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Nejsum FM, Måstrup R, Torp-Pedersen C, Løkkegaard ECL, Wiingreen R, Hansen BM. Exclusive breastfeeding: Relation to gestational age, birth weight, and early neonatal ward admission. A nationwide cohort study of children born after 35 weeks of gestation. PLoS One 2023; 18:e0285476. [PMID: 37224110 DOI: 10.1371/journal.pone.0285476] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 04/22/2023] [Indexed: 05/26/2023] Open
Abstract
OBJECTIVES Prematurity, being small for gestational age and early neonatal ward admission are the major neonatal conditions that may interfere with breastfeeding supportive practices in infants born at gestational age ≥35+0 weeks. We aimed to investigate the associations between gestational age, small for gestational age, early neonatal ward admission and exclusive breastfeeding at one and four months. METHODS A register-based cohort-study of all Danish singletons with gestational age ≥35+0 weeks born in 2014-2015. In Denmark, health visitors routinely conduct free home visits throughout infants' first year and thereby report breastfeeding data to The Danish National Child Health Register. These data were linked with data from other national registers. Logistic regression models estimated the odds ratio for exclusive breastfeeding at one and four months, adjusted for confounding variables. RESULTS The study population comprised 106,670 infants. Compared to gestational age 40 weeks, the adjusted odds ratio for exclusive breastfeeding at one month showed a decreasing tendency from gestational age ≥42 (n = 2,282) (1.07; 95% confidence interval (CI) 0.97-1.17) to 36 weeks (n = 2,062) (0.80; 95% CI 0.73-0.88). Small for gestational age (n = 2,342) was associated with decreased adjusted odds ratio for exclusive breastfeeding at one month (0.84; 95% CI 0.77-0.92). Neonatal ward admission was associated with increased adjusted odds ratio for exclusive breastfeeding at one month among late preterm infants (gestational age 35-36 weeks; n = 3,139) (1.31; 95% CI 1.12-1.54), as opposed to among early term (gestational age 37-38 weeks; n = 19,171) (0.84; 95% CI 0.77-0.92) and term infants (gestational age >38 weeks; n = 84,360) (0.89; 95% CI 0.83-0.94). The associations seemed to persist at four months. CONCLUSIONS Decreasing gestational age and small for gestational age were associated with decreased exclusive breastfeeding rates. Neonatal ward admission was associated with increased exclusive breastfeeding rates among late preterm infants, whereas the opposite was observed among early term and term infants.
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Affiliation(s)
- Freja Marie Nejsum
- Department of Pediatrics, Copenhagen University Hospital - North Zealand, Hillerød, Denmark
| | - Ragnhild Måstrup
- Department of Neonatology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Christian Torp-Pedersen
- Department of Cardiology, Copenhagen University Hospital - North Zealand, Hillerød, Denmark
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Ellen Christine Leth Løkkegaard
- Department of Gynaecology and Obstetrics, Copenhagen University Hospital - North Zealand, Hillerød, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Rikke Wiingreen
- Department of Pediatrics, Copenhagen University Hospital - North Zealand, Hillerød, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Bo Mølholm Hansen
- Department of Pediatrics, Copenhagen University Hospital - North Zealand, Hillerød, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Doughty KN, Abeyaratne D, Merriam AA, Taylor SN. Self-Efficacy and Outcomes in Women with Diabetes: A Prospective Comparative Study. Breastfeed Med 2023; 18:307-314. [PMID: 36999939 PMCID: PMC10124167 DOI: 10.1089/bfm.2022.0298] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/01/2023]
Abstract
Background: Breastfeeding is especially beneficial to women with diabetes and their infants, yet diabetic mothers frequently experience less favorable breastfeeding outcomes. Objectives: To identify facilitators and barriers to breastfeeding for women with diabetes by comparing cognitive and social factors, health and hospital-related factors, and breastfeeding outcomes between women with and without diabetes. Design/Methods: Women with any type of diabetes (n = 28) and without diabetes (n = 29) were recruited during pregnancy. Data were collected from the electronic medical record and maternal surveys at 24-37 weeks' gestation, birth hospitalization, and 4 weeks' postbirth. We compared differences in mother's regard for breastfeeding, breastfeeding intention, and birth hospital experience by diabetes status, and estimated odds ratios for exclusive breastfeeding (EBF) and unmet intention to breastfeed. Results: Women with and without diabetes had similar breastfeeding intentions, attitudes, and self-efficacy. Women with diabetes were less likely to EBF, and more likely to have unmet intentions to EBF at hospital discharge, compared to women without diabetes. At 4 weeks' postpartum, there was no difference in breastfeeding by diabetes status, although EBF at hospital discharge was strongly associated with EBF at 4 weeks. Infant neonatal intensive care unit (NICU) admission and hypoglycemia were significantly associated with diabetes status, reduced EBF rates, and unmet breastfeeding intentions. Conclusions: Despite having a strong intent to breastfeed, women with diabetes experienced less favorable early breastfeeding outcomes and were less likely to meet their own breastfeeding goals. These differences may be driven by neonatal complications, such as infant hypoglycemia and NICU admissions, rather than maternal cognitive and social factors.
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Affiliation(s)
- Kimberly N Doughty
- Egan School of Nursing and Health Studies, Public Health Fairfield University, Fairfield, Connecticut, USA
| | - Dhatri Abeyaratne
- Yale School of Medicine, Department of Pediatrics, Division of Neonatology, New Haven, Connecticut, USA
| | - Audrey A Merriam
- Yale School of Medicine, Department of Pediatrics, Division of Neonatology, New Haven, Connecticut, USA
| | - Sarah N Taylor
- Yale School of Medicine, Department of Pediatrics, Division of Neonatology, New Haven, Connecticut, USA
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Tahmasebifard N, Briley PM, Ellis C, Perry JL. Early Nutrition among Infants Admitted to the NICU with Cleft Lip and Palate. Cleft Palate Craniofac J 2023; 60:299-305. [PMID: 34812064 DOI: 10.1177/10556656211059371] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE The objective of this study was to examine differences in human milk feeding outcomes among infants admitted to a neonatal intensive care unit (NICU) with and without cleft lip and palate (CLP). METHOD Data were used from a sample of infants admitted to the NICU with and without CLP from the 2018 National Vital Statistics System. For baseline comparisons, Chi-square tests of independence were used to compare categorical variables, and independent samples t tests were used for continuous variables. Logistic regression models were performed to determine the odds of human milk feeding at discharge in infants admitted to the NICU with CLP. RESULTS The total sample included 345,429 infants admitted to the NICU, of which 660 had CLP. Significant differences were found among the following variables when baseline comparisons were made between infants admitted to the NICU with and without CLP: mother's race, mother's education, maternal smoking record, childbirth delivery method, presence of maternal pre-pregnancy diabetes, five-minute APGAR score, multiparity record (having more than one baby at birth), gestational age, and gestational weight. After controlling for baseline differences, results indicated reduced odds of human milk feeding at discharge in infants admitted to the NICU with CLP compared to those without CLP (OR = .543; 95% CI.455,.648). CONCLUSION Results suggest reduced odds of human milk feeding at discharge among infants admitted to the NICU with CLP compared to those without CLP. These findings emphasize the necessity of awareness and facilitation of human milk feeding in this population.
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Affiliation(s)
- Neda Tahmasebifard
- Department of Communication Sciences & Disorders, 3627East Carolina University, Greenville, USA
| | - Patrick M Briley
- Department of Communication Sciences & Disorders, 3627East Carolina University, Greenville, USA
| | - Charles Ellis
- Department of Speech, Language, and Hearing Sciences, University of Florida, USA
| | - Jamie L Perry
- Department of Communication Sciences & Disorders, 3627East Carolina University, Greenville, USA
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Martin JK, Price-Haywood EG, Gastanaduy MM, Fort DG, Ford MK, Peterson SP, Biggio JR. Unexpected Term Neonatal Intensive Care Unit Admissions and a Potential Role for Centralized Remote Fetal Monitoring. Am J Perinatol 2023; 40:297-304. [PMID: 33882588 DOI: 10.1055/s-0041-1727214] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVE Centralized remote fetal monitoring (CRFM) has been proposed as a method to improve the performance of intrapartum fetal heart rate (FHR) monitoring and perinatal outcomes. The purpose of this study is to determine whether CRFM was associated with a reduction in unexpected term neonatal intensive care unit (NICU) admissions. STUDY DESIGN A pre-post design was used to examine the effectiveness of CRFM which was implemented in stages across five hospitals. The exposure group was all women who underwent intrapartum monitoring via CRFM. The unexposed group was of women who delivered at the same hospitals prior to implementation of CRFM. Pregnancies with expected NICU admissions, gestational age <37 weeks, birth weight <2,500 g, or major fetal anomalies detected prenatally were excluded. The primary outcome was unexpected term NICU admission; secondary outcomes were cesarean and operative vaginal delivery (OVD), and 5-minute Apgar's score of <7 rates. Maternal and delivery characteristics were examined with Student's t, Wilcoxon's, Chi-square, and Fisher's exact tests. Multivariable logistic regression was performed to control for potential confounders. RESULTS There were 19,392 live births included in this analysis. In the univariable analysis, the odds of unexpected term NICU admission was lower among the CRFM exposed group compared with the unexposed group (odds ratio [OR] = 0.86, 95% confidence interval [CI]: 0.75-0.99; p = 0.038). In multivariable analysis, this did not reach statistical significance (OR = 0.92, 95% CI: 0.79-1.06; p = 0.24). Cesarean and OVD were less likely in the exposed group (OR = 0.91, 95% CI: 0.85-0.97; p = 0.008) and (OR = 0.70, 95% CI: 0.59-0.83, p < 0.001), respectively, in univariable analysis. When adjusted for potential confounders, the effect remained statistically significant for cesarean delivery (OR = 0.92, 95% CI: 0.85-0.98; p = 0.012). When adjusted for hospital, OVD rate was lower at the highest volume and highest acuity site (OR = 0.48, 95% CI: 0.36-0.65, p < 0.001). CONCLUSION In some practice settings, utilization of a CRFM system may decrease the risk of unexpected term NICU admission, cesarean, and OVD rate. KEY POINTS · CRFM may decrease unexpected term NICU admissions in some clinical settings.. · CRFM may decrease cesarean delivery rates in some clinical settings.. · CRFM may decrease OVD rates in some clinical settings..
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Affiliation(s)
- Jane K Martin
- Section of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Women's Service Line, Ochsner Health, New Orleans, Louisiana
| | - Eboni G Price-Haywood
- Ochsner Center for Outcomes and Health Services Research, New Orleans, Louisiana.,University of Queensland, Ochsner Clinical School, New Orleans, Louisiana
| | | | - Daniel G Fort
- Ochsner Center for Outcomes and Health Services Research, New Orleans, Louisiana
| | - Mary K Ford
- Section of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Women's Service Line, Ochsner Health, New Orleans, Louisiana
| | - Sydney P Peterson
- Section of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Women's Service Line, Ochsner Health, New Orleans, Louisiana
| | - Joseph R Biggio
- Section of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Women's Service Line, Ochsner Health, New Orleans, Louisiana.,University of Queensland, Ochsner Clinical School, New Orleans, Louisiana
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Sokou R, Parastatidou S, Ioakeimidis G, Tavoulari EF, Makrogianni A, Isaakidou E, Iacovidou N, Konstantinidi A. Breastfeeding in Neonates Admitted to an NICU: 18-Month Follow-Up. Nutrients 2022; 14:nu14183841. [PMID: 36145216 PMCID: PMC9500865 DOI: 10.3390/nu14183841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 09/12/2022] [Accepted: 09/13/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction: The admission of neonates to Neonatal Intensive Care Units (NICUs) has been identified as a primary inhibiting factor in the establishment of breastfeeding. The aims of this study were to (1) estimate the prevalence and duration of breastfeeding in infants/toddlers who had been admitted to an NICU in Greece and (2) to investigate factors, associated with the NICU stay, which affected the establishment and maintenance of breastfeeding in infants/toddlers previously admitted to the NICU. Materials and methods: Data for this cohort study were retrieved from interviews with mothers of infants/toddlers who had been admitted to our NICU as neonates during the period of 2017−2019. Interviews were conducted based on a questionnaire regarding the child’s nutrition from birth to the day of the interview, including previous maternal experience with breastfeeding. Information related to the prenatal period, gestation age, delivery mode, duration of NICU stay, and neonatal feeding strategies during their hospital stay were recorded. Results: The response rate to the telephone interviews was 57%, resulting in 279 mother−infant pairs being included in this study. The results showed that 78.1% of children received maternal milk during their first days of life. Of all infants, 58.1% were exclusively breastfed during their first month, with a gradual decrease to 36.9% and 19.4% by the end of the third and sixth months of life, respectively. The prevalence of breastfed children reached 14.7% and 7.5% at the ages of twelve and eighteen months, respectively. In the multivariate analysis, prematurity emerged as an independent prognostic factor for the duration of exclusive and any breastfeeding (aHR 1.64, 95% CI: 1.03−2.62; and 1.69, 95% CI: 1.05−2.72, respectively; p < 0.05). Additionally, the nationality of the mother, NICU breastfeeding experience, the administration of maternal milk during neonatal hospital stay, and previous breastfeeding experience of the mother were independent prognostic factors for the duration of breastfeeding. Conclusions: Although breastfeeding is a top priority in our NICU, the exclusive-breastfeeding rates at 6 months were quite low for the hospitalized neonates, not reaching World Health Organization (WHO) recommendations. Mothers/families of hospitalized neonates should receive integrated psychological and practical breastfeeding support and guidance.
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Affiliation(s)
- Rozeta Sokou
- Neonatal Intensive Care Unit, “Agios Panteleimon” General Hospital of Nikea, 3 D. Mantouvalou Str., Nikea, 18454 Piraeus, Greece
- Neonatal Department, Aretaieio Hospital, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece
- Correspondence: ; Tel.: +30-2132077346 or +30-2132077000
| | - Stavroula Parastatidou
- Neonatal Intensive Care Unit, “Agios Panteleimon” General Hospital of Nikea, 3 D. Mantouvalou Str., Nikea, 18454 Piraeus, Greece
| | - Georgios Ioakeimidis
- Neonatal Intensive Care Unit, “Agios Panteleimon” General Hospital of Nikea, 3 D. Mantouvalou Str., Nikea, 18454 Piraeus, Greece
| | - Evangelia-Filothei Tavoulari
- Neonatal Intensive Care Unit, “Agios Panteleimon” General Hospital of Nikea, 3 D. Mantouvalou Str., Nikea, 18454 Piraeus, Greece
| | - Athanasia Makrogianni
- Neonatal Intensive Care Unit, “Agios Panteleimon” General Hospital of Nikea, 3 D. Mantouvalou Str., Nikea, 18454 Piraeus, Greece
| | - Elina Isaakidou
- Neonatal Intensive Care Unit, “Agios Panteleimon” General Hospital of Nikea, 3 D. Mantouvalou Str., Nikea, 18454 Piraeus, Greece
| | - Nicoletta Iacovidou
- Neonatal Department, Aretaieio Hospital, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece
| | - Aikaterini Konstantinidi
- Neonatal Intensive Care Unit, “Agios Panteleimon” General Hospital of Nikea, 3 D. Mantouvalou Str., Nikea, 18454 Piraeus, Greece
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6
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Jonsdottir RB, Flacking R, Jonsdottir H. Breastfeeding initiation, duration, and experiences of mothers of late preterm twins: a mixed-methods study. Int Breastfeed J 2022; 17:68. [PMID: 36076279 PMCID: PMC9461222 DOI: 10.1186/s13006-022-00507-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 08/25/2022] [Indexed: 11/17/2022] Open
Abstract
Background Twins and late preterm (LPT) infants are at an increased risk of being breastfed to a lesser extent than term singletons. This study aimed to describe the initiation and duration of any and exclusive breastfeeding at the breast for mothers of LPT twins and term twins during the first 4 months and to explore the breastfeeding experiences of mothers of LPT twins. Methods A sequential two-sample quantitative–qualitative explanatory mixed-methods design was used. The quantitative data were derived from a longitudinal cohort study in which 22 mothers of LPT twins and 41 mothers of term twins answered questionnaires at one and four months after birth (2015–2017). The qualitative data were obtained from semi-structured interviews with 14 mothers of LPT twins (2020–2021), based on results from the quantitative study and literature. Analysis included descriptive statistics of quantitative data and deductive content analysis of the qualitative data, followed by condensation and synthesis. Results All mothers of LPT twins (100%) and most mothers of term twins (96%) initiated breastfeeding. There was no difference in any breastfeeding during the first week at home (98% versus 95%) and at 1 month (88% versus 85%). However, at 4 months, the difference was significant (44% versus 75%). The qualitative data highlighted that mothers of LPT twins experienced breastfeeding as complex and strenuous. Key factors influencing mothers’ experiences and decisions were their infants’ immature breastfeeding behaviors requiring them to express breast milk alongside breastfeeding, the burden of following task-oriented feeding regimes, and the lack of guidance from healthcare professionals. As a result, mothers started to question the worth of their breastfeeding efforts, leading to changes in breastfeeding management with diverse results. Support from fathers and grandparents positively influenced sustained breastfeeding. Conclusions Mothers of LPT twins want to breastfeed, but they face many challenges in breastfeeding during the first month, leading to more LPT twins’ mothers than term twins’ mothers ceasing breastfeeding during the following months. To promote and safeguard breastfeeding in this vulnerable group, care must be differentiated from routine term infant services, and healthcare professionals need to receive proper education and training. Supplementary Information The online version contains supplementary material available at 10.1186/s13006-022-00507-3.
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Affiliation(s)
- Rakel B Jonsdottir
- Neonatal Intensive Care Unit, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland. .,Faculty of Nursing, School of Health Sciences, University of Iceland, Reykjavik, Iceland.
| | - Renée Flacking
- School of Health and Welfare, Dalarna University, Falun, Sweden
| | - Helga Jonsdottir
- Faculty of Nursing, School of Health Sciences, University of Iceland, Reykjavik, Iceland
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Dani C, Ciarcià M, Miselli F, Luzzati M, Coviello C, Azzarelli F, Ferrara M, Lori I, Pezzati M. The management of late preterm infants: effects of rooming-in assistance versus direct admission to neonatal care units. Eur J Pediatr 2022; 181:1643-1649. [PMID: 34993626 DOI: 10.1007/s00431-021-04337-z] [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] [Received: 09/06/2021] [Revised: 11/08/2021] [Accepted: 11/30/2021] [Indexed: 11/28/2022]
Abstract
Late preterm infants (LPIs) represent a significant percentage of all neonates (6-8%), but there are limited published data on their postnatal management. Our aim was to compare the frequency of neonatal intensive care unit (NICU) admission and the breastfeeding rate of LPIs born at 35+0-36+6 weeks of gestation who were cared for by initial rooming in strategy rather than directly admitted to the special care unit (SCU) and, eventually, to the NICU. We carried out a retrospective study in the perinatal centers of Careggi University Hospital (CUH) and San Giovanni di Dio Hospital in Florence, Italy, where the first and second strategies were applied, respectively. Main outcomes were LPIs admission rate at SCU/NICU and breastfeeding rate at discharge. We studied 190 LPIs born at SGDH and 240 born at CUH. The admission rate in SCU (81 vs. 43%; P < 0.001) and NICU (20 vs. 10%; P = 0.008) was higher in SGDH than in CUH, as was the exclusive breastfeeding rate (36 vs. 22%; P < 0.001). However, infants who were assisted in rooming-in at CUH and infants with similar clinical characteristics at SGDH had similar mixed (60 vs. 69%) and exclusive (35 vs. 31%) breastfeeding rates. Conclusion: Postnatal assistance of LPIs in rooming-in, eventually followed by admission in SCU/NICU based on their clinical conditions, allowed to safely halve their hospitalization. The assistance of infants in rooming-in did not negatively affect their breastfeeding rate. These results support the possibility of assisting LPIs in rooming-in. What is Known: • Late preterm infants represent a significant percentage of all neonates. • Early rooming-in and breastfeeding is recommended for late preterm infants. What is New: • Postnatal assistance of late preterm infants in rooming-in, followed when necessary by admission in neonatal units based on clinical conditions, allowed to safely avoid about half the number of hospitalizations in comparison with direct admission in neonatal units. • This strategy did not affect breastfeeding rate. Infants who were admitted to SCU/NICU after initial rooming-in had worst breastfeeding rate.
