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Bergman NJ. New policies on skin-to-skin contact warrant an oxytocin-based perspective on perinatal health care. Front Psychol 2024; 15:1385320. [PMID: 39049943 PMCID: PMC11267429 DOI: 10.3389/fpsyg.2024.1385320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 06/10/2024] [Indexed: 07/27/2024] Open
Abstract
Background In 2023, the World Health Organization (WHO) published a Global Position Paper on Kangaroo Mother Care (KMC), which is applicable to all countries worldwide: from the moment of birth, every "small and sick" newborn should remain with mother in immediate and continuous skin-to-skin contact (SSC), receiving all required clinical care in that place. This was prompted by the startling results of a randomized controlled trial published in 2021: in which 1,609 infants receiving immediate SSC were compared with 1,602 controls that were separated from their mothers but otherwise received identical conventional state-of-the-art care. The intervention infants showed a 25% reduction in mortality after 28 days. New perspectives The new WHO guidelines are a significant change from earlier guidance and common clinical practice. The author presents that separating mothers and babies is assumed to be "normal" (a paradigm) but actually puts newborns at increased risk for morbidity and mortality. The author presents arguments and ethical perspectives for a new perspective on what is "normal," keeping newborns with their mothers is the infant's physiological expectation and critical requirement for healthy development. The author reviews the scientific rationale for changing the paradigm, based on synchronous interactions of oxytocin on both mother and infant. This follows a critique of the new policies that highlights the role of immediate SSC. Actionable recommendations This critique strengthens the case for implementing the WHO guidelines on KMC for small and sick babies. System changes will be necessary in both obstetric and neonatal settings to ensure seamless perinatal care. Based on the role of oxytocin, the author identifies that many current routine care practices may actually contribute to stress and increased vulnerability to the newborn. WHO has actionable recommendations about family involvement and presence in newborn intensive care units. Discussion The concepts of resilience and vulnerability have specific definitions well known in perinatal care: the key outcome of care should be resilience rather than merely the absence of vulnerability. Newborns in all settings and contexts need us to re-evaluate our paradigms and adopt and implement the new WHO guidelines on KMC in perinatal care.
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Affiliation(s)
- Nils J. Bergman
- Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
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Idei Y, Ochiai Y, Yoshibe K, Kuroishi S, Takase M, Mizuno K. Evaluating milk flow patterns using the high flow rate period during breast pumping. Midwifery 2024; 136:104039. [PMID: 38909553 DOI: 10.1016/j.midw.2024.104039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 04/16/2024] [Accepted: 05/28/2024] [Indexed: 06/25/2024]
Abstract
PROBLEM Breast pumping practices have scope for improvement. BACKGROUND Breast milk weight measurement can be used to evaluate milk flow pattern dynamics during breast pumping. AIM To determine inter-individual differences in milk flow patterns and their practical implications based on high milk flow rate period (HFP) data among Japanese women expressing breast milk using an electric pump. METHODS This cross-sectional, observational study analysed data from 19 women (33.0 ± 3.9 years) nursing 1-6-month-old infants and with previous breast milk expression experience. Breast milk was weighed continuously during a 15-min single-breast electric pumping session. The HFP features and flow rate time (≥0.1 g/s) were analysed to determine each individual's milk flow pattern. FINDINGS The total expressed breast milk was 69.8 ± 42.5 g with a maximum individual flow rate of 0.5 ± 0.2 g/s. The breast milk yielded during the HFPs was 43.1 (34.4-81.3) g, accounting for 82.5 % (69.9-89.5 %) of the total expressed breast milk. HFP occurred 0-3 times during the 15-min session. Multiple discrete and continuous milk flow patterns were observed. Among those with discrete HFP, the HFP interval was 221 (68-371) s. Breast milk fat content changes and subjective residual milk measurements implied sufficient milk removal. A strong positive correlation was noted between HFP length and total breast milk expression volume. DISCUSSION Individual differences in milk flow patterns were observed among the women using HFP. Milk flow patterns were consistent with previous reports. CONCLUSION Milk flow pattern data can be used to guide individualised lactation support.
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Affiliation(s)
- Yoko Idei
- Research & Development Division, Pigeon Corporation, 6-20-4, Kinunodai, Tsukubamirai, Ibaraki 300-2495, Japan.
| | - Yukifumi Ochiai
- Research & Development Division, Pigeon Corporation, 6-20-4, Kinunodai, Tsukubamirai, Ibaraki 300-2495, Japan
| | - Kanae Yoshibe
- Research & Development Division, Pigeon Corporation, 6-20-4, Kinunodai, Tsukubamirai, Ibaraki 300-2495, Japan
| | - Sumiko Kuroishi
- Research & Development Division, Pigeon Corporation, 6-20-4, Kinunodai, Tsukubamirai, Ibaraki 300-2495, Japan
| | - Mariko Takase
- Department of Paediatrics, Showa University School of Medicine, 1-5-8, Hatanodai, Shinagawa, Tokyo 142-8555, Japan
| | - Katsumi Mizuno
- Department of Paediatrics, Showa University School of Medicine, 1-5-8, Hatanodai, Shinagawa, Tokyo 142-8555, Japan
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Spatz DL, Rodríguez SÁ, Benjilany S, Finderle B, von Gartzen A, Yates A, Brumley J. Having Enough Milk to Sustain a Lactation Journey: A Call to Action. Nurs Womens Health 2024:S1751-4851(24)00090-4. [PMID: 38823783 DOI: 10.1016/j.nwh.2024.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Revised: 02/26/2024] [Accepted: 04/18/2024] [Indexed: 06/03/2024]
Abstract
The rates of human milk feeding are suboptimal worldwide. Recommendations for healthy, term mother-infant dyads include early breastfeeding initiation, frequent skin-to-skin contact, and frequent breastfeeding. The normal physiology of lactation can be affected by prenatal factors such as diabetes, obesity, and excessive gestational weight gain. Furthermore, birth-related factors such as early-term gestation, stressful labor, unscheduled cesarean birth, and postpartum hemorrhage can additionally disrupt recommended practices such as early initiation of breastfeeding and skin-to-skin contact. Given that the first 2 to 3 days postpartum are critical to achieving timely secretory activation and establishing an adequate volume of milk, a proactive approach to care can include building awareness of risk factors and development of protocols for the effective early initiation of lactation.
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Massa K, Ramireddy S, Ficenec S, Mank C, Josephsen J, Babbar S. A Randomized Control Trial of Meditation for Mothers Pumping Breastmilk for Preterm Infants. Am J Perinatol 2024; 41:842-852. [PMID: 35240703 DOI: 10.1055/a-1787-7576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVE Mothers of preterm infants face unique challenges in establishing milk supply. We hypothesized that daily meditation practice while pumping would increase milk volume. STUDY DESIGN This was a randomized control trial examining the effect of meditation on the breastmilk supply of women delivering preterm infants. The meditation group engaged in daily use of a mindfulness-focused meditation app in addition to routine lactation support. The primary outcome was mean breastmilk volume on the infant's nineth day of life. Secondary outcomes included use of lactation-promoting behaviors, continuation of breastfeeding, and measures of mental health and breastfeeding self-efficacy by validated questionnaires. In addition to the intention to treat analysis, a per protocol analysis examined the association of frequent meditation with these breastfeeding and mental health outcomes. RESULTS A total of 60 women were analyzed. Mean milk volume was 647.1 ± 467.8 mL in the meditation group and 514.9 ± 393.5 mL in the routine care group (p = 0.27). Median number of pumping sessions was 7 (interquartile range [IQR] 5-8) in the meditation group, compared to 6 (IQR 4-7) in the routine care group (p = 0.11). Other lactation-promoting behaviors, breastfeeding continuation, and questionnaire scores were similar.Adjusting for confounders, we found an increase in breastmilk production of 223.2 mL (95% CI 98.8-347.5, p = 0.001) and in pumping episodes by 0.93 (95% CI 0.16-1.70, p = 0.020) associated with frequent meditation. Skin-to-skin contact was increased to 100% (p = 0.006) among women who meditated seven or more times. Adjusted odds of a clinically significant Edinburgh Postnatal Depression Scale score of >9 was 0.057 (95% CI 0.0014-0.711, p = 0.023) with frequent meditation. CONCLUSION Breastmilk production was similar in mothers practicing meditation compared to those receiving routine lactation support. For women engaging in frequent mediation, there may be an effect in establishing breastmilk supply and reduction of depression symptoms. KEY POINTS · Breastmilk is not increased for neonatal intensive care unit (NICU) moms asked to engage in meditation.. · Maternal mental health is not improved among NICU moms asked to meditate.. · However, higher-frequency meditation is associated with increased milk volume and lower odds of high scores on depression screening..
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Affiliation(s)
- Katherine Massa
- Department of Obstetrics and Gynecology, Washington University, Saint Louis, Missouri
| | - Soumya Ramireddy
- Saint Louis University School of Medicine, Saint Louis, Missouri
| | - Sara Ficenec
- Department of Obstetrics and Gynecology, University of Washington, Seattle, Washington
| | - Carolyn Mank
- Department of Obstetrics and Gynecology, Saint Louis University School of Medicine, Saint Louis, Missouri
| | - Justin Josephsen
- Department of Pediatrics, Saint Louis University School of Medicine, Saint Louis, Missouri
| | - Shilpa Babbar
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Missouri-Kansas City, Children's Mercy Kansas City, Kansas City, Missouri
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Boone N, Bohara B, Rohrer A, Gros M, Gregoski MJ, Lee K, Wagner CL, Chetta K. Multi-prong quality improvement approach for increasing mother's own milk use for very low birth weight infants. J Perinatol 2024; 44:671-679. [PMID: 38123800 DOI: 10.1038/s41372-023-01835-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 11/08/2023] [Accepted: 11/16/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVE Evaluate a single center quality improvement (QI) collaborative designed to increase the provision of mother's own milk (MOM) at discharge to premature infants through evidence-based practices while targeting perinatal health disparities. DESIGN This QI initiative was designed for preterm infants admitted to a single-center NICU within 24 h of life. Interventions were implemented between March 2022 and June 2022. MOM provision rates were compared between baseline (August 2021-February 2022), and after interventions (March 2022-December 2022). RESULTS The percentage of mothers who discontinued pumping during the infant hospitalization decreased from 49% to 35% (p < 0.01). Infant discharge diet with MOM improved from 36% to 58% (p < 0.001). Pump frequency at two weeks increased from 4.0 ± 2.6 to 5.1 ± 2.4 (p = 0.026). CONCLUSION Our collaborative increased the percentage of preterm infants receiving MOM at discharge and reduced the number of mothers who discontinue pumping during the NICU hospitalization.
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Affiliation(s)
- Neal Boone
- Division of Neonatology, Department of Pediatrics, Shawn Jenkins Children's Hospital, Medical University of South Carolina, Charleston, SC, USA.
| | - Beth Bohara
- Division of Neonatology, Department of Pediatrics, Shawn Jenkins Children's Hospital, Medical University of South Carolina, Charleston, SC, USA
| | - Allison Rohrer
- Department of Clinical Nutrition, Shawn Jenkins Children's Hospital, Medical University of South Carolina, Charleston, SC, USA
| | - Molly Gros
- Department of Lactation Services, Medical University of South Carolina, Charleston, SC, USA
| | - Mathew J Gregoski
- Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Kimberly Lee
- Division of Neonatology, Department of Pediatrics, Shawn Jenkins Children's Hospital, Medical University of South Carolina, Charleston, SC, USA
| | - Carol L Wagner
- Division of Neonatology, Department of Pediatrics, Shawn Jenkins Children's Hospital, Medical University of South Carolina, Charleston, SC, USA
- Darby Children's Research Institute, Medical University of South Carolina, Charleston, SC, USA
| | - Katherine Chetta
- Division of Neonatology, Department of Pediatrics, Shawn Jenkins Children's Hospital, Medical University of South Carolina, Charleston, SC, USA
- Darby Children's Research Institute, Medical University of South Carolina, Charleston, SC, USA
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Mallick LM, Shenassa ED. Variation in Breastfeeding Initiation and Duration by Mode of Childbirth: A Prospective, Population-Based Study. Breastfeed Med 2024; 19:262-274. [PMID: 38535749 DOI: 10.1089/bfm.2023.0180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
Introduction: Despite known benefits of breastfeeding, including prevention against infections for infants, in the presence of numerous barriers, less than half of infants in high-income countries breastfeed for 6 months. One potential barrier to breastfeeding is birth by cesarean section (C-Section), which can invoke long-term difficulties. However, our structured literature review found that existing empirical research does not fully elucidate this relationship due to differences in operationalization of C-section and breastfeeding, omission of important confounders, and failure to exclude those who did not initiate breastfeeding (or use time-to-event analyses). In this article, we attempt to overcome these limitations. Methods: We analyzed data from 14,414 mother-infant dyads enrolled in the United Kingdom-based prospective Millennium Cohort Study, beginning in 2001. Using multivariable logistic regression, we examined the association between mode of birth (vaginal, emergency C-section, and elective C-section) and likelihood of breastfeeding initiation. We then applied adjusted Accelerated Failure Time survival models to examine the associations between mode of birth and duration of any and exclusive breastfeeding. Results: Those with planned (but not emergency) C-section were less likely to initiate breastfeeding (odds ratio: 0.84, 95% confidence interval [CI]: 0.71-0.99) relative to vaginal births. However, those with either planned or unplanned C-section discontinued both any and exclusive breastfeeding sooner than vaginal births. This effect was more pronounced for those with planned C-section (time ratio [TR]: 0.75, 95% CI: 0.64-0.89) than unplanned C-section (TR: 0.85, 95% CI: 0.74, 0.97) compared with vaginal births. Conclusions: Through application of rigorous methods, this study provides compelling evidence that breastfeeding duration may be impeded by C-section birth. The findings suggest that additional support for mothers who intend to breastfeed and have a C-section birth may be warranted.
