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Dell LG, Spatz DL. Managing tandem breastfeeding during acute hospitalization: A case study. J Pediatr Nurs 2023; 73:e134-e137. [PMID: 37544856 DOI: 10.1016/j.pedn.2023.07.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 07/31/2023] [Accepted: 07/31/2023] [Indexed: 08/08/2023]
Abstract
This case study presents a mother who continued tandem breastfeeding throughout the acute admission of her critically ill newborn. Her younger child, the subject of this case report was admitted to our hospital with septic shock and progressing bullous scalp lesions. The infant had streptococcal toxic shock syndrome and necrotizing fasciitis of the scalp due to streptococcus pyogenes. The infant required immediate life-sustaining interventions, followed by weekly surgical procedures which meant the infant had brief periods of intravenous nutrition surrounding the time of anesthesia administration. During instances when the infant was unable to orally feed, such as while intubated for procedures, she was fed her mother's milk via nasogastric tube. At times that the infant was stable to orally feed, the mother directly breastfed the infant. Even when the infant was on strict bedrest, bedside nurses assisted the mother with infant positioning to breastfeed. In addