Breastfeeding Support in Neonatal Care: An Example of the Integration of International Evidence and Experience

Breastfed or bottle-fed: who goes home sooner?

A literature search was conducted to answer the clinical question, "Do premature infants who breastfeed have different oral feeding outcomes compared with those who receive bottles?" The CINAHL, PubMed, and PsycInfo databases were queried for articles published in the past 10 years that reported original research available in English. Two studies specifically addressed a comparison between infants who received exclusive direct breastfeeding, mixed direct breast and bottle, and/or exclusive bottle-feeding. Additional studies were included that addressed oral feeding outcomes specific to either direct breastfeeding (n = 2) or those that grouped bottle and breastfeeding together (n = 3). The findings from these studies indicate that the statement that bottle-feeding leads to sooner discharge is not based in evidence. Although more data are needed to fully understand the differences between direct breastfeeding and bottle-feeding, neonatal intensive care unit staff should be aware of the message they send to breastfeeding families when they encourage the use of bottles over direct breastfeeding.

State of the science: a contemporary review of feeding readiness in the preterm infant

Oral feeding readiness has been described by researchers in the neonatal intensive care unit, and research has continued on this topic for many years. The purpose of this narrative review is to identify research and practice guidelines related to oral feeding readiness in preterm infants that have occurred during the last decade. The introduction and mastery of oral feeding is a major developmental task for the preterm infant that is often a prerequisite for discharge from the neonatal intensive care unit. Having a better understanding of the evidence supporting the development of this skill will help the practicing nurse choose appropriate interventions and the researcher to develop trajectories of research that continue to increase our knowledge in this important practice area.

Expansion of the baby-friendly hospital initiative ten steps to successful breastfeeding into neonatal intensive care: expert group recommendations

In the World Health Organization/United Nations Children's Fund document Baby-Friendly Hospital Initiative: Revised, Updated and Expanded for Integrated Care, neonatal care is mentioned as 1 area that would benefit from expansion of the original Ten Steps to Successful Breastfeeding. The different situations faced by preterm and sick infants and their mothers, compared to healthy infants and their mothers, necessitate a specific breastfeeding policy for neonatal intensive care and require that health care professionals have knowledge and skills in lactation and breastfeeding support, including provision of antenatal information, that are specific to neonatal care. Facilitation of early, continuous, and prolonged skin-to-skin contact (kangaroo mother care), early initiation of breastfeeding, and mothers' access to breastfeeding support during the infants' whole hospital stay are important. Mother's own milk or donor milk (when available) is the optimal nutrition. Efforts should be made to minimize parent-infant separation and facilitate parents' unrestricted presence with their infants. The initiation and continuation of breastfeeding should be guided only by infant competence and stability, using a semi-demand feeding regimen during the transition to exclusive breastfeeding. Pacifiers are appropriate during tube-feeding, for pain relief, and for calming infants. Nipple shields can be used for facilitating establishment of breastfeeding, but only after qualified support and attempts at the breast. Alternatives to bottles should be used until breastfeeding is well established. The discharge program should include adequate preparation of parents, information about access to lactation and breastfeeding support, both professional and peer support, and a plan for continued follow-up.

Breastfeeding the premature infant and nursing implications

Research indicates that feeding preterm infants at the breast is physiologically less stressful than bottle-feeding. Poor sucking reflexes make it difficult to initiate breastfeeding for these high-risk infants. Mothers need to understand the difficulties of breastfeeding, as well as the advantages for herself and her baby. It is important for nurses to be well educated on how preterm infants are breastfed and how to best support the mother through her experience. The nurse must focus on caring for the infant as well as fostering the mother-infant connection to promote breastfeeding. A mother will need continual support, encouragement, and advice from the nurse, while teaching her baby how to breastfeed.

Breast milk expression and maintenance in mothers of very low birth weight infants: supports and barriers

The study objective was to identify patterns of factors that supported or hindered initiation of breast milk expression and maintenance of breast milk production after the birth of a very low birth weight (VLBW) infant in a sample of US women with varied prenatal infant feeding intentions. In-depth interviews were conducted 1 to 6 months after delivery in 32 women who initiated breast milk expression after encouragement from hospital staff. Pregnancy complications, anxiety regarding their infant's health, and lack of privacy interfered with initiation of milk expression. After hospital discharge, using manual or small electric breast pumps, travel to the neonatal intensive care unit, return to work, and difficulty with time management interfered with maintenance of breast milk production. Family support, positive attitudes toward pumping, and anticipation of breastfeeding supported maintenance of breast milk production. From these data emerge points of intervention where additional support could improve mothers' experiences and increase duration of breast milk feeding.

Characterization of parturients assisted by the Speech Therapy Care Service of a school maternity

BACKGROUND

parturients assisted by a speech therapy care service.

AIM

to characterize the parturient population assisted by the Speech Therapy Care Service, who were participating of the second phase of the Kangaroo Mother Method, in a school maternity, reference for high risk cases, in 2006.

METHOD

retrospective analytical descriptive study by means of the analysis of 204 medical registers. Descriptive statistical techniques were used as well as the Mann-Whitney test for the comparison of variables without normal distribution. The adopted significance level was of 5%.