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Affiliation(s)
- Lindsay M Mallick
- Maternal and Child Health Program, Department of Family Science, School of Public Health, University of Maryland, College Park, Maryland, USA
- College of Behavioral and Social Sciences, Maryland Population Research Center, University of Maryland, College Park, Maryland, USA
- Avenir Health, Glastonbury, Connecticut, USA
| | - Edmond D Shenassa
- Maternal and Child Health Program, Department of Family Science, School of Public Health, University of Maryland, College Park, Maryland, USA
- College of Behavioral and Social Sciences, Maryland Population Research Center, University of Maryland, College Park, Maryland, USA
- Department of Epidemiology and Biostatistics, School of Public Health, University of Maryland, College Park, Maryland, USA
- Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island, USA
- Department of Epidemiology & Biostatistics, School of Medicine, University of Maryland, Baltimore, Maryland, USA
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Levene I, Quigley MA, Fewtrell M, O'Brien F. Does extremely early expression of colostrum after very preterm birth improve mother's own milk quantity? A cohort study. Arch Dis Child Fetal Neonatal Ed 2024:fetalneonatal-2023-326784. [PMID: 38442953 DOI: 10.1136/archdischild-2023-326784] [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: 12/19/2023] [Accepted: 02/16/2024] [Indexed: 03/07/2024]
Abstract
OBJECTIVE Assess the relationship of time to first expression after very preterm birth and mothers' own milk quantity. DESIGN A cohort study (nested within a randomised trial). SETTING Four neonatal units in the UK. PATIENTS 132 mothers of single or twin infants born at 23+0 to 31+6 weeks postmenstrual age. EXPOSURES Time to the first attempt to express after birth. PRIMARY OUTCOMES 24-hour mother's own milk yield on days 4, 14 and 21 after birth. RESULTS Median time to first expression attempt was 6 hours. 51.7% expressed within 6 hours of birth (62/120) and 48.3% expressed more than 6 hours after birth (58/120). Expressing within 6 hours of birth was associated with higher milk yield on day 4 (88.3 g, 95% CI 7.1 to 169.4) and day 14 (155.7 g, 95% CI 12.2 to 299.3) but not on day 21 (73.6 g, 95% CI -91.4 to 238.7). There was an interaction between expressing frequency and time to first expression (p<0.005), with increased expressing frequency being associated with higher yield only in those who expressed within 6 hours. Expressing within 2 hours of birth was not associated with further milk yield increase. CONCLUSIONS Mothers who expressed within 6 hours of birth had higher milk yield, and a greater yield per expressing session, in the first 3 weeks after birth. This information will be highly motivating for families and the clinicians supporting them. There was no evidence of further benefit of extremely early expression (first 2 hours after birth). TRIAL REGISTRATION NUMBER ISRCTN 16356650.
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Affiliation(s)
- Ilana Levene
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, Oxford University, Oxford, UK
| | - Maria A Quigley
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, Oxford University, Oxford, UK
| | - Mary Fewtrell
- UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Frances O'Brien
- Neonatal Unit, John Radcliffe Hospital, Oxford, Oxfordshire, UK
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Fleiss N, Morrison C, Nascimento A, Stone D, Myers E. Improving Early Colostrum Administration to Very Low Birth Weight Infants in a Level 3 Neonatal Intensive Care Unit: A Quality Improvement Initiative. J Pediatr 2023; 260:113421. [PMID: 37076038 DOI: 10.1016/j.jpeds.2023.113421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 02/13/2023] [Accepted: 02/28/2023] [Indexed: 04/21/2023]
Abstract
OBJECTIVE To improve our human milk practices by increasing early and sustained use of colostrum as oral immune therapy (OIT) in very low birthweight (VLBW) infants admitted at a level 3 neonatal intensive care unit. STUDY DESIGN Using the Institute for Healthcare Improvement's Model for Improvement, several interventions aimed at increasing early OIT administration were implemented. Four key drivers included: optimizing evidence-based OIT guidelines, personnel alignment and engagement, optimal electronic health record use for ordering practices, and timely lactation consultant involvement. The primary outcome measure was early OIT administration, whereas secondary outcome measures examined all OIT administration and human milk at discharge. Process measures included the percentage of staff members who were compliant with OIT protocol. RESULTS Early OIT administration increased from a baseline mean of 6% to 55% in the 12-month study period. Percentage of total (early and late) OIT administration to VLBW infants increased from a baseline of 21% to 85%. Average human milk at discharge for VLBW infants remained at 44%, without significant improvement. CONCLUSIONS A multidisciplinary quality improvement initiative led to significant improvement in OIT administration to infants at a level 3 neonatal intensive care unit.
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Affiliation(s)
- Noa Fleiss
- Department of Pediatrics, Division of Neonatology, Yale School of Medicine, New Haven, CT; Bridgeport Campus Neonatal Intensive Care Unit, Yale New Haven Children's Hospital, Bridgeport, CT.
| | - Corinne Morrison
- Bridgeport Campus Neonatal Intensive Care Unit, Yale New Haven Children's Hospital, Bridgeport, CT
| | - Allison Nascimento
- Bridgeport Campus Neonatal Intensive Care Unit, Yale New Haven Children's Hospital, Bridgeport, CT
| | - Debra Stone
- Department of Pediatrics, Bridgeport Hospital, Bridgeport, CT
| | - Eliza Myers
- Department of Pediatrics, Division of Neonatology, Yale School of Medicine, New Haven, CT; Bridgeport Campus Neonatal Intensive Care Unit, Yale New Haven Children's Hospital, Bridgeport, CT
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Berwick M, Louis-Jacques AF. Prenatal Counseling and Preparation for Breastfeeding. Obstet Gynecol Clin North Am 2023; 50:549-565. [PMID: 37500216 DOI: 10.1016/j.ogc.2023.03.007] [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: 07/29/2023]
Abstract
Breastfeeding is the gold standard of infant nutrition and current guidelines suggest exclusive breastfeeding for 6 months, with continued breastfeeding through 24 months or beyond. Obstetric care professionals can encourage and educate their patients about breastfeeding through the prenatal period when many expectant parents make decisions about their infant feeding choices. Education and support should extend through the postpartum period and include parents who may have concerns surrounding medical comorbidities, breast augmentation, or substance use disorders.
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Affiliation(s)
- Margarita Berwick
- Department of Obstetrics and Gynecology, University of Florida College of Medicine, University of Florida, PO Box 100294, 1600 Southwest Archer Road, Gainesville, FL 32610-0294, USA.
| | - Adetola F Louis-Jacques
- Department of Obstetrics and Gynecology, University of Florida College of Medicine, University of Florida, PO Box 100294, 1600 Southwest Archer Road, Gainesville, FL 32610-0294, USA
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Quan M, Li Z, Ward LP, Feng S, Jing Y, Wang L, Yuan J. A quality improvement project to increase breast milk feeding of hospitalized late preterm infants in China. Int Breastfeed J 2023; 18:45. [PMID: 37612777 PMCID: PMC10463707 DOI: 10.1186/s13006-023-00582-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 08/12/2023] [Indexed: 08/25/2023] Open
Abstract
BACKGROUND The breastfeeding rates of late preterm infants are lower than both term and extremely preterm infants. To explore the interventions of increasing full breast milk feeding rate of hospitalized late preterm infants on the 7th day after birth (D7) and evaluate the effect of these quality improvement (QI) interventions. METHODS The full breast milk feeding (amount of enteral breast milk reached 120ml/kg/d on D7) rate of hospitalized late preterm infants during May 2017 and November 2017 was set as the baseline before intervention, and the specific aim of promoting breast milk feeding was put forward. The Pareto Chart was used to analyze the factors that affect breast milk feeding process, as well as the discussion of multidisciplinary experts. Key drivers were constructed, including informational materials and education about breast milk feeding, consultations and support on optimal breast milk initiation, initiating breast milk expression within one hour after birth, accurate measurement and recording of expressed breast milk, stimulating continuous and effective lactation, proper breast pump selection in and out of hospital and sending and preserving of expressed milk to NICU. Control chart was used to monitor the monthly change of full breast milk feeding rate until the aim was achieved and sustained. RESULTS The baseline of full breast milk feeding rate of late preterm infants was 10%, and the aim of QI was to increase the rate to 60% within a two-year period. Control chart dynamically showed the full breast milk feeding rate increased to 80% with the implementation of the interventions, achieved and made the aim of QI sustained. CONCLUSION QI interventions including breast milk feeding education, early postpartum breast milk pumping, kangaroo care to stimulate breast milk secretion, and convenient way of transporting breast milk to NICU, could significantly improve the full breast milk feeding rate of hospitalized late preterm infants.
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Affiliation(s)
- Meiying Quan
- Pediatric department, State Key Laboratory of Complex Severe and Rare Disease, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, No.1 Shuaifuyuan, Wangfujing, Dongcheng District, Beijing, 100730, China
| | - Zhenghong Li
- Pediatric department, State Key Laboratory of Complex Severe and Rare Disease, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, No.1 Shuaifuyuan, Wangfujing, Dongcheng District, Beijing, 100730, China.
| | - Laura Placke Ward
- Division of Neonatology, NICU, Cincinnati Children's Hospital Medical Center, Ohio, United States
| | - Shuju Feng
- Pediatric department, State Key Laboratory of Complex Severe and Rare Disease, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, No.1 Shuaifuyuan, Wangfujing, Dongcheng District, Beijing, 100730, China
| | - Yalin Jing
- Pediatric department, State Key Laboratory of Complex Severe and Rare Disease, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, No.1 Shuaifuyuan, Wangfujing, Dongcheng District, Beijing, 100730, China
| | - Lin Wang
- Pediatric department, State Key Laboratory of Complex Severe and Rare Disease, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, No.1 Shuaifuyuan, Wangfujing, Dongcheng District, Beijing, 100730, China
| | - Jing Yuan
- Pediatric department, State Key Laboratory of Complex Severe and Rare Disease, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, No.1 Shuaifuyuan, Wangfujing, Dongcheng District, Beijing, 100730, China
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11
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Yuan S, Li Q, Wang H, Xu X. The Utilization of Sodium Concentration in Human Milk from Pump-Dependent Mothers of Preterm Infants as a Measure of Milk Production. Breastfeed Med 2023. [PMID: 37327383 DOI: 10.1089/bfm.2022.0263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Objective: This study investigated changes in sodium concentrations in human milk from mothers of premature infants using different breast pumps for 14 days postpartum, and the correlation between the sodium concentration in mother's own milk (MOM) and the volume pumped. Study Design: This randomized controlled study recruited 66 mothers of premature infants delivered in our hospital from February to December 2018, and we assigned them to three groups using an envelope method. In intervention group 1, a hospital-grade electric breast pump was used from postpartum day 1 to 14; in intervention group 2, a hospital-grade electric breast pump was used on postpartum days 1 to 5 and a normal personal electric breast pump on postpartum days 6 to 14; in the control group, a personal normal electric breast pump was used from postpartum day 1 to 14. Data recorded included the breast milk volume pumped and milk sodium concentration. Results: The average daily volume of MOM pumped differed statistically (p < 0.05) between the intervention and control groups at postpartum days 7 and 14. The average daily volume pumped did not differ between intervention groups 1 and 2 by postpartum day 14 (p > 0.05). However, the time taken for the sodium concentrations to normalize differed significantly (p < 0.01). At postpartum day 5, the sodium concentrations of 73% of intervention group 1 and 2 mothers were within normal limits, and they were maintained until day 14. In comparison, only 41% of the controls had normal MOM sodium levels on day 5, and they were still high on day 7 in 27.3% of controls. Conclusions: In the early stage of lactation initiation (within 5 days postpartum), using a hospital-grade electric breast pump promotes lactation in mothers who deliver prematurely and the sodium concentrations normalize more quickly. Sodium can be used as an objective biomarker of MOM to evaluate the possibility of delayed lactation in mothers of premature infants, and it could assist interventions in the early postpartum period. Trial Registration: Chinese Clinical Trial Registry, ChiCTR2200061384.
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Affiliation(s)
- Shuiqin Yuan
- NICUs, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Qiufang Li
- Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Hua Wang
- NICUs, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Xinfen Xu
- Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
- Haining Maternal and Child Health Hospital, Branch of Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, China
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12
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Demirci JR, Glasser M, Bogen DL, Sereika SM, Ren D, Ray K, Bodnar LM, O'Sullivan TA, Himes K. Effect of antenatal milk expression education on lactation outcomes in birthing people with pre-pregnancy body mass index ≥25: protocol for a randomized, controlled trial. Int Breastfeed J 2023; 18:16. [PMID: 36927811 PMCID: PMC10019405 DOI: 10.1186/s13006-023-00552-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 02/19/2023] [Indexed: 03/18/2023] Open
Abstract
BACKGROUND Birthing people with pre-pregnancy body mass indices (BMIs) ≥ 25 kg/m2, particularly those without prior breastfeeding experience, are at increased risk for suboptimal lactation outcomes. Antenatal milk expression (AME) may be one way to counteract the negative effects of early infant formula supplementation common in this population. METHODS This ongoing, randomized controlled trial in the United States evaluates the efficacy of a telelactation-delivered AME education intervention versus an attention control condition on lactation outcomes to 1 year postpartum among 280 nulliparous-to-primiparous, non-diabetic birthing people with pre-pregnancy BMI ≥ 25 kg/m2. The assigned study treatment is delivered via four weekly online video consultations between gestational weeks 37-40. Participants assigned to AME meet with study personnel and a lactation consultant to learn and practice AME. Instructions are provided for home practice of AME between study visits. Control group participants view videos on infant care/development at study visits. Participants complete emailed surveys at enrollment (340/7-366/7 gestational weeks) and 2 weeks, 6 weeks, 12 weeks, 6 months, and 12 months postpartum. Surveys assess lactation and infant feeding practices; breastfeeding self-efficacy, attitudes, and satisfaction; perception of insufficient milk; onset of lactogenesis-II; lactation support and problems; and reasons for breastfeeding cessation. Surveys also assess factors associated with lactation outcomes, including demographic characteristics, health problems, birth trauma, racial discrimination, and weight stigma. Health information and infant feeding data are abstracted from the pregnancy and birth center electronic health record. Milk samples are collected from the intervention group at each study visit and from both groups at each postpartum follow-up for future analyses. Qualitative interviews are conducted at 6 weeks postpartum to understand AME experiences. Primary outcomes of interest are breastfeeding exclusivity and breastfeeding self-efficacy scores at 2 weeks postpartum. Outcomes will be examined longitudinally with generalized linear mixed-effects modeling. DISCUSSION This is the first adequately powered trial evaluating the effectiveness of AME among U.S. birthing people and within a non-diabetic population with pre-pregnancy BMI ≥ 25 kg/m2. This study will also provide the first evidence of acceptability and effectiveness of telelactation-delivered AME. TRIAL REGISTRATION ClinicalTrials.gov: NCT04258709.