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Affiliation(s)
- Carlo Dani
- Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy. .,Division of Neonatology, Careggi University Hospital of Florence, Largo Brambilla 3, Florence, 50141, Italy.
| | - Martina Ciarcià
- Division of Neonatology, Careggi University Hospital of Florence, Largo Brambilla 3, Florence, 50141, Italy
| | - Francesca Miselli
- Division of Neonatology, Careggi University Hospital of Florence, Largo Brambilla 3, Florence, 50141, Italy
| | - Michele Luzzati
- Division of Neonatology, Careggi University Hospital of Florence, Largo Brambilla 3, Florence, 50141, Italy
| | - Caterina Coviello
- Division of Neonatology, Careggi University Hospital of Florence, Largo Brambilla 3, Florence, 50141, Italy
| | | | - Marianna Ferrara
- Neonatal Intensive Care Unit, San Giovanni Di Dio Hospital, Florence, Italy
| | - Ilaria Lori
- Neonatal Intensive Care Unit, San Giovanni Di Dio Hospital, Florence, Italy
| | - Marco Pezzati
- Neonatal Intensive Care Unit, San Giovanni Di Dio Hospital, Florence, Italy
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Griffin LB, Ding JJ, Has P, Ayala N, Kole-White MB. Lactation Consultation by an International Board Certified Lactation Consultant Improves Breastfeeding Rates for Mothers With Gestational Diabetes Mellitus. J Hum Lact 2022; 38:141-147. [PMID: 34162243 DOI: 10.1177/08903344211018622] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND In patients with gestational diabetes, breastfeeding decreases the lifetime risk of Type 2 diabetes by half. Lactation consultation has been shown to increase breastfeeding rates in the general population but has not been assessed in a gestational diabetes population. RESEARCH AIMS To determine if (1) a postpartum International Board Certified Lactation Consultant (IBCLC) consultation during delivery hospitalization improved inclusive (any) or exclusive breastfeeding rates at hospital discharge and 3 months postpartum in participants with GDM; and if (2) obstetrical providers' acknowledgement of maternal feeding preference affected the rates of IBCLC consultation for patients. METHODS This was a retrospective, comparative, secondary analysis of a prospective cohort (N = 517) study of women gestational diabetes. Participants who received a IBCLC consultation (n = 386; 74.5%) were compared to those who did not (n = 131; 25.5%). Baseline demographics, antepartum characteristics, neonatal information, mode of infant feeding at hospital discharge and 3 months postpartum, and IBCLC consultation during postpartum hospitalization were measured. RESULTS After adjusting for baseline differences, participants who received an IBCLC consultation were more likely to report any breastfeeding at postpartum discharge (aOR 4.87; 95% CI [2.67, 8.86]) and at 3 months postpartum (aOR 5.39; 95% CI [2.61, 11.16]) compared to participants who did not. However, there was no difference in exclusive breastfeeding rates between those who did and did not receive IBCLC consultation. CONCLUSION Inpatient IBCLC consultation during the immediate postpartum period was associated with improved rates of any breastfeeding in participants with GDM.
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Affiliation(s)
- Laurie Beth Griffin
- 22209 Department of Obstetrics and Gynecology, Women and Infants Hospital, Alpert Medical School of Brown University, Providence, RI, USA
| | - Jia Jennifer Ding
- 22209 Department of Obstetrics and Gynecology, Women and Infants Hospital, Alpert Medical School of Brown University, Providence, RI, USA
| | - Phinnara Has
- 22209 Department of Obstetrics and Gynecology, Women and Infants Hospital, Alpert Medical School of Brown University, Providence, RI, USA
| | - Nina Ayala
- 22209 Department of Obstetrics and Gynecology, Women and Infants Hospital, Alpert Medical School of Brown University, Providence, RI, USA
| | - Martha B Kole-White
- 22209 Department of Obstetrics and Gynecology, Women and Infants Hospital, Alpert Medical School of Brown University, Providence, RI, USA
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Heine E, Mehler K, Schöpping M, Ganesh L, Klein R, Kribs A, Keller T. Privacy, Early Colostrum, and Gestational Age are Associated with Exclusive Breastfeeding in Preterm and Sick Term Infants. Z Geburtshilfe Neonatol 2021; 225:346-352. [PMID: 34384133 DOI: 10.1055/a-1524-3328] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Our study was designed to assess the rates of exclusive breastfeeding (defined as direct breastfeeding) and the use of mother's own milk (MOM) in preterm infants and sick term infants at discharge and to identify potential influencing factors such as gestational age, early colostrum, and privacy. The study was conducted at a German level III neonatal department. All preterm and sick term infants admitted to the neonatal intensive care unit, the pediatric intensive care unit, the intermediate care unit, and the low care ward were included in the study. Infants were recruited between March and October 2015 (phase 1) and April to July 2016 (phase 2). Due to an emergency evacuation, privacy was limited during the first phase. Breastfeeding and the use of MOM were assessed daily using a self-designed score. In total, 482 infants of 452 mothers were included. More than 90% initiated breastfeeding and one-third were exclusively breastfed at discharge. Extremely immature infants and late preterm infants were less likely to be exclusively breastfed at discharge. Privacy (p<0.001) and early colostrum (p=0.002) significantly increased exclusive breastfeeding. Conclusion Extremely immature and late preterm infants were least likely to be exclusively breastfed at discharge and need special support. Interventions such as privacy and early colostrum should be promoted to increase breastfeeding.
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Affiliation(s)
- Eva Heine
- Division of Neonatology, Children's Hospital, University of Cologne, Cologne, Germany
| | - Katrin Mehler
- Division of Neonatology, Children's Hospital, University of Cologne, Cologne, Germany
| | - Michiko Schöpping
- Division of Neonatology, Children's Hospital, University of Cologne, Cologne, Germany
| | - Lisa Ganesh
- Division of Neonatology, Children's Hospital, University of Cologne, Cologne, Germany
| | - Ruth Klein
- Division of Neonatology, Children's Hospital, University of Cologne, Cologne, Germany
| | - Angela Kribs
- Division of Neonatology, Children's Hospital, University of Cologne, Cologne, Germany
| | - Titus Keller
- Division of Neonatology, Children's Hospital, University of Cologne, Cologne, Germany
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10
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Von Kohorn I, Flaherman V. Human Milk for the Term Newborn. Clin Perinatol 2021; 48:513-531. [PMID: 34353578 DOI: 10.1016/j.clp.2021.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Human milk provides optimal nutrition for term newborns, but the prevalence of its use is below target, and risks have been identified. Infants of black mothers as well as term newborns admitted to the neonatal intensive care unit are at risk for not receiving human milk. To improve human milk intake, multiple individual-level interventions have been shown to be effective, but some popular system-level interventions are ineffective or harmful. Expressed milk and donor milk may be less beneficial than direct breastfeeding. Nuanced public policies can help support lactation while promoting individual choice and equity.
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Affiliation(s)
- Isabelle Von Kohorn
- Department of Pediatrics, Holy Cross Health, 1500 Forest Glen Road, Silver Spring, MD 20910, USA; Department of Pediatrics, The George Washington University School of Medicine & Health Sciences, Washington, DC, USA.
| | - Valerie Flaherman
- Department of Pediatrics, University of California, San Francisco, 3333 California Street, Box 0503, San Francisco, CA 94118, USA; Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
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Kang JH, Son H, Byun SY, Han G. [Effect of Direct Breastfeeding Program for Premature Infants in Neonatal Intensive Care Unit]. J Korean Acad Nurs 2021; 51:119-132. [PMID: 33706336 DOI: 10.4040/jkan.20240] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 01/17/2021] [Accepted: 01/20/2021] [Indexed: 11/09/2022]
Abstract
PURPOSE This study aimed to identify the effects of a direct breastfeeding program for premature infants in neonatal intensive care units (NICUs). METHODS This quasi-experimental study was conducted during August 2016 to April 2017. Sixty mothers of premature infants were assigned to the experimental (n = 31) or control groups (n = 29). The program was comprised of breastfeeding education and direct breastfeeding support. The experimental and control groups were provided with education and counseling on breastfeeding at the time of admission and discharge. In the experimental group, the mothers initiated oral feeding with direct breastfeeding and engaged in breastfeeding at least seven times during the NICU stay. The collected data were analyzed by the χ²-test and repeated measures ANOVA using an SPSS program. RESULTS The experimental group showed a higher direct breastfeeding practice rate (χ² = 19.29, p < .001), breastfeeding continuation rate (χ² = 3.76, p < .001), and self-efficacy (F = 25.37, p < .001) than the control group except for maternal attachment. CONCLUSION The direct breastfeeding program in the NICU has significant effects on the practice and continuation rate of breastfeeding and breastfeeding self-efficacy. Therefore, this program can be applied in the NICU settings where direct breastfeeding is limited.
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Affiliation(s)
- Ji Hyun Kang
- Department of Nursing, Pusan National University Hospital, Busan, Korea
| | - Hyunmi Son
- College of Nursing, Pusan National University, Yangsan, Korea.
| | - Shin Yun Byun
- Department of Pediatrics, Pusan National University School of Medicine, Yangsan, Korea
| | - Gyumin Han
- College of Nursing, Pusan National University, Yangsan, Korea
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12
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Hannan KE, Smith RA, Barfield WD, Hwang SS. Association between Neonatal Intensive Care Unit Admission and Supine Sleep Positioning, Breastfeeding, and Postnatal Smoking among Mothers of Late Preterm Infants. J Pediatr 2020; 227:114-120.e1. [PMID: 32698029 DOI: 10.1016/j.jpeds.2020.07.053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Revised: 07/14/2020] [Accepted: 07/16/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To evaluate the association between neonatal intensive care unit (NICU) admission and breastfeeding practices, infant supine sleep positioning, and postnatal smoking among mothers of late preterm infants. STUDY DESIGN Data from 36 states using the 2000-2013 Pregnancy Risk Assessment Monitoring System were analyzed. χ2 tests and 95% CI assessed infant and maternal characteristics and recommended care practices for late preterm infants based on NICU admission after birth. Adjusted prevalence ratios (APR) for breastfeeding initiation and continuation at 10 weeks, supine sleep position, and postnatal smoking were estimated using multivariable logistic regression models, controlling for infant and maternal characteristics. Analyses were weighted and SEs accounted for the complex survey design. RESULTS Our sample included 62 494 late preterm infants, representing a weighted population of 1 441 451 late preterm infants. In the adjusted analysis, mothers of late preterm infants admitted to a NICU were more likely to initiate breastfeeding (APR 1.07; 95% CI 1.05-1.09) and place their infants in supine sleep position (1.04; 95% CI 1.01-1.06) than mothers of late preterm infants not admitted to a NICU. There was no significant difference between groups for breastfeeding continuation or postnatal smoking. CONCLUSIONS Mothers of late preterm infants admitted to a NICU were more likely to initiate breastfeeding and practice supine sleep position than mothers of late preterm infants not admitted to a NICU. Future work should seek to identify the drivers of these differences to develop effective strategies to engage mothers in these health promoting infant care practices.
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Affiliation(s)
- Kathleen E Hannan
- Section of Neonatology, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO.
| | - Ruben A Smith
- Division of Reproductive Health, Centers for Disease Control, Atlanta, GA
| | - Wanda D Barfield
- Division of Reproductive Health, Centers for Disease Control, Atlanta, GA
| | - Sunah S Hwang
- Section of Neonatology, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO
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13
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Abstract
High-dose mother's own milk (MOM) feedings during the first 14 days post birth reduce the risk of necrotizing enterocolitis in very low birthweight (VLBW; <1500 g birthweight). However, high-dose MOM feedings are only possible if mothers provide sufficient quantities of MOM in a timely manner, and data indicate that the lack of MOM during the early post-birth period is a global problem. This paper reviews the modifiable and unmodifiable barriers to accessing adequate quantities of MOM during the early post-birth period and proposes evidence-based strategies to increase and improve the use of MOM during the neonatal intensive care unit (NICU) hospitalization with an emphasis on the critical first 2 weeks post birth.
