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Danielo Jouhier M, Boscher C, Roze JC, Cailleau N, Chaligne F, Legrand A, Flamant C, Muller JB. Osteopathic manipulative treatment to improve exclusive breast feeding at 1 month. Arch Dis Child Fetal Neonatal Ed 2021; 106:591-595. [PMID: 33789971 DOI: 10.1136/archdischild-2020-319219] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 02/18/2021] [Accepted: 03/14/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Previous studies have assessed breastfeeding-support programmes. Among these, osteopathic manipulative treatment (OMT) is a frequently used approach, although without strong evidence of efficacy. METHODS A double-blind randomised controlled trial was conducted between July 2013 and March 2016. Breastfed term infants were eligible if one of the following criteria was met: suboptimal breastfeeding behaviour, maternal cracked nipples or maternal pain. The infants were randomly assigned to the intervention or the control group. The intervention consisted of two sessions of early OMT, while in the control group, the manipulations were performed on a doll behind a screen. The primary outcome was the exclusive breastfeeding rate at 1 month, which was assessed in an intention-to-treat analysis. Randomisation was computer generated and only accessible to the osteopath practitioner. The parents, research assistants and paediatricians were masked to group assignment. RESULTS One hundred twenty-eight mother-infant dyads were randomised, with 64 assigned to each group. In each group, five infants were lost to follow-up. In the intervention group, 31 of 59 (53%) of infants were still exclusively breast fed at 1 month vs 39 of 59 (66%) in the control group, (OR 0.55, 95% CI 0.26 to 1.17; p=0.12). After adjustment for suboptimal breastfeeding behaviour, caesarean section, use of supplements and breast shields, the adjusted OR was 0.44 (95% CI 0.17 to 1.11; p=0.08). No adverse effects were reported in either group. CONCLUSION OMT did not improve exclusive breast feeding at 1 month. TRIAL REGISTRATION NUMBER NCT01890668.
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Affiliation(s)
- Marie Danielo Jouhier
- Department of Neonatal Medicine, University Hospital Centre Nantes, Nantes, France
- Clinical Epidemiology, Clinical investigation Center (CIC004), University Hospital Centre Nantes, Nantes, France
| | - Cécile Boscher
- Department of Neonatal Medicine, University Hospital Centre Nantes, Nantes, France
- Clinical Epidemiology, Clinical investigation Center (CIC004), University Hospital Centre Nantes, Nantes, France
| | - Jean-Christophe Roze
- Department of Neonatal Medicine, University Hospital Centre Nantes, Nantes, France
- Clinical Epidemiology, Clinical investigation Center (CIC004), University Hospital Centre Nantes, Nantes, France
| | | | | | - Arnaud Legrand
- Clinical Epidemiology, Clinical investigation Center (CIC004), University Hospital Centre Nantes, Nantes, France
| | - Cyril Flamant
- Department of Neonatal Medicine, University Hospital Centre Nantes, Nantes, France
- Clinical Epidemiology, Clinical investigation Center (CIC004), University Hospital Centre Nantes, Nantes, France
| | - Jean-Baptiste Muller
- Department of Neonatal Medicine, University Hospital Centre Nantes, Nantes, France
- Clinical Epidemiology, Clinical investigation Center (CIC004), University Hospital Centre Nantes, Nantes, France
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Shahrani ASA, Hushan HM, Binjamaan NK, Binhuwaimel WA, Alotaibi JJ, Alrasheed LA. Factors associated with early cessation of exclusive breast feeding among Saudi mothers: A prospective observational study. J Family Med Prim Care 2021; 10:3657-3663. [PMID: 34934662 PMCID: PMC8653446 DOI: 10.4103/jfmpc.jfmpc_852_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 06/22/2021] [Accepted: 07/04/2021] [Indexed: 12/01/2022] Open
Abstract
CONTEXT World Health Organization recommending initiation of breastfeeding within hour of birth, exclusive breastfeeding for the first 6 months. In Saudi Arabia, there is a paucity of studies on the factors associated with early cessation of exclusive breastfeeding. AIMS We aimed to assess the exclusive breastfeeding rates and to identify the risk factors for early breastfeeding cessation at maternal and institutional levels. SETTINGS AND DESIGN A prospective observational study carried out at King Abdullah bin Abdulaziz University Hospital, Riyadh, Saudi Arabia. METHODS AND MATERIALS It included all postpartum women who had given birth to full term, singleton, healthy newborns, and were breastfeeding before discharge. Data were collected before discharge, 2 weeks, and 8 weeks postpartum using an adapted instrument. STATISTICAL ANALYSIS Using JMP14 software with appropriate statistical tests. RESULTS The study included 136 mothers, of whom 37.5% were exclusively breastfeeding in the first 2 weeks; this rate dropped to 19% with a statistically significant difference (P < 0.0001). Early breastfeeding cessation was significantly associated with maternal age, health status, mother's knowledge, and attitude, in addition to other modifiable factors that was encountered during hospital stay such as latching difficulties and introduction of formula feeding. CONCLUSIONS This study reported low exclusive breastfeeding rates in the first 2 months postpartum among Saudi mothers. Multiple factors were associated with breastfeeding, and some are modifiable. Breastfeeding promotion and support for is a critical role required from healthcare workers in all settings, including primary health care. Healthcare professionals play a major role in promoting, protecting, and supporting exclusive breastfeeding.
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Affiliation(s)
- Abeer Salem Al Shahrani
- Department of Clinical Sciences, College of Medicine, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Hessah Mamdouh Hushan
- Department of Clinical Sciences, College of Medicine, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Noura Khalid Binjamaan
- Department of Clinical Sciences, College of Medicine, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Wajd Abdulrahman Binhuwaimel
- Department of Clinical Sciences, College of Medicine, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Jawaher Jazaa Alotaibi
- Department of Clinical Sciences, College of Medicine, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Lama Ali Alrasheed
- Health Sciences Research Center, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
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3
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Ballesta-Castillejos A, Gómez-Salgado J, Rodríguez-Almagro J, Hernández-Martínez A. Development and validation of a predictive model of exclusive breastfeeding at hospital discharge: Retrospective cohort study. Int J Nurs Stud 2021; 117:103898. [PMID: 33636452 DOI: 10.1016/j.ijnurstu.2021.103898] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 01/29/2021] [Accepted: 01/30/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND The benefits of breastfeeding for both mother and newborn have been widely demonstrated. However, breastfeeding rates at discharge are lower than recommended, so being able to identify women at risk of not breastfeeding at discharge could allow professionals to prioritise care. OBJECTIVE To develop and validate a predictive model of exclusive breastfeeding at hospital discharge. DESIGN Retrospective cohort study on women who gave birth between 2014 and 2019 in Spain. DATA SOURCES The data source was a questionnaire distributed through the Spanish breastfeeding associations. The development of the predictive model was made on a cohort of 3387 women and was validated on a cohort of 1694 women. A multivariate analysis was performed by means of logistic regression, and predictive ability was determined by areas under the ROC curve (AUC). RESULTS 80.2% (2717) women exclusively breastfed at discharge in the derivation cohort, and 82.1% (1390) in the validation cohort. The predictive factors in the final model were: maternal age at birth; BMI; number of children; previous breastfeeding; birth plan; induced birth; epidural analgesia; type of birth; prematurity; multiple pregnancy; macrosomia; onset of breastfeeding within the first hour; and skin-to-skin contact. The predictive ability (ROC AUC) in the derivation cohort was 0.76 (CI 95%: 0.74-0.78), while in the validation cohort it was 0.74 (CI 95%: 0.71-0.77). CONCLUSIONS A predictive model of exclusive maternal breastfeeding at hospital discharge has been developed, based on thirteen variables, with satisfactory predictive ability in both the derivation cohort and the validation cohort according to the Swets' criteria. This model can identify women who are at high risk of not breastfeeding at hospital discharge.
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Affiliation(s)
| | - Juan Gómez-Salgado
- PhD.Department of Sociology, Social Work and Public Health, University of Huelva, 21071 Huelva, Spain; Safety and Health Posgrade Program, Universidad Espíritu Santo, Guayaquil 091650, Ecuador.
| | - Julián Rodríguez-Almagro
- PhD. Department of Nursing. Ciudad Real School of Nursing, University of Castilla La-Mancha, Ciudad Real, Spain.
| | - Antonio Hernández-Martínez
- Msc. Department of Obstetrics & Gynaecology, Alcázar de San Juan, Ciudad Real, Spain; Safety and Health Posgrade Program, Universidad Espíritu Santo, Guayaquil 091650, Ecuador.
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4
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Brugaletta C, Le Roch K, Saxton J, Bizouerne C, McGrath M, Kerac M. Breastfeeding assessment tools for at-risk and malnourished infants aged under 6 months old: a systematic review. F1000Res 2020; 9:1310. [PMID: 33628437 PMCID: PMC7898355 DOI: 10.12688/f1000research.24516.2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/09/2021] [Indexed: 11/20/2022] Open
Abstract
Background: Many small and malnourished infants under 6 months of age have problems with breastfeeding and restoring effective exclusive breastfeeding is a common treatment goal. Assessment is a critical first step of case management, but most malnutrition guidelines do not specify how best to do this. We aimed to identify breastfeeding assessment tools for use in assessing at-risk and malnourished infants in resource-poor settings. Methods: We systematically searched: Medline and Embase; Web of Knowledge; Cochrane Reviews; Eldis and Google Scholar databases. Also the World Health Organization (WHO), United Nations International Children's Emergency Fund (UNICEF), CAse REport guidelines, Emergency Nutrition Network, and Field Exchange websites. Assessment tool content was analysed using a framework describing breastfeeding 'domains' (baby's behaviour; mother's behaviour; position; latching; effective feeding; breast health; baby's health; mother's view of feed; number, timing and length of feeds). Results: We identified 29 breastfeeding assessment tools and 45 validation studies. Eight tools had not been validated. Evidence underpinning most tools was low quality and mainly from high-income countries and hospital settings. The most comprehensive tools were the Breastfeeding, Evaluation and Education Tool, UNICEF Baby-Friendly Hospital Initiative tools and CARE training package. The tool with the strongest evidence was the WHO/UNICEF B-R-E-A-S-T-Feed Observation Form. Conclusions: Despite many possible tools, there is currently no one gold standard. For assessing malnourished infants in resource-poor settings, UNICEF Baby-Friendly Hospital Initiative tools, Module IFE and the WHO/UNICEF B-R-E-A-S-T-Feed Observation Form are the best available tools but could be improved by adding questions from other tools. Allowing for context, one tool for rapid community-based assessment plus a more detailed one for clinic/hospital assessment might help optimally identify breastfeeding problems and the support required. Further research is important to refine existing tools and develop new ones. Rigorous testing, especially against outcomes such as breastfeeding status and growth, is key.