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Affiliation(s)
- Jill R Demirci
- Department of Health Promotion & Development, University of Pittsburgh School of Nursing, Pittsburgh, PA, USA.
| | - Melissa Glasser
- Department of Health Promotion & Development, University of Pittsburgh School of Nursing, Pittsburgh, PA, USA
| | - Debra L Bogen
- Allegheny County Health Department, Pittsburgh, PA, USA
| | - Susan M Sereika
- Department of Health & Community Systems, University of Pittsburgh School of Nursing, Pittsburgh, PA, USA
| | - Dianxu Ren
- Department of Health & Community Systems, University of Pittsburgh School of Nursing, Pittsburgh, PA, USA
| | - Kristin Ray
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.,UPMC Children's Community Pediatrics, Pittsburgh, PA, USA
| | - Lisa M Bodnar
- Department of Epidemiology, University of Pittsburgh School of Public Health, Pittsburgh, PA, USA
| | - Therese A O'Sullivan
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
| | - Katherine Himes
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Division of Maternal-Fetal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.,UPMC Magee-Womens Hospital, Pittsburgh, PA, USA
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13
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Stipelman CH, Stoddard GJ, Bennion J, Young PC, Brown LL. Real-Time Breastfeeding Documentation: Timing of Breastfeeding Initiation and Outpatient Duration. Acad Pediatr 2023; 23:351-358. [PMID: 35863738 PMCID: PMC10516406 DOI: 10.1016/j.acap.2022.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 07/06/2022] [Accepted: 07/08/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Current breastfeeding guidelines promote initiating breastfeeding ≤1 h after birth to establish long-term breastfeeding. Previous studies dichotomized initiation to ≤1 h versus subsequent hours combined. There are limited data evaluating the effect of initiation in each subsequent hour on breastfeeding duration. Our objective was to evaluate the association between breastfeeding initiated at ≤1 h versus the subsequent 23 hours after birth and outpatient breastfeeding duration. METHODS In this retrospective cohort study, we analyzed real-time, discretely documented electronic health record (EHR) breastfeeding data for 3315 infants born at a university center and followed to age ≥12 mo at 27 university primary care clinics. The primary outcome was breastfeeding duration. The exposure variable was hour of breastfeeding initiation within 24 h postnatally. Data were analyzed by univariable and multivariable linear regression separately for infants born by vaginal versus cesarean delivery. RESULTS In adjusted models, initiating breastfeeding during each hour from age >1 to ≤6 h and during ages >6 to ≤24 h was not associated with decreased breastfeeding duration versus initiating breastfeeding at ≤1 h after birth for infants born via vaginal or cesarean delivery. CONCLUSIONS Delaying breastfeeding initiation to >1 to ≤24 h after birth is not associated with decreased breastfeeding duration compared with initiating breastfeeding at ≤1 h after birth. Integration of breastfeeding measures into inpatient and outpatient EHR discrete data fields may clarify best practices that support long-term breastfeeding as a public health imperative.
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Affiliation(s)
- Carole H Stipelman
- University Pediatric Clinic, Department of Pediatrics (CH Stipelman, PC Young, and LL Brown), University of Utah School of Medicine, Salt Lake City; Sugar House Health Center, Department of Pediatrics (CH Stipelman), University of Utah School of Medicine, Salt Lake City; University Information Technology (CH Stipelman and J Bennion), University of Utah, Salt Lake City.
| | - Gregory J Stoddard
- Department of Internal Medicine (GJ Stoddard), University of Utah School of Medicine, Salt Lake City
| | - Jeff Bennion
- University Information Technology (CH Stipelman and J Bennion), University of Utah, Salt Lake City
| | - Paul C Young
- University Pediatric Clinic, Department of Pediatrics (CH Stipelman, PC Young, and LL Brown), University of Utah School of Medicine, Salt Lake City
| | - Laura L Brown
- University Pediatric Clinic, Department of Pediatrics (CH Stipelman, PC Young, and LL Brown), University of Utah School of Medicine, Salt Lake City
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14
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Bendixen MM, Iapicca LC, Parker LA. Nonpharmacologic Factors Affecting Milk Production in Pump-Dependent Mothers of Critically Ill Infants: State of the Science. Adv Neonatal Care 2023; 23:51-63. [PMID: 36700680 PMCID: PMC9883598 DOI: 10.1097/anc.0000000000000990] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Improved health outcomes for critically ill infants including neurodevelopmental, immunological, and cost benefits are dependent upon the dose and duration of mother's own milk feedings. However, mothers of infants admitted to the neonatal intensive care unit (NICU) must express their milk (pump-dependent) and often struggle with milk production. PURPOSE To examine the state of the science on nonpharmacologic modifiable expression factors that may influence milk production in pump-dependent mothers of critically ill infants admitted to the NICU. DATA SOURCES PubMed, Embase, and CINAHL databases from 2005 to 2020. SEARCH STRATEGY Guided by the lactation conceptual model, the authors searched for peer-reviewed studies with terms related to milk volume, pump dependency, critically ill infants, and modifiable factors, which may influence milk volume and assessed 46 eligible studies. DATA EXTRACTION Data were extracted by 3 reviewers with a systematic staged review approach. RESULTS Evidence from 26 articles found expressed milk volume may be influenced by multiple potentially modifiable factors. Simultaneous expression with a hospital-grade electric pump at least 5 times per day beginning 3 to 6 hours after delivery, and adding complementary techniques including hand expression, hands-on-pumping, music, breast massage, warm compresses, skin-to-skin care, and the mother expressing near her infant may promote increased milk volume. IMPLICATIONS FOR PRACTICE AND RESEARCH Healthcare providers should assist pump-dependent mothers with early initiation and frequent milk removal with a hospital-grade breast pump. Further research is needed to explore optimal frequency of expressions, dose and timing of skin-to-skin care, and other targeted strategies to improve expressed milk volume.
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15
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Kedida MH, Asfaw HM, Abebe F. Factors Associated with an Inadequate Volume of Expressed Milk Among Mothers of Preterm and Low Birth Weight Neonates Admitted to Neonatal Intensive Care Units of Government Hospitals in Addis Ababa, Ethiopia. Pediatric Health Med Ther 2023; 14:1-10. [PMID: 36636558 PMCID: PMC9829976 DOI: 10.2147/phmt.s380807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 12/22/2022] [Indexed: 01/05/2023] Open
Abstract
Background Around 15 million live newborns are born prematurely each year around the world before 37 weeks. One cause of inadequate nursing is prematurity. The goal of this study was to find parameters linked to an insufficient volume of expressed milk among mothers of preterm and low birth weight neonates at government hospitals in Addis Ababa, Ethiopia. Methods An nstitution-based cross-sectional study was conducted on a total of 124 mothers who were available in neonatal intensive care units during the study period in government hospitals that provided such units. Results One-third of the responders (33.9%) were unable to express the necessary amount of milk. An inadequate volume of expressed breast milk was significantly associated with a baby's stable health status (AOR=0.24; CI=0.07-0.86), the fair (subcritical) health status of the baby (AOR=0.178; CI=0.04-0.76), worry about the volume of milk (AOR=7.50; CI=3.32-16.95), and worry about the baby's health status (AOR=4.63; CI=2.21-9.70). Conclusion According to our findings, 33.9% of mothers were unable to express sufficient amounts of milk. To produce an adequate volume of expressed breast milk, health care workers must address mothers' psychological issues in the neonatal intensive care units and give all necessary care to prevent neonatal deterioration.
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Affiliation(s)
- Misgana Hirpha Kedida
- School of Nursing and Midwifery, College Health Science, Addis Ababa University (AAU), Addis Ababa, Ethiopia
| | - Hussen Mekonnen Asfaw
- School of Nursing and Midwifery, College Health Science, Addis Ababa University (AAU), Addis Ababa, Ethiopia,Correspondence: Hussen Mekonnen Asfaw, Email
| | - Fikirtemariam Abebe
- School of Nursing and Midwifery, College Health Science, Addis Ababa University (AAU), Addis Ababa, Ethiopia
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16
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Anderson LA, Kildea S, Kynoch K, Gao Y, Lee N. Midwives experiences of interventions to improve breast expression following preterm birth: A qualitative study. Midwifery 2023; 116:103530. [PMID: 36334529 DOI: 10.1016/j.midw.2022.103530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 10/03/2022] [Accepted: 10/20/2022] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Preterm birth impacts approximately 10% of women globally. Midwives are often the first point of care after the birth of a preterm infant providing mothers with information and support for breast expression. However, despite guidelines that suggest expression within the first hour of birth, most first expressions occur much later. This study aimed to seek an understanding of midwives' experiences with the first expression for mothers of preterm infants, including the barriers and facilitators that midwives may face. DESIGN A qualitative design using semi-structured interviews via focus groups. Thematic analysis was used to identify relevant themes and sub-themes. PARTICIPANTS Participants included midwives providing care to women in preterm labour and birth at a tertiary maternity hospital in Australia (N=12). All participating midwives cared for mothers of preterm infants between 28 and 35 weeks' gestation up to six hours following birth. FINDINGS Two major themes resulted from the data, including the changing expectations of infant feeding and the responsibility versus expectation to support a woman to express in the first hour of birth with other competing clinical and organisational tasks. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE Whilst individual philosophies on the benefits of human milk were positive, expressing in the birth suite was dictated by essential clinical tasks and by the institutions value placed on expressing in the first hour. Clear objectives to undertake expressing within the first hour or within the birth suite stay, need to be included in policy and supported by management and team leaders, to increase early expressing rates.
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Affiliation(s)
- Loretta A Anderson
- School of Nursing, Midwifery and Social Work, University of Queensland, Level 3 Chamberlain Building, St Lucia, Australia.
| | - Sue Kildea
- Molly Wardaguga Research Centre, College of Nursing and Midwifery, Charles Darwin University, Alice Springs Campus, NT, Australia
| | - Kathryn Kynoch
- Mater Health and QLD Centre for Evidence Based Nursing and Midwifery: A JBI Centre of Excellence, South Brisbane, QLD, Australia; Australian Centre for Health Services Innovation (AusHSI) and School of Public Health and Social Work, Queensland University of Technology, Kelvin Grove, QLD, Australia
| | - Yu Gao
- Molly Wardaguga Research Centre, College of Nursing and Midwifery, Charles Darwin University, Brisbane Campus, Brisbane, Australia
| | - Nigel Lee
- School of Nursing, Midwifery and Social Work, University of Queensland, Level 3 Chamberlain Building, St Lucia, Australia
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17
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Raymond M, Gudmundson B, Seshia MM, Helewa M, Alvaro R, Day C, Yoon EW, Pylypjuk CL. Perinatal Factors Associated With Breastfeeding Trends After Preterm Birth <29 Weeks Gestation: Can We Predict Early Discontinuation? JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2023; 45:27-34. [PMID: 36436805 DOI: 10.1016/j.jogc.2022.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 11/02/2022] [Accepted: 11/03/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To determine the rates and perinatal factors associated with initiation and early discontinuation of breastfeeding among very preterm neonates. METHODS This was a retrospective cohort study of very preterm infants (<29 weeks gestation) admitted to 2 regional Level III neonatal intensive care units (NICUs) from January 1, 2015, to December 31, 2019. A national neonatal database was used to evaluate initiation and continuation rates of breastfeeding and associated perinatal factors. Stored nutrition profiles and delivery record books were used to determine feeding volumes associated with continuation of breastfeeding to hospital discharge for a subgroup of infants at a single site. Descriptive and inferential statistics were used to present the results between groups, and logistic regression modeling was used to calculate crude and adjusted odds ratios (OR) and 95% CI. RESULTS Of 391 eligible neonates, 84% initiated breastfeeding but only 38% continued to discharge. Interestingly, frequency of breastfeeding initiation (P < 0.001) and continuation (P < 0.001) declined over the study period. After adjustment for confounders, younger maternal age, earlier gestational age, cigarette smoking, and multiparity were significantly associated with early discontinuation of breastfeeding prior to hospital discharge. Early discontinuation of breastfeeding was also related to lower volumes of breastmilk by day 7 of life (P = 0.004). CONCLUSION Very preterm neonates are at high risk for non-initiation and early discontinuation of breastfeeding. The early postnatal period represents a critical time to establish breastmilk volumes, and the identification of key perinatal risk factors allows for early and targeted breastfeeding support.
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Affiliation(s)
- Meg Raymond
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Manitoba, Winnipeg, MB.
| | | | - Mary M Seshia
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB
| | - Michael Helewa
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Manitoba, Winnipeg, MB
| | - Ruben Alvaro
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB
| | - Chelsea Day
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Manitoba, Winnipeg, MB; Children's Hospital Research Institute of Manitoba, Winnipeg, MB
| | - Eugene W Yoon
- Maternal-infant Care Research Centre of Mount Sinai Hospital in Toronto, Toronto, ON
| | - Christy L Pylypjuk
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Manitoba, Winnipeg, MB; Children's Hospital Research Institute of Manitoba, Winnipeg, MB
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18
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Tanaka R, Horiuchi S. Benefits and issues of education program for nurse-midwives on milk expression care for preterm mothers in postpartum period. Heliyon 2022; 8:e11072. [PMID: 36299512 PMCID: PMC9589177 DOI: 10.1016/j.heliyon.2022.e11072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 10/08/2022] [Accepted: 10/10/2022] [Indexed: 11/06/2022] Open
Abstract
Background and aims Breastfeeding is important for preterm mothers and infants. However, evidence-based practice and standardized education remain inadequate. To implement evidence-based practice, continuous education is mandatory for nurse-midwives. We previously implemented our developed education program on early essential milk expression care for preterm mothers among Japanese nurse-midwives. Herein, we aimed to assess the effects of our education program on nurse-midwives' knowledge of milk expression care for preterm mothers in terms of changes in their correct answer rates for 20 specific knowledge items before and after the education program implementation. We also aimed to identify program-related issues from nurse-midwives' comments to improve the program. Methods We conducted a secondary analysis of our previous data and surveyed the knowledge of 36 nurse-midwives who received a similar face-to-face education program on milk expression care for mothers three months before (Pre-1), just before (Pre-2), just after (Post-1), and three months after (Post-2) the program. We obtained their comments at Post-2 and identified issues for program improvement. Results The knowledge items, in which the correct answer rates of Post-1 were significantly higher than those of Pre-2, were Verification of the motivation and intent, Benefits of breastfeeding for mothers and infants, Milk volume on the fourth day and at around the second week after birth, Lactogenesis stage 3, Autocrine control, Time between birth and the initiation of milk expression, Early initiation of milk expression, Frequent milk expression, and Duration of pumping. The issues identified were practical training, knowledge retention, and misunderstanding knowledge. Conclusions Nurse-midwives' unacquired knowledge of milk expression care for preterm mothers was effectively supplemented by the education program. Pre-education knowledge items with low correct answer rates must be strengthened during in-service education. Practical training, knowledge retention, and misunderstanding knowledge can be improved.