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14
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Factors associated with breastfeeding to 3 months postpartum among women with type 1 and type 2 diabetes mellitus: An exploratory study. Women Birth 2020; 33:e274-e279. [DOI: 10.1016/j.wombi.2019.06.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 06/08/2019] [Accepted: 06/08/2019] [Indexed: 11/20/2022]
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15
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Jang GJ, Hong YR. Effects of a Breastfeeding Support Program on the Prevalence of Exclusive Breastfeeding and Growth in Late Preterm Infants. CHILD HEALTH NURSING RESEARCH 2020; 26:90-97. [PMID: 35004454 PMCID: PMC8650884 DOI: 10.4094/chnr.2020.26.1.90] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 01/02/2020] [Accepted: 01/08/2020] [Indexed: 11/13/2022] Open
Abstract
Purpose The purpose of this study was to investigate the effects of a breastfeeding support program (BSP) on the prevalence of exclusive breastfeeding and growth in late-preterm infants. Methods A quasi-experimental study was conducted. The participants were 40 late preterm infants (LPIs), of whom 20 were assigned to the experimental group and 20 to the control group. For the mothers in the experimental group, a BSP was provided prior to the LPIs’ discharge and reinforced once a week for 4 weeks. Information on the feeding type was collected by observation and the LPIs’ body weight was measured. Results There were significant differences in feeding type by group and time. Exclusive breastfeeding was 5.18 times more common in the experimental group than in the control group (odds ratio=5.18, 95% confidence interval=1.11~16.70). However, weekly weight gain did not show a significant relationship with group and time (F=0.40, p=.712). Conclusion The BSP was helpful for increasing the rate of exclusive breastfeeding in LPIs. Furthermore, the LPIs in the experimental group, which had a higher likelihood of being exclusively breastfed, showed an equivalent amount of weight gain as the LPIs in the control group, in which infants were more likely to be formula-fed.
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Affiliation(s)
- Gun Ja Jang
- Associate Professor, Department of Nursing, Daegu University, Daegu, Korea
| | - Yeon Ran Hong
- Professor, Department of Nursing, Sunchon National University, Sunchon, Korea
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16
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Jónsdóttir RB, Jónsdóttir H, Skúladóttir A, Thorkelsson T, Flacking R. Breastfeeding progression in late preterm infants from birth to one month. MATERNAL AND CHILD NUTRITION 2019; 16:e12893. [PMID: 31595692 PMCID: PMC7038874 DOI: 10.1111/mcn.12893] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 08/07/2019] [Accepted: 08/29/2019] [Indexed: 12/01/2022]
Abstract
This study aimed to describe and compare breastfeeding progression, infants' feeding behaviours, maternal feeding difficulties, and mothers' usage of breastfeeding interventions for singleton late preterm (LPT) and term infants. A further aim was to identify associated factors for exclusive breastfeeding at breast at 1 month in LPT infants. This was a cohort study where mothers of LPT infants from a neonatal unit (n = 60), LPT infants from a maternity unit (n = 62), and term infants from a maternity unit (n = 269) answered a questionnaire approximately 1 month after delivery. Findings showed no significant differences in exclusive breastfeeding at breasts between LPT infants admitted to the neonatal unit compared with the maternity unit, during the first week at home (38% vs. 48%), or at 1 month of age (52% vs. 50%). Term infants were more likely to be exclusively breastfed at the breast (86% and 74%, p < 0.05) compared with LPT infants. Multiple regression analysis showed that usage of a nipple shield, not feeding breast milk exclusively during the first week at home, or feeding less than 10 times per day at 1 month were statistically significant for not exclusively breastfeed at the breast. A protective factor was the mothers' experience of having an abundance of milk during the first week at home. In conclusion, LPT infants are less likely to be exclusively breastfed at the breast than term infants, highlighting the need for further research to guide interventions aimed at optimising exclusive breastfeeding rates.
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Affiliation(s)
- Rakel B Jónsdóttir
- Neonatal Intensive Care Unit, Landspitali-The National University Hospital of Iceland, Reykjavík, Iceland.,Faculty of Nursing, School of Health Sciences, University of Iceland, Reykjavík, Iceland
| | - Helga Jónsdóttir
- Faculty of Nursing, School of Health Sciences, University of Iceland, Reykjavík, Iceland
| | - Arna Skúladóttir
- Faculty of Nursing, School of Health Sciences, University of Iceland, Reykjavík, Iceland
| | - Thordur Thorkelsson
- Neonatal Intensive Care Unit, Landspitali-The National University Hospital of Iceland, Reykjavík, Iceland.,Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavík, Iceland
| | - Renée Flacking
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
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17
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Feeding the Late and Moderately Preterm Infant: A Position Paper of the European Society for Paediatric Gastroenterology, Hepatology and Nutrition Committee on Nutrition. J Pediatr Gastroenterol Nutr 2019; 69:259-270. [PMID: 31095091 DOI: 10.1097/mpg.0000000000002397] [Citation(s) in RCA: 85] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Nutritional guidelines and requirements for late or moderately preterm (LMPT) infants are notably absent, although they represent the largest population of preterm infants. The European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) Committee on Nutrition (CoN) performed a review of the literature with the aim to provide guidance on how to feed infants born LMPT, and identify gaps in the literature and research priorities.Only limited data from controlled trials are available. Late preterm infants have unique, often unrecognized, vulnerabilities that predispose them to high rates of nutritionally related morbidity and hospital readmissions. They frequently have feeding difficulties that delay hospital discharge, and poorer rates of breastfeeding initiation and duration compared with term infants. This review also identified that moderately preterm infants frequently exhibit postnatal growth restriction.The ESPGHAN CoN strongly endorses breast milk as the preferred method of feeding LMPT infants and also emphasizes that mothers of LMPT infants should receive qualified, extended lactation support, and frequent follow-up. Individualized feeding plans should be promoted. Hospital discharge should be delayed until LMPT infants have a safe discharge plan that takes into account local situation and resources.In the LMPT population, the need for active nutritional support increases with lower gestational ages. There may be a role for enhanced nutritional support including the use of human milk fortifier, enriched formula, parenteral nutrition, and/or additional supplements, depending on factors, such as gestational age, birth weight, and significant comorbidities. Further research is needed to assess the benefits (improved nutrient intakes) versus risks (interruption of breast-feeding) of providing nutrient-enrichment to the LMPT infant.
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18
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Delle Donne A, Hatch A, Carr NR, Aden J, Shapiro J. Extended Maternity Leave and Breastfeeding in Active Duty Mothers. Pediatrics 2019; 144:peds.2018-3795. [PMID: 31331985 DOI: 10.1542/peds.2018-3795] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/06/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES In 2016, the Department of Defense extended maternity leave from 6 to 12 weeks for active duty mothers to support breastfeeding initiation and duration. Limited data exist regarding the impact of prolonged maternity leave. Our objective was to evaluate the prolongation of maternity leave on the initiation and duration of breastfeeding in active duty mothers. METHODS In this single-center retrospective cohort study, we used data collected from Department of Defense electronic health care records of infants born to active duty mothers who were delivered during calendar years 2014 and 2016. The primary outcomes were initiation and duration of breastfeeding and breastfeeding exclusivity evaluated throughout the first year of life. Secondary outcomes were differences in breastfeeding rates between military-branch affiliation and military rank. RESULTS No changes in breastfeeding initiation occurred between the 2 cohorts (n = 423 and 434). However, an increase in breastfeeding establishment was identified at the 2- (81.5% vs 72.4%; P = .002), 4- (70.5% vs 56.7%; P < .001), 6- (60.3% vs 46.5%; P < .001), and 9-month (45.4% vs 34.9%; P = .003) visits in the 12-week leave cohort. Exclusive breastfeeding increased at 2 (56.4% vs 47.2%; P = .007), 4 (47.5% vs 36.4%; P = .001), and 6 (37.3% vs 29.3%; P = .016) months. CONCLUSIONS Increases in maternity leave correlated with increased breastfeeding duration and exclusivity through 9 months for active duty mothers. These data support the benefit of extended maternity leave in the military and the need for future studies to validate findings at other military treatment facilities.
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Affiliation(s)
- Andrew Delle Donne
- Department of Pediatrics, Naval Medical Center Portsmouth, Portsmouth, Virginia; .,Departments of Pediatrics and
| | - Alex Hatch
- Departments of Pediatrics and.,Department of Pediatrics, University of Utah and Primary Children's Hospital, Salt Lake City, Utah
| | | | - James Aden
- Statistics, Brooke Army Medical Center, Fort Sam Houston, Texas; and
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19
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Gertz B, DeFranco E. Predictors of breastfeeding non-initiation in the NICU. MATERNAL & CHILD NUTRITION 2019; 15:e12797. [PMID: 30767426 PMCID: PMC7198952 DOI: 10.1111/mcn.12797] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Revised: 01/23/2019] [Accepted: 01/28/2019] [Indexed: 01/29/2023]
Abstract
This study compared predictors of breastfeeding non-initiation between infants who were and were not admitted to the NICU so that interventions can target high-risk mothers whose infants desperately need breastmilk. This was a population-based retrospective cohort study of singleton Ohio live births using birth certificates, 2006-2015. In babies who were and were not admitted to the NICU, a multivariable logistic regression model assessed the association between breastfeeding non-initiation and predictors relating to the mother, neonate, and labour and delivery events while adjusting for covariables. Of 1,463,506 births, 76,855 infants were admitted to the NICU (5.8% of study population), and breastfeeding was not initiated in 39.4% of them, compared with 31.5% of infants in the newborn nursery, p < 0.001. Apart from abnormal newborn conditions, smoking during pregnancy was the most significant risk factor for not breastfeeding in the NICU (RR 1.91 [95% CI 1.82-2.02]) and newborn nursery (RR 2.10 [95% CI 2.08-2.13]), followed by socioeconomic factors and multiparity. Limited prenatal visits (≤5) were a significantly higher risk factor in the NICU (RR 1.41 [95% CI 1.34-1.49]) than in the newborn nursery (RR 1.24 [95% CI 1.22-1.26]). Intentional home birth and use of infertility treatment were associated with breastfeeding initiation. The rate of breastfeeding initiation is lower in infants admitted to the NICU than those who are not, especially among mothers with limited prenatal care. Interventions should target mothers who smoke because they are least likely to breastfeed, and their babies, who are prone to serious health conditions, could especially benefit from breastmilk.