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Affiliation(s)
- Concetta Brugaletta
- Gastrointestinal Physiology Unit, University College London Hospitals NHS Trust, London, England, NW12BW, UK
| | - Karine Le Roch
- Mental Health and Care Practices Department, Action Contre la Faim, 75017 Paris, France
| | | | - Cécile Bizouerne
- Mental Health and Care Practices Department, Action Contre la Faim, 75017 Paris, France
| | - Marie McGrath
- Emergency Nutrition Network, Kidlington, England, OX5 2DN, UK
| | - Marko Kerac
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, England, WC1E 7HT, UK
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5
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Brugaletta C, Le Roch K, Saxton J, Bizouerne C, McGrath M, Kerac M. Breastfeeding assessment tools for at-risk and malnourished infants aged under 6 months old: a systematic review. F1000Res 2020; 9:1310. [PMID: 33628437 PMCID: PMC7898355 DOI: 10.12688/f1000research.24516.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/01/2020] [Indexed: 11/08/2023] Open
Abstract
Background: Many small and malnourished infants under 6 months of age have problems with breastfeeding and restoring effective exclusive breastfeeding is a common treatment goal. Assessment is a critical first step of case management, but most malnutrition guidelines do not specify how best to do this. We aimed to identify breastfeeding assessment tools for use in assessing at-risk and malnourished infants in resource-poor settings. Methods: We systematically searched: Medline and Embase; Web of Knowledge; Cochrane Reviews; Eldis and Google Scholar databases. Also the World Health Organization (WHO), United Nations International Children's Emergency Fund (UNICEF), CAse REport guidelines, Emergency Nutrition Network, and Field Exchange websites. Assessment tool content was analysed using a framework describing breastfeeding 'domains' (baby's behaviour; mother's behaviour; position; latching; effective feeding; breast health; baby's health; mother's view of feed; number, timing and length of feeds). Results: We identified 29 breastfeeding assessment tools and 45 validation studies. Eight tools had not been validated. Evidence underpinning most tools was low quality and mainly from high-income countries and hospital settings. The most comprehensive tools were the Breastfeeding, Evaluation and Education Tool, UNICEF Baby-Friendly Hospital Initiative tools and CARE training package. The tool with the strongest evidence was the WHO/UNICEF B-R-E-A-S-T-Feed Observation Form. Conclusions: Despite many possible tools, there is currently no one gold standard. For assessing malnourished infants in resource-poor settings, UNICEF Baby-Friendly Hospital Initiative tools, Module IFE and the WHO/UNICEF B-R-E-A-S-T-Feed Observation Form are the best available tools but could be improved by adding questions from other tools. Allowing for context, one tool for rapid community-based assessment plus a more detailed one for clinic/hospital assessment might help optimally identify breastfeeding problems and the support required. Further research is important to refine existing tools and develop new ones. Rigorous testing, especially against outcomes such as breastfeeding status and growth, is key.
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Affiliation(s)
- Concetta Brugaletta
- Gastrointestinal Physiology Unit, University College London Hospitals NHS Trust, London, England, NW12BW, UK
| | - Karine Le Roch
- Mental Health and Care Practices Department, Action Contre la Faim, 75017 Paris, France
| | | | - Cécile Bizouerne
- Mental Health and Care Practices Department, Action Contre la Faim, 75017 Paris, France
| | - Marie McGrath
- Emergency Nutrition Network, Kidlington, England, OX5 2DN, UK
| | - Marko Kerac
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, England, WC1E 7HT, UK
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6
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Fadiloglu E, Karatas E, Tez R, Cagan M, Unal C, Nar M, Tanacan A, Beksac MS. Assessment of Factors Affecting Breastfeeding Performance and Latch Score: A Prospective Cohort Study. Z Geburtshilfe Neonatol 2020; 225:353-360. [PMID: 33022737 DOI: 10.1055/a-1255-3525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To determine the risk factors that may affect LATCH scores. MATERIALS AND METHODS We prospectively evaluated the LATCH scores and any relevant risk factors of patients who delivered at our institution during April and May 2020. All examinations were performed by the same physicians during the study period. LATCH scores were determined at initial breastfeeding session, and postnatal days 1 and 2. RESULTS We analyzed 338 patients in this prospective study. Patients with high-risk pregnancies were found to have lower LATCH scores at each measurement (p: 0.002, 0.001, and 0.09, respectively). Skin-to-skin contact immediately after delivery and breastfeeding longer than 20 min in the first session did not improve LATCH scores (p>0.05). Breastfeeding within 30 min after delivery significantly improved LATCH scores at each session (p<0.01 for all). Odds ratios of having a LATCH score lower than 8 was 10.9 (95% CI: 4.22-28.37) for the patients breastfed after more than 30 min, while this ratio was 2.17 (95% CI: 1.34-3.50) and 6.5 (95% CI: 3.46-12.58) for the patients having a high-risk pregnancy and cesarean section, respectively. Furthermore, we also determined a positive statistically significant association between parity and all LATCH scores according to regression analyses (p: 0.005, 0.028, and 0.035 for LATCH scores at initial breastfeeding, postnatal day 1 and 2, respectively) CONCLUSION: High-risk pregnancies, patients who delivered by cesarean section, and patients not attempting to breastfeed within 30 min tend to have lower LATCH scores.
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Affiliation(s)
- Erdem Fadiloglu
- Division of Perinatal Medicine, Department of Obstetrics and Gynecology, Hacettepe University Medical Faculty, Ankara, Turkey
| | - Esra Karatas
- Division of Perinatal Medicine, Department of Obstetrics and Gynecology, Hacettepe University Medical Faculty, Ankara, Turkey
| | - Ruya Tez
- Division of Perinatal Medicine, Department of Obstetrics and Gynecology, Hacettepe University Medical Faculty, Ankara, Turkey
| | - Murat Cagan
- Division of Perinatal Medicine, Department of Obstetrics and Gynecology, Hacettepe University Medical Faculty, Ankara, Turkey
| | - Canan Unal
- Division of Perinatal Medicine, Department of Obstetrics and Gynecology, Hacettepe University Medical Faculty, Ankara, Turkey
| | - Makbule Nar
- Division of Perinatal Medicine, Department of Obstetrics and Gynecology, Hacettepe University Medical Faculty, Ankara, Turkey
| | - Atakan Tanacan
- Division of Perinatal Medicine, Department of Obstetrics and Gynecology, Hacettepe University Medical Faculty, Ankara, Turkey
| | - Mehmet Sinan Beksac
- Division of Perinatal Medicine, Department of Obstetrics and Gynecology, Hacettepe University Medical Faculty, Ankara, Turkey
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Feldman-Winter L, Kellams A. In-Hospital Formula Feeding and Breastfeeding Duration. Pediatrics 2020; 146:peds.2020-1221. [PMID: 32518169 DOI: 10.1542/peds.2020-1221] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/17/2020] [Indexed: 11/24/2022] Open
Affiliation(s)
- Lori Feldman-Winter
- Department of Pediatrics, Cooper Medical School, Rowan University and Children's Regional Hospital at Cooper, Cooper University Health Care, Camden, New Jersey; and
| | - Ann Kellams
- Department of Pediatrics, School of Medicine, University of Virginia, Charlottesville, Virginia
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8
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Feldman-Winter L, Kellams A, Peter-Wohl S, Taylor JS, Lee KG, Terrell MJ, Noble L, Maynor AR, Meek JY, Stuebe AM. Evidence-Based Updates on the First Week of Exclusive Breastfeeding Among Infants ≥35 Weeks. Pediatrics 2020; 145:peds.2018-3696. [PMID: 32161111 DOI: 10.1542/peds.2018-3696] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/06/2019] [Indexed: 11/24/2022] Open
Abstract
The nutritional and immunologic properties of human milk, along with clear evidence of dose-dependent optimal health outcomes for both mothers and infants, provide a compelling rationale to support exclusive breastfeeding. US women increasingly intend to breastfeed exclusively for 6 months. Because establishing lactation can be challenging, exclusivity is often compromised in hopes of preventing feeding-related neonatal complications, potentially affecting the continuation and duration of breastfeeding. Risk factors for impaired lactogenesis are identifiable and common. Clinicians must be able to recognize normative patterns of exclusive breastfeeding in the first week while proactively identifying potential challenges. In this review, we provide new evidence from the past 10 years on the following topics relevant to exclusive breastfeeding: milk production and transfer, neonatal weight and output assessment, management of glucose and bilirubin, immune development and the microbiome, supplementation, and health system factors. We focus on the early days of exclusive breastfeeding in healthy newborns ≥35 weeks' gestation managed in the routine postpartum unit. With this evidence-based clinical review, we provide detailed guidance in identifying medical indications for early supplementation and can inform best practices for both birthing facilities and providers.
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Affiliation(s)
- Lori Feldman-Winter
- Department of Pediatrics, Cooper Medical School, Rowan University and Children's Regional Hospital at Cooper, Cooper University Health Care, Camden, New Jersey;
| | - Ann Kellams
- Department of Pediatrics, School of Medicine, University of Virginia, Charlottesville, Virginia
| | | | - Julie Scott Taylor
- American University of the Caribbean School of Medicine, Sint Maarten, Netherlands Antilles.,Department of Family Medicine, Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Kimberly G Lee
- Division of Neonatology, Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina
| | - Mary J Terrell
- Division of Neonatology, Department of Pediatrics, University of North Carolina Hospitals, Chapel Hill, North Carolina
| | - Lawrence Noble
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Angela R Maynor
- Department of Food and Nutrition, University of North Carolina Health Care, Chapel Hill, North Carolina; and
| | - Joan Younger Meek
- Department of Clinical Sciences, College of Medicine, Florida State University, Tallahassee, Florida
| | - Alison M Stuebe
- Obstetrics and Gynecology, School of Medicine and.,Department of Maternal and Child Health and Carolina Global Breastfeeding Institute, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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9
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Medina Poeliniz C, Engstrom JL, Hoban R, Patel AL, Meier P. Measures of Secretory Activation for Research and Practice: An Integrative Review. Breastfeed Med 2020; 15:191-212. [PMID: 32155345 DOI: 10.1089/bfm.2019.0247] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Background: Maternal concern about inadequate milk volume commonly emerges in the first 2 weeks postpartum, a critical lactation period that includes secretory activation. This review summarizes the biology of secretory activation and evaluates the accuracy and feasibility of published measures of secretory activation. Materials and Methods: A systematic search of measures of secretory activation for mothers of healthy term and preterm infants yielded 62 abstracts. Following additional screening, 15 publications qualified for quantitative synthesis review and were evaluated with respect to accuracy (validated with another measure of secretory activation in the same mother) and feasibility (accessibility, cost, and ease of use). Results:Maternal perception of milk coming in (MP) is the most feasible measure, but its accuracy has not been established. Patterns of increase in maternal milk volume have been validated with maternal milk-borne biomarkers in breastfeeding, and breast pump-dependent mothers and normal values have been published. Accuracy of serial maternal urinary lactose concentrations has not been established for secretory activation and lacks feasibility. Maternal milk biomarkers are the accurate standard to which other measures are compared but currently lack feasibility for routine use. Conclusions: Use of secretory activation measures can personalize lactation care by matching maternal risk with appropriate diagnostics. Priorities for research and practice include validation of MP as a population-based screening tool, implementation of techniques that measure patterns of increase in milk volume for moderate risk populations, and the development of milk biomarker science for point-of-care use in the most complicated lactation scenarios.