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Affiliation(s)
- Rie Tanaka
- Graduate Course of Midwifery, Teikyo University, Tokyo, Japan,Corresponding author.
| | - Shigeko Horiuchi
- Graduate School of Nursing Science, St. Luke’s International University, Tokyo, Japan
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19
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A report on parent involvement in planning a randomised controlled trial in neonatology and lactation – insights for current and future research. Int Breastfeed J 2022; 17:69. [PMID: 36104819 PMCID: PMC9472727 DOI: 10.1186/s13006-022-00509-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 08/25/2022] [Indexed: 11/25/2022] Open
Abstract
Background Patient and Public Involvement (PPI) is a rich and valuable part of the process of planning, designing, carrying out and disseminating research. It is important to communicate PPI findings in detail so that the contributions of those involved are fully utilised and disseminated. The extended and iterative PPI process used within a neonatal randomised controlled trial related to the expression of breastmilk after very preterm birth is reported here. Methods Seven iterative stages of PPI were used. Stage 1 was informal PPI using historical interaction with parents and publicly available resources. Stage 2 was an online questionnaire open to parents of premature babies and advertised via a charity collaborator. Stage 3 was partnership with a charity collaborator. Stage 4 was a set of online panels focusing on study design and documents. Stage 5 was an interactive exercise to modify the trial intervention. Stage 6 is the presence of PPI contributors on the trial steering committee. Stage 7 is a dissemination panel. At each stage attention was paid to the diversity of participants involved, with strategies to increase the involvement of parents from under-reached groups. Results Six hundred and seventy-five participants responded at Stage 2, six parents were involved at Stage 4 and 12 parents at Stage 5. PPI contributed to the choice of study question, outcomes and produced a set of questions for future research. PPI impacted on the study design, with specific emphasis on reducing participant distress related to lactation, and reducing the burden of being involved in research at a time of significant stress. Conclusions PPI had a far-reaching influence on this neonatal randomised controlled trial during the planning and design phase, which reinforces the importance of PPI at the earliest stages of the research cycle. The online questionnaire format elicited an unexpectedly deep and broad pool of transferable insights, which will have an impact on future research focus and design in the area of lactation and prematurity. Approaches to increasing PPI involvement from under-reached populations are important and can be successful despite resource constraints. Supplementary Information The online version contains supplementary material available at 10.1186/s13006-022-00509-1.
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20
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Chauhan A, Kumar M, Tripathi S, Singh SN, Singh VK. Breastfeeding rates at discharge for very low birthweight neonates and their determinants: An observational study from a tertiary care neonatal intensive care unit in India. J Paediatr Child Health 2022; 58:1653-1660. [PMID: 35778999 DOI: 10.1111/jpc.16074] [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: 01/18/2022] [Revised: 04/22/2022] [Accepted: 04/27/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Mother's milk is the best milk for neonates. Preterm very low birthweight (VLBW) neonates face many challenges leading to low rates of breastfeeding at discharge. AIMS (i) To determine the proportion of <32 weeks preterm VLBW neonates who are exclusively breastfed (EB) at discharge and (ii) determinants of exclusive breastfeeding (EBF) at discharge. METHODS An observational study was conducted for a duration of 1 year, from May 2019 to April 2020 in a tertiary care neonatal intensive care unit (NICU) in North India. Consecutive <32 weeks preterm VLBW neonates admitted within 72 h of birth and on full enteral feeds (FEF) within 10 days of birth were included in this study and followed up till discharge. RESULTS Forty-four of 97 (45.4%) preterm VLBW neonates were exclusively breastfed and 31/97 (32%) received more than 80% mother's own milk (MOM) at discharge. Male sex (P = 0.03), those whose first feed had any amount of MOM (P = 0.038) or exclusive MOM in their first feed or when initiated on first FEF (P = 0.002), and neonates with longer duration of hospital stay (P = 0.035) had an increased chance of being exclusively breastfed at discharge. CONCLUSION Preterm VLBW neonates who receive any amount of MOM in their first feed or first FEF, male infants and those who stay longer in hospital are more likely to be exclusively breastfed at discharge.
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Affiliation(s)
- Avantika Chauhan
- Department of Pediatrics, King Georges' Medical University, Lucknow, India
| | - Mala Kumar
- Department of Pediatrics, King Georges' Medical University, Lucknow, India
| | - Shalini Tripathi
- Department of Pediatrics, King Georges' Medical University, Lucknow, India
| | - Shakal N Singh
- Department of Pediatrics, King Georges' Medical University, Lucknow, India
| | - Vijay K Singh
- Department of Community Medicine, King Georges' Medical University, Lucknow, India
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21
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Balasundaram M, Land R, Miller S, Profit J, Porter M, Arnold C, Sivakumar D. Increasing early exposure to mother's own milk in premature newborns. J Perinatol 2022; 42:1126-1134. [PMID: 35396577 DOI: 10.1038/s41372-022-01376-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 03/02/2022] [Accepted: 03/17/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Increase the proportion of ≤33 weeks newborns exposed to mother's own milk (MOM) oral care by 12 h of age by 20% over 2 years to support a healthier microbiome. STUDY DESIGN We implemented interventions to support early expression of colostrum and reliable delivery of resultant MOM to premature newborns. Statistical process control charts were used to track progress and provide feedback to staff. Proportions of newborns exposed to MOM by 12 h were compared relative to baseline. RESULTS There were 46, 66, and 46 newborns in the baseline, implementation, and sustainability periods, respectively. The primary outcome improved from 48% to 61% in the implementation period (relative change 1.27, 95% CI 0.89, 1.81, p = 0.2), to 69% in sustainability period (relative to baseline 1.45, 95% CI 1.02, 2.08, p = 0.03). CONCLUSION An interdisciplinary team-based, multicycle, quality improvement intervention resulted in increased rates of early exposure to MOM.
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Affiliation(s)
- Malathi Balasundaram
- Division of Neonatal & Developmental Medicine, Stanford University School of Medicine, Palo Alto, CA, USA. .,Neonatal Intensive Care Unit, El Camino Health, Mountain View, CA, USA.
| | - Rachel Land
- Division of Neonatal & Developmental Medicine, Stanford University School of Medicine, Palo Alto, CA, USA.,Neonatal Intensive Care Unit, El Camino Health, Mountain View, CA, USA
| | - Stephanie Miller
- Division of Neonatal & Developmental Medicine, Stanford University School of Medicine, Palo Alto, CA, USA.,Neonatal Intensive Care Unit, El Camino Health, Mountain View, CA, USA
| | - Jochen Profit
- Division of Neonatal & Developmental Medicine, Stanford University School of Medicine, Palo Alto, CA, USA.,California Perinatal Quality Care Collaborative, Palo Alto, CA, USA
| | - Melinda Porter
- Neonatal Intensive Care Unit, El Camino Health, Mountain View, CA, USA
| | - Cody Arnold
- Division of Neonatal & Developmental Medicine, Stanford University School of Medicine, Palo Alto, CA, USA.,Neonatal Intensive Care Unit, El Camino Health, Mountain View, CA, USA
| | - Dharshi Sivakumar
- Division of Neonatal & Developmental Medicine, Stanford University School of Medicine, Palo Alto, CA, USA.,Neonatal Intensive Care Unit, El Camino Health, Mountain View, CA, USA
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22
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Demirci JR, Glasser M, Himes KP, Sereika SM. Structured antenatal milk expression education for nulliparous pregnant people: results of a pilot, randomized controlled trial in the United States. Int Breastfeed J 2022; 17:50. [PMID: 35799299 PMCID: PMC9261047 DOI: 10.1186/s13006-022-00491-8] [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: 08/27/2021] [Accepted: 06/22/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hand-expression, collection, and storage of breast milk during pregnancy (i.e., antenatal milk expression or AME) is a safe, potentially effective practice to reduce early, undesired infant formula supplementation among women with diabetes. The feasibility and potential impact of AME on lactation outcomes in the United States (U.S.) and among non-diabetic birthing people is unknown. METHODS The purpose of this study was to examine the feasibility of a structured AME intervention among nulliparous birthing people in the United States. We recruited 45 low-risk, nulliparous individuals at 34-366/7 weeks of gestation from a hospital-based midwife practice. Participants were randomized to AME or a control group receiving lactation education handouts. Interventions were delivered at weekly visits at 37-40 weeks of pregnancy. The AME intervention involved technique demonstration and feedback from a lactation consultant and daily independent practice. Lactation outcomes were assessed during the postpartum hospitalization, 1-2 weeks postpartum, and 3-4 months postpartum. RESULTS Between December 2016 and February 2018, 63 individuals were approached and screened for eligibility, and 45 enrolled into the study (71%). Of 22 participants assigned to AME, 18 completed at least one AME study visit. Participants reported practicing AME on at least 60% of days prior to their infant's birth. Most were able to express milk antenatally (15/18), more than half collected and froze antenatal milk (11/18), and 39% (7/18) supplemented their infants with antenatal milk after birth. No major problems were reported with AME. Perinatal and lactation outcomes, including infant gestational age at birth, neonatal intensive care unit admissions, delayed onset of lactogenesis II, and use of infant formula were similar between AME and control groups. Among participants in both groups who were feeding any breast milk at each assessment, breastfeeding self-efficacy increased and perceptions of insufficient milk decreased over the postpartum course. CONCLUSIONS In a small group of nulliparous birthing people in the U.S., AME education and independent practice beginning at 37 weeks of pregnancy was feasible. In some cases, AME provided a back-up supply of milk when supplementation was indicated or desired. The relationship between AME and lactation outcomes requires further study with adequately powered samples. TRIAL REGISTRATION This trial was retrospectively registered at ClinicalTrials.gov on May 11, 2021 under the following registration ID: NCT04929301. https://clinicaltrials.gov/ct2/show/NCT04929301 .
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Affiliation(s)
- Jill R Demirci
- Department of Health Promotion & Development, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Melissa Glasser
- Department of Health Promotion & Development, University of Pittsburgh, Pittsburgh, PA, USA
| | - Katherine P Himes
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Division of Maternal-Fetal Medicine, University of Pittsburgh, Pittsburgh, PA, USA.,UPMC Magee-Womens Hospital, Pittsburgh, PA, USA
| | - Susan M Sereika
- Department of Health & Community Systems, University of Pittsburgh, Pittsburgh, PA, USA
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Abstract
INTRODUCTION Mother's own milk improves health outcomes in infants of all gestational ages. Although pump-dependent mothers of extremely premature infants are at risk of insufficient milk production, whether mother's milk production is impacted by gestational age and pump dependency in mothers of more mature critically ill infants is unknown. PURPOSE To determine whether there is a relationship between gestational age, milk production, and time to secretory activation in mothers delivering a critically ill infant. METHODS A convenience sample of 136 pump-dependent mothers whose infants were admitted to the neonatal intensive care unit was enrolled between 2013 and 2016 as part of a quality improvement project. Group 1 (early preterm) delivered infants at 30 to 33 weeks of gestation (n = 41), group 2 (late preterm) 34 to 36 weeks (n = 48), and group 3 (term) 37 weeks and more (n = 47). Milk volume on days 1 to 7 was measured by weighing each vial of expressed milk and compared using general linear mixed-model analysis. Time to the onset of secretory activation was compared using censored regression analysis. RESULTS Main effect for gestational age controlling for day was statistically significant (P = .0234). The early preterm group produced more milk over the 7-day study than the term (P = .01) and late preterm (P = .02) groups. The early preterm group achieved secretory activation earlier than the late preterm group (adjusted P = .039). IMPLICATIONS FOR PRACTICE Pump-dependent mothers of all infants admitted to the neonatal intensive care unit may be at risk of inadequate milk production and delayed secretory activation and may therefore benefit from early milk production monitoring and lactation support. IMPLICATIONS FOR RESEARCH Further studies should examine targeted interventions to increase milk production in pump-dependent mothers.
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Ozkaya M, Korukcu O. Breast milk expression as a challenge for mothers of premature infants. J OBSTET GYNAECOL 2022; 42:1962-1971. [PMID: 35616235 DOI: 10.1080/01443615.2022.2055454] [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: 10/18/2022]
Abstract
The aim of this study was to examine the psychometric properties of the 11-item Breast Milk Expression Experience Scale and determine the level of breast milk expression experience of mothers after preterm delivery in Turkey. 165 mothers who agreed to participate between February 2019 and March 2020 used the Breast Milk Expression Experience Scale (BMEE-S). The general Cronbach alpha coefficient was 0.82 for the BMEE-S. The fit indices calculated by confirmatory factor analysis were χ2 (41) = 87.95, p = .00003, χ2/sd = 2.15, GFI = 0.91, NNFI = 0.93, CFI = 0.95, RMSEA = 0.08 and SRMR = 0.078. The BMEE-S three-factor structure was verified by the confirmatory factor analysis. The BMEE-S was a valid and reliable instrument for mothers of preterm infants. Multiparity and high-risk pregnancy history negatively affected the milk expression experience, whereas spousal support positively affected it.Impact statementWhat is already known on this subject? The risk of infectious diseases, obesity, diabetes, and impaired intellectual development increases in children who do not breast milk (Verduci et al. 2014). International breastfeeding guidelines recommend supporting all mothers to start breastfeeding within one hour of birth, and counselling mothers who are separated from their babies about expressing milk.What the results of this study add? The breast milk expression experience scale is a valid and reliable tool for women who give preterm birth and express milk. The experience of expressing breast milk can affect the amount of milk that passes from mother to baby. Multiparity and high risk pregnancy history of mothers negatively affects the milk expression experience while husband support positively affects the milk expression experience.What the implications are of these findings for clinical practice and/or further research? Our study provides a quantitative examination of the experiences of mothers who are separated from their babies. The BMEE-S should be adapted to different cultures and the experiences of mothers in this process should be determined.