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Affiliation(s)
- Brooke Gertz
- OB/GYN DepartmentUniversity of CincinnatiCincinnati OHUSA
| | - Emily DeFranco
- OB/GYN DepartmentUniversity of CincinnatiCincinnati OHUSA
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20
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Evans L, Hilditch C, Keir A. Are there interventions that improve breastfeeding and the use of breast milk in late preterm infants? J Paediatr Child Health 2019; 55:477-480. [PMID: 30957329 DOI: 10.1111/jpc.14404] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 01/15/2019] [Accepted: 01/17/2019] [Indexed: 11/28/2022]
Abstract
To answer the clinical question 'Among late preterm infants are there any interventions that improve the rates of breastfeeding and the use of breast milk compared with current practice?'. MEDLINE via Ovid, Embase via Ovid, the Maternity and Infant Care Database and the Cochrane Library were searched for relevant articles. Articles were excluded if they did not discuss specific interventions to improve breastfeeding, for example, if they only commented on factors such as age, race and education. Articles were also excluded if they were not specific to the late preterm infant population. A total of 516 articles were found and screened by title and abstract independently by two reviewers. The full text of 17 articles was independently reviewed. The reference lists of these full-text articles were screened, and 14 abstracts were subsequently reviewed. The final analysis included three studies. There is limited high-quality research evidence for interventions to improve breastfeeding in late preterm infants. In the absence of robust academic research, clinical practice should be guided by clinical expertise and involve a multidisciplinary team, including qualified lactation consultants. While it seems reasonable for hospitals to support interventions that improve breastfeeding in term infants, managing late preterm infants as healthy term infants without additional specialist support may result in high breastfeeding failure rates among late preterm infants.
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Affiliation(s)
- Louise Evans
- Department of Neonatal Medicine, Women's and Children's Hospital Network, Adelaide, South Australia, Australia
| | - Cathie Hilditch
- Department of Neonatal Medicine, Women's and Children's Hospital Network, Adelaide, South Australia, Australia.,Healthy Mothers, Babies and Children Theme, South Australian Health, Medical Research Institute, Adelaide, South Australia, Australia.,Adelaide Medical School and the Robinson Research Institute, University of Adelaide, Adelaide, South Australia, Australia
| | - Amy Keir
- Department of Neonatal Medicine, Women's and Children's Hospital Network, Adelaide, South Australia, Australia.,Healthy Mothers, Babies and Children Theme, South Australian Health, Medical Research Institute, Adelaide, South Australia, Australia.,Adelaide Medical School and the Robinson Research Institute, University of Adelaide, Adelaide, South Australia, Australia
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21
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Fernández L, Ruiz L, Jara J, Orgaz B, Rodríguez JM. Strategies for the Preservation, Restoration and Modulation of the Human Milk Microbiota. Implications for Human Milk Banks and Neonatal Intensive Care Units. Front Microbiol 2018; 9:2676. [PMID: 30473683 PMCID: PMC6237971 DOI: 10.3389/fmicb.2018.02676] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 10/19/2018] [Indexed: 12/11/2022] Open
Abstract
Studies carried in the last years have revealed that human milk contains a site-specific microbiota and constitutes a source of potentially beneficial bacteria to the infant gut. Once in the infant gut, these bacteria contribute to the assembly of a physiological gut microbiota and may play several functions, contributing to infant metabolism, protection against infections, immunomodulation or neuromodulation. Many preterm neonates are fed with pasteurized donor’s human milk (DHM) or formula and, therefore, are devoid of contact with human milk microbes. As a consequence, new strategies are required to allow the exposition of a higher number of preterm infants to the human milk microbiota early in life. The first strategy would be to promote and to increase the use of own mother’s milk (OMM) in Neonatal Intensive Care Units (NICUs). Even small quantities of OMM can be very valuable since they would be added to DHM in order to microbiologically “customize” it. When OMM is not available, a better screening of donor women, including routine cytomegalovirus (CMV) screening of milk, may help to avoid the pasteurization of the milk provided by, at least, a relevant proportion of donors. Finally, when pasteurized DHM or formula are the only feeding option, their supplementation with probiotic bacteria isolated from human milk, such as lactic acid bacteria or bifidobacteria, may be an alternative to try to restore a human milk-like microbiota before feeding the babies. In the future, the design of human milk bacterial consortia (minimal human milk microbiotas), including well characterized strains representative of a healthy human milk microbiota, may be an attractive strategy to provide a complex mix of strains specifically tailored to this target population.
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Affiliation(s)
- Leónides Fernández
- Department of Galenic Pharmacy and Food Technology, Complutense University of Madrid, Madrid, Spain
| | - Lorena Ruiz
- Department of Microbiology and Biochemistry of Dairy Products, Instituto de Productos Lácteos de Asturias - Consejo Superior de Investigaciones Científicas, Villaviciosa, Spain
| | - Josué Jara
- Department of Galenic Pharmacy and Food Technology, Complutense University of Madrid, Madrid, Spain
| | - Belén Orgaz
- Department of Microbiology and Biochemistry of Dairy Products, Instituto de Productos Lácteos de Asturias - Consejo Superior de Investigaciones Científicas, Villaviciosa, Spain
| | - Juan M Rodríguez
- Department of Nutrition and Food Science, Complutense University of Madrid, Madrid, Spain
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22
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Romaine A, Clark RH, Davis BR, Hendershot K, Kite V, Laughon M, Updike I, Miranda ML, Meier PP, Patel AL, Smith PB, Cotten CM, Benjamin DK, Greenberg RG. Predictors of Prolonged Breast Milk Provision to Very Low Birth Weight Infants. J Pediatr 2018; 202:23-30.e1. [PMID: 30170862 PMCID: PMC6203611 DOI: 10.1016/j.jpeds.2018.07.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 05/16/2018] [Accepted: 07/02/2018] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To identify factors associated with prolonged maternal breast milk (BM) provision in very low birth weight (VLBW) infants. STUDY DESIGN This was a cohort study of VLBW infants who initially received maternal BM and were born at one of 197 neonatal intensive care units managed by the Pediatrix Medical Group from 2010 to 2012. We used multivariable logistic regression to identify demographic, clinical, and maternal factors associated with provision of maternal BM on day of life (DOL) 30 and at discharge. RESULTS Median gestational age for all infants was 28 weeks (25th, 75th percentiles: 26, 30), and median maternal age was 28 years (23, 33). Of 8806 infants, 6261 (71%) received maternal BM on DOL 30, and 4003 of 8097 (49%) received maternal BM at discharge to home. Predictors of maternal BM provision at DOL 30 included increased maternal age, white maternal race, absence of history of necrotizing enterocolitis or late-onset sepsis, higher household income, lower education level, lack of donor BM exposure, and lower gestational age. CONCLUSIONS Our results suggest that maternal-infant demographic and clinical factors and household neighborhood socioeconomic characteristics were associated with provision of maternal BM at 30 postnatal days to VLBW infants. Identification of these factors allows providers to anticipate mothers' needs and develop tailored interventions designed to improve rates of prolonged maternal BM provision and infant outcomes.
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Affiliation(s)
- Andrew Romaine
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | | | - Briana R Davis
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - Kaitlin Hendershot
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - Vance Kite
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - Madeleine Laughon
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - Isaac Updike
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | | | - Paula P Meier
- Department of Pediatrics, Rush University Medical Center, Chicago, IL
| | - Aloka L Patel
- Department of Pediatrics, Rush University Medical Center, Chicago, IL
| | - P Brian Smith
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC; Department of Pediatrics, Duke University School of Medicine, Durham, NC
| | - C Michael Cotten
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC; Department of Pediatrics, Duke University School of Medicine, Durham, NC
| | - Daniel K Benjamin
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC; Department of Pediatrics, Duke University School of Medicine, Durham, NC
| | - Rachel G Greenberg
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC; Department of Pediatrics, Duke University School of Medicine, Durham, NC.
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23
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Racial/ethnic differences in necrotizing enterocolitis incidence and outcomes in premature very low birth weight infants. J Perinatol 2018; 38:1386-1390. [PMID: 30087454 DOI: 10.1038/s41372-018-0184-x] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 06/18/2018] [Accepted: 07/09/2018] [Indexed: 11/08/2022]
Abstract
BACKGROUND As advances in neonatal intensive care increase the survival of extremely premature infants, the at-risk population for necrotizing enterocolitis (NEC) continues to rise. Although racial health disparities in preterm births have been well documented, large-scale studies exploring racial differences in NEC outcomes are lacking. Here, we conduct a study of racial health disparities in NEC using a nationally representative multicenter cohort. STUDY DESIGN Infants ≤1500 g birth weight and ≤30 weeks gestational age admitted in the first week after birth to neonatal intensive care units in the Pediatrix Medical group from 1997 to 2015 were included. Multivariable logistic regression was used to determine the adjusted odds ratio (AOR) of risk factors related to NEC and associated mortality. RESULTS Of the 126,089 (45% non-Hispanic White, 27% non-Hispanic Black, and 19% Hispanic) infants who met the inclusion criteria, 8796 (7%) developed NEC. On multivariable analysis, non-Hispanic Black and Hispanic infants had higher odds of developing NEC (AOR 1.31, 95% confidence interval (CI) [1.24-1.39], p < 0.001 and AOR 1.30 [1.21-1.39], p < 0.001, respectively). Among infants with NEC, mortality was higher in non-Hispanic Black and Hispanic infants compared to non-Hispanic White infants (AOR 1.35 [1.15-1.58], p < 0.001 and AOR 1.31 [1.09-1.56], p = 0.003, respectively). CONCLUSION Our study demonstrates that non-Hispanic Black and Hispanic infants are significantly more likely to be diagnosed with NEC. In addition, non-Hispanic Black and Hispanic infants have higher odds of death after NEC compared to non-Hispanic White infants. Further studies are necessary to investigate the etiology of these health disparities and to test interventions to improve these health outcomes.
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24
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Ding W, Zhao L, Sheng N, Ma J, Zhang Y. Impact of Neonatal Intensive Care Unit oral feeding on neuropsychomotor outcomes at 9 months of corrected age in Chinese low-birthweight preterm infants: A retrospective study. J Clin Nurs 2018; 28:420-429. [PMID: 29777555 DOI: 10.1111/jocn.14537] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 04/12/2018] [Accepted: 05/07/2018] [Indexed: 12/17/2022]
Abstract
AIMS AND OBJECTIVES To examine the changes in neuropsychomotor development and investigate the effect of feeding progression in Neonatal Intensive Care Unit (NICU) on neuropsychomotor outcomes in low-birthweight preterm infants within 9 months of corrected age. BACKGROUND Low-birthweight (LBW) preterm infants (<37 weeks of gestation and birthweight <2,500 g) are at a high risk for neuropsychomotor development delay. Therefore, exploring NICU practices related to neuropsychomotor development is important. DESIGN This is a retrospective hospital-based cohort study. METHODS This study included 196 LBW preterm infants who were admitted to the NICU between January 2014-March 2016 and attended the follow-up growth evaluation in the clinic after discharge. The neuropsychomotor development of preterm infants was assessed every 3 months to a corrected age of 9 months using the paediatric neuropsychomotor diagnostic scale (PNDS). Generalised linear mixed models (GLMM) were performed. RESULTS The total PNDS scores had a downward trend, but the difference on pairwise comparison was not statistically significant. In total, 18.1%, 15.2% and 9.7% of preterm infants were examined for neuropsychomotor disorders at 3, 6 and 9 months of corrected age, respectively. The result of GLMM showed that the early initiation of oral feeding with breast milk was associated with optimal neuropsychomotor development. The first 3 months of corrected age is the critical period for neurodevelopmental disorders. CONCLUSIONS This study showed the importance of the early initiation of oral feeding with breast milk as early as possible within the NICU setting and highlighted the importance of close developmental follow-up. RELEVANCE TO CLINICAL PRACTICE The early initiation of oral feeding with breast milk may be recommended to promote neuropsychomotor development of LBW preterm infants within the NICU setting. Early identification of neuropsychomotor developmental delays within the first 3 months may guide early interventions.
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Affiliation(s)
- Wenwen Ding
- School of Nursing, Shanghai Jiao Tong University, Shanghai, China
| | - Lijin Zhao
- School of Nursing, Shanghai Jiao Tong University, Shanghai, China
| | - Nan Sheng
- School of Nursing, Shanghai Jiao Tong University, Shanghai, China
| | - Jiali Ma
- School of Nursing, Shanghai Jiao Tong University, Shanghai, China
| | - Ying Zhang
- School of Nursing, Shanghai Jiao Tong University, Shanghai, China
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Impact of NICU admission on Colorado-born late preterm infants: breastfeeding initiation, continuation and in-hospital breastfeeding practices. J Perinatol 2018; 38:557-566. [PMID: 29371628 DOI: 10.1038/s41372-018-0042-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2017] [Revised: 12/07/2017] [Accepted: 01/02/2018] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Compare breastfeeding initiation and continuation rates, and in-hospital breastfeeding practices, of late preterm infants (LPIs) cared for in a NICU versus those cared for exclusively in the nursery (non-NICU). STUDY DESIGN Using data from the 2009-2014 Colorado Pregnancy Risk Assessment Monitoring System (PRAMS), breastfeeding initiation, continuation, and in-hospital breastfeeding practices of NICU versus non-NICU LPIs (34 0/7 to 36 6/7 weeks gestation, n = 20,767) were analyzed, and multivariate models were created controlling for maternal and infant characteristics. RESULTS Mothers of NICU LPIs were equally likely to initiate breastfeeding (APR 1.0; 95% CI 0.95-1.06) but less likely to continue breastfeeding at 10 weeks (APR 0.86; 95% CI 0.76-0.99) compared to mothers of non-NICU LPIs. Mothers of NICU LPIs were less likely to breastfeed in the hospital, less likely to be told to feed infants on demand, and more likely to be given a breast pump during hospitalization. CONCLUSIONS There are significant differences in both breastfeeding continuation and several in-hospital breastfeeding practices for NICU versus non-NICU LPIs. Further research is needed so that targeted policies and programs can be developed to improve breastfeeding rates in this vulnerable population.
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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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27
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Lau Y, Tha PH, Ho-Lim SST, Wong LY, Lim PI, Citra Nurfarah BZM, Shorey S. An analysis of the effects of intrapartum factors, neonatal characteristics, and skin-to-skin contact on early breastfeeding initiation. MATERNAL AND CHILD NUTRITION 2017; 14. [PMID: 28799193 DOI: 10.1111/mcn.12492] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 05/31/2017] [Accepted: 06/20/2017] [Indexed: 12/16/2022]
Abstract
This study aims to determine relationships between intrapartum factors, neonatal characteristics, skin-to-skin contact (SSC), and early breastfeeding initiation after spontaneous vaginal and Caesarean section or operative vaginal birth. A total of 915 mother-newborn dyads were considered in a hypothetical model based on integrated concepts of breastfeeding initiation model, infant learning framework, and attachment theory. Multiple-group path analysis was used to determine whether differences exist between effects of immediate SSC (≤30 min) on early breastfeeding initiation in different modes of birth. SSC, mode of birth, labour duration, and neonatal intensive care unit admission were significantly associated with early breastfeeding initiation, as indicated by the path analysis model, which included all samples. Women with immediate SSC were more likely to initiate early breastfeeding in different modes of birth. In the spontaneous vaginal birth group, women showed a lower likelihood of initiating early breastfeeding when their neonates were admitted to the neonatal intensive care unit and presented an Apgar score of <7 at 1 min. Multiple-group analysis showed no significant difference between effects of immediate SSC on early breastfeeding initiation in different modes of birth (critical ratio = -0.309). Results showed that models satisfactorily fitted the data (minimum discrepancy divided by degrees of freedom = 1.466-1.943, goodness of fit index = 0.981-0.986, comparative fit index = 0.947-0.955, and root mean square error of approximation = 0.023-0.032). Our findings emphasize the crucial importance of prioritizing promotion of immediate SSC under different modes of birth.
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Affiliation(s)
- Ying Lau
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Pyai Htun Tha
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - Lai Ying Wong
- Department of Obstetrics and Gynaecology, National University Hospital, Singapore
| | - Peng Im Lim
- Department of Obstetrics and Gynaecology, National University Hospital, Singapore
| | | | - Shefaly Shorey
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Abstract
BACKGROUND The provision of human milk and breastfeeding is essential in the neonatal intensive care unit (NICU) population. However, recent national research has demonstrated very low percentages of NICU nurses providing lactation-based support and care to patients and families, and less than half of all NICUs have an International Board Certified Lactation Consultant (IBCLC) on staff. PURPOSE The purpose of this study was to describe how NICU bedside nurses are providing lactation-based support and care during their shifts and the frequency of that support. The secondary aim was to gain an understanding of the NICU nurses' attitudes toward human milk and breastfeeding. METHODS Through a prospective descriptive cohort design, the authors of this study created and disseminated a web-based survey (SurveyMonkey) of 21 questions including the Iowa Infant Feeding Attitude Scale (IIFAS) to a Northeastern urban hospital staff of bedside nurses. RESULTS A total of 140 of the 389 eligible NICU bedside nurses responded to the survey. Between 50.7% and 72.9% of nurses reported to providing lactation-based support and care during the previous shift worked and during the previous week worked, respectively. The participants' responses to the IIFAS resulted in an overall score of 69.1, indicating an attitude of "positive to breastfeeding." IMPLICATIONS FOR PRACTICE The study demonstrates that the majority provide lactation-based support and care on every shift and hold very positive attitudes toward the provision of human milk and breastfeeding. Hospitals should be encouraged to promote educational and training programs in their respective institutions. IMPLICATIONS FOR RESEARCH Researchers should examine NICU nurses' attitudes and beliefs about human milk and breastfeeding on a national scale.
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Meier PP, Johnson TJ, Patel AL, Rossman B. Evidence-Based Methods That Promote Human Milk Feeding of Preterm Infants: An Expert Review. Clin Perinatol 2017; 44:1-22. [PMID: 28159199 PMCID: PMC5328421 DOI: 10.1016/j.clp.2016.11.005] [Citation(s) in RCA: 106] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Best practices translating the evidence for high-dose human milk (HM) feeding for preterm infants during neonatal intensive care unit (NICU) hospitalization have been described, but their implementation has been compromised. Although the rates of any HM feeding have increased over the last decade, efforts to help mothers maintain HM provision through to NICU discharge have remained problematic. Special emphasis should be placed on prioritizing the early lactation period of coming to volume so that mothers have sufficient HM volume to achieve their personal HM feeding goals. Donor HM does not provide the same risk reduction as own mother's HM.
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Affiliation(s)
- Paula P Meier
- Rush University Medical Center, 1653 West Congress Parkway, Chicago, IL 60612, USA.
| | - Tricia J Johnson
- Rush University Medical Center, 1653 West Congress Parkway, Chicago, IL 60612, USA
| | - Aloka L Patel
- Rush University Medical Center, 1653 West Congress Parkway, Chicago, IL 60612, USA
| | - Beverly Rossman
- Rush University Medical Center, 1653 West Congress Parkway, Chicago, IL 60612, USA
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Giannì ML, Bezze E, Sannino P, Stori E, Plevani L, Roggero P, Agosti M, Mosca F. Facilitators and barriers of breastfeeding late preterm infants according to mothers' experiences. BMC Pediatr 2016; 16:179. [PMID: 27821185 PMCID: PMC5100217 DOI: 10.1186/s12887-016-0722-7] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 10/28/2016] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Late preterm infants account for the majority of preterm births. They are at an increased risk of neonatal mortality and morbidity and are less likely to initiate breastfeeding and to be exclusively breastfed at discharge compared to infants born at term. The aim of this study was to identify the facilitators and barriers to breastfeeding during hospital stays according to the experiences of mothers of late preterm infants. METHODS We conducted a cross-sectional questionnaire survey. Mothers who intended to breastfeed and had given birth to a newborn admitted to level I and II care, with a gestational age of 34 0/7 to 36 6/7 weeks, were enrolled. Sociodemographic data, neonatal variables, mode of feeding and feeding status at discharge were also collected. RESULTS A total of 92 mothers who had given birth to 121 infants were enrolled. At discharge, any human milk was fed to 94 % of infants, with exclusively human milk being fed in 43 % of cases; exclusively formula was fed to 6 % of infants. In the multivariate analysis, having expressed breast milk was independently associated with an increased risk of being fed with either any human milk or formula only (OR = 2.73, 95 % CI 1.05-7.1, p = 0.039), whereas being encouraged to practice kangaroo mother care tended to have a protective effect (OR = 0.46, 95 % CI 0.2-1.06, p = 0.07). CONCLUSIONS Based on the present findings, health care professionals should strive to fully implement breastfeeding support for mothers of late preterm infants who intend to breastfeed, in particular optimizing breast milk expression and promoting kangaroo mother care. Further studies are needed to gain further insight into the complex interplay of the factors that modulate breastfeeding outcome in late preterm infants.
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Affiliation(s)
- Maria Lorella Giannì
- Fondazione I.R.C.C.S. Ca Granda Ospedale Maggiore Policlinico, Neonatal Intensive Care Unit Department of Clinical Science and Community Health, University of Milan, Via Commenda 12, 20122, Milan, Italy.
| | - Elena Bezze
- Fondazione I.R.C.C.S. Ca Granda Ospedale Maggiore Policlinico, S.I.T.R.A. Basic Education Sector, Via Francesco Sforza 28, 20122, Milan, Italy
| | - Patrizio Sannino
- Fondazione I.R.C.C.S. Ca Granda Ospedale Maggiore Policlinico, S.I.T.R.A. Basic Education Sector, Via Francesco Sforza 28, 20122, Milan, Italy
| | - Elena Stori
- Fondazione I.R.C.C.S. Ca Granda Ospedale Maggiore Policlinico, Neonatal Intensive Care Unit Department of Clinical Science and Community Health, University of Milan, Via Commenda 12, 20122, Milan, Italy
| | - Laura Plevani
- Fondazione I.R.C.C.S. Ca Granda Ospedale Maggiore Policlinico, Neonatal Intensive Care Unit Department of Clinical Science and Community Health, University of Milan, Via Commenda 12, 20122, Milan, Italy
| | - Paola Roggero
- Fondazione I.R.C.C.S. Ca Granda Ospedale Maggiore Policlinico, Neonatal Intensive Care Unit Department of Clinical Science and Community Health, University of Milan, Via Commenda 12, 20122, Milan, Italy
| | - Massimo Agosti
- Neonatologia e Terapia Intensiva Neonatale, Polo Universitario F. Del Ponte, Viale Borri 54, 21100, Varese, Italy
| | - Fabio Mosca
- Fondazione I.R.C.C.S. Ca Granda Ospedale Maggiore Policlinico, Neonatal Intensive Care Unit Department of Clinical Science and Community Health, University of Milan, Via Commenda 12, 20122, Milan, Italy
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Demirci JR, Bare S, Cohen SM, Bogen DL. Feasibility and Acceptability of Two Complementary and Alternative Therapies for Perceived Insufficient Milk in Mothers of Late Preterm and Early Term Infants. ALTERNATIVE & COMPLEMENTARY THERAPIES : A NEW BIMONTHLY PUBLICATION FOR HEALTH CARE PRACTITIONERS 2016; 22:196-203. [PMID: 29180842 PMCID: PMC5123620 DOI: 10.1089/act.2016.29072.jrd] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background: Complementary and alternative medicine (CAM) could be one option to address perceived insufficient milk (PIM), but there are few data comparing the effectiveness, acceptability, and safety of various CAM therapies. The purpose of this study was to describe and compare, among women delivering at 34-376/7 weeks, the feasibility and acceptability of two CAM interventions for treatment of PIM: (1) a meditation/relaxation intervention via an MP3 (Apple iPod Shuffle©) player and (2) a commercially available combination-blend herbal supplement (Motherlove: More Milk Plus Alcohol Free®). Materials and Methods: After randomization, over 9 days, women received three home visits from a lactation consultant, recorded pre/post intervention test weights and expressed milk volume, tracked daily breastfeeding behavior, and completed an end-of-study interview about the interventions. Women in each group were offered the other group's intervention on study day 9. Breastfeeding status and intervention continuation were assessed at 2 months. Results: Of 183 women screened, 11 were eligible, enrolled into, and completed the 9-day trial. Six women were randomized to the herbal supplement and 5 to meditation. One participant (meditation) stopped breastfeeding on study day 8. At 2 months, 3 of 6 women assigned to the herbal supplement and 3 of 5 women assigned to meditation were still breastfeeding; 1 (herbal supplement) was exclusively breastfeeding. Most participants were adherent to the prescribed protocols for both interventions. Interventions were generally perceived as safe, with benefits not necessarily related to increased milk supply. Conclusion: Mothers of late preterm and early term infants who had PIM found the CAM interventions acceptable and safe. The effect of CAM therapies on breastfeeding outcomes, with and without in-home lactation assistance, requires further investigation.
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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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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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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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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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Jang GJ. Comparing Factors Associated with Breastfeeding in Late Preterm Infants of Different Gestational Ages. CHILD HEALTH NURSING RESEARCH 2015. [DOI: 10.4094/chnr.2015.21.4.302] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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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: 11] [Impact Index Per Article: 1.2] [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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Berrani H, Mdaghri Alaoui A, Kasouati J, Alaoui K, Thimou Izgua A. [Breastfeeding preterm infants at 6 months in Morocco: prevalence and associated factors]. Arch Pediatr 2015; 22:141-5. [PMID: 25555645 DOI: 10.1016/j.arcped.2014.11.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Revised: 07/14/2014] [Accepted: 11/27/2014] [Indexed: 11/18/2022]
Abstract
PURPOSE Evaluate the rate of breastfeeding at hospital discharge and then at 3 and 6 months in a population of premature infants. Analyze demographic and neonatal characteristics that may influence breastfeeding. METHOD Prospective study in children born before 37 weeks of gestation from 1 June 2011 to 31 December 2011 hospitalized in the neonatology department at the Rabat children's hospital. The sociodemographic data and initial breastfeeding decision were collected from mothers. Newborns were reviewed in consultation at 1, 3, and 6 months to determine dietary habits. The association of variables with breastfeeding was analyzed by univariate and multivariate analysis using a logistic regression model. RESULTS The analysis was based on 170 mother-infant pairs. At discharge, 80% of preterm infants received partial breastfeeding and 12.4% exclusive breastfeeding. At 6 months, 8.8% of mothers breastfed exclusively, 32.4% partially, and 58.8% had stopped breastfeeding. The factors associated with breastfeeding at 6 months were the duration of hospitalization in a neonatology unit and a neonatal intensive care unit, the time to first expressing breast milk, and breastfeeding. There was an inverse link between breastfeeding rates and duration of stay in neonatology in multivariate analysis with an odds ratio (OR) of 1.3 and a 95% confidence interval (1,1; 1,7); P=0.015. CONCLUSION In our context, the rates of breastfeeding in premature infants remain below the recommended goals. The negative impact of the length of stay in the neonatal unit on breastfeeding is a challenge for health professionals who must adapt and strengthen the strategy of encouragement and support breastfeeding during the stay in neonatology and after discharge to ensure adequate nutrition for premature infants.
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Affiliation(s)
- H Berrani
- Service de néonatologie, pédiatrie V, hôpital d'enfants, faculté de médecine et pharmacie, université Mohammed V-Souissi, avenue Belarbi El Alaoui, BP 6203, Rabat, Maroc.
| | - A Mdaghri Alaoui
- Service de néonatologie, pédiatrie V, hôpital d'enfants, faculté de médecine et pharmacie, université Mohammed V-Souissi, avenue Belarbi El Alaoui, BP 6203, Rabat, Maroc
| | - J Kasouati
- Laboratoire de biostatistique et de recherche clinique et épidémiologique, faculté de médecine et pharmacie, université Mohammed V-Souissi, avenue Belarbi El Alaoui, BP 6203, Rabat, Maroc
| | - K Alaoui
- Laboratoire de biostatistique et de recherche clinique et épidémiologique, faculté de médecine et pharmacie, université Mohammed V-Souissi, avenue Belarbi El Alaoui, BP 6203, Rabat, Maroc
| | - A Thimou Izgua
- Service de néonatologie, pédiatrie V, hôpital d'enfants, faculté de médecine et pharmacie, université Mohammed V-Souissi, avenue Belarbi El Alaoui, BP 6203, Rabat, Maroc.
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Kozhimannil KB, Jou J, Attanasio LB, Joarnt LK, McGovern P. Medically complex pregnancies and early breastfeeding behaviors: a retrospective analysis. PLoS One 2014; 9:e104820. [PMID: 25118976 PMCID: PMC4132072 DOI: 10.1371/journal.pone.0104820] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Accepted: 07/16/2014] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Breastfeeding is beneficial for women and infants, and medical contraindications are rare. Prenatal and labor-related complications may hinder breastfeeding, but supportive hospital practices may encourage women who intend to breastfeed. We measured the relationship between having a complex pregnancy (entering pregnancy with hypertension, diabetes, or obesity) and early infant feeding, accounting for breastfeeding intentions and supportive hospital practices. METHODS We performed a retrospective analysis of data from a nationally-representative survey of women who gave birth in 2011-2012 in a US hospital (N = 2400). We used logistic regression to examine the relationship between pregnancy complexity and breastfeeding. Self-reported prepregnancy diabetes or hypertension, gestational diabetes, or obesity indicated a complex pregnancy. The outcome was feeding status 1 week postpartum; any breastfeeding was evaluated among women intending to breastfeed (N = 1990), and exclusive breastfeeding among women who intended to exclusively breastfeed (N = 1418). We also tested whether breastfeeding intentions or supportive hospital practices mediated the relationship between pregnancy complexity and infant feeding status. RESULTS More than 33% of women had a complex pregnancy; these women had 30% lower odds of intending to breastfeed (AOR = 0.71; 95% CI, 0.52-0.98). Rates of intention to exclusively breastfeed were similar for women with and without complex pregnancies. Women who intended to breastfeed had similar rates of any breastfeeding 1 week postpartum regardless of pregnancy complexity, but complexity was associated with >30% lower odds of exclusive breastfeeding 1 week among women who intended to exclusively breastfeed (AOR = 0.68; 95% CI, 0.47-0.98). Supportive hospital practices were strongly associated with higher odds of any or exclusive breastfeeding 1 week postpartum (AOR = 4.03; 95% CI, 1.81-8.94; and AOR = 2.68; 95% CI, 1.70-4.23, respectively). CONCLUSIONS Improving clinical and hospital support for women with complex pregnancies may increase breastfeeding rates and the benefits of breastfeeding for women and infants.
