 and CL 4 by the nutrition screening tool may have higher nutrition risk.
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Affiliation(s)
- Christy Hannah Sanini Belin
- Child and Adolescent Health Program, Department of Nutrition, Medical School, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Nutrition and Dietetic Service, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Roberta Aguiar Sarmento
- Nutrition and Dietetic Service, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Lília Farret Refosco
- Nutrition and Dietetic Service, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Juliana Rombaldi Bernardi
- Child and Adolescent Health Program, Food, Nutrition and Health Program, Department of Nutrition, Medical School, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
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Dias Emidio SC, Moorhead S, Oliveira HC, Herdman TH, Oliveira‐Kumakura ARDS, Carmona EV. Validation of Nursing Outcomes Related to Breastfeeding Establishment. Int J Nurs Knowl 2020; 31:134-144. [DOI: 10.1111/2047-3095.12256] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 07/09/2019] [Accepted: 07/17/2019] [Indexed: 01/06/2023]
Affiliation(s)
| | - Sue Moorhead
- Center for Nursing Classification and Clinical EffectivenessUniversity of Iowa Iowa City Iowa
| | | | - T. Heather Herdman
- University of Wisconsin‐Green Bay Green Bay Wisconsin
- Chief Executive Officer, NANDA International, Inc. Philadelphia Pennsylvania
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Lima APE, Castral TC, Leal LP, Javorski M, Sette GCS, Scochi CGS, de Vasconcelos MGL. Exclusive breastfeeding of premature infants and reasons for discontinuation in the first month after hospital discharge. ACTA ACUST UNITED AC 2019; 40:e20180406. [PMID: 31596342 DOI: 10.1590/1983-1447.2019.20180406] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 05/09/2019] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To estimate the prevalence of exclusive breastfeeding premature infants at hospital discharge, and after 15 and 30 days, and to identify the mothers' claims for discontinuation. METHODS Cross-sectional study with 108 premature infants born in two Baby-Friendly Hospitals between April and July 2014. A survey was conducted on medical records and through telephone interviews. A descriptive analysis, Pearson's chi-square test, and Fisher's exact test were used, with a 95% confidence interval. RESULTS The prevalence of exclusive breastfeeding at discharge was 85.2%, 75% after 15 days, and 46.3% after 30 days. The main claim for the introduction of other foods and/or liquids was insufficient milk. CONCLUSIONS There was a significant reduction in the rates of exclusive breastfeeding after discharge, pointing out the importance of continuity of patient care to reduce early weaning, especially with educational actions that help prevent real and perceived deficits in milk supply.
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Affiliation(s)
- Ana Paula Esmeraldo Lima
- Universidade Federal de Pernambuco (UFPE), Departamento de Enfermagem. Recife, Pernambuco, Brasil
| | - Thaíla Corrêa Castral
- Universidade Federal de Goiás (UFG), Faculdade de Enfermagem e Nutrição,Departamento de Enfermagem. Goiânia, Goiás, Brasil
| | - Luciana Pedrosa Leal
- Universidade Federal de Pernambuco (UFPE), Departamento de Enfermagem. Recife, Pernambuco, Brasil
| | - Marly Javorski
- Universidade Federal de Pernambuco (UFPE), Departamento de Enfermagem. Recife, Pernambuco, Brasil
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Brown LJ, Sear R. Are mothers less likely to breastfeed in harsh environments? Physical environmental quality and breastfeeding in the Born in Bradford study. MATERNAL AND CHILD NUTRITION 2019; 15:e12851. [PMID: 31119874 DOI: 10.1111/mcn.12851] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 05/06/2019] [Accepted: 05/09/2019] [Indexed: 11/27/2022]
Abstract
We use the United Kingdom's Born in Bradford study to investigate whether women in lower quality environments are less likely to breastfeed. We use measures of physical environmental quality (water disinfectant by-products [DBPs], air pollution, passive cigarette smoke, and household condition) alongside socio-economic indicators, to explore in detail how different exposures influence breastfeeding. Drawing on evolutionary life history theory, we predict that lower environmental quality will be associated with lower odds of initiating, and higher hazards of stopping, breastfeeding. As low physical environmental quality may increase the risk of adverse birth outcomes, which may in turn affect breastfeeding chances, we also test for mediation by gestational age, birthweight, head circumference, and abdominal circumference. Our