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Affiliation(s)
| | - Janet L Engstrom
- Department of Women and Children's Nursing, College of Nursing, Rush University, Chicago, Illinois
| | - Rebecca Hoban
- Department of Pediatrics, Section of Neonatology, Rush University Medical Center, Chicago, Illinois.,Department of Pediatrics, Division of Neonatology, The Hospital for Sick Children, Toronto, Canada
| | - Aloka L Patel
- Department of Women and Children's Nursing, College of Nursing, Rush University, Chicago, Illinois.,Department of Pediatrics, Section of Neonatology, Rush University Medical Center, Chicago, Illinois
| | - Paula Meier
- Department of Women and Children's Nursing, College of Nursing, Rush University, Chicago, Illinois.,Department of Pediatrics, Section of Neonatology, Rush University Medical Center, Chicago, Illinois
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10
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Dennis CL, Shiri R, Brown HK, Santos HP, Schmied V, Falah-Hassani K. Breastfeeding rates in immigrant and non-immigrant women: A systematic review and meta-analysis. MATERNAL AND CHILD NUTRITION 2019; 15:e12809. [PMID: 30884175 DOI: 10.1111/mcn.12809] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 02/28/2019] [Accepted: 03/06/2019] [Indexed: 11/30/2022]
Abstract
Breastfeeding benefits mothers and infants. Although immigration in many regions has increased in the last three decades, it is unknown whether immigrant women have better breastfeeding outcomes than non-immigrants. The aim of this study was to conduct a systematic review and meta-analysis to determine whether breastfeeding rates differ between immigrant and non-immigrant women. We searched Medline, Embase, PsycINFO, CINAHL and Google Scholar, 1950 to 2016. We included peer-reviewed cross-sectional and cohort studies of women aged ≥16 years that assessed and compared breastfeeding rates in immigrant and non-immigrant women. Two independent reviewers extracted data using predefined standard procedures. The analysis included 29 studies representing 1,539,659 women from 14 countries. Immigrant women were more likely than non-immigrants to initiate any (exclusive or partial) breastfeeding (pooled adjusted prevalence ratio 1.13, 95% confidence interval [CI] 1.07-1.19; 11 studies). Exclusive breastfeeding initiation was higher but borderline significant (adjusted prevalence ratio 1.20, 95% CI 1.00-1.45; 5 studies, p = 0.056). Immigrant women were more likely than non-immigrants to continue any breastfeeding between 12- and 24-week postpartum (pooled adjusted risk ratio 2.04, 95% CI 1.79-2.32; 3 studies) and > 24 weeks (adjusted risk ratio 1.33, 95% CI 1.02-1.73; 6 studies) but not exclusive breastfeeding. Immigrant women are more likely than non-immigrants to initiate and maintain any breastfeeding, but exclusive breastfeeding remains a challenge for both immigrants and non-immigrants. Social and cultural factors need to be considered to understand the extent to which immigrant status is an independent predictor of positive breastfeeding practices.
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Affiliation(s)
- Cindy-Lee Dennis
- Faculty of Nursing, University of Toronto, Toronto, Canada.,St. Michael's Hospital, Toronto, Canada
| | - Rahman Shiri
- Finnish Institute of Occupational Health, Helsinki, Finland
| | - Hilary K Brown
- Faculty of Nursing, University of Toronto, Toronto, Canada
| | - Hudson P Santos
- School of Nursing, University of North Carolina, Chapel Hill, USA
| | - Virginia Schmied
- School of Nursing and Midwifery, Western Sydney University, Sydney, Australia
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11
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Chapman DJ, Kuhnly JE. Lactation Assessment Tools: A Qualitative Analysis of Registered Nurses' Perceptions of Tool Limitations and Suggested Improvements. J Hum Lact 2018; 34:682-690. [PMID: 29979609 DOI: 10.1177/0890334418766283] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Several lactation assessment tools are available for in-hospital assessment of breastfeeding dyads, and their components vary widely. To date, no research has evaluated the perceptions of registered nurses (RNs) regarding the limitations and future improvements of these tools. Research Aim The aim was to describe RNs' perceptions of the limitations of currently used lactation assessment tools and how these tools could be enhanced. Methods Focus groups ( n = 7) were conducted with RNs ( N = 28) whose current responsibilities included in-hospital breastfeeding assessment. Recruitment occurred from April through July 2015 at regional and international lactation conferences. Focus groups were audiotaped and transcribed verbatim. Two lactation researchers analyzed the transcripts to identify emerging themes and subthemes. Results RNs identified three key limitations of the tools included being too subjective and time-consuming, difficulty in assessing audible swallows, and missing the big picture (e.g., overemphasizing numbers, being a snapshot in time). Suggested improvements focused on maternal characteristics (evolving breasts and nipples, holding it together, "got milk?," risk factors, embracing the role), infant characteristics (day of life, latch/suck/swallow, baby's "driving the bus," risk factors for supplemental feeding), their interaction (two to tango, positioning, better qualitative descriptors), and tool organization (formatting and multiple versions). Conclusions RNs suggested novel components for consideration when developing future lactation assessment scales, including removing audible swallowing, adding mother/infant interactions, infant output, and expressible colostrum, and developing criteria specific to infant age. Future research should translate these suggestions into evidence-based indicators and evaluate the resulting proposed tools for reliability and validity.
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12
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Lai CT, Gardner H, Geddes D. Comparison of Inductively Coupled Plasma Optical Emission Spectrometry with an Ion Selective Electrode to Determine Sodium and Potassium Levels in Human Milk. Nutrients 2018; 10:E1218. [PMID: 30177589 PMCID: PMC6164336 DOI: 10.3390/nu10091218] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 08/24/2018] [Accepted: 08/27/2018] [Indexed: 11/16/2022] Open
Abstract
Sodium (Na), potassium (K), and the ratio Na:K in human milk (HM) may be useful biomarkers to indicate secretory activation or inflammation in the breast. Previously, these elements have been measured in a laboratory setting requiring expensive equipment and relatively large amounts of HM. The aim of this study was to compare measurements of Na and K in HM using inductively coupled plasma optical emission spectrometry (ICP-OES) with small portable ion selective electrode probes for Na and K. Sixty-five lactating women donated 5 mL samples of HM. Samples were analyzed with two ion selective probes (Na and K) and also ICP-OES. The data were analyzed using paired t-test and Bland⁻Altman plots. Na concentrations were not significantly different when measured with ion selective electrode (6.18 ± 2.47mM; range: 3.59⁻19.8) and ICP-OES (5.91 ± 3.37 mM; range: 2.59⁻21.5) (p = 0.20). K concentrations measured using the ion selective electrode (11.7 ± 2.21 mM: range: 7.69⁻18.1) and ICP-OES (11.1 ± 1.55 mM: range: 7.91⁻15.2) were significantly different (p = 0.01). However, the mean differences of 0.65 mM would not be clinically relevant when testing at point of care. Compared to ICP-OES, ion selective electrode is sufficiently accurate to detect changes in concentrations of Na and K in HM associated with secretory activation and inflammation in the mammary gland.
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Affiliation(s)
- Ching Tat Lai
- School of Molecular Sciences, University of Western Australia, 35 Stirling Highway, Crawley, 6009 WA, Australia.
| | - Hazel Gardner
- School of Molecular Sciences, University of Western Australia, 35 Stirling Highway, Crawley, 6009 WA, Australia.
| | - Donna Geddes
- School of Molecular Sciences, University of Western Australia, 35 Stirling Highway, Crawley, 6009 WA, Australia.
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Sartorio BT, Coca KP, Marcacine KO, Abuchaim ÉDSV, Abrão ACFDV. Breastfeeding assessment instruments and their use in clinical practice. ACTA ACUST UNITED AC 2017; 38:e64675. [PMID: 28443975 DOI: 10.1590/1983-1447.2017.01.64675] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 01/31/2017] [Indexed: 11/22/2022]
Abstract
Objectives To identify breastfeeding assessment tools, their application in clinical practice, and their validation and cross-cultural adaptation. Method This is an integrative review of literature obtained from six databases and an online library, conducted from August 2014 to December 2015, without a temporal delimitation. Results We identified 19 assessment tools, of which 12 were validated and five were cross-culturally adapted. In terms of adaptation, the tools were used to assess the risk of early weaning (BAPT) and the perception/behaviour of mothers during nursing (BSES-SF and IIFAS). Conclusions The identification of the available instruments and their indications for breastfeeding assessments can help health workers choose the ideal instrument, and qualify maternal and child care.