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Affiliation(s)
- Meltem Ozkaya
- Faculty of Nursing, Akdeniz University, Antalya, Turkey
| | - Oznur Korukcu
- Faculty of Nursing, Akdeniz University, Antalya, Turkey
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25
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Anderson LA, Kildea S, Lee N, Kynoch K, Gao Y. A Comparison of the Timing of Hand Expressing of Human Milk With Breast Massage to Standard Care for Mothers of Preterm Infants: An Exploratory Pilot Using a Randomized Controlled Design. J Hum Lact 2022; 39:226-235. [PMID: 35543459 DOI: 10.1177/08903344221088789] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Globally, 10% of all births are preterm. Access to human milk via manual breast expression is required to reduce the incidence of adverse outcomes related to prematurity. However, there is little evidence to recommend optimum timing to commence breast expression in mothers of preterm infants or the most effective method. RESEARCH AIMS (1) To test feasibility of recruitment and compliance to the protocol and (2) to determine influence of using hand expressing and breast massage on milk production, engorgement, mastitis, and breastfeeding status at 3 months. METHODS This study was an exploratory parallel two-group, pilot randomized controlled trial. Mothers of preterm infants at a metropolitan maternity hospital in Queensland Australia (N = 31) were randomized to receive either hand expressing and breast massage within the 1st hr of birth or standard care, hand expressing within 6 hr of birth, to determine the influence on milk production, engorgement, mastitis, and breastfeeding status at 3 months. RESULTS Feasibility targets were not met; however, valuable learning from this trial uncovered barriers facing midwives in the birth suite to commencing expressing in the 1st hr of birth. There was no difference in occurrence of secondary outcomes, although trends support future study. CONCLUSIONS Overall, unpredictability of preterm birth influenced our ability to recruit participants. Important directions for future study design would benefit from incorporating expressing times up to 6 hr with a replicable breast massage.
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Affiliation(s)
- Loretta A Anderson
- School of Nursing Midwifery and Social Work, University of Queensland, St Lucia, QLD, Australia
| | - Sue Kildea
- Molly Wardaguga Research Centre, College of Nursing and Midwifery, Charles Darwin University, Casuarina, NT, Australia.,Mater Research, School of Nursing Midwifery and Social Work, University of Queensland, South Brisbane, QLD, Australia
| | - Nigel Lee
- School of Nursing Midwifery and Social Work, University of Queensland, St Lucia, QLD, Australia
| | - Kathryn Kynoch
- Mater Health and QLD Centre for Evidence Based Nursing and Midwifery: A JBI Centre of Excellence, South Brisbane, QLD, Australia.,Australian Centre for Health Services Innovation (AusHSI) and School of Public Health and Social Work, Queensland University of Technology, Kelvin Grove, QLD, Australia
| | - Yu Gao
- Molly Wardaguga Research Centre, College of Nursing and Midwifery, Charles Darwin University, Casuarina, NT, Australia.,Mater Research, School of Nursing Midwifery and Social Work, University of Queensland, South Brisbane, QLD, Australia
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26
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Scholten N, Mause L, Horenkamp-Sonntag D, Klein M, Dresbach T. Initiation of lactation and the provision of human milk to preterm infants in German neonatal intensive care units from the mothers' perspective. BMC Pregnancy Childbirth 2022; 22:158. [PMID: 35216574 PMCID: PMC8881865 DOI: 10.1186/s12884-022-04468-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 02/07/2022] [Indexed: 11/25/2022] Open
Abstract
Background If infants with a very low birth weight (VLBW) are to be fed exclusively with human milk, it is essential to focus on lactation initiation. The aim of the study is to learn more about the current state of lactation initiation and human milk provision in neonatal intensive care units in Germany from the mothers' perspective. Methods Written surveys were conducted with mothers of VLBW infants to learn more about the timing of initiation of lactation, pumping frequency during the first three days postpartum and feeding of the preterm infant during hospitalisation. Results The data of 437 mothers (response rate: 44.7%) were included in the analyses. Of these, only 7.8% stated that they had initiated lactation immediately after delivery and 38.2% within 6 h. In terms of pumping frequency, 50.1% pumped 7–9 times a day within the first 3 days postpartum; 60.9% reported that their infant received formula feedings during the hospital stay. Conclusion Overall, deficits were still evident with regard to the initiation of lactation in mothers of VLBW infants in Germany, resulting in a large proportion of VLBW infants receiving formula in the hospital. Trial registration German Clinical Trial Register: DRKS00017755.
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Affiliation(s)
- N Scholten
- Institute of Medical Sociology Health Services Research and Rehabilitation Science, Faculty of Human Sciences and Faculty of Medicine, University of Cologne, Cologne, Germany.
| | - L Mause
- Institute of Medical Sociology Health Services Research and Rehabilitation Science, Faculty of Human Sciences and Faculty of Medicine, University of Cologne, Cologne, Germany
| | | | - M Klein
- DAK Gesundheit, Hamburg, Germany
| | - T Dresbach
- Department of Neonatology and Pediatric Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
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27
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Gato S, Biziyaremye F, Kirk CM, De Sousa CP, Mukuralinda A, Habineza H, Asir M, de Silva H, Manirakiza ML, Karangwa E, Nshimyiryo A, Tugume A, Beck K. Promotion of early and exclusive breastfeeding in neonatal care units in rural Rwanda: a pre- and post-intervention study. Int Breastfeed J 2022; 17:12. [PMID: 35193639 PMCID: PMC8864904 DOI: 10.1186/s13006-022-00458-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 02/08/2022] [Indexed: 11/27/2022] Open
Abstract
Background Early initiation of breastfeeding after birth and exclusive breastfeeding for the first six months improves child survival, nutrition and health outcomes. However, only 42% of newborns worldwide are breastfed within the first hour of life. Small and sick newborns are at greater risk of not receiving breastmilk and often require additional support for feeding. This study compares breastfeeding practices in Rwandan neonatal care units (NCUs) before and after the implementation of a package of interventions aimed to improve breastfeeding. Methods This pre-post intervention study was conducted at two district hospital NCUs in rural Rwanda from October–December 2017 (pre-intervention) and September 2018–March 2019 (post-intervention). Only newborns admitted before their second day of life (DOL) were included. Data were extracted from patient charts for clinical and demographic characteristics, feeding, and patient outcomes. Exclusive breastfeeding at discharge was based on last recorded infant feeding on the day of discharge. Logistic regression analysis was used to evaluate factors associated with exclusive breastfeeding at discharge. Results Pre-intervention, 255 newborns were admitted in the NCUs and 793 were admitted in post-intervention. Exclusive breastfeeding on the day of birth (DOL0) increased from 5.4% (12/255) to 35.9% (249/793). At discharge, exclusive breastfeeding increased from 69.6% (149/214) to 87.0% (618/710). The mortality rate decreased from 16.1% (41/255) to 10.5% (83/793). Factors associated with greater odds of exclusive breastfeeding at discharge included admission during the post-intervention period (aOR 4.91; 95% CI 1.99, 12.11), and admission for infection (aOR 2.99; 95% CI 1.13, 7.93). Home deliveries (aOR 0.15; 95% CI 0.05, 0.47), preterm delivery (aOR 0.36; 95% CI 0.15, 0.87) and delayed first breastmilk feed (aOR 0.04 for DOL3 vs. DOL0; 95% CI 0.01, 0.35) reduced odds of exclusive breastfeeding at discharge. Conclusions Expansion and adoption of evidenced-based guidelines, using innovative approaches, aimed at the unique needs of small and sick newborns may help to improve earlier initiation of breastfeeding, decrease mortality, and improve exclusive breastfeeding on discharge from hospital among small and sick newborns. These interventions should be replicated in similar settings to determine their effectiveness.
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Affiliation(s)
- Saidath Gato
- Partners In Health/Inshuti Mu Buzima, Rwinkwavu, Rwanda.
| | | | | | - Chiquita Palha De Sousa
- Partners In Health/Inshuti Mu Buzima, Rwinkwavu, Rwanda.,Boston Children's Hospital, Boston, USA
| | | | | | | | | | | | | | | | - Alex Tugume
- Rwinkwavu District Hospital, Ministry of Health, Kigali, Rwanda
| | - Kathryn Beck
- Partners In Health/Inshuti Mu Buzima, Rwinkwavu, Rwanda
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28
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Dong D, Ru X, Huang X, Sang T, Li S, Wang Y, Feng Q. A prospective cohort study on lactation status and breastfeeding challenges in mothers giving birth to preterm infants. Int Breastfeed J 2022; 17:6. [PMID: 35012631 PMCID: PMC8751123 DOI: 10.1186/s13006-021-00447-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 12/26/2021] [Indexed: 11/18/2022] Open
Abstract
Background Mothers of preterm infants face many challenges in breastfeeding, especially regarding lactation. This study aimed to investigate the lactation status and challenges in breastfeeding faced by preterm infants’ mothers. Methods We approached 124 mothers who gave birth to preterm infants between 26 May and 31 October 2018 in a tertiary hospital in China. Lactation status and challenges in breastfeeding on day 7 postpartum, at discharge of infants, 2 weeks post-discharge, and 3 months of corrected age were collected using questionnaires. The area under the receiver operating characteristic (ROC) curve for expressed milk volume on day 7 postpartum for predicting expressed milk volume ≥ 300 mL/d at discharge was calculated. Logistic regression analyses were performed to identify factors associated with delayed lactogenesis II onset and continuation of breastfeeding at 3 months of corrected age. Results Seventy mothers were enrolled, and 51.4% had delayed lactogenesis II. Multivariate logistic regression analysis revealed that older maternal age (aOR = 1.19; 95% CI: 1.01, 1.40) and first live birth (aOR = 4.81; 95% CI 1.43, 16.18) were significant independent predictors of delayed lactogenesis II. Mothers with delayed lactogenesis II had significantly lower expressed milk volume (day 7 postpartum: 160.0 mL vs. 300.0 mL, U = 328.50, p = 0.001; at discharge: 425.0 mL vs. 612.5 mL, U = 372.00, p = 0.005), with a lower proportion of exclusive breastfeeding in their infants (at discharge: 33.3% vs. 69.8%, χ2 = 12.39, df = 1, p < 0.001; 3 months of corrected age: 17.8% vs. 52.8%, χ2 = 11.03, df = 1, p = 0.001). The ROC showed that expressed milk volume > 190 mL/d on day 7 postpartum significantly predicted expressed milk volume ≥ 300 mL/d at discharge. Insufficient human milk was the main reason for breastfeeding discontinuation at 3 months of corrected age. Twins were less likely to continue breastfeeding at 3 months of corrected age (aOR = 0.27; 95% CI 0.09, 0.86). In singleton infants, mother’s own milk ≥50% of total milk uptake at 2 weeks post-discharge (aOR = 32.66; 95% CI 3.00, 355.25) was an independent predictor of continuous breastfeeding at 3 months of corrected age. Feeding complications in infants, poor breastfeeding technique, and low milk output are the main challenges in breastfeeding. Conclusion Interventions to improve early postpartum lactation and breastfeeding techniques may increase breastfeeding adoption in mothers of preterm infants. Supplementary Information The online version contains supplementary material available at 10.1186/s13006-021-00447-4.
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Affiliation(s)
- Dingding Dong
- Department of Pediatrics, Peking University First Hospital, No.1 Xi'anmen Street, Xicheng District, Beijing, China
| | - Xifang Ru
- Department of Pediatrics, Peking University First Hospital, No.1 Xi'anmen Street, Xicheng District, Beijing, China
| | - Xiaofang Huang
- Department of Pediatrics, Peking University First Hospital, No.1 Xi'anmen Street, Xicheng District, Beijing, China
| | - Tian Sang
- Department of Pediatrics, Peking University First Hospital, No.1 Xi'anmen Street, Xicheng District, Beijing, China
| | - Shan Li
- Department of Pediatrics, Peking University First Hospital, No.1 Xi'anmen Street, Xicheng District, Beijing, China
| | - Ying Wang
- Department of Pediatrics, Peking University First Hospital, No.1 Xi'anmen Street, Xicheng District, Beijing, China
| | - Qi Feng
- Department of Pediatrics, Peking University First Hospital, No.1 Xi'anmen Street, Xicheng District, Beijing, China.
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29
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Johnson TJ, Meier PP, Schoeny ME, Bucek A, Janes JE, Kwiek JJ, Zupancic JAF, Keim SA, Patel AL. Study protocol for reducing disparity in receipt of mother's own milk in very low birth weight infants (ReDiMOM): a randomized trial to improve adherence to sustained maternal breast pump use. BMC Pediatr 2022; 22:27. [PMID: 34996401 PMCID: PMC8739536 DOI: 10.1186/s12887-021-03088-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 12/22/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Black very low birth weight (VLBW; < 1500 g birth weight) and very preterm (VP, < 32 weeks gestational age, inclusive of extremely preterm, < 28 weeks gestational age) infants are significantly less likely than other VLBW and VP infants to receive mother's own milk (MOM) through to discharge from the neonatal intensive care unit (NICU). The costs associated with adhering to pumping maternal breast milk are borne by mothers and contribute to this disparity. This randomized controlled trial tests the effectiveness and cost-effectiveness of an intervention to offset maternal costs associated with pumping. METHODS This randomized control trial will enroll 284 mothers and their VP infants to test an intervention (NICU acquires MOM) developed to facilitate maternal adherence to breast pump use by offsetting maternal costs that serve as barriers to sustaining MOM feedings and the receipt of MOM at NICU discharge. Compared to current standard of care (mother provides MOM), the intervention bundle includes three components: a) free hospital-grade electric breast pump, b) pickup of MOM, and c) payment for opportunity costs. The primary outcome is infant receipt of MOM at the time of NICU discharge, and secondary outcomes include infant receipt of any MOM during the NICU hospitalization, duration of MOM feedings (days), and cumulative dose of MOM feedings (total mL/kg of MOM) received by the infant during the NICU hospitalization; maternal duration of MOM pumping (days) and volume of MOM pumped (mLs); and total cost of NICU care. Additionally, we will compare the cost of the NICU acquiring MOM versus NICU acquiring donor human milk if MOM is not available and the cost-effectiveness of the intervention (NICU acquires MOM) versus standard of care (mother provides MOM). DISCUSSION This trial will determine the effectiveness of an economic intervention that transfers the costs of feeding VLBWand VP infants from mothers to the NICU to address the disparity in the receipt of MOM feedings at NICU discharge by Black infants. The cost-effectiveness analysis will provide data that inform the adoption and scalability of this intervention. TRIAL REGISTRATION ClinicalTrials.gov: NCT04540575 , registered September 7, 2020.
