Combined peer counselor and lactation consultant support increases breastfeeding in the NICU

Breastfeeding peer counselling for mothers of preterm neonates: protocol of a stepped-wedge cluster randomised controlled trial

INTRODUCTION

Among preterm infants, mother's own milk feeding reduces neonatal morbidity and decreases the length of hospital stay. However, breastfeeding rates and duration are lower than among term infants. It is reported that peer counselling is effective in increasing breast feeding in term infants in low-income and middle-income countries, but results are mixed in high-income countries. We aim to investigate herein whether peer counselling may be a feasible and effective breastfeeding support among preterm infants in French-speaking high-income countries.

METHODS AND ANALYSIS

Eight European centres will participate in this stepped-wedge cluster randomised controlled trial. We plan to include 2400 hospitalised neonates born before 35 gestational weeks. Each centre will begin with an observational period. Every 3 months, a randomised cluster (centre) will begin the interventional period with peer counsellors until the end of the study. The counsellors will be trained and supervised by the trained nurses. They will have a weekly contact with participating mothers, with a face-to-face meeting at least once every fortnight. During these meetings, peer counsellors will listen to mothers' concerns, share experiences and help the mother with their own knowledge of breast feeding. The main outcome is breastfeeding rate at 2 months corrected age. Secondary outcomes are breastfeeding rates at hospital discharge and at 6 months, breastfeeding duration and severe neonatal morbidity and mortality. The mental health of the mother, mother-infant bonding and infant behaviour will be assessed using self-report questionnaires. A neurodevelopmental follow-up, a cost-effectiveness analysis and a cost-consequence at 2 years corrected age will be performed among infants in a French subgroup.

ETHICS AND DISSEMINATION

French, Belgian and Swiss ethics committees gave their agreement. Publications in peer-reviewed journals are planned on breast feeding, mental health and economic outcomes.

TRIAL REGISTRATION NUMBER

NCT03156946.

Necrotizing Enterocolitis and Human Milk Feeding: A Systematic Review

This article summarizes evidence regarding whether a donor human milk (DHM) and/or an exclusively human milk (EHM) diet decreases the incidence of necrotizing enterocolitis (NEC) and the dose of human milk (HM) necessary to reduce the risk of NEC in premature infants. Additional research regarding protection afforded by DHM and EHM is necessary as well as research elucidating the exact dose of HM necessary for NEC risk reduction. Research is also needed to determine whether there is a dose-dependent effect of DHM, a combination of mother's own milk and DHM, and an EHM diet on NEC incidence.

A Quality Improvement Project to Decrease Human Milk Errors in the NICU

BACKGROUD AND OBJECTIVE

Ensuring safe human milk in the NICU is a complex process with many potential points for error, of which one of the most serious is administration of the wrong milk to the wrong infant. Our objective was to describe a quality improvement initiative that was associated with a reduction in human milk administration errors identified over a 6-year period in a typical, large NICU setting.

METHODS

We employed a quasi-experimental time series quality improvement initiative by using tools from the model for improvement, Six Sigma methodology, and evidence-based interventions. Scanned errors were identified from the human milk barcode medication administration system. Scanned errors of interest were wrong-milk-to-wrong-infant, expired-milk, or preparation errors. The scanned error rate and the impact of additional improvement interventions from 2009 to 2015 were monitored by using statistical process control charts.

RESULTS

From 2009 to 2015, the total number of errors scanned declined from 97.1 per 1000 bottles to 10.8. Specifically, the number of expired milk error scans declined from 84.0 per 1000 bottles to 8.9. The number of preparation errors (4.8 per 1000 bottles to 2.2) and wrong-milk-to-wrong-infant errors scanned (8.3 per 1000 bottles to 2.0) also declined.

CONCLUSIONS

By reducing the number of errors scanned, the number of opportunities for errors also decreased. Interventions that likely had the greatest impact on reducing the number of scanned errors included installation of bedside (versus centralized) scanners and dedicated staff to handle milk.