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Affiliation(s)
- Bárbara Tideman Sartorio
- Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Enfermagem, Departamento de Enfermagem na Saúde da Mulher. São Paulo, São Paulo, Brasil
| | - Kelly Pereira Coca
- Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Enfermagem, Departamento de Enfermagem na Saúde da Mulher. São Paulo, São Paulo, Brasil
| | - Karla Oliveira Marcacine
- Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Enfermagem, Departamento de Enfermagem na Saúde da Mulher. São Paulo, São Paulo, Brasil
| | - Érika de Sá Vieira Abuchaim
- Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Enfermagem, Departamento de Enfermagem na Saúde da Mulher. São Paulo, São Paulo, Brasil
| | - Ana Cristina Freitas de Vilhena Abrão
- Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Enfermagem, Departamento de Enfermagem na Saúde da Mulher. São Paulo, São Paulo, Brasil
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Wambach K, Domian EW, Page-Goertz S, Wurtz H, Hoffman K. Exclusive Breastfeeding Experiences among Mexican American Women. J Hum Lact 2016; 32:103-11. [PMID: 26289059 PMCID: PMC4710489 DOI: 10.1177/0890334415599400] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Accepted: 07/09/2015] [Indexed: 11/15/2022]
Abstract
BACKGROUND According to the Centers for Disease Control and Prevention, Hispanic breastfeeding mothers begin early formula supplementation at higher rates than other ethnic groups, which can lead to shorter breastfeeding duration and decreased exclusive breastfeeding. Acculturation, the process of adopting beliefs and behaviors of another culture, appears to influence breastfeeding practices of Hispanic women in the United States. Little is known about Mexican American mothers' formula use and exclusive breastfeeding within the context of acculturation. OBJECTIVE Our study identified perceived benefits and barriers to exclusive breastfeeding and levels of acculturation among Mexican American women living in a Midwestern city. METHODS We used a qualitative descriptive design integrating Pender's Health Promotion Model concepts. Individual interviews were conducted in English or Spanish (N = 21). The revised Acculturation Rating Scale for Mexican Americans was used to examine acculturation levels. RESULTS Acculturation scores indicated that the majority (66%) of the sample was "very Mexican oriented." Most women exclusively breastfed, with a few using early supplementation for "insufficient milk production." Three themes emerged: (1) It is natural that a woman give life and also provide the best food for her baby; (2) Breastfeeding is ultimately a woman's decision but is influenced by tradition, guidance, and encouragement; and (3) Breast milk is superior but life circumstances can challenge one's ability to breastfeed. CONCLUSION Strong familial/cultural traditions supported and normalized breastfeeding. Barriers to exclusive breastfeeding were similar to breastfeeding women in general, in the United States. Findings support the need for culturally competent and individualized lactation care.
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Affiliation(s)
- Karen Wambach
- School of Nursing, University of Kansas, Kansas City, KS, USA
| | | | - Sallie Page-Goertz
- Department of Pediatrics, University of Kansas Medical Center, Kansas City, KS, USA
| | - Heather Wurtz
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
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15
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[Hospital practices and breastfeeding cessation risk within 6 months of delivery]. Arch Pediatr 2015; 22:924-31. [PMID: 26231320 DOI: 10.1016/j.arcped.2015.06.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Revised: 05/27/2015] [Accepted: 06/26/2015] [Indexed: 11/23/2022]
Abstract
BACKGROUND The impact of maternity ward practices on breastfeeding duration remains uncertain in France. OBJECTIVE This study aimed to determine whether compliance with an increasing number of Baby-Friendly Hospital Initiative recommended practices was associated with a decreasing risk for breastfeeding cessation within 6 months of delivery. METHODS We analyzed the original data from a prospective cohort study carried out in eight maternity centers in France in 2005-2006. A pediatrician or a midwife prospectively collected data on breastfeeding initiation within 1h of birth, rooming-in 24h a day, pacifier non-use, and giving breast milk only for 908 mothers who were breastfeeding at discharge. RESULTS Overall, 315 (34.7%), 309 (34.0%), 186 (20.5%), and 98 (10.8%) mothers experienced 4, 3, 2, or 0-1 maternity ward practices. The median breastfeeding duration was 18 weeks (25th-75th percentiles, 9 to >26), with 87.6% and 31.5% of mothers who were still breastfeeding by 4 and 26 weeks after delivery, respectively. After adjusting for study center and baseline characteristics, the hazard ratios of breastfeeding cessation associated with 3, 2, and 0-1 practices were 1.32 (95% confidence interval [CI], 1.06-1.64), 1.54 (95% CI, 1.20-1.98), and 1.59 (95% CI, 1.13-2.25) as compared with compliance with four practices (p for trend <0.001). CONCLUSION Although the causal interpretation for this relationship remains speculative, these findings support interventions aimed to implement or reinforce Baby-Friendly Hospital Initiative recommended practices in order to establish prolonged breastfeeding and decrease the risk for early cessation after discharge to home.
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Lau Y, Htun TP, Tam WSW, Klainin-Yobas P. Efficacy of e-technologies in improving breastfeeding outcomes among perinatal women: a meta-analysis. MATERNAL AND CHILD NUTRITION 2015; 12:381-401. [PMID: 26194599 DOI: 10.1111/mcn.12202] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
A growing line of research has highlighted that e-technologies may play a promising role in improving breastfeeding outcomes. The objective of this review was to synthesise the best of available evidence by conducting a meta-analysis to evaluate whether e-technologies have had any effect in improving breastfeeding outcomes among perinatal women. The review was conducted using nine electronic databases to search for English-language research studies from 2007 to 2014. A 'risk of bias' table was used to assess methodological quality. Meta-analysis was performed with the RevMan software. The Q test and I(2) test was used to assess the heterogeneity. The test of overall effect was assessed using z-statistics at P < 0.05. Of 1842 studies identified through electronic searches and reference lists, 16 experimental studies were selected after applying the inclusion and exclusion criteria. Half of the selected studies had a low risk of bias, from which a total of 5505 women in six countries in these studies were included. Meta-analyses revealed that e-technologies significantly improved exclusive breastfeeding initiation (z = 6.90, P < 0.00001), exclusive breastfeeding at 4 weeks (z = 2.12, P = 0.03) and 6 months (z = 3.2, P = 0.001), breastfeeding attitude (z = 3.01, P = 0.003) and breastfeeding knowledge (z = 4.54, P = < 0.00001) in subgroup analyses. This review provides support for the development of web-based, texting messaging, compact disc read-only memory, electronic prompts and interactive computer agent interventions for promoting and supporting breastfeeding.
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Affiliation(s)
- Ying Lau
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Tha P Htun
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Wai S W Tam
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Piyanee Klainin-Yobas
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Dégrange M, Delebarre M, Turck D, Mestdagh B, Storme L, Deruelle P, Rakza T. [Is self-confidence a factor for successful breastfeeding?]. Arch Pediatr 2015; 22:708-17. [PMID: 26033192 DOI: 10.1016/j.arcped.2015.04.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Revised: 02/25/2015] [Accepted: 04/21/2015] [Indexed: 11/27/2022]
Abstract
CONTEXT Maternal self-confidence and self-efficacy in breastfeeding are recognized as factors positively associated with the initiation and duration of breastfeeding. OBJECTIVE To evaluate the importance of this association using the Breast Feeding Self-Efficacy Scale (BSES). METHOD This prospective study was conducted in 2012 in the Jeanne-de-Flandre maternity department in the Lille University Hospital (France). During their time in the maternity department, breastfeeding mothers who participated in the study completed the BSES, a brief self-assessment of their feelings of self-efficacy relating to breastfeeding. They then received follow-up telephone interviews at 1 and 3 months postpartum. RESULTS One hundred and forty-nine mothers were included in the study. Breastfeeding rates were 86.5% at 1 month and 60% at 3 months. The BSES score of mothers who continued to breastfeed at 1 and 3 months was significantly higher than the score of mothers who had already weaned their children, with an AUROC of 0.72 at 3 months. This confirmed the reliability of the BSES for predicting adherence to breastfeeding. The BSES score of mothers who had previously breastfed was significantly higher than for those breastfeeding for the first time. The threshold score for the BSES was determined as 116/165. CONCLUSION It is important that mothers who lack confidence in their ability to breastfeed be identified early, whether on the maternity ward or even before this point. The value of BSES-based breastfeeding support intervention needs to be evaluated through randomized trials.
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Affiliation(s)
- M Dégrange
- Service de pédiatrie et néonatologie, hôpital de Tourcoing, 59200 Tourcoing, France
| | - M Delebarre
- Service des urgences pédiatriques, hôpital Roger-Salengro, CHRU de Lille, 59000 Lille, France
| | - D Turck
- Service de gastro-nutrition pédiatrique, hôpital Jeanne-de-Flandre, CHRU de Lille, 59000 Lille, France
| | - B Mestdagh
- Service de pédiatrie en maternité, hôpital Jeanne-de-Flandre, CHRU de Lille, avenue Eugène-Avinée, 59037 Lille cedex, France
| | - L Storme
- Unité de réanimation néonatale, service médecine néonatale, hôpital Jeanne-de-Flandre, CHRU de Lille, 59000 Lille, France; EA 4489, faculté de médecine de Lille, 59000 Lille, France
| | - P Deruelle
- EA 4489, faculté de médecine de Lille, 59000 Lille, France; Service d'obstétrique, hôpital Jeanne-de-Flandre, CHRU de Lille, 59000 Lille, France
| | - T Rakza
- Service de pédiatrie en maternité, hôpital Jeanne-de-Flandre, CHRU de Lille, avenue Eugène-Avinée, 59037 Lille cedex, France; EA 4489, faculté de médecine de Lille, 59000 Lille, France.
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18
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Raskovalova T, Teasley SL, Gelbert-Baudino N, Mauri PA, Schelstraete C, Massoutier M, Berger M, François P, Labarère J. Breastfeeding Assessment Score: Systematic Review and Meta-analysis. Pediatrics 2015; 135:e1276-85. [PMID: 25869379 DOI: 10.1542/peds.2014-3072] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/04/2015] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Previous studies have revealed conflicting results for the Breastfeeding Assessment Score (BAS) in predicting early breastfeeding cessation. Our objective was to externally validate the BAS and provide summary accuracy estimates for this clinical prediction model. METHODS We used the original data from a prospective cohort study. Additional studies were identified by searching electronic databases (Medline, Embase, Cumulative Index to Nursing and Allied Health Literature, and Cochrane) from 2002 to 2013 and contacting research groups that had derived or validated the BAS. Prospective cohort studies were eligible if the BAS was computed at baseline and mothers were followed up for breastfeeding cessation. Two physicians extracted relevant information and independently assessed the methodological quality for the included studies. RESULTS In the external validation cohort, 22 of 424 mothers (5.2%) discontinued breastfeeding within 14 days of infant age. The BAS predicted early breastfeeding cessation with an area under the curve of 0.70 (95% confidence interval [CI]: 0.65 to 0.74) and inadequate calibration. When restricting the meta-analysis to 3169 mother-infant pairs enrolled in 4 higher-quality studies, a BAS value <8 predicted early cessation with 0.80 sensitivity (95% CI: 0.69 to 0.91) and 0.51 specificity (95% CI: 0.32 to 0.70) summary estimates. CONCLUSIONS Substantial between-study heterogeneity limited the interpretation of summary accuracy estimates. The BAS predicts early breastfeeding cessation with moderate accuracy, although local recalibration is advised before implementation. Further study is warranted to determine whether the BAS can help pediatricians in identifying mother-infant pairs that may benefit from more extensive breastfeeding assessment and support.