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Affiliation(s)
- Tricia J Johnson
- Department of Health Systems Management, Rush University, 1700 West Van Buren Street, TOB Suite 126B, Chicago, USA.
| | - Paula P Meier
- Department of Pediatrics, Rush University Medical Center, Chicago, USA.,College of Nursing, Rush University, Chicago, USA
| | - Michael E Schoeny
- Department of Community, Systems and Mental Health Nursing, Rush University, Chicago, USA
| | - Amelia Bucek
- Department of Pediatrics, Rush University Medical Center, Chicago, USA
| | - Judy E Janes
- Department of Pediatrics, Rush University Medical Center, Chicago, USA
| | - Jesse J Kwiek
- Department of Microbiology, The Center for Retrovirus Research and the Infectious Disease Institute, The Ohio State University, Columbus, USA
| | - John A F Zupancic
- Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, USA.,Harvard Medical School, Boston, USA
| | - Sarah A Keim
- Center for Biobehavioral Health, The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, USA.,Department of Pediatrics, The Ohio State University College of Medicine, Columbus, USA.,Division of Epidemiology, The Ohio State University College of Public Health, Columbus, USA
| | - Aloka L Patel
- Department of Pediatrics, Rush University Medical Center, Chicago, USA
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30
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Wang L, He J. Exclusive breastfeeding of full-term infants during the first 6 months after discharge from a neonatal unit in China: A cross-sectional study. Jpn J Nurs Sci 2021; 19:e12466. [PMID: 34931439 DOI: 10.1111/jjns.12466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 11/22/2021] [Accepted: 11/26/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To elucidate breastfeeding patterns, the reasons for stopping exclusive breastfeeding, and the sociodemographic characteristics associated with exclusive breastfeeding of full-term infants during the 6 months after discharge from a neonatal unit in China. METHODS This cross-sectional study included mothers of full-term infants who were discharged from the 40-bed neonatal unit (level IIA) of a tertiary hospital in Hunan province, China between August 2019 and September 2020. Information on breastfeeding patterns was collected through telephone interviews with the mothers 6 months after their infants had been discharged from the neonatal unit. Binary logistic regression was used to determine the factors associated with exclusive breastfeeding. RESULTS This study included 489 mother-infant dyads. At 6 months after discharge, 51.5% of mothers were exclusively breastfeeding, 29.0% of mothers were partially breastfeeding, and 19.4% of mothers were not breastfeeding. The most common reason for stopping breastfeeding was "poor milk supply" (81.2%). Factors associated with exclusive breastfeeding included multiparity, exclusive breastfeeding before the hospitalization, providing breast milk to the hospitalized infant, and a high level of maternal education. CONCLUSIONS In the Chinese culture, mothers who experienced multiparity and higher-level education were more likely to breastfeed their infants to 6 months after discharge from the neonatal unit. In addition, infants who were exclusively breastfed before and during hospitalization were also more likely to be exclusively breastfed after discharge. The results will help inform future research aimed at identifying interventions to reduce early breastfeeding cessation.
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Affiliation(s)
- Li Wang
- Nursing Department, Shenzhen University General Hospital, Shen Zhen, China
| | - Junli He
- Department of Pediatrics, Shenzhen University General Hospital, Shen Zhen, China
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31
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Abstract
Mother's own milk provides personalized nutrition and immune protection to the developing infant. The presence of healthy microbes plays an important role in the infant's gut by programming the microbiota and excluding potential pathogens. This review describes the important components in mother's own milk that contribute to its superiority for infant nutrition and suggest potential strategies to replicate these factors in alternative feedings when sufficient milk is unavailable. Current strategies to supplement, substitute and replicate mother's own milk including microbial restoration, use of unpasteurized donor human milk, probiotics and fortification are discussed. Critical work remains to be done in understanding the human milk microbiome and metabolome and in improving lactation support for mothers of preterm infants. Increasing delivery of mother's own milk and milk components to infants would likely positively impact infant mortality and health worldwide.
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Affiliation(s)
- Evon DeBose-Scarlett
- Department of Microbiology and Cell Science, Genetics Institute, Institute of Food and Agricultural Sciences, University of Florida, 2033 Mowry Road Rm 307, Gainesville, FL 32610 USA.
| | - Marion M Bendixen
- College of Nursing, University of Florida, PO Box 100197, Gainesville, FL 32610-0197 USA.
| | - Graciela L Lorca
- Department of Microbiology and Cell Science, Genetics Institute, Institute of Food and Agricultural Sciences, University of Florida, 2033 Mowry Road Rm 307, Gainesville, FL 32610 USA.
| | - Leslie Ann Parker
- College of Nursing, University of Florida, PO Box 100197, Gainesville, FL 32610-0197 USA.
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Bin-Nun A, Kassirer Y, Jarallah Y, Barg M, Mimouni FB, Hammerman C, Sela HY. Early breast expression for very low birth infants admitted to neonatal intensive care unit: the challenges of cesarean deliveries. J Matern Fetal Neonatal Med 2021; 35:8249-8256. [PMID: 34459334 DOI: 10.1080/14767058.2021.1969357] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
AIM OF THE STUDY In preterm infants, the use of human milk is associated with unique benefits. However, successful breast feeding rates and prolonged breastfeeding duration is often reduced in preterm infants. Nevertheless, early initiation of breast expression after birth is believed to be one of the major variables that should improve the odds of successful breastfeeding. Hence, we aimed to assess correlation between timing of milk expression initiation and volume produced in regards to mode-of-delivery. MATERIALS AND METHODS Prospective, observational study. Mothers delivering infants weighing < 1500 g measured 24-h milk volumes on days 1-7, 14, and 21. RESULTS Mothers delivering vaginally (N = 11) expressed milk sooner (3.82 ± 5.03 h) than mothers in the cesarean group (N = 42; 11.5 ± 9.1 h). There were no significant differences in daily number of expressions (i.e. day 1 3.6 ± 1.6 versus 2.5 ± 2.1, p = .125) or daily volume (i.e. day 1 - 7.5 ± 6.1 ml versus 11.6 ± 22.9 ml, p = .563), until day 6 from which, both were lower in the cesarean group (i.e. day 21 - number - 6.0 ± 1.3 versus 4.6 ± 1.7, p = .029; volume - 796 ± 465ml versus 435 ± 368ml, p = .018). Expressed volume initially did not correlate with earlier expression, however, latter expressed volume inversely correlated with earlier expression. In multivariate-analysis, mode of delivery, gestational age, and daily number of expressions were correlated with volumes on day 21 (p = .001). CONCLUSIONS Earlier human-milk expression is related to volumes on the second and the third week of lactation. This is overwhelmed by delivery mode, and by frequent milk expression from day 2. When early milk expression is not possible, more frequent milk expression might help increasing volumes.
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Affiliation(s)
- Alona Bin-Nun
- Shaare Zedek Medical Center, Jerusalem, Israel.,The Faculty of Medicine of the Hebrew University, Jerusalem, Israel
| | | | | | - Moshe Barg
- Shaare Zedek Medical Center, Jerusalem, Israel
| | - Francis B Mimouni
- Shaare Zedek Medical Center, Jerusalem, Israel.,Sackler Faculty of Medicine Tel Aviv University, Tel Aviv, Israel
| | - Cathy Hammerman
- Shaare Zedek Medical Center, Jerusalem, Israel.,The Faculty of Medicine of the Hebrew University, Jerusalem, Israel
| | - Hen Y Sela
- Shaare Zedek Medical Center, Jerusalem, Israel.,The Faculty of Medicine of the Hebrew University, Jerusalem, Israel
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Effects of Total Enteral Nutrition on Early Growth, Immunity, and Neuronal Development of Preterm Infants. Nutrients 2021; 13:nu13082755. [PMID: 34444915 PMCID: PMC8401306 DOI: 10.3390/nu13082755] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 07/23/2021] [Accepted: 07/25/2021] [Indexed: 11/16/2022] Open
Abstract
The feeding of colostrum and mother's transitional milk improves immune protection and neurodevelopmental outcomes. It also helps with gut maturation and decreases the risks of infection. The supply of nutrients from human milk (HM) is not adequate for preterm infants, even though preterm mother's milk contains higher concentrations of protein, sodium, zinc, and calcium than mature HM. The human milk fortifiers, particularly those with protein, calcium, and phosphate, should be used to supplement HM to meet the necessities of preterm infants. The management of fluid and electrolytes is a challenging aspect of neonatal care of preterm infants. Trace minerals such as iron, zinc, copper, iodine, manganese, molybdenum, selenium, chromium, and fluoride are considered essential for preterm infants. Vitamins such as A, D, E, and K play an important role in the prevention of morbidities, such as bronchopulmonary dysplasia, retinopathy of prematurity, and intraventricular hemorrhage. Therefore, supplementation of HM with required nutrients is recommended for all preterm infants.
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Piwoszkin LM, Corley M, Meganathan K, Narendran V, Nommsen-Rivers L, Ward LP. Predictors of the Provision of Mother's Milk Feedings in Newborns Admitted to the Neonatal Intensive Care Unit. Breastfeed Med 2021; 16:640-647. [PMID: 33835834 DOI: 10.1089/bfm.2020.0284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background: Breast milk reduces morbidity and mortality in infants admitted to neonatal intensive care unit (NICU). Objectives: We determined predictors of procuring mother's own milk (MOM) among NICU-admitted newborn-mother dyads: (1) initiation of any milk expression; (2) initiation of milk expression within 6 hours of birth; (3) MOM as the first enteral feeding; (4) colostrum for oral care within 36 hours of birth if not yet orally fed; and (5) provision of MOM at 21 days of life or discharge, whichever occurred first. Methods: We performed a retrospective chart review of NICU-admitted newborn-mother dyads at an urban medical center from June 1, 2018-May 31, 2019. We excluded infants not directly admitted to the NICU, those never enterally fed, multiple gestations if not the first to be discharged, and infants discharged to a nonbiological caregiver. We used chi-square analysis to examine unadjusted associations between independent variables and MOM outcomes and then used logistic regression to determine the adjusted odds ratio and 95% confidence interval (AOR [95% CI]) for predictors of MOM outcomes. Results: There were 341 mother-infant dyads who met inclusion criteria and 71% of these mothers initiated milk expression. Smoking, multiparity, gestational diabetes, and Hepatitis C lowered the odds for at least one MOM outcome; whereas mothers who delivered at 28-32 weeks versus ≥33 weeks, and infants with birthweight <1,500 g versus 1,500-2,500 g had higher odds for at least one MOM outcome. Conclusion: Maternal/infant dyad characteristics may predict some, but not all NICU breastfeeding outcomes. This suggests that hospital practices may influence these outcomes and can inform future interventions.
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Affiliation(s)
- Lisa Marie Piwoszkin
- Division of Neonatology and Pulmonary Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Megan Corley
- Department of Rehabilitation, Exercise, and Nutrition, University of Cincinnati College of Allied Health Sciences, Cincinnati, Ohio, USA
| | - Karthikeyan Meganathan
- Department of Analytical and Diagnostic Sciences, University of Cincinnati, Cincinnati, Ohio, USA
| | - Vivek Narendran
- Division of Neonatology and Pulmonary Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
| | - Laurie Nommsen-Rivers
- Department of Rehabilitation, Exercise, and Nutrition, University of Cincinnati College of Allied Health Sciences, Cincinnati, Ohio, USA
| | - Laura P Ward
- Division of Neonatology and Pulmonary Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
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Parker LA, Sullivan S, Cacho N, Engelmann C, Krueger C, Mueller M. Indicators of Secretory Activation in Mothers of Preterm Very Low Birth Weight Infants. J Hum Lact 2021; 37:581-592. [PMID: 33351691 DOI: 10.1177/0890334420980424] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Inconsistent information exists regarding indicators of secretory activation in mothers delivering very low birth weight infants. RESEARCH AIMS To compare time to the onset of secretory activation using three separate indicators. A secondary aim examined the association between indicators of secretory activation and milk production. METHODS Indicators of secretory activation included maternal perception, volume attainment (production of ≥ 20 mL in two consecutive expression sessions) and biomarkers (sodium and lactose) obtained at volume attainment. Milk production was measured on Days 1-7 and then weekly for 6 weeks. RESULTS In 69 mothers of infants born ≤ 32 weeks' gestation and < 1500 g, we found no correlation in time to secretory activation between indicators. Earlier volume attainment was associated with increased milk production on Days 1-7, 14, 21, and 28 (all p < .007). Participants who exhibited both normal lactose and sodium levels produced more milk on Days 28 and 42 (p = .028 and .011), those with only normal lactose levels produced more on Day 42 (p = .026) and those with only normal sodium levels on Day 28 (p = .036). Earlier secretory activation by volume attainment was associated with increased expression frequency during Days 2-5 (all p < .014) and participants with normal biomarkers expressed more frequently during Days 2-5 (all p < .020). CONCLUSION Mothers of very low birth weight infants are at risk for delayed secretory activation, which may decrease their milk production. Frequent expression during the first 5 days postpartum may promote earlier secretory activation. Valid methods of determining secretory activation are necessary to develop interventions promoting earlier secretory activation.
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Affiliation(s)
- Leslie A Parker
- 3463 College of Nursing, University of Florida, Gainesville, FL, USA
| | - Sandra Sullivan
- 3463 College of Nursing, University of Florida, Gainesville, FL, USA
| | - Nicole Cacho
- 3463 College of Nursing, University of Florida, Gainesville, FL, USA
| | - Clara Engelmann
- 213850 Patient Revenue Management Organization, Duke University Health System, Durham, NC, USA
| | - Charlene Krueger
- 3463 College of Nursing, University of Florida, Gainesville, FL, USA
| | - Martina Mueller
- 2345 College of Nursing, Medical University of South Carolina, Charleston, SC, USA
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Wiechers C, Bernhard W, Goelz R, Poets CF, Franz AR. Optimizing Early Neonatal Nutrition and Dietary Pattern in Premature Infants. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:7544. [PMID: 34300000 PMCID: PMC8304391 DOI: 10.3390/ijerph18147544] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 07/09/2021] [Accepted: 07/12/2021] [Indexed: 12/18/2022]
Abstract
Providing adequate amounts of all essential macro- and micronutrients to preterm infants during the period of extraordinarily rapid growth from 24 to 34 weeks' postmenstrual age to achieve growth as in utero is challenging yet important, since early growth restriction and suboptimal neonatal nutrition have been identified as risk factors for adverse long-term development. Along with now well-established early parenteral nutrition, this review emphasizes enteral nutrition, which should be started early and rapidly increased. To minimize the side effects of parenteral nutrition and improve outcomes, early full enteral nutrition based on expressed mothers' own milk is an important goal. Although neonatal nutrition has improved in recent decades, existing knowledge about, for example, the optimal composition and duration of parenteral nutrition, practical aspects of the transition to full enteral nutrition or the need for breast milk fortification is limited and intensively discussed. Therefore, further prospective studies on various aspects of preterm infant feeding are needed, especially with regard to the effects on long-term outcomes. This narrative review will summarize currently available and still missing evidence regarding optimal preterm infant nutrition, with emphasis on enteral nutrition and early postnatal growth, and deduce a practical approach.