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Affiliation(s)
- Katy B. Kozhimannil
- Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, Minnesota, United States of America
| | - Judy Jou
- Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, Minnesota, United States of America
| | - Laura B. Attanasio
- Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, Minnesota, United States of America
| | - Lauren K. Joarnt
- Harvard University, Cambridge, Massachusetts, United States of America
| | - Patricia McGovern
- Division of Environmental Health Sciences, University of Minnesota School of Public Health, Minneapolis, Minnesota, United States of America
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Hallowell SG, Spatz DL, Hanlon AL, Rogowski JA, Lake ET. Characteristics of the NICU work environment associated with breastfeeding support. Adv Neonatal Care 2014; 14:290-300. [PMID: 25075926 PMCID: PMC4868552 DOI: 10.1097/anc.0000000000000102] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE The provision of breastfeeding support in the neonatal intensive care unit (NICU) may assist a mother to develop a milk supply for the NICU infant. Human milk offers unique benefits and its provision unique challenges in this highly vulnerable population. The provision of breastfeeding support in this setting has not been studied in a large, multihospital study. We describe the frequency of breastfeeding support provided by nurses and examined relationships between NICU nursing characteristics, the availability of a lactation consultant (LC), and breastfeeding support. SUBJECTS AND DESIGN This was a secondary analysis of 2008 survey data from 6060 registered nurses in 104 NICUs nationally. Nurse managers provided data on LCs. These NICUs were members of the Vermont Oxford Network, a voluntary quality and safety collaborative. METHODS Nurses reported on the infants (n = 15,233) they cared for on their last shift, including whether breastfeeding support was provided to parents. Breastfeeding support was measured as a percentage of infants on the unit. The denominator was all infants assigned to all nurse respondents on that NICU. The numerator was the number of infants that nurses reported providing breastfeeding support. Nurses also completed the Practice Environment Scale of the Nursing Work Index (PES-NWI), a nationally endorsed nursing care performance measure. The NICU nursing characteristics include the percentages of nurses with a BSN or higher degree and with 5 or more years of NICU experience, an acuity-adjusted staffing ratio, and PES-NWI subscale scores. Lactation consultant availability was measured as any/none and in full-time equivalent positions per 10 beds. RESULTS The parents of 14% of infants received breastfeeding support from the nurse. Half of the NICUs had an LC. Multiple regression analysis showed a significant relationship between 2 measures of nurse staffing and breastfeeding support. A 1 SD higher acuity-adjusted staffing ratio was associated with a 2% increase in infants provided breastfeeding support. A 1 SD higher score on the Staffing and Resource Adequacy PES-NWI subscale was associated with a 2% increase in infants provided breastfeeding support. There was no association between other NICU nursing characteristics or LCs and nurse-provided breastfeeding support. CONCLUSIONS Nurses provide breastfeeding support around the clock. On a typical shift, about 1 in 7 NICU infants receives breastfeeding support from a nurse. Lactation consultants are not routinely available in NICUs, and their presence does not influence whether nurses provide breastfeeding support. Better nurse staffing fosters nurse provision of breastfeeding support.
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Affiliation(s)
- Sunny G Hallowell
- Center for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing and Leonard Davis Institute of Health Economics, Philadelphia (Dr Hallowell); University of Pennsylvania School of Nursing, Philadelphia, and Lactation Program, Children's Hospital of Philadelphia, Pennsylvania (Dr Spatz); University of Pennsylvania School of Nursing, Philadelphia (Dr Hanlon); Rutgers School of Public Health, State University of New Jersey, New Brunswick, and Leonard Davis Institute of Health Economics, Philadelphia, Pennsylvania (Dr Rogowski); and Nursing and Health Policy and Sociology, Center of Health Outcomes and Policy Research, University of Pennsylvania School of Nursing and Leonard Davis Institute of Health Economics, Philadelphia (Dr Lake)
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Oza-Frank R, Bhatia A, Smith C. Impact of peer counselors on breastfeeding outcomes in a nondelivery NICU setting. Adv Neonatal Care 2014; 14:E1-8. [PMID: 25000101 DOI: 10.1097/anc.0000000000000101] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Although the independent effects of lactation consultants and peer counselors have been shown to improve breastfeeding outcomes, the joint effects have yet to be considered, particularly in the neonatal intensive care unit (NICU) in nondelivery hospitals. Therefore, the objective of this study was to assess the effect of lactation staff type on breastfeeding outcomes during hospital stay after the addition of peer counselors to a NICU lactation program. SUBJECTS A total of 596 mother-infant pairs admitted to Nationwide Children's Hospital, Columbus, Ohio, pre- and postlactation program expansion. DESIGN A descriptive pre-/posttest study as conducted. MAIN OUTCOME MEASURES Differences in provision of any maternal breast milk, exclusive breast milk, or direct breastfeeding during NICU stay and at discharge were evaluated pre and postprogram implementation. Logistic regression was used to determine associations between lactation staff type and each outcome during hospital stay. RESULTS Infants receiving any breast milk during NICU stay increased from baseline to postprogram year 1 (63% vs 73%; P= 0.03). Direct breastfeeding increased from baseline to postprogram year 4 (42% vs 53%; P= 0.03). Mothers seen by only peer counselors were less likely to provide any breast milk at discharge, provide exclusive breast milk during stay or discharge, to be direct breastfeeding during stay or at discharge compared with mothers seen by both peer counselors and lactation consultants. CONCLUSIONS NICU lactation programs should consider including both peer counselors and lactation consultants to improve breastfeeding outcomes during hospital stay.
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Craighead DV, Elswick R. The Influence of Early‐Term Birth on NICU Admission, Length of Stay, and Breastfeeding Initiation and Duration. J Obstet Gynecol Neonatal Nurs 2014; 43:409-21. [DOI: 10.1111/1552-6909.12472] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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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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Colaizy TT. Donor human milk for preterm infants: what it is, what it can do, and what still needs to be learned. Clin Perinatol 2014; 41:437-50. [PMID: 24873842 DOI: 10.1016/j.clp.2014.02.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Donor human milk is a dietary intervention rapidly increasing in usage in the very low birth weight (VLBW) preterm population. Donor milk may decrease risk of necrotizing enterocolitis and improve neurodevelopmental outcomes in VLBW infants compared with formula diets. The exclusive human milk diet shows promise as an intervention to decrease risk of necrotizing enterocolitis compared with formula. Further research is needed to assess the impact of donor human milk on infectious, growth, and neurodevelopmental outcomes of VLBW infants, as well as the effect of milk fortifier choice (human vs bovine) on these outcomes.
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Affiliation(s)
- Tarah T Colaizy
- Carver College of Medicine, Department of Pediatrics, University of Iowa, 200 Hawkins Drive, 8809 JPP, Iowa City, IA 52242, USA.
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Nagulesapillai T, McDonald SW, Fenton TR, Mercader HFG, Tough SC. Breastfeeding difficulties and exclusivity among late preterm and term infants: results from the all our babies study. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2013; 104:e351-6. [PMID: 24044478 PMCID: PMC6973566 DOI: 10.17269/cjph.104.3803] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2012] [Revised: 08/09/2013] [Accepted: 07/24/2013] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To compare breastfeeding difficulties attributable to the baby and mother/milk and exclusive breastfeeding between a group of late preterm (LP) infants and term infants. METHODS We utilized data from a prospective community-based cohort (n=2977) in Calgary, Alberta, and performed bivariate and multivariable analyses to identify demographic, obstetric, maternal and infant health indicators that were independently associated with term status and breastfeeding outcomes. RESULTS Multivariable analyses found that LP status was an independent risk factor for breastfeeding difficulties attributable to the baby (OR 1.72, 95% CI 1.24-2.38), but not for difficulties due to mother/milk (defined as not producing enough milk or having flat or inverted nipples). Among women who were breastfeeding at hospital discharge, mothers of LP infants were less likely to report exclusive breastfeeding at 4 months (OR 0.67, 95% CI 0.46-0.97), after controlling for household income level, mode of delivery and postpartum maternal physical health. CONCLUSIONS Mothers of LP infants need increased support to establish successful breastfeeding outcomes and to ensure that these infants receive the full benefits of breast milk.
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Affiliation(s)
- Tharsiya Nagulesapillai
- Departments of Pediatrics and Community Health Sciences, Faculty of Medicine, University of Calgary Calgary, AB Canada.
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Northrup TF, Wootton SH, Evans PW, Stotts AL. Breastfeeding practices in mothers of high-respiratory-risk NICU infants: impact of depressive symptoms and smoking. J Matern Fetal Neonatal Med 2013; 26:1838-43. [DOI: 10.3109/14767058.2013.805195] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Ross ES, Browne JV. Feeding Outcomes in Preterm Infants After Discharge From the Neonatal Intensive Care Unit (NICU): A Systematic Review. ACTA ACUST UNITED AC 2013. [DOI: 10.1053/j.nainr.2013.04.003] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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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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Lapillonne A, O'Connor DL, Wang D, Rigo J. Nutritional recommendations for the late-preterm infant and the preterm infant after hospital discharge. J Pediatr 2013; 162:S90-100. [PMID: 23445854 DOI: 10.1016/j.jpeds.2012.11.058] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Early nutritional support of preterm infants is critical to life-long health and well being. Numerous studies have demonstrated that preterm infants are at increased risk of mortality and morbidity, including disturbances in brain development. To date, much attention has focused on enhancing the nutritional support of very low and extremely low birth weight infants to improve survival and quality of life. In most countries, preterm infants are sent home before their expected date of term birth for economic or other reasons. It is debatable whether these newborns require special nutritional regimens or discharge formulas. Furthermore, guidelines that specify how to feed very preterm infants after hospital discharge are scarce and conflicting. On the other hand, the late-preterm infant presents a challenge to health care providers immediately after birth when decisions must be made about how and where to care for these newborns. Considering these infants as well babies may place them at a disadvantage. Late-preterm infants have unique and often-unrecognized medical vulnerabilities and nutritional needs that predispose them to greater rates of morbidity and hospital readmissions. Poor or inadequate feeding during hospitalization may be one of the main reasons why late-preterm infants have difficulty gaining weight right after birth. Providing optimal nutritional support to late premature infants may improve survival and quality of life as it does for very preterm infants. In this work, we present a review of the literature and provide separate recommendations for the care and feeding of late-preterm infants and very preterm infants after discharge. We identify gaps in current knowledge as well as priorities for future research.
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Jang GJ, Lee SL, Kim HM. [Breast feeding rates and factors influencing breast feeding practice in late preterm infants: comparison with preterm born at less than 34 weeks of gestational age]. J Korean Acad Nurs 2012; 42:181-9. [PMID: 22699167 DOI: 10.4040/jkan.2012.42.2.181] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
PURPOSE This study was done to compare breast feeding rates and factors influencing feeding practice between late preterm (34 ≤ GA < 37) and preterm infants (GA<34). METHODS A survey was done of 207 late preterm and 117 preterm infants in neonatal intensive care units (NICU) of 4 university hospitals in D city. Data were collected from July 2009 to June 2010 from 324 medical records in the NICU. Breast-feeding at home was checked either by telephone survey or questioning during hospital visits. RESULTS Rate of breast feeding for late preterm infants was significantly lower than for preterm infants. There was no significant difference in breast-feeding at home. We found differences in factors influencing breast feeding between the two groups. Factors influencing feeding for late preterm infants were type of delivery, mothers' occupation, feeding type during hospitalization, time elapse from hospital discharge, total admission days, infant's body weight at first feeding and length of NPO (nothing by mouth). Factors influencing feeding for preterm infants were birth order, maternal disease and obstetric complications, and one-minute Apgar score. CONCLUSION Results of the study show low rates of breast-feeding for late preterm infants indicating a need for breast-feeding education for mothers of these infants.
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Affiliation(s)
- Gun Ja Jang
- Department of Nursing, Daegu University, Daegu, Korea
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