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Affiliation(s)
| | | | | | | | | | | | - Marc Berger
- University Hospital, Clermont-Ferrand, France
| | - Patrice François
- University Hospital, Grenoble, France; and Techniques de l'Ingénierie Médicale et de la Complexité - Informatique, Mathématiques et Applications, Grenoble, Unité Mixte de Recherche 5525, Centre National de la Recherche Scientifique, Université Joseph Fourier-Grenoble 1, Grenoble, France
| | - José Labarère
- University Hospital, Grenoble, France; and Techniques de l'Ingénierie Médicale et de la Complexité - Informatique, Mathématiques et Applications, Grenoble, Unité Mixte de Recherche 5525, Centre National de la Recherche Scientifique, Université Joseph Fourier-Grenoble 1, Grenoble, France
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Wilhelm SL, Aguirre TM, Koehler AE, Rodehorst TK. Evaluating motivational interviewing to promote breastfeeding by rural Mexican-American mothers: the challenge of attrition. ACTA ACUST UNITED AC 2014; 38:7-21. [PMID: 25373565 DOI: 10.3109/01460862.2014.971977] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Although most Hispanic/Latino-American mothers initiate breastfeeding, duration and exclusivity of breastfeeding remain low. We explored whether a motivational interviewing (MI) intervention could help rural Mexican-American mothers continue breastfeeding. We used a two-group (MI intervention n = 26, attention control [AC] n = 27) repeated measures experimental design. Assessments and interventions occurred at 3 days, 2 weeks, and 6 weeks postpartum (time points when mothers are particularly vulnerable to discontinuing breastfeeding), with a final phone assessment at 6 months postpartum. We collected demographic data and measured intent to breastfeed for 6 months (intent question), self-efficacy (Breastfeeding Self-Efficacy Scale-Short Form), and collected breastfeeding information (breastfeeding assessment questionnaire). Independent t-tests and Mann Whitney U non-parametric tests were used to evaluate group differences (α = 0.05). High levels of attrition by week 6 impaired our ability to evaluate the potential of our MI intervention. No significant differences were found between groups for any of the outcome variables (intent to breastfeed for 6 months, breastfeeding self-efficacy, and duration of breastfeeding). Though the mothers intended to breastfeed for 6 months and were confident in their ability to do so, most did not breastfeed for 6 months. At 6 months, mothers receiving the MI intervention had breastfed an average of 90 days compared to 82 days for those receiving the AC sessions and 22% of the mothers in each group were still breastfeeding at some level. Because of the impact of attrition during this study, we discuss factors that contributed to attrition and approaches to lessen this problem in future studies. Such efforts may require a greater investment of time and resources and should be budgeted accordingly. Culturally appropriate interventions are needed to help rural Mexican-American mothers meet their breastfeeding goals, thus providing an opportunity to reduce their children's risk of multiple diseases and obesity. Only when we address these considerations will we have an opportunity to decrease health disparities, promote healthy behaviors, and be trusted health care partners.
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Affiliation(s)
- Susan L Wilhelm
- University of Nebraska Medical Center, College of Nursing-West Nebraska Division , Scottsbluff, Nebraska , USA
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Miller J, Fontana M, Jernlås K, Olofsson H, Verwijst I. Risks and rewards of early musculoskeletal assessment: An evidence-based case report. ACTA ACUST UNITED AC 2013. [DOI: 10.12968/bjom.2013.21.10.736] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Joyce Miller
- Advanced Professional Practice in Musculoskeletal Health in Paediatrics Bournemouth University
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Demirci JR, Sereika SM, Bogen D. Prevalence and predictors of early breastfeeding among late preterm mother-infant dyads. Breastfeed Med 2013; 8. [PMID: 23199304 PMCID: PMC3663454 DOI: 10.1089/bfm.2012.0075] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Although late preterm infants (LPIs), at 34(0/7)-36(6/7) weeks of gestation, are reported to have suboptimal rates of breastfeeding, there is a lack of quantitative evidence describing this trend. This study examined the prevalence of breastfeeding initiation and factors associated with breastfeeding non-initiation within a Pennsylvania population-based cohort of late preterm mother-infant dyads. SUBJECTS AND METHODS Descriptive statistics and odds ratios were used to assess and compare breastfeeding initiation rates in 2003-2009 among LPI mothers (n=62,451) and their infants (n=68,886) with moderately preterm (n=17,325) and term (n=870,034) infants. Binary logistic regression was used to determine the association of system/provider, sociodemographic, and medical factors with breastfeeding non-initiation in late preterm mother-infant dyads for the year 2009 (n=7,012). RESULTS Although LPI breastfeeding initiation in Pennsylvania increased significantly from 2003 (54%) to 2009 (61.8%) (p<0.001), the 2009 prevalence remained well below rates in term infant populations and national standards. The regression model indicated that interactions involving sociodemographic variables, including marital status, age, race/ethnicity, education, parity, Women, Infants and Children Program participation, and smoking status were among the most significant factors associated with LPI breastfeeding non-initiation (p<0.05). The univariate results were similar to those reported in preterm and term populations. CONCLUSIONS Our data suggest that certain, unexpected demographic groups in the late preterm population be prioritized for further analysis and possibly greater breastfeeding support. More research is indicated to understand the effect of modifiable psychosocial factors on LPI breastfeeding initiation.
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Affiliation(s)
- Jill Radtke Demirci
- General Academic Pediatrics, University of Pittsburgh School of Medicine , Children's Hospital of Pittsburgh, Pittsburgh, PA 15213, USA.
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Mauri PA, Zobbi VF, Zannini L. Exploring the mother's perception of latching difficulty in the first days after birth: An interview study in an Italian hospital. Midwifery 2012; 28:816-23. [DOI: 10.1016/j.midw.2011.09.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2011] [Revised: 09/10/2011] [Accepted: 09/24/2011] [Indexed: 11/28/2022]
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Dennis CL, Gagnon A, Van Hulst A, Dougherty G. Predictors of breastfeeding exclusivity among migrant and Canadian-born women: results from a multi-centre study. MATERNAL AND CHILD NUTRITION 2012; 10:527-44. [PMID: 22974539 DOI: 10.1111/j.1740-8709.2012.00442.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The objective of this study was to examine and compare predictors of breastfeeding exclusivity among migrant and Canadian-born women. As part of a longitudinal study, a sample of 1184 mothers were recruited from 12 hospitals in Canada and completed questionnaires at 1 and 16 weeks post-partum that included diverse questions from the following domains: demographic, social, migration, obstetrical, breastfeeding and maternal mood. After bivariate analysis, multivariate logistic regression analysis was completed to examine and compare predictors of exclusive breastfeeding at 16 weeks post-partum. Among migrant women, factors predictive of breastfeeding exclusivity included non-refugee immigrant or asylum-seeking status, residence in Toronto or Vancouver, maternal age of ≥35 years, feels most comfortable in the country of origin or nowhere and higher Gender-related Development Index of the country of origin. Factors predictive of not exclusively breastfeeding included maternal age of <20 years, not planning to exclusively breastfeed, not making the decision to breastfeed before pregnancy and not exclusively breastfeeding at 1 week post-partum. Among Canadian-born women, factors predictive of a lower likelihood of breastfeeding exclusivity included not living with father of infant, infant neonatal intensive care unit admission, planned duration of exclusive breastfeeding for <6 months, not exclusively breastfeeding at 1 week post-partum and Edinburgh Postnatal Depression Scale score of ≥10. The only similar risk factor predicting a lower likelihood of breastfeeding exclusivity between migrant and Canadian-born women was not exclusively breastfeeding at 1 week post-partum; all other risk factors were dissimilar, suggesting that these groups might benefit from different strategies to optimise breastfeeding outcomes.
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Affiliation(s)
- Cindy-Lee Dennis
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
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Bakar FT, Ozen A, Karatepe HÖ, Berber M, Ercan H. Impact of early weight loss on growth of Caesarean delivered babies: how long does it last? Child Care Health Dev 2012; 38:706-13. [PMID: 21827527 DOI: 10.1111/j.1365-2214.2011.01291.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND We hypothesized that Caesarean delivered babies might experience excessive weight loss during neonatal period. AIM To investigate amount of weight loss among Caesarean delivered babies with exclusive breastfeeding and to identify role of relative weight change (RWC) in early postnatal period on the growth of infants in subsequent months. METHODS We studied healthy infants born ≥36 completed weeks, by Caesarean section between September 2008 and August 2009, with Apgar scores >7. Weight measurements were performed at birth, at 24 h postpartum and at days 2, 4, 7, 14, 30 and monthly up to 6 months. Predictive roles of RWC at each assessment on detecting excessive weight loss and poor weight gain in 1st month, as well as bodyweight z scores in subsequent months were assessed. RESULTS We studied 160 infants (88 female, 72 male) with a mean gestational age of 38.01 ± 1 weeks and birthweight of 3239 ± 421 g. Overall, 22.5% of infants lost >10% of birthweight; 11.9% at day 2, 16.9% at day 4 and 6.6% at day 7. Degree of weight loss was not related with parity, gestational age, birthweight or type of anaesthesia. Predictive values of RWCs in detecting poor weight gain in 0-30 days were: 2nd day; limit =-9.4%, specificity = 91.5%, 4th day; limit =-10.2%, specificity = 89.4%, 7th day; limit =-6.3%, specificity = 85%, sensitivity = 78%, 14th day; limit =+0.8%, specificity = 91.5%, sensitivity = 83.3%. Adjusting for birthweight z scores, RWC at 14th day had a significant influence on 1st and 2nd month bodyweight z scores. Bodyweight z scores were significantly correlated with the z scores of bodyweight in 1-5 months but not with that of 6 months. CONCLUSION Incidence of excessive weight loss is very high among Caesarean delivered babies. RWC at earlier measurements proves satisfactory in predicting poor infant growth. Management strategies based on identifying infants at risk could prevent excessive weight loss and improve future growth of those infants.
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Affiliation(s)
- F T Bakar
- Department of Neonatology, Yeditepe University School of Medicine, Istanbul, Turkey.