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Affiliation(s)
- Cornelia Wiechers
- Department of Neonatology, University Children′s Hospital, Eberhard Karls University, Calwerstr. 7, 72076 Tübingen, Germany; (W.B.); (R.G.); (C.F.P.); (A.R.F.)
| | - Wolfgang Bernhard
- Department of Neonatology, University Children′s Hospital, Eberhard Karls University, Calwerstr. 7, 72076 Tübingen, Germany; (W.B.); (R.G.); (C.F.P.); (A.R.F.)
| | - Rangmar Goelz
- Department of Neonatology, University Children′s Hospital, Eberhard Karls University, Calwerstr. 7, 72076 Tübingen, Germany; (W.B.); (R.G.); (C.F.P.); (A.R.F.)
| | - Christian F. Poets
- Department of Neonatology, University Children′s Hospital, Eberhard Karls University, Calwerstr. 7, 72076 Tübingen, Germany; (W.B.); (R.G.); (C.F.P.); (A.R.F.)
| | - Axel R. Franz
- Department of Neonatology, University Children′s Hospital, Eberhard Karls University, Calwerstr. 7, 72076 Tübingen, Germany; (W.B.); (R.G.); (C.F.P.); (A.R.F.)
- Center for Pediatric Clinical Studies, University Children′s Hospital, Eberhard Karls University, 72076 Tübingen, Germany
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Tanaka R, Horiuchi S. Implementing an education program for nurse-midwives focused on early essential care for breast milk expression among mothers of preterm infants. Int Breastfeed J 2021; 16:47. [PMID: 34174915 PMCID: PMC8235824 DOI: 10.1186/s13006-021-00395-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 06/08/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although breastfeeding guidelines for infants admitted to the neonatal intensive care unit (NICU) have been introduced in Japan, these guidelines have not been reflected in practice. To improve this situation, it is important for nurses and nurse-midwives to acquire knowledge of appropriate care. This study examined changes in nurse-midwives' knowledge, attitude, and implementation of appropriate care after implementing an education program focused on early essential care for breast milk expression among mothers of preterm infants. METHODS This pre- and post-intervention study using a single group was conducted from June 2018 to May 2019 and enrolled 36 nurse-midwives in one perinatal medical center. The education program content included nurses' roles in early essential care for milk expression and the necessary care to promoting breast milk production among mothers of preterm infants. The nurse-midwives' knowledge and attitude on care were investigated 3 months before (pre-1), just before (pre-2), just after (post-1), and 3 months after (post-2) the program. The nurse-midwives' care implementation was investigated at pre-1, pre-2, and post-2. During this time, 11 mothers (before: 7, after: 4) reported the status of milk expression for 10 days after birth. RESULTS The mean knowledge scores of the nurse-midwives at post-1 and post-2 were significantly higher than that at pre-2 (post-1: p < 0.001, post-2: p < 0.001). The attitude on care scores at post-1 and post-2 were significantly higher than that at pre-2 (post-1: p < 0.001, post-2: p = 0.010). The care implementation score at post-2 was significantly higher than that at pre-2 in eight items (e.g., Q7 Explain about the effect of initiating milk expression early and assist mothers in it). However, the education program did not cause any changes in the mothers' initiation and frequency of milk expression, and breast milk volume after birth. CONCLUSIONS The significant increases in the knowledge, attitude on care, and care implementation scores of the nurse-midwives suggest the beneficial effects of the education program. The small number of mothers in the survey on the practice of breast milk expression limited the full determination of the benefits of the education program for nurse-midwives.
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Affiliation(s)
- Rie Tanaka
- Graduate Course of Midwifery, Teikyo University, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-8605, Japan.
| | - Shigeko Horiuchi
- St. Luke's International University, 10-1 Akashi-cho, Chuo-ku, Tokyo, 104-0044, Japan
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Atwah AF, Koshak EA, Alhussaini BH, Alsaedi SA. The Prevalence and Trends of the Early Introduction of Cow Milk to Newborns at Tertiary Care Center: A Risk of Atopy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18136686. [PMID: 34206183 PMCID: PMC8296947 DOI: 10.3390/ijerph18136686] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 06/18/2021] [Accepted: 06/20/2021] [Indexed: 11/16/2022]
Abstract
Although all health organizations recommend exclusive breastfeeding (EBF), few neonates meet these recommended goals. The early intake of cow milk formulas (CMFs) has been linked to several childhood illnesses, including atopic diseases. Therefore, this study aimed to evaluate the prevalence of early exposure to CMFs in the nursery of a tertiary care hospital in Jeddah, Kingdom of Saudi Arabia. A retrospective review was conducted on the medical records of feeding practices of neonates born in King Abdulaziz University Hospital (KAUH) at Jeddah, Kingdom of Saudi Arabia. Two months from each year (May and December) were selected over the last five years. Approval from the ethical research committee at KAUH was obtained. Eight hundred and ninety-four different neonate files were reviewed. Four hundred and eighty-seven (54.5%) were males. Out of the total of 894, 838 (93.7%) newborns experienced an early introduction to CMFs, 797 (89.1%) received mixed CMF and breast milk, 41 (4.6%) received CMF only, and 56 (6.3%) received exclusive breastfeeding (EBF). Surprisingly, EBF has declined over time, from 39% in May 2016 to 1% in December 2020. The prevalence of early exposure to CMF was very high in newborns at KAUH nursery, and this prevalence was trending upwards. Extensive teaching programs on EBF and allergy prevention for mothers and related health care providers are highly recommended
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Affiliation(s)
- Ali F. Atwah
- Department of Pediatrics, Faculty of Medicine in Rabigh, King Abdulaziz University, Jeddah 21589, Saudi Arabia
- Correspondence:
| | - Emad A. Koshak
- Department of Medicine, Faculty of Medicine in Jeddah, King Abdulaziz University, Jeddah 21589, Saudi Arabia;
| | - Bakr H. Alhussaini
- Department of Pediatrics, Faculty of Medicine in Jeddah, King Abdulaziz University, Jeddah 21589, Saudi Arabia; (B.H.A.); (S.A.A.)
| | - Saad A. Alsaedi
- Department of Pediatrics, Faculty of Medicine in Jeddah, King Abdulaziz University, Jeddah 21589, Saudi Arabia; (B.H.A.); (S.A.A.)
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Hirpha M, Mekonnen H, Fenta FA. Initiation of Breast Milk Expression and Associated Factors Among Mothers of Preterm and Low Birth Weight Neonates Admitted to Neonatal Intensive Care Units of Government Hospitals in Addis Ababa, Ethiopia,2020. Pediatric Health Med Ther 2021; 12:213-221. [PMID: 33976584 PMCID: PMC8106526 DOI: 10.2147/phmt.s294032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 04/08/2021] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND In early preterm and very low birth weight, breast milk expression is an optimal solution to continue with breastfeeding. This study aimed to assess the initiation of breast milk expression and associated factors among preterm and low birth weight mothers in the neonatal intensive care units of public hospitals in Addis Ababa. METHODS Institution-based cross-sectional study was performed in selected public hospitals, Addis Ababa, among 124 breast feeding mothers chosen from different public health facilities of Addis Ababa; from April 5 to May 15, 2020. Information was collected using questionnaires administered by the interviewer, double data entry was performed using Epi Info version 4.6.02 software, cleaned finally exported to SPSS statistics version 26 for analysis. To predict the association of research variables, logistic regression models were used and adjusted for potential confounders. RESULTS All respondents were started milk expression after six hours following delivery. Getting instruction on the method of their choice (AOR=0.55; CI=0.31 to 0.96) and gestational age ≤32 weeks (AOR=2.39; CI=1.34 to 4.24) were factors significantly associated with initiation of milk expression. CONCLUSION The study indicated breast milk expression was poor. Inter-departmental collaboration is required in order to promote good practice of breast milk expression among mothers of neonates with preterm and low birth weight.
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Affiliation(s)
- Misgana Hirpha
- School of Nursing and Midwifery, College Health Science, Addis Ababa University (AAU), Addis Ababa, Ethiopia
| | - Hussen Mekonnen
- School of Nursing and Midwifery, College Health Science, Addis Ababa University (AAU), Addis Ababa, Ethiopia
| | - Fikrtemariam Abebe Fenta
- School of Nursing and Midwifery, College Health Science, Addis Ababa University (AAU), Addis Ababa, Ethiopia
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40
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Porta R, Miralles N, Paltrinieri A, Ibáñez B, Giménez J, Roca T, Vega A. A Breast Milk Pump at the Bedside: A Project to Increase Milk Production in Mothers of Very Low Birth Weight Infants. Breastfeed Med 2021; 16:309-312. [PMID: 33351698 DOI: 10.1089/bfm.2020.0122] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The amount of milk production in mothers of babies admitted to the neonatal intensive care unit (NICU) is mostly determined by some actions focused on the first hours and days after birth. Working for an improvement in our previous results in terms of maternal expressed breast milk (MEBM) production, we designed a pilot project and a small observational study. After increasing the number of breast milk pumps to allow full-time availability and implementing educational strategies and updated information for parents, the volume of MEBM production by day 14 after birth was doubled and increased to >500 mL per day. The rate of exclusive breastfeeding at discharge improved from 26.67% to 76.19%. The cost of the use of donor milk per patient decreased by 15.7%. This study is an example of a cost-beneficial quality improvement strategy. It demonstrates the importance of an optimal supply of breast milk pumps in NICU and educational interventions focused on enhancing MEBM production.
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Affiliation(s)
- Roser Porta
- Neonatology Unit, Hospital Universitari Dexeus-Quiron, Barcelona, Spain
| | - Natàlia Miralles
- Neonatology Unit, Hospital Universitari Dexeus-Quiron, Barcelona, Spain
| | - Anna Paltrinieri
- Neonatology Unit, Hospital Universitari Dexeus-Quiron, Barcelona, Spain
| | - Beatriz Ibáñez
- Neonatology Unit, Hospital Universitari Dexeus-Quiron, Barcelona, Spain
| | - Júlia Giménez
- Neonatology Unit, Hospital Universitari Dexeus-Quiron, Barcelona, Spain
| | - Teresa Roca
- Neonatology Unit, Hospital Universitari Dexeus-Quiron, Barcelona, Spain
| | - Ana Vega
- Neonatology Unit, Hospital Universitari Dexeus-Quiron, Barcelona, Spain
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41
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Abstract
Congenital heart disease (CHD) is the most common birth defect for infants born in the United States, with approximately 36,000 affected infants born annually. While mortality rates for children with CHD have significantly declined, there is a growing population of individuals with CHD living into adulthood prompting the need to optimise long-term development and quality of life. For infants with CHD, pre- and post-surgery, there is an increased risk of developmental challenges and feeding difficulties. Feeding challenges carry profound implications for the quality of life for individuals with CHD and their families as they impact short- and long-term neurodevelopment related to growth and nutrition, sensory regulation, and social-emotional bonding with parents and other caregivers. Oral feeding challenges in children with CHD are often the result of medical complications, delayed transition to oral feeding, reduced stamina, oral feeding refusal, developmental delay, and consequences of the overwhelming intensive care unit (ICU) environment. This article aims to characterise the disruptions in feeding development for infants with CHD and describe neurodevelopmental factors that may contribute to short- and long-term oral feeding difficulties.
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42
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Ward LP, Tonnis R, Otuneye AT, Clemens N, Akinbi H, Morrow AL. Impact of Institutional Breastfeeding Support in Very Low-Birth Weight Infants. Breastfeed Med 2021; 16:238-244. [PMID: 33211538 DOI: 10.1089/bfm.2020.0137] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background and Objectives: Feeding of human milk is associated with improved health outcomes in preterm infants. Mothers of preterm infants have difficulty establishing and maintaining an adequate milk supply. Our institution participated in Best Fed Beginnings (BFB), a national breastfeeding quality improvement collaborative, in 2012. Although most practice changes targeted healthy term infants, we hypothesized that mother's milk feeding (MMF) to preterm infants would also improve. Our objective was to compare MMF in very low-birth weight (VLBW) infants at discharge before and after our participation in BFB. Materials and Methods: We completed a retrospective chart review of VLBW infants born between January 2006 and June 2016. The primary outcome measure was the percentage of VLBW infants receiving MMF at hospital discharge. We used Fisher's exact test to determine the difference before and after 2012 and performed the Kruskal-Wallis test to determine changes in median time to pump initiation in mothers of VLBW infants. Multiple logistic regression was used to determine variables associated with the primary outcome. Results: A total of 1,077 VLBW infants were eligible. After launching BFB, MMF at discharge increased in VLBW infants, from 35.2% to 46.0%, p < 0.001. Median time to pump initiation decreased from 11 to 5 hours after 2012, p = 0.0001. Factors significantly associated with receiving MMF at discharge included birth post-BFB; private insurance; non-Black race; shorter length of stay; older maternal age; and mother's milk as first feeding. Conclusions: Hospital culture supportive of breastfeeding impacts not only healthy term infants but also VLBW infants. Earlier initiation of milk expression significantly improves provision of MMF to preterm infants at discharge.
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Affiliation(s)
- Laura P Ward
- Division of Neonatology, Cincinnati Children's Hospital Medical Center, Perinatal Institute, Cincinnati, Ohio, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Rachel Tonnis
- Pediatric Residency Program, UT Southwestern Medical Center, Dallas, Texas, USA
| | | | - Nancy Clemens
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Henry Akinbi
- Division of Neonatology, Cincinnati Children's Hospital Medical Center, Perinatal Institute, Cincinnati, Ohio, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Ardythe L Morrow
- Department of Environmental and Public Health Sciences, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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Abstract
Mother's own milk (MOM) feeding is a cost-effective strategy to reduce risks of comorbidities associated with prematurity and improve long-term health of infants hospitalized in the Neonatal Intensive Care Unit (NICU). Significant racial and socioeconomic disparities exist in MOM provision in the NICU, highlighting the importance of developing strategies to reduce these disparities. Mothers of infants in the NICU experience many health concerns which may negatively impact lactation physiology. Objective measures of lactation physiology are limited but may assist in identifying mothers at particular risk. Several strategies to assist mothers of hospitalized infants are essential, including maternal education, qualified lactation professionals, early and frequent milk expression with a hospital-grade double electric breast pump, and providing support for transitioning to direct breastfeeding prior to discharge from the NICU.