Trends in breastfeeding initiation in the NICU by gestational age in Ohio, 2006-2012

BACKGROUND

While breastfeeding in the United States is on the rise, trends among infants admitted to the Neonatal Intensive Care Unit (NICU) are less known. The objective of this study was to examine trends in breastfeeding initiation among NICU-admitted infants in Ohio from 2006 to 2012 and to determine differences in breastfeeding initiation trends by gestational age.

METHODS

Using Ohio Vital Statistics birth certificate data, the Cochran-Armitage test for trend was used to determine significant trends in breastfeeding by gestational age. Logistic regression was used to examine the association between breastfeeding initiation and gestational age by year.

RESULTS

From 2006 to 2012, 48,758 infants born in Ohio were admitted to the NICU, representing 5.6 percent of all newborns. Breastfeeding among NICU-admitted infants increased from 53.3 percent in 2006 to 63.8 percent in 2012 (p < 0.01). Increasing, significant trends in breastfeeding were also observed within each gestational age category over the 7 years. In 2011 and 2012, preterm infants were significantly more likely than term infants to be fed breastmilk in the NICU.

DISCUSSION

The gap between breastfeeding initiation among NICU-admitted and non-admitted infants appears to be narrowing, particularly for the most extreme gestational ages. While these increasing trends in breastfeeding among the most premature infants are encouraging, nearly 40 percent of mothers of term infants admitted to the NICU, the largest proportion of the NICU population, are still not initiating breastfeeding. More education and support specific to mothers of infants admitted to the NICU is needed.

Furthering our understanding of the needs of mothers who are pumping breast milk for infants in the NICU: an integrative review

The purpose of this integrative review was to uncover information regarding emotional and other types of support required by mothers providing breast milk for infants in the neonatal intensive care unit (NICU). These high-risk infants are often unable to directly breastfeed and, thus, mothers need to pump their breast milk for weeks to months, which can be both a pleasing experience that increases satisfaction and infant involvement, while at the same time being an uncomfortable and tiring endeavor. Understanding this notion is important because pumping at least 8 times each day is central to increasing or maintaining breast milk production. Articles were gathered using PubMed and CINAHL databases. Forty-four sources were chosen for inclusion in this review. Search terms included "breastfeeding," "pumping," "neonatal intensive care unit," "emotional support," and "breast milk." We identified that the emotional and practical support for NICU mothers is different from those of other breastfeeding mothers, especially around the development of early bonding behaviors. These mothers require significant ongoing emotional support from healthcare professionals and their partners and peers. Healthcare providers need to monitor breast milk production and provide educated encouragement that anticipates breastfeeding challenges, especially when the mother is pumping for an extended period of time while their infant is maturing in the NICU. Effective providers' support may be best provided by selectively bundling interventions to support pumping initiation and transition to direct breastfeeding.

Impact of peer counselors on breastfeeding outcomes in a nondelivery NICU setting

PURPOSE

Although the independent effects of lactation consultants and peer counselors have been shown to improve breastfeeding outcomes, the joint effects have yet to be considered, particularly in the neonatal intensive care unit (NICU) in nondelivery hospitals. Therefore, the objective of this study was to assess the effect of lactation staff type on breastfeeding outcomes during hospital stay after the addition of peer counselors to a NICU lactation program.

SUBJECTS

A total of 596 mother-infant pairs admitted to Nationwide Children's Hospital, Columbus, Ohio, pre- and postlactation program expansion.

DESIGN

A descriptive pre-/posttest study as conducted.

MAIN OUTCOME MEASURES

Differences in provision of any maternal breast milk, exclusive breast milk, or direct breastfeeding during NICU stay and at discharge were evaluated pre and postprogram implementation. Logistic regression was used to determine associations between lactation staff type and each outcome during hospital stay.

RESULTS

Infants receiving any breast milk during NICU stay increased from baseline to postprogram year 1 (63% vs 73%; P= 0.03). Direct breastfeeding increased from baseline to postprogram year 4 (42% vs 53%; P= 0.03). Mothers seen by only peer counselors were less likely to provide any breast milk at discharge, provide exclusive breast milk during stay or discharge, to be direct breastfeeding during stay or at discharge compared with mothers seen by both peer counselors and lactation consultants.

CONCLUSIONS

NICU lactation programs should consider including both peer counselors and lactation consultants to improve breastfeeding outcomes during hospital stay.