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Zobbi VF, Calistri D, Consonni D, Nordio F, Costantini W, Mauri PA. Breastfeeding: validation of a reduced Breastfeeding Assessment Score in a group of Italian women. J Clin Nurs 2011; 20:2509-18. [DOI: 10.1111/j.1365-2702.2011.03767.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Spence K, Swinsburg D, Griggs JA, Johnston L. Infant well-being following neonatal cardiac surgery. J Clin Nurs 2011; 20:2623-32. [PMID: 21605213 DOI: 10.1111/j.1365-2702.2011.03716.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES To investigate infant well-being as measured by feeding and sleeping and parental support following discharge from the NICU in infants following major cardiac surgery. BACKGROUND Infant feeding and sleeping have been identified as two of the most important concerns reported by parents. These concerns have been reported anecdotally for infants who have undergone cardiac surgery in the neonatal period. DESIGN A prospective study using questionnaires and phone interviews followed a cohort of parents of neonates who underwent surgery in the neonatal period for congenital heart disease. METHODS The study was conducted using validated questionnaires and phone interviews with a semi-structured questionnaire. The questionnaires were administered prior to discharge from the NICU and interviews took place following discharge on five occasions within nine months. RESULTS Fifty six infants and mothers were followed for nine months following discharge from NICU. Sixty-eight per cent were breastfeeding on discharge however the rates decline over time in line with healthy infants. Mothers were not bothered by their infant's sleep patterns which were consistent with those of healthy infants at six months. There were 37 episodes of re-hospitalisation and the average time of further surgery was five months following discharge from their initial period of hospitalisation. CONCLUSION The issues from this pilot study warrant further investigation. Factors such as multiple hospitalisations, parent education and support may vary within contexts and need to be studied to ensure optimal supports are identified for this high risk population. RELEVANCE TO CLINICAL PRACTICE This study identified several issues that can improve care provided to these infants and their parents. Support following discharge could include: lactation consultant to provide follow-up calls to identify concerns with breastfeeding, lactation course for paediatric nurses providing follow-up and education for Early Childhood Clinics on Congenital Heart Disease.
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Affiliation(s)
- Kaye Spence
- Clinical Nurse Consultant, Grace Centre for Newborn Care, The Children's Hospital at Westmead, Sydney, NSW, Australia.
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Abstract
While substantial evidence exists identifying risks factors associated with premature weaning from breastfeeding, there are no previously published definitions of patient acuity in the lactation field. This article defines evidence-based levels of lactation acuity based on maternal and infant characteristics. Patient acuity, matching severity of illness to intensity of care required, is an important determinant of patient safety and outcomes. It is often used as part of a patient classification system to determine staffing needs and acceptable workloads in health care settings. As acuity increases, more resources, including more skilled clinicians, are needed to provide optimal care. Developing an evidence-based definition of lactation acuity can help to standardize terminology, more effectively distribute health care staff resources, encourage research to verify the validity and reliability of lactation acuity, and potentially improve breastfeeding initiation and duration rates.
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Affiliation(s)
- Rebecca Mannel
- Corporate Lactation Consultant Workgroup for HCA Healthcare, USA.
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Crivelli-Kovach A, Chung EK. An evaluation of hospital breastfeeding policies in the Philadelphia metropolitan area 1994-2009: a comparison with the baby-friendly hospital initiative ten steps. Breastfeed Med 2011; 6:77-84. [PMID: 20958103 DOI: 10.1089/bfm.2010.0009] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The purpose of this study was to describe current breastfeeding policies and practices among Philadelphia, PA metropolitan hospitals and changes in their policies and practices over time. METHODS In-person group interviews were conducted to obtain a composite picture of actual breastfeeding policies and practices. One questionnaire per hospital was completed based on responses from group consensus. Twenty-five hospitals providing maternity care were contacted. Information was obtained from personnel representing different areas of maternity services. Hospitals were classified according to the degree to which they were implementing the Ten Steps to Successful Breastfeeding. RESULTS Mean breastfeeding rates at suburban hospitals were significantly higher than urban hospitals (72% vs. 49%, p = 0.015). Most hospitals were classified as high or moderately high implementers on six of the Ten Steps, including staff training (67%), printed information distributed to breastfeeding mothers (94%), breastfeeding initiation (61%), oral breastfeeding instruction given to mothers (83%), infant feeding schedules (89%), and hospital postpartum support (83%). Most hospitals reported partial or low implementation on two maternity practices: infant formula supplementation (61%) and rooming-in (72%). CONCLUSIONS In the past 15 years, hospitals in the Philadelphia area have an increased awareness about breastfeeding and enhanced support of breastfeeding by healthcare professionals. In spite of an increase in overall breastfeeding rates, formula supplementation in hospitals and contact time between mothers and their newborns continue to be areas of concern.
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Affiliation(s)
- Andrea Crivelli-Kovach
- Department of Medical Science and Community Health, Arcadia University, Glenside, Pennsylvania 19038, USA.
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Abstract
Lactogenesis II is the onset of copious milk production (i.e., the milk "coming in"), which usually occurs between 30 to 40 hours postpartum. When lactogenesis II fails to occur or is delayed, it may be due to a number of underlying hormonal or non-hormonal conditions. Of the various hormonal etiologies, many can be identified with the aid of a few standard blood tests. Gestational ovarian theca lutein cysts may cause delayed lactogenesis II and are fairly easily detected by ordering testosterone levels. Although this condition can delay lactogenesis II for as long as 31 days, with proper management women affected by these cysts have established breastfeeding. Three of the four women reviewed in this article were eventually able to produce 100% of their infants' caloric requirements.
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Walker M. International Breastfeeding Initiatives and their Relevance to the Current State of Breastfeeding in the United States. J Midwifery Womens Health 2010; 52:549-55. [DOI: 10.1016/j.jmwh.2007.06.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Matias SL, Nommsen-Rivers LA, Creed-Kanashiro H, Dewey KG. Risk factors for early lactation problems among Peruvian primiparous mothers. MATERNAL AND CHILD NUTRITION 2010; 6:120-33. [PMID: 20624209 DOI: 10.1111/j.1740-8709.2009.00195.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The aim of this study was to determine the incidence and risk factors for early lactation problems [suboptimal infant breastfeeding behaviour (SIBB), delayed onset of lactogenesis (OL) and excessive neonatal weight loss] among mother-infant pairs in Lima, Peru. All primiparous mothers who gave birth to a healthy, single, term infant at a government hospital in a peri-urban area of Lima during the 8-month recruitment period were invited to participate in the study. Data were collected at the hospital (day 0) and during a home visit (day 3). Infant breastfeeding behaviour was evaluated using the Infant Breastfeeding Assessment Tool; SIBB was defined as < or = 10 score. OL was determined by maternal report of breast fullness changes; delayed OL was defined as perceived after 72 h. Excessive neonatal weight loss was defined as > or = 10% of birthweight by day 3. One hundred seventy-one mother-infant pairs participated in the study. SIBB prevalence was 52% on day 0 and 21% on day 3; it was associated with male infant gender (day 0), < 8 breastfeeds during the first 24 h (days 0 and 3), and gestational age < 39 weeks (day 3). Delayed OL incidence was 17% and was associated with infant Apgar score < 8. Excessive neonatal weight loss occurred in 10% of neonates and was associated with maternal overweight and Caesarean-section delivery. Early lactation problems may be influenced by modifiable factors such as delivery mode and breastfeeding frequency. Infant status at birth and maternal characteristics could indicate when breastfeeding dyads need extra support.
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Affiliation(s)
- Susana L Matias
- Department of Public Health Sciences, University of California, Davis, California 95616, USA.
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Otoo GE, Marquis GS, Sellen DW, Chapman DJ, Pérez-Escamilla R. HIV-negative status is associated with very early onset of lactation among Ghanaian women. J Hum Lact 2010; 26:107-17. [PMID: 19809094 PMCID: PMC3170523 DOI: 10.1177/0890334409348214] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This is a longitudinal cohort study investigating the association between maternal HIV status and the reported onset of lactation. The Research to Improve Infant Nutrition and Growth project recruited 442 mothers from 3 antenatal clinics in the eastern region of Ghana, based on positive, negative, and unknown HIV status. Onset of lactation was assessed by maternal perception and validated with 2 subsamples: measurement of infant breast milk intake (n = 40) and daily infant weight measurement for 2 weeks (n = 150). Multivariate logistic regression was used to identify predictors of very early onset of lactation (onset of lactation < 6 hours). Predictors of very early onset of lactation include HIV-negative status (odds ratio = 2.68; P = .014), multiparity (odds ratio = 2.93; P = .009), vaginal delivery (odds ratio = 2.55; P = .035), and having a male child (odds ratio = 1.86; P = .032). The findings indicate an association between maternal HIV status and very early onset of lactation.
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Affiliation(s)
- Gloria E Otoo
- Department of Nutritional Sciences at the University of Connecticut, CT, USA.
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ABM clinical protocol #22: guidelines for management of jaundice in the breastfeeding infant equal to or greater than 35 weeks' gestation. Breastfeed Med 2010; 5:87-93. [PMID: 20387269 DOI: 10.1089/bfm.2010.9994] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Labarère J, Gelbert-Baudino N, Laborde L, Arragain D, Schelstraete C, François P. CD-ROM-based program for breastfeeding mothers. MATERNAL AND CHILD NUTRITION 2010; 7:263-72. [PMID: 21689269 DOI: 10.1111/j.1740-8709.2009.00235.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The vast majority of breastfeeding mothers in Western countries have routine access to multimedia and Internet resources at home. The aim of this study was to assess the effectiveness of a CD-ROM-based intervention in increasing the rates of breastfeeding. We conducted a pre- and post-intervention study involving four control and four intervention maternity units in France. All breastfeeding mothers in intervention units were given a CD-ROM-based program addressing various breastfeeding topics. The primary outcome was any breastfeeding at 4 weeks assessed by follow-up telephone interview. The secondary outcomes included breastfeeding duration, breastfeeding difficulties after discharge and satisfaction with the breastfeeding experience. The rates of any breastfeeding at 4 weeks varied from 88.6% (209/236) to 87.9% (211/240) and from 86.0% (222/258) to 88.0% (228/259) for mothers enrolled in intervention and control maternity units, respectively (P for interaction=0.54). The hazard of breastfeeding discontinuation for mothers enrolled in intervention units did not vary significantly across study periods after adjusting for education level, epidural anaesthesia, breastfeeding assessment score and return to work (P for interaction=0.18). The rates of breastfeeding at 4 weeks remained unchanged when restricting the analysis to the mothers who actually received (87.8% [173/197]) or used [88.2% (105/119)] the CD-ROM during the post-intervention period. No significant differences were found in secondary outcomes between the two study groups. A CD-ROM-based intervention for breastfeeding mothers provides no additional benefit to usual post-natal care. Further study is needed to assess the effectiveness of multimedia packages as part of more intensive multifaceted interventions.
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Affiliation(s)
- José Labarère
- Quality of Care Unit, Grenoble University Hospital, pavillon Taillefer, 38043 Grenoble Cedex 9, France.
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Mercer AM, Teasley SL, Hopkinson J, McPherson DM, Simon SD, Hall RT. Evaluation of a breastfeeding assessment score in a diverse population. J Hum Lact 2010; 26:42-8. [PMID: 19759350 DOI: 10.1177/0890334409344077] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A previous study performed in a predominately suburban population developed a breastfeeding assessment score (BAS) that was designed to predict, prior to hospital discharge, those mothers who would discontinue breastfeeding within the first 10 days of age. The purpose of the present study was to assess the BAS in a more diverse population. Patients were solicited from 3 urban hospitals serving patients primarily supported by public funding. Results of the present study with 1182 mother-infant pairs confirmed that 5 variables scored on a 0-2 scale (maternal age, previous breastfeeding experience, latching difficulty, breastfeeding interval, number bottles) remained highly significant for predicting discontinuation of breastfeeding. The data also demonstrate that the BAS is inversely related to the risk of cessation of breastfeeding at 7 to 10 days of age. Those at an early risk of cessation of breastfeeding, identified by the BAS, may benefit from early identification and a lactation consultation.
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Affiliation(s)
- Anne M Mercer
- Children's Mercy Hospitals and Clinics (CMH&C), Kansas City, Missouri 64108, USA
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Miller JE, Miller L, Sulesund AK, Yevtushenko A. Contribution of chiropractic therapy to resolving suboptimal breastfeeding: a case series of 114 infants. J Manipulative Physiol Ther 2010; 32:670-4. [PMID: 19836604 DOI: 10.1016/j.jmpt.2009.08.023] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2009] [Revised: 07/13/2009] [Accepted: 07/27/2009] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The purpose of this study was to describe the circumstances, clinical features, role, and results of chiropractic management of infants who were referred to a chiropractic clinic for failure to adequately feed at the breast. METHODS Clinical case series of 114 infant cases of hospital-diagnosed or lactation consultant diagnosed feeding problems that were treated with chiropractic therapy in addition to routine care and followed to short-term result. RESULTS The most common age of referral was 1 week (mean, 3 weeks; range, 2 days-12 weeks), and the most common physical findings were cervical posterior joint dysfunction (89%), temporomandibular joint imbalance (36%), and inadequate suck reflex (34%). Treatment was chiropractic therapy in addition to any support given elsewhere. All children showed some improvement with 78% (N = 89) being able to exclusively breast feed after 2 to 5 treatments within a 2-week time period. CONCLUSION Cooperative multidisciplinary care to support breastfeeding was demonstrated in this population. Chiropractic treatment may be a useful adjunct to routine care given by other professionals in cases of diagnosed breastfeeding problems with a biomechanical component.
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Affiliation(s)
- Joyce E Miller
- Advanced Professional Practice Chiropractic Paediatrics, Bournemouth University, Bournemouth, UK.
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McCarter-Spaulding D, Gore R. Breastfeeding self-efficacy in women of African descent. J Obstet Gynecol Neonatal Nurs 2009; 38:230-43. [PMID: 19323720 DOI: 10.1111/j.1552-6909.2009.01011.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To determine whether breastfeeding self-efficacy predicts the duration and pattern of breastfeeding in a sample of Black women of African descent. DESIGN Descriptive, longitudinal, cohort study. Participants were recruited during the postpartum hospitalization and followed monthly for 6 months or until complete weaning. Breastfeeding self-efficacy was measured using the Breastfeeding Self-Efficacy Scale--Short Form (BSES-SF) (Dennis, 2003). SETTING A large urban teaching hospital in New England. PATIENTS/PARTICIPANTS Women who self-identified as being of African descent with full-term infants who were planning to breastfeed (N=125). MAIN OUTCOME MEASURES Breastfeeding pattern was determined by the total number of feedings the infant received in the past 24 hours and how many of these were breast milk. Duration of breastfeeding was defined as the number of weeks until complete weaning. RESULTS Higher levels of breastfeeding self-efficacy predicted longer duration and a more exclusive pattern of breastfeeding at 1 and 6 months postpartum, consistent with prior research (p<.01). Planned pattern of feeding predicted actual pattern of feeding at 1 month postpartum (p<.01). Returning to work after 12 weeks was protective of breastfeeding to 6 months postpartum (p<.01). CONCLUSION Theory-based interventions to enhance self-efficacy will help improve breastfeeding outcomes.
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Stark AR, Lannon CM. Systems changes to prevent severe hyperbilirubinemia and promote breastfeeding: pilot approaches. J Perinatol 2009; 29 Suppl 1:S53-7. [PMID: 19177060 DOI: 10.1038/jp.2008.215] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Providing safe and effective care requires coordination among the multiple levels of the health care system. These levels comprise the newborn (patient, family and community), nursery or primary care practice (microsystem), hospital or managed care organization (macro-organization) and policy, payment or regulatory issues (environmental context). Contemporary care practices associated with childbirth and early newborn care often reflect disruptions in coordination of these processes and place newborns at risk for poor outcomes. For example, with routine early postpartum discharge, often at less than 48 h after vaginal birth, the peak of serum bilirubin at 3 to 5 days of age typically occurs at home, rather than observed by clinicians in a newborn nursery. In addition, lactation is rarely well established by early discharge and support is often inadequate, increasing the risk of hyperbilirubinemia and discontinuation of breastfeeding. Also, late preterm infants are frequently cared for in the newborn nursery, although they often have difficulty establishing oral feeding and are at substantially higher risk for severe hyperbilirubinemia than infants born at term. Finally, pediatric follow-up is often delayed beyond the first week, after the optimal time for continued assessment of jaundice and lactation. The American Academy of Pediatrics Safe and Healthy Beginnings Initiative, a pilot quality improvement project, will target newborn nurseries, primary care practices and coordination between these sites using a systems-based approach to facilitate implementation of the 2004 guideline for management of hyperbilirubinemia.
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Affiliation(s)
- A R Stark
- Section of Neonatology, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA.
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Wilhelm SL, Rodehorst TK, Stepans MBF, Hertzog M, Berens C. Influence of intention and self-efficacy levels on duration of breastfeeding for midwest rural mothers. Appl Nurs Res 2008; 21:123-30. [PMID: 18684405 DOI: 10.1016/j.apnr.2006.10.005] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2006] [Revised: 10/20/2006] [Accepted: 10/23/2006] [Indexed: 10/21/2022]
Abstract
OBJECTIVES The purpose of this study was to explore the relationship of two modifiable factors (intention to breastfeed for 6 months and breastfeeding self-efficacy) with the duration of breastfeeding in primiparous women. FINDINGS Analyzed by logistic regression in a single prediction model, stronger intention (odds ratio = 1.89) and higher levels of self-efficacy at 2 weeks postpartum (odds ratio = 1.04) were significantly (p < .05) associated with an increased probability of breastfeeding for 6 months. CONCLUSIONS The combined influence of higher intention and self-efficacy increased the likelihood of breastfeeding for the recommended 6 months. Interventions to reinforce both should be designed and evaluated.
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Affiliation(s)
- Susan L Wilhelm
- University of Nebraska College of Nursing, West Nebraska Division, Scottsbluff, NE 69361, USA.
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Flower KB, Willoughby M, Cadigan RJ, Perrin EM, Randolph G. Understanding breastfeeding initiation and continuation in rural communities: a combined qualitative/quantitative approach. Matern Child Health J 2008; 12:402-14. [PMID: 17636458 PMCID: PMC2692345 DOI: 10.1007/s10995-007-0248-6] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2006] [Accepted: 06/15/2007] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To determine factors associated with breastfeeding in rural communities. METHODS We combined qualitative and quantitative data from the Family Life Project, consisting of: (1) a longitudinal cohort study (N=1292) of infants born September 2003-2004 and (2) a parallel ethnographic study (N=30 families). Demographic characteristics, maternal and infant health factors, and health services were used to predict breastfeeding initiation and discontinuation using logistic and Cox regression models, respectively. Ethnographic interviews identified additional reasons for not initiating or continuing breastfeeding. RESULTS Fifty-five percent of women initiated breastfeeding and 18% continued for at least 6 months. Maternal employment at 2 months and receiving WIC were associated with decreased breastfeeding initiation and continuation. Ethnographic data suggested that many women had never even considered breastfeeding and often discontinued breastfeeding due to discomfort, embarrassment, and lack of assistance. CONCLUSIONS Breastfeeding rates in these rural communities lag behind national averages. Opportunities for increasing breastfeeding in rural communities include enhancing workplace support, maximizing the role of WIC, increasing hospital breastfeeding assistance, and creating a social environment in which breastfeeding is normative.
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Affiliation(s)
- Kori B Flower
- Charles Drew Community Health Center, Piedmont Health Services, 221 North Graham-Hopedale Road, Burlington, NC, USA.
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Johnson TS, Mulder PJ, Strube K. Mother-Infant Breastfeeding Progress Tool: a guide for education and support of the breastfeeding dyad. J Obstet Gynecol Neonatal Nurs 2007; 36:319-27. [PMID: 17594406 DOI: 10.1111/j.1552-6909.2007.00165.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To describe the development of the Mother-Infant Breastfeeding Progress Tool to be used at the bedside by nurses to guide ongoing support and education for the mother-baby dyad. DESIGN Cross-sectional study. SETTING Community hospital in a Midwestern city. PARTICIPANTS Sixty-two English-speaking mother-infant dyads. METHODS Three nurse raters (two per session) independently scored the eight characteristics on the Mother-Infant Breastfeeding Progress Tool during 81 breastfeeding sessions. MAIN OUTCOME MEASURE Percent agreement between raters and suggested modifications for the Mother-Infant Breastfeeding Progress Tool. RESULTS The results support the use of the tool as a checklist for assessment of the breastfeeding mother-infant dyad to guide education and support. CONCLUSIONS The interrater agreement was high for individual items of the Mother-Infant Breastfeeding Progress Tool. The Mother-Infant Breastfeeding Progress Tool is useful as a checklist for assessing maternal and infant breastfeeding progress, though additional research is needed to support the validity of the tool.
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Affiliation(s)
- Teresa S Johnson
- College of Nursing at the University of Wisconsin-Milwaukee, WI 53201, USA.
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Laborde L, Fulcheri J, Gelbert-Baudino N, Schelstraete C, Mathieu M, Durand M, Baudino F, Vié Le Sage F, Gothie I, Roche F, Devoldere C, Salinier C, Gout JP, Plasse M, Caron FM, François P, Labarere J. Intérêt du Breastfeeding Assessment Score pour la prédiction du sevrage précoce de l'allaitement maternel en France. Arch Pediatr 2007; 14:978-84. [PMID: 17512178 DOI: 10.1016/j.arcped.2007.03.031] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2006] [Revised: 02/09/2007] [Accepted: 03/19/2007] [Indexed: 10/23/2022]
Abstract
BACKGROUND The Breastfeeding Assessment Score (BAS) was derived to help identify mothers at increased risk of early weaning in United States. Data are currently lacking on the accuracy of the BAS for French mother-infant pairs. OBJECTIVE To assess the accuracy of the BAS in a French validation cohort. METHODS We used the original data from a prospective cohort study of 488 mothers who were breastfeeding at discharge in 9 maternity wards in 2005. The outcome measures were assessed using structured follow-up telephone interviews at 4 and 26 weeks. RESULTS The weaning rate was 3% at 14 days of infant age. The corresponding area under ROC curve was 0.73 [0.60-0.85] and was comparable to that observed in the derivation cohort (0.75). For a cut point of 8 recommended by the authors of the BAS, 43% of mother-infant pairs were categorized at high risk and the weaning rate in this subgroup was 5%. The mother-infant pairs with a score lower than 8 had a shorter median breastfeeding duration (18 versus 20 weeks, P=0.02), were more likely to report breastfeeding difficulties after discharge (63% versus 53%, P=0.03), and were less likely to be "very satisfied" with breastfeeding experience (66% versus 77%, P=0.007). CONCLUSION The intrinsic properties of the BAS are robust. However, its use would be of limited interest in France because of the relatively low rate of early weaning. Randomized trials are needed before recommending routine use of BAS-based breastfeeding support intervention.
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Affiliation(s)
- L Laborde
- Unité d'évaluation médicale, centre hospitalier universitaire, 38043 Grenoble cedex 09, France
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Laborde L, Gelbert-Baudino N, Fulcheri J, Schelstraete C, Francois P, Labarere J. Breastfeeding outcomes for mothers with and without home access to e-technologies. Acta Paediatr 2007; 96:1071-5. [PMID: 17577342 DOI: 10.1111/j.1651-2227.2007.00369.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM To estimate the percentage of breastfeeding mothers with home access to e-technologies and to compare breastfeeding outcomes for mothers with and without access to e-technologies. METHODS We conducted a prospective observational study of 550 breastfeeding mothers discharged from nine maternity units in France. RESULTS Overall, 435 mothers (79%; 95% confidence interval [95% CI], 75-82) had home access to e-technologies. Mothers with access to e-technologies were less likely to be unemployed (6% vs. 15%, p = 0.004), to smoke during pregnancy (8% vs. 16%, p = 0.03), to have a breastfeeding assessment score <8 (39% vs. 59%, p < 0.001) and to use a pacifier (23% vs. 41%, p < 0.001). Although mothers with access to e-technologies had a longer median breastfeeding duration than those without home access to e-technologies (19 vs. 16 weeks, p = 0.02), adjusted hazard ratios for breastfeeding discontinuation (0.85; 95% CI, 0.60-1.21), overall satisfaction rates (73% vs. 67%, p = 0.19) and breastfeeding difficulties after discharge (58% vs. 61%, p = 0.60) were not different for the two groups. CONCLUSION A vast majority of breastfeeding mothers have home access to e-technologies in France. However, access to e-technologies was not independently associated with better breastfeeding outcomes in this study.
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Abstract
Meeting national breast-feeding objectives and mothers' personal breast-feeding goals depends on a number of factors, including the provision of current, consistent, and timely help with breast-feeding. Nurses are in a prime position to guide mothers during their hospital stay and provide community follow-up postdischarge. Mothers and infants need to acquire a set of breast-feeding skills prior to hospital discharge so that a mother goes home confident that she can adequately nourish her infant, initiate and maintain an abundant milk supply, avoid problems, and address them if they occur. This article describes strategies for optimizing breast-feeding during the first 48 hours and delineates what mothers need to know before they leave the hospital.
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Affiliation(s)
- Marsha Walker
- National Alliance for Breast-feeding Advocacy, Weston, MA 02493, USA.
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Kronborg H, Vaeth M, Olsen J, Iversen L, Harder I. Early breastfeeding cessation: validation of a prognostic breastfeeding score. Acta Paediatr 2007; 96:688-92. [PMID: 17376182 DOI: 10.1111/j.1651-2227.2007.00245.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM To validate a simple breastfeeding score to identify mothers who stop breastfeeding within 4 months after birth. METHODS Two independent cohorts of Danish mothers in 1999 and 2004 with 4 months of follow-up on breastfeeding duration were used. The breastfeeding score was developed from 471 mothers' responses to a questionnaire in 1999 and based on duration of schooling, previous breastfeeding experience, self-efficacy, and mother's confidence in ability to produce milk. The 2004 cohort consisting of 723 mothers was used to validate the score. RESULTS A breastfeeding score of 7 or higher classified 45% of the mothers in the 2004 cohort as being at risk of breastfeeding cessation. With this cut-point the sensitivity was 70% and the specificity 71%. Among primipara the cut-point gave a sensitivity of 76% and a specificity of 54% and classified 60% to be in the risk group. Among multipara the corresponding figures were 66%, 81% and 34%, respectively. The area under the ROC curve was 0.78. CONCLUSION The breastfeeding score based on a simple scoring system derived from four risk factors was capable of predicting the breastfeeding duration in an independent sample. It may help health professionals to identify mothers at risk of breastfeeding cessation before 4 months.
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Affiliation(s)
- Hanne Kronborg
- Department of Nursing Science, Institute of Public Health, University of Aarhus, 8000 Aarhus, Denmark.
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Glenn LL, Quillin SIM. Opposing effects of maternal and paternal socioeconomic status on neonatal feeding method, place of sleep, and maternal sleep time. J Perinat Neonatal Nurs 2007; 21:165-72. [PMID: 17505238 DOI: 10.1097/01.jpn.0000270635.27359.3c] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study was conducted to compare the relative influence of the socioeconomic status of both mothers and fathers on feeding method and cosleeping. METHODS The time and method of feeding and sleeping were recorded in a log during the 4th-week postpartum and analyzed according to the parental Hollingshead Index of Social Position in 33 families with their first newborn. RESULTS The effect of socioeconomic status on feeding and sleep was parent specific. Low socioeconomic status of the mother, but not the father, was associated with cosleeping (t = 2.39, P < .01); whereas, a low socioeconomic status of the father, but not the mother, was associated with bottle-feeding rather than breast-feeding (t = 1.94, P < .05). CONCLUSIONS Socioeconomic status of the parents differentially affects neonatal care. Programs to increase breast-feeding rates would be most effective if designed for and aimed at the fathers.
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Affiliation(s)
- L Lee Glenn
- Department of Professional Roles and Mental Health Nursing, East Tennessee State University, Johnson City, TN 37614, USA.
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Peat JK, Allen J, Nguyen N, Hayen A, Oddy WH, Mihrshahi S. Motherhood meets epidemiology: measuring risk factors for breast–feeding cessation. Public Health Nutr 2007; 7:1033-7. [PMID: 15548341 DOI: 10.1079/phn2004640] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
AbstractObjective:To examine statistical models that have been used to predict the cessation of breast–feeding.Setting:In nutritional epidemiology, a knowledge of risk factors that lead to breast-feeding cessation is essential to promote optimal infant health by increasing or sustaining breast–feeding rates. However, a number of methodological issues complicate the measurement of such risk factors. It is important when building multivariate models that variables entered into the model are not intervening variables, factors on the causal pathway or surrogate outcomes. Inclusion of these types of variable can lead to inaccurate models and biased results. A factor often cited to predict breast–feeding is ‘intention to breast–feed’ prior to the birth of the infant, although this factor is directly on the causal decision–making pathway. Another factor often cited is the age of introduction of formula feeding, which is actually part of the outcome variable because formula feeding defines the difference between full, complementary and no breast-feeding. Rather than include these as risk factors in multivariate models, factors removed from the causal pathway such as influences of educational practices, including advice to complementary feed, and beliefs and attitudes of families and health-care practitioners should be measured.Conclusions:The accurate quantification of modifiable risk factors is essential for designing public health education campaigns that are effective in sustaining or increasing breast–feeding duration.
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Affiliation(s)
- Jennifer K Peat
- Clinical Epidemiology Unit, The Children's Hospital at Westmead, Locked Bag 4001, Westmead, New South Wales 2145, Australia.
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Giannì ML, Vegni C, Ferraris G, Mosca F. Usefulness of an assessment score to predict early stopping of exclusive breast-feeding. J Pediatr Gastroenterol Nutr 2006; 42:329-30. [PMID: 16540806 DOI: 10.1097/01.mpg.0000214166.68069.98] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
Exclusive breast-feeding is recommended during the first 6 months of life. Use of simple indicators to predict early stopping of exclusive breast-feeding may be desirable in clinical practice. A breast-feeding assessment evaluated at discharge and including maternal age, previous breast-feeding experience, latching difficulty, and breast-feeding interval could be useful.
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Affiliation(s)
- M L Giannì
- NICU-Ospedale Maggiore, CI Mangiagalli-IRCCS-University of Milan, Milan, Italy.
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Abstract
Few women breastfeed for 6 months or longer, and many who stop breastfeeding do so in the early postpartum period. To increase the number of breastfeeding mothers, health-care providers need to identify women at greatest risk for early breastfeeding attrition. This integrative review describes instruments used to assess breastfeeding in the early postpartum period and reports the results of studies using these tools. The instruments are then evaluated for similarities in variables and usefulness for clinical practice.
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Affiliation(s)
- Lynne Porter Lewallen
- LYNNE PORTER LEWALLEN is an assistant professor in the School of Nursing at the University of North Carolina at Greensboro
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