sample is composed of mothers who gave birth at the Bradford Royal Infirmary in West Yorkshire between March 2007 and December 2010 for whom breastfeeding initiation data was available. Analyses were stratified by the two largest ethnic groups: White British (n = 3,951) and Pakistani-origin (n = 4,411) mothers. After controlling for socio-economic position, Pakistani-origin mothers had lower chances of initiating and higher chances of stopping breastfeeding with increased water DBP exposure (e.g., OR for 0.03-0.61 vs. <0.02 μg/day dibromochloromethane exposure 0.70 [0.58-0.83], HR 1.16 [0.99-1.36]), greater air pollution exposure predicted lower chances of initiation for both ethnic groups (e.g., OR for 10 μg/m3 increase in nitrogen dioxide 0.81 [0.66-0.99] for White British mothers and 0.79 [0.67-0.94] for Pakistani-origin mothers) but also a reduced hazard of stopping breastfeeding for White British mothers (HR 0.65 [0.52-0.80]), and exposure to household damp/mould predicted higher chances of breastfeeding initiation amongst White British mothers (OR 1.66 [1.11-2.47]). We found no evidence that physical environmental quality effects on breastfeeding were mediated through birth outcomes amongst Pakistani-origin mothers and only weak evidence (p < 0.10) amongst White British mothers (exposure to passive cigarette smoke was associated with having lower birthweight infants who were in turn less likely to be breastfed whereas greater air pollution exposure was associated with longer gestations and in turn reduced hazards of stopping breastfeeding). Overall, our findings suggest that there is differential susceptibility to environmental exposures according to ethnicity. Although the water DBP results for Pakistani-origin mothers and air pollution-initiation results for both ethnic groups support our hypothesis that mothers exhibit reduced breastfeeding in poorer quality environments, several physical environmental quality indicators showed null or positive associations with breastfeeding outcomes. We consider physiological explanations for our findings and their implications for life history theory and public health policy.
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Affiliation(s)
- Laura J Brown
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Rebecca Sear
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
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8
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Perrella SL, Nancarrow K, Trevenen M, Murray K, Geddes DT, Simmer KN. Effect of vacuum-release teat versus standard teat use on feeding milestones and breastfeeding outcomes in very preterm infants: A randomized controlled trial. PLoS One 2019; 14:e0214091. [PMID: 30901356 PMCID: PMC6430377 DOI: 10.1371/journal.pone.0214091] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 03/05/2019] [Indexed: 01/17/2023] Open
Abstract
Background Breast milk is important to infant health, yet shorter breastfeeding duration is reported for preterm infants. Both breast and bottle feeds are given in the neonatal unit, with full oral feeding often the last milestone to be achieved prior to discharge home. Unlike standard bottle teats, a vacuum release teat requires the application of negative intra-oral pressure to release milk, and so may facilitate breastfeeding in preterm infants. The objective of this study was to determine the effect of vacuum release teat use on timing of achievement of the first full oral feed and on first completion of 24 h full oral feeds. Feeding method at discharge home, 2 weeks, 6 weeks and 12 weeks corrected gestational age were also examined. Methods A randomized controlled trial was completed with mothers of preterm infants born 24–33 weeks gestation in the neonatal unit of a tertiary women’s hospital. Infants were randomized to one of two parallel groups using a vacuum release teat or standard teat for oral feeds when the mother was not available to breastfeed. Test weights were completed for all oral feeds. It was not possible to blind participants, care givers and outcome assessors to group assignment due to the nature of the study. Results The groups did not differ with regard to timing of achievement of first full oral feed or 24 h of full oral feeds. Significantly more infants in the vacuum release teat group were exclusively fed breast milk at discharge from hospital and breastfed at 3 months corrected gestational age. Conclusions Use of a vacuum release teat when the mother is not available to breastfeed may promote preterm breastfeeding skills, resulting in higher rates of exclusivity and longer breastfeeding duration. Trial registration The trial is registered with the Australian New Zealand Clinical Trials Registry ACTRN12615000245594.