RESULTS

the mean age of the mothers was of 24.61 years (SD = 7.36), being 125 (61.27%) from the countryside and 201 (50%) single. Most of the assisted population had been to school for 4 to 5 years (35.29%), most were housewives (76.47%) and had no previous experience concerning breastfeeding (53.43%). The prevalent birth method was Caesarean section (n=98; 48.03%) and 89 (43.62%) reported 1 to 3 sessions of pre-natal care counseling.

CONCLUSION

the population assisted by the Speech Therapy Care Service was characterized mainly as single precipitous from the countryside, who had low income and no remunerated job, however they presented high schooling in terms of study years. Also a low number of pre-natal counseling sessions was observed, as well as caesarean section, low pregnancy age and extended hospital stay time.

Evidence-based clinical guidelines

In the November/December 2008 issue of Neonatal Network, a feeding care map for breastfeeding ELBW infants was presented by Dougherty and Luther. The aim of this document was described as providing caregivers with an instrument for assisting mothers in optimizing breast milk production, providing them with realistic expectations, and enhancing their chances of establishing breastfeeding. The authors must be commended for their systematic approach to this very important aspect of neonatal intensive care. However, the article left me very concerned about several crucial requirements that need to be met in the formulation of clinical guidelines.

[Lactation counselling support provided to mothers of preterm babies who intend to breastfeed. Evaluation of an educational intervention in a level III perinatal unit]

OBJECTIVE

To evaluate the educational intervention provided in a perinatal unit to support mothers of preterm babies who intend to breastfeed.

PATIENTS AND METHODS

The study was prospective and included all the infants born between 30 and 34 weeks of gestation at the Jeanne-de-Flandre university hospital in Lille and whose mothers intended to breastfeed. The studied period extended from January to December 2005, comparing the first and the last semester. The different actions were guided by the formation of the staff and lactation counselling to mothers, especially in the initiation of lactation. They were provided by one full-time nurse who was lactation consultant. The main outcome measure was the time to the first breast milk expression. Secondary outcome was the rate of infants breastfed at discharge.

RESULTS

Twenty-one educational interventions were organised for all the people working in the unit. One hundred thirty-two nurses and 17 doctors attended to these sessions. During the study period, 175 babies were born preterm at a gestational age between 30 and 34 weeks: 81 during the first semester and 94 during the second. The two populations were comparable for gestational age and the social class of the mothers, but the birth weight was higher during the second semester (1681+/-140 vs 1774+/-216 g, P=0, 01). Mothers of 65.1% of the neonates intended to breastfeed. The time of the first breast milk expression decreased significatively during the second semester (37,5 vs 30,7 h, P<0, 01). The rate of exclusively or partially breastfed neonates at discharge was stable (88,5 vs 91,9%, ns).

CONCLUSION

The program improved the initiation of lactation. This work emphasises the difficulties and the different steps necessary to promote breastfeeding in preterm babies with respect to developmental care.

[Skin to skin contact in neonatal care: knowledge and expectations of health professionals in 2 neonatal intensive care units]

Skin to skin contact is a method derived from kangaroo care whose implementation in industrialized countries has rarely been assessed.

OBJECTIVES

To evaluate the barriers, knowledge and expectations of health professionals regarding this care in 2 level III neonatal care units in the Nord-Pas-de-Calais.

MATERIALS AND METHODS

Investigation was conducted by means of 2 questionnaires, one intended to physicians, the other to the nursing staff sharing some common questions. The 2 neonatal units differed by the level of implementation of skin to skin contact. Results were compared according to occupation and site of work.

RESULTS

80% of the physicians and 71.4% of the paramedical staff answered to the questionnaires. The difficulties were linked to technical or architectural constraints. Responses were not very different between the 2 teams. The majority (90%) considered this practice as a fully-fledged care. The positive effects on attachment (96% of the answers) were well-known but those on sleep (2,9%), breast-feeding (5%) and pain (0%) were only rarely mentioned. Barriers to implementation were centred on infant's safety. The majority of the team wished to benefit from an educational intervention.

DISCUSSION

Although the perception of skin to skin contact was positive in these 2 teams, increased knowledge of the evidence supporting its practice could enable babies and parents to benefit from all its positive effects. The need for educational program was clearly mentioned to improve parents' information.

CONCLUSION

This work emphasises the complexity of introducing new procedures in neonatal care particularly in the field of developmental care.

Breastfeeding and family life

The problems faced by breastfeeding mothers are well documented. However, the influence of social networks has mainly received attention solely through the eyes of the women. Therefore, we explored the views of the family as a whole. This exploratory study utilizes semi-structured interviews, diaries and questionnaires. A purposive sample of 24 women and their families, from a hospital in the north-west of England were invited to participate. Questionnaire data were analysed descriptively. Diaries and interviews were analysed using an open coding mechanism to identify emergent themes. Twenty-three women and 27 of their family members participated. Questionnaire data showed that the majority of women (n = 17) expected to breastfeed for more than 3 months; 12 actually did this. Women anticipated that family members would provide the main source of breastfeeding support. Three main themes emerged from the interviews and diaries: "moving with the times", "marketable commodity" and "disparate communications". The authors conclude that multi-layered approach to breastfeeding promotion and support should be considered. Society needs to proactively encourage a positive breastfeeding culture, family members need direction on how to support a woman to breastfeed and women need to be able to articulate their individual requirements. Midwives could be instrumental in supporting such needs and facilitating change.