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Froh EB, Lee R, Spatz DL. The Critical Window of Opportunity: Lactation Initiation Following Cesarean Birth. Breastfeed Med 2021; 16:258-263. [PMID: 33347346 DOI: 10.1089/bfm.2020.0155] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Introduction: Cesarean birth is reported to be risk factor for the delayed onset of maternal lactation. The purpose of this study was to describe the timing of lactation initiation, subsequent feeding/milk expression patterns, and daily milk volumes among women who had a cesarean birth of an infant with a known congenital anomaly during the 3-day postpartum hospital stay. Materials and Methods: Retrospective descriptive cohort study. The electronic medical records of dyads, between 2014 and 2017 at the study setting, were abstracted for demographic and clinical data. Milk expression and milk volume data were abstracted from maternal lactation logs. Data were analyzed using descriptive statistics. Results: Among the cohort (n = 468 dyads), the mean time from infant delivery by cesarean to lactation initiation was 257.5 minutes. The cohort was divided into three groups by the timing of lactation initiation: EARLY (≤60 minutes; n = 112), MID (>60 minutes to ≤360 minutes; n = 309), and LATE (>360 minutes; n = 47). Statistically significant differences are seen between groups for the daily means: number of feeds/pumps and maternal milk volumes (irrespective of the presence of lactation risk factors). Discussion: This is the first study to explore the relationship of lactation initiation among women postcesarean birth whose infants have a known congenital anomaly. The time between the infant's birth and the first feed/milk expression, and the patterns of feeding/milk expression during the postpartum hospital stay, are key drivers for maternal milk supply.
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Affiliation(s)
- Elizabeth B Froh
- Department of Nursing & Clinical Care Services, Center for Pediatric Nursing Research and Evidence-Based Practice, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Rachel Lee
- Children's Hospital of Philadelphia, Volunteer Research, Philadelphia, Pennsylvania, USA
| | - Diane L Spatz
- Department of Nursing & Clinical Care Services, Center for Pediatric Nursing Research and Evidence-Based Practice, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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The Acceptability, Feasibility, and Effectiveness of Breast Massage Combined with Acupoint Stimulation to Promote the Volume of Human Milk in Mothers with Preterm Infants: A Pilot Study. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2021. [DOI: 10.1155/2021/5979810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background. Preterm infant mothers have always encountered difficulties in human milk production. For this reason, an intervention of breast massage combined with acupoint stimulation was designed to increase the production. Purpose. Through a pilot randomized trial, we assessed the acceptability, feasibility, and effectiveness of breast massage combined with acupoint stimulation and the study procedures. Methods. 40 participants of preterm infants born at less than 34 weeks of gestation were randomly allocated to the CG (control group) or the EG (group with breast massage combined with acupoint stimulation). Data related to the acceptability, feasibility, and effectiveness of the intervention and research procedures were collected and analysed. Results. The daily volume progressively increased each day in the first 7 days in both groups and a significant difference was observed between the groups (
< 0.001). The initiation time of lactogenesis stage II was 50.06 ± 6.78 (40.00–64.00) hours in the EG and 66.18 ± 14.64 (48.00–96.00) hours in the CG, where a significant difference was detected (
< 0.05). The mean score of satisfaction with the intervention in the EG was 4.56 ± 0.32 (4.0–5.0), while the retention rates were 82.5% and 85.5% (17/20) in the CG, and 80% (16/20) in the EG. Conclusion. This pilot study was oriented towards the effectiveness of breast massage combined with acupuncture stimulation for the increase of human milk production in the participants. The intervention was accepted well and the study process was reasonable. A large-scale RCT will be able to determine the beneficial effects of this intervention on human milk production.
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Maastrup R, Rom AL, Walloee S, Sandfeld HB, Kronborg H. Improved exclusive breastfeeding rates in preterm infants after a neonatal nurse training program focusing on six breastfeeding-supportive clinical practices. PLoS One 2021; 16:e0245273. [PMID: 33534831 PMCID: PMC7857627 DOI: 10.1371/journal.pone.0245273] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 12/27/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Early breast milk expression, prolonged skin-to-skin contact, rooming-in, use of test-weighing and minimizing use of pacifiers are positively associated with exclusive breastfeeding of preterm infants, whereas use of nipple shields is negatively associated. AIM To test whether a training program for neonatal nurses with a focus on these six breastfeeding-supportive clinical practices affects the rate of preterm infants exclusively breastfed at discharge to home, the postmenstrual age at establishment of exclusive breastfeeding, and maternal self-reported use of the practice in the neonatal intensive care unit, the. METHODS A quasi-experimental multi-centre intervention study from 2016-2019 including a control group of 420 preterm mother-infant dyads, an intervention with a training program for neonatal nurses and implementation of weekly breastfeeding meetings for neonatal nurses, and an intervention group of 494 preterm mother-infant dyads. RESULTS Significantly more preterm infants in the intervention group were exclusively breastfed at discharge to home (66.6%) than in the control group (58.1%) p = 0.008. There was no significant difference in postmenstrual age at establishment of exclusive breastfeeding between control and intervention group (37.5 vs.37.8 weeks, p = 0.073). Compared to the control group the number of infants continuing daily skin-to-skin contact after incubator care increased (83.2% vs. 88.3%, p = 0.035), infants using a nipple shield decreased (61.8% vs. 54.2%, p = 0.029), and the number of mothers initiating breast milk expression before six hours post-partum increased (32.6% vs. 42.4%, p = 0.007). There was a significant correlation between percentage of neonatal nurses participating in the breastfeeding training program and changes in exclusive breastfeeding rates (Pearson Correlation 0.638, p = 0.047). CONCLUSION Exclusive breastfeeding rates in preterm infants and maternal self-reported use of breastfeeding-supportive practices increased by training neonatal nurses in the six clinical practices. It is important to include all nurses in the breastfeeding training program to ensure positive effect on exclusive breastfeeding rates.
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Affiliation(s)
- Ragnhild Maastrup
- Department of Neonatology, Knowledge Centre for Breastfeeding Infants with Special Needs, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,Research Unit Women's and Children's Health, Juliane Marie Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Ane L Rom
- Research Unit Women's and Children's Health, Juliane Marie Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Sisse Walloee
- Dept of Clinical Research, OPEN-Patient data Explorative Network, University of Southern Denmark, Odense, Denmark
| | | | - Hanne Kronborg
- Department of Public Health, Section for Nursing, Aarhus University, Aarhus, Denmark
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47
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Panda SK, Sahoo K, Jena PK, Dhanawat A. Availability of Breast Milk for Preterm Neonates by Gestational Age during NICU Stay. JOURNAL OF CHILD SCIENCE 2021. [DOI: 10.1055/s-0041-1735534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
AbstractThe objective of this study was to explore the availability of expressed breast milk (EBM) volume for the premature neonates born from mothers in different gestational age groups during neonatal intensive care unit (NICU) stay. All preterm infants (extreme-preterm infant [EPTI, <28 weeks], very-preterm infant [VPTI, 28–316/7 weeks], and moderate-preterm infant [MPTI, 32–336/7 weeks]) and their mothers were included in the study. Infants not receiving mother's own milk and neonates deceased or discharged against medical advice, and the mother with illness during postpartum period were excluded from the study. A predesigned tool was used to collect information on maternal characteristics, neonatal characteristics, and milk diary for preterm neonates from the NICU case records. The primary outcome variable EBM volume available on day 7 was compared across three gestational groups. Logistic regression was used to predict EBM availability. A total of 78 preterm neonates, including 10 EPTI, 37 VPTI, and 31 MPTI, had average birth weight of 962.5 ± 228.25, 1,185.1 ± 183.14, and 1,293.2 ± 182.92 g, respectively. Receipt of exclusive breast milk among EPTI, VPTI, and MPTI was 80, 94, and 83.8%, respectively. Maternal characteristics were similar except for the mode of conception (p = 0.001), mode of delivery (p = 0.04), and antenatal steroid exposure (p = 0.02) among three gestational categories. The median (Q1–Q3) volume of EBM on day 7 were 160 (136.3–202.5), 150 (140–187.5), and 160 (150–220) mL for EPTI, VPTI, and MPTI neonates, respectively, without any statistical significance. Regression analysis suggests no effect of gestational age on EBM availability. The feasibility of mother's own milk use for extremely preterm neonates is similar to higher gestational preterm neonates.
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Affiliation(s)
- Santosh Kumar Panda
- Department of Paediatrics, Kalinga Institute of Medical Sciences, Kalinga Institute of Industrial Technology, Bhubaneswar, Odisha, India
| | - Kalpita Sahoo
- Department of Paediatrics, Institute of Medical Sciences and Sum Hospital, Siksha 'O' Anusandhan, Bhubaneswar, Odisha, India
| | - Pratap Kumar Jena
- School of Public Health, Kalinga Institute of Industrial Technology, Bhubaneswar, Odisha, India
| | - Avantika Dhanawat
- Department of Paediatrics, Kalinga Institute of Medical Sciences, Kalinga Institute of Industrial Technology, Bhubaneswar, Odisha, India
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48
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Spatz DL, Miller J. When Your Breasts Might Not Work: Anticipatory Guidance for Health-Care Professionals. J Perinat Educ 2020; 30:13-18. [PMID: 33488043 DOI: 10.1891/j-pe-d-20-00014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
There are many factors that can negatively impact a mother developing a copious milk supply and being able to exclusively breastfeed her infant. In this article, we present two case exemplars (glandular hypoplasia and breast reduction surgery) to illustrate that not all mothers may be able to develop a full milk supply, and that families should receive appropriate prenatal anticipatory education and guidance from childbirth educators and all health-care providers. Important considerations include the value of every drop of milk that the mother is able to produce, treating the milk as an important medical intervention, and developing a plan with the family for supplementation so the infant can receive adequate intake for growth.
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49
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Rudland VL, Price SAL, Hughes R, Barrett HL, Lagstrom J, Porter C, Britten FL, Glastras S, Fulcher I, Wein P, Simmons D, McIntyre HD, Callaway L. ADIPS 2020 guideline for pre-existing diabetes and pregnancy. Aust N Z J Obstet Gynaecol 2020; 60:E18-E52. [PMID: 33200400 DOI: 10.1111/ajo.13265] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 09/14/2020] [Indexed: 02/07/2023]
Abstract
This is the full version of the Australasian Diabetes in Pregnancy Society (ADIPS) 2020 guideline for pre-existing diabetes and pregnancy. The guideline encompasses the management of women with pre-existing type 1 diabetes and type 2 diabetes in relation to pregnancy, including preconception, antepartum, intrapartum and postpartum care. The management of women with monogenic diabetes or cystic fibrosis-related diabetes in relation to pregnancy is also discussed.
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Affiliation(s)
- Victoria L Rudland
- Department of Diabetes and Endocrinology, Westmead Hospital, Sydney, New South Wales, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Sarah A L Price
- Department of Diabetes and Endocrinology, Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of Diabetes, Royal Women's Hospital, Melbourne, Victoria, Australia.,Mercy Hospital for Women, Melbourne, Victoria, Australia.,Faculty of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Ruth Hughes
- Department of Obstetrics and Gynaecology, University of Otago, Christchurch, New Zealand
| | - Helen L Barrett
- Department of Endocrinology, Mater Health, Brisbane, Queensland, Australia.,Mater Research, The University of Queensland, Brisbane, Queensland, Australia
| | - Janet Lagstrom
- Green St Specialists Wangaratta, Wangaratta, Victoria, Australia.,Denis Medical Yarrawonga, Yarrawonga, Victoria, Australia.,Corowa Medical Clinic, Corowa, New South Wales, Australia.,NCN Health, Numurkah, Victoria, Australia
| | - Cynthia Porter
- Geraldton Diabetes Clinic, Geraldton, Western Australia, Australia
| | - Fiona L Britten
- Department of Obstetric Medicine, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,Mater Private Hospital and Mater Mother's Private Hospital, Brisbane, Queensland, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Sarah Glastras
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Department of Diabetes, Endocrinology and Metabolism, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Ian Fulcher
- Liverpool Hospital, Sydney, New South Wales, Australia
| | - Peter Wein
- Mercy Hospital for Women, Melbourne, Victoria, Australia.,Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia
| | - David Simmons
- Western Sydney University, Sydney, New South Wales, Australia.,Campbelltown Hospital, Sydney, New South Wales, Australia
| | - H David McIntyre
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia.,Mater Health, Brisbane, Queensland, Australia
| | - Leonie Callaway
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia.,Women's and Children's Services, Metro North Hospital and Health Service District, Brisbane, Queensland, Australia.,Women's and Newborn Services, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
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50
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Çelik K, Asena M, İpek MŞ. The trends in the usage of breast milk in neonatal intensive care setting. Pediatr Int 2020; 62:1064-1072. [PMID: 32315473 DOI: 10.1111/ped.14263] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 04/06/2020] [Accepted: 04/16/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Many interventions have been designed to increase breast milk (BM) consumption among preterm and critical-term infants in neonatal units. The aim of this study was to determine the trends in the usage of BM in a neonatal unit and the risk factors for insufficient breast-milk feeding at discharge. METHODS This retrospective study included newborn infants who hospitalized in the neonatal unit during two periods in different years, a 15-month period in 2012-2013 and in 2017-2018. The primary outcomes were the availability of BM within 24 h after delivery and the status of infant feeding at discharge. RESULTS During two periods of the study, a total of 3,018 infants were included in the study. The rate of BM expression within the first 24 h after delivery was 92.9%, and it was found that the first period of the study, caesarean section delivery, very low birth weight, being first-time mother, and young maternal age were each independently associated with the delayed initiation of BM expression (P < 0.05). At discharge, 87.6% of the infants had been feeding with BM. Multiple births, the delayed initiation of BM expression, and the length of hospital stay were associated with inadequate BM feeding at discharge (P < 0.001). CONCLUSION This study showed that interventions supporting BM feeding, which have recently been carried out, made improvements to the initiation of BM expression among mothers whose babies were admitted to the neonatal unit, and in the rate of BM feeding among infants at discharge.
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Affiliation(s)
- Kıymet Çelik
- Division of Neonatology, Department of Pediatrics, University of Health Science Gaziyaşargil Education and Research Hospital, Diyarbakir, Turkey
| | - Muhammed Asena
- Department of Pediatrics, University of Health Science Gaziyaşargil Education and Research Hospital, Diyarbakir, Turkey
| | - Mehmet Şah İpek
- Division of Neonatology, Department of Pediatrics, Memorial Dicle Hospital, Diyarbakir, Turkey
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