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Affiliation(s)
- Sharon Lisa Perrella
- School of Molecular Sciences, Faculty of Science, The University of Western Australia, Crawley, Western Australia, Australia
- * E-mail:
| | - Kathryn Nancarrow
- Neonatology Clinical Care Unit, King Edward Memorial Hospital, Subiaco, Western Australia, Australia
| | - Michelle Trevenen
- School of Mathematics and Statistics, Faculty of Engineering and Mathematical Sciences, The University of Western Australia, Crawley, Western Australia, Australia
| | - Kevin Murray
- School of Population and Global Health, Faculty of Health and Medical Sciences, The University of Western Australia, Crawley, Western Australia, Australia
| | - Donna Tracy Geddes
- School of Molecular Sciences, Faculty of Science, The University of Western Australia, Crawley, Western Australia, Australia
| | - Karen Norrie Simmer
- Neonatology Clinical Care Unit, King Edward Memorial Hospital, Subiaco, Western Australia, Australia
- Centre for Neonatal Research and Education, School of Paediatrics and Child Health, Faculty of Health and Medical Sciences, The University of Western Australia, Crawley, Western Australia, Australia
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Méio MDBB, Villela LD, Gomes Júnior SCDS, Tovar CM, Moreira MEL. Breastfeeding of preterm newborn infants following hospital discharge: follow-up during the first year of life. CIENCIA & SAUDE COLETIVA 2018; 23:2403-2412. [PMID: 30020392 DOI: 10.1590/1413-81232018237.15742016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Accepted: 08/02/2016] [Indexed: 11/22/2022] Open
Abstract
This paper aims to evaluate the prevalence of breastfeeding among premature infants following hospital discharge. Cohort (< 33 gestation weeks) followed up to 12 months (adjusted age). VARIABLES breastfeeding, anthropometric measurements, social and family information. The proportion of breastfeeding during follow-up was calculated. Survival analysis was conducted to estimate breastfeeding duration. In total, 242 of the 258 infants (93.7%) returned to follow-up; 170 (69.9%) at 6 months and 139 (57.2%) at 12 months (adjusted age). A history of miscarriages (27.5%), stillbirths (11.7%), neonatal deaths (9.5%) and preterm births (21.1%) was noted in 65.5% of women. At hospital discharge: 5.5% received exclusive breastfeeding, 65.8% breastfeeding and formula, 28.6% formula. At month 1, 81.3% received breastfeeding, decreasing to 68.5% at month 2, 62.4% at month 3, 48.1% at month 4 and 22.4% at month 6 (adjusted age). The median of breastfeeding duration was 4 months. Breastfeeding occurred up to four months adjusted age in almost half of the population. Despite the need to improve these rates, the results could reflect the profile of the Child-Friendly Hospital Initiative Unit. Maintaining breastfeeding amongst preterm infants following hospital discharge is still a challenge, for both mothers and health professionals.
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Affiliation(s)
| | - Letícia Duarte Villela
- Instituto Fernandes Figueira, Fiocruz. Av. Rui Barbosa 716, Flamengo. 22250-020 Rio de Janeiro RJ Brasil.
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Menezes LVP, Steinberg C, Nóbrega AC. Complementary feeding in infants born prematurely. Codas 2018; 30:e20170157. [PMID: 30328902 DOI: 10.1590/2317-1782/20182017157] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2017] [Accepted: 04/30/2018] [Indexed: 11/22/2022] Open
Abstract
PURPOSE To investigate if there is difficulty in introducing complementary feeding in premature infants. METHODS This is an exploratory, cross-sectional study performed in premature infants between six and twenty-four months of gestationally corrected age, using complementary feeding. Thirty-eight infants born prematurely were included. The feeding difficulties presented by the infants were investigated through an objective question followed by the application of a food behavior checklist for the last month. The children's clinical variables were investigated through a medical record review. An interview was conducted with those responsible for the child to identify the sociodemographic aspects and the type of breastfeeding before the corrected six months of age. RESULTS Asked about the general perception, 50% of parents answered that their children did not present feeding difficulties in the last month. However, when a checklist was applied, 73.7% of the parents reported that their children had at least one defensive behavior at mealtime. Refusal to open their mouths (42.1%), food selectivity (28.9%), and feeding refusal (26.3%) were the most frequent defensive behaviors. The food refusal item (44.4%) had a greater association with formula feeding (p = 0.033). CONCLUSION The present study showed an association between the type of breastfeeding and the difficulties in complementary feeding, especially in premature infants with formula feeding, presenting food refusal during meals. We found the presence of different types of defensive behaviors at mealtime in the majority of premature infants investigated.
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Affiliation(s)
- Larissa Vieira Pinto Menezes
- Departamento de Fonoaudiologia, Universidade Federal da Bahia - UFBA - Salvador (BA), Brasil.,Maternidade Climério de Oliveira, Universidade Federal da Bahia - UFBA - Salvador (BA), Brasil
| | - Carla Steinberg
- Departamento de Fonoaudiologia, Universidade Federal da Bahia - UFBA - Salvador (BA), Brasil
| | - Ana Caline Nóbrega
- Departamento de Fonoaudiologia, Universidade Federal da Bahia - UFBA - Salvador (BA), Brasil
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Rodrigues C, Teixeira R, Fonseca MJ, Zeitlin J, Barros H. Prevalence and duration of breast milk feeding in very preterm infants: A 3-year follow-up study and a systematic literature review. Paediatr Perinat Epidemiol 2018; 32:237-246. [PMID: 29469986 DOI: 10.1111/ppe.12457] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND The World Health Organization recommends exclusive breast milk feeding until 6 months and continuing up to 2 years of age; little is known about whether very preterm infants are fed in accordance with these recommendations. We aimed to describe the prevalence and duration of breast milk feeding in very preterm children and to systematically review internationally published data. METHODS We evaluated breast milk feeding initiation and duration in very preterm children born in 2 Portuguese regions (2011-2012) enrolled in the EPICE cohort and followed-up to the age of 3 (n = 466). We searched PubMed® from inception to January 2017 to identify original studies reporting the prevalence and/or duration of breast milk feeding in very preterm children. RESULTS 91.0% of children received some breast milk feeding and 65.3% were exclusively breast fed with a median duration of 2 months for exclusive and 3 months for any breast milk; only 9.9% received exclusive breast milk for at least 6 months, 10.2% received any breast milk for 12 months or more, and 2.0% for up to 24 months. The literature review identified few studies on feeding after hospital discharge (n = 9); these also reported a low prevalence of exclusive breast milk feeding at 6 months (1.0% to 27.0%) and of any breast milk at 12 months (8.0% to 12.0%). CONCLUSIONS The duration of breast milk feeding among Portuguese very preterm infants was shorter than recommended. However, this appears to be common globally. Research is needed to inform strategies to promote continued breast milk feeding.
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Affiliation(s)
- Carina Rodrigues
- EPIUnit-Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
| | - Raquel Teixeira
- EPIUnit-Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
| | - Maria João Fonseca
- EPIUnit-Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal.,Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Jennifer Zeitlin
- INSERM, Obstetrical, Perinatal and Paediatric Epidemiology Research Team, Centre for Epidemiology and Biostatistics (U1153), Paris-Descartes University, Paris, France
| | - Henrique Barros
- EPIUnit-Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal.,Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
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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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Dadalto ECV, Rosa EM. KNOWLEDGE ABOUT THE BENEFITS OF BREASTFEEDING AND DISADVANTAGES OF THE PACIFIER RELATED TO THE MOTHER'S PRACTICE WITH PRETERM INFANTS. REVISTA PAULISTA DE PEDIATRIA : ORGAO OFICIAL DA SOCIEDADE DE PEDIATRIA DE SAO PAULO 2017; 35:399-406. [PMID: 28977129 PMCID: PMC5737258 DOI: 10.1590/1984-0462/;2017;35;4;00005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 01/25/2017] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate the knowledge and expectations of mothers of preterm newborn infants admitted in a neonatal intensive care unit about breastfeeding and pacifier use, and to analyze their experience in dealing with the sucking urge in the first months of life. METHODS Mothers were interviewed during hospitalization of the newborn in the neonatal intensive care unit and when the infant was six months old. All mothers with availability to participate in the study were included. Exclusion criteria comprised infants with syndromes and neurological disorders and mothers with cognitive impairment, depression, and drug users. Data were analyzed with the SPSS software, with descriptive statistics and chi-square test. RESULTS Sixty-two mothers were interviewed in the beginning and 52 at a six-month follow-up. Mothers' expectations concerning breastfeeding were positive when they listed the benefits to the mother (90.3%) and infant (100%). However, they had difficulties maintaining exclusive breastfeeding and used the baby bottle (75.0%), which most mothers (69.4%) had already acquired before the infant was born. The fact of having a pacifier in the infant's layette (43.6%) did not influence its use (p=0.820). This also occurred among mothers who said they would not offer the pacifier due to disadvantages to the mother (80.7%) and infant (96.8%). The previous expectation that the pacifier could bring benefits for mother and infant did not affect its use (p=0.375 and p=0.158). CONCLUSIONS Mothers demonstrated prior knowledge about breastfeeding benefits and disadvantages of the pacifiers. However, they changed their view when dealing with the infant and introduced bottles and pacifiers.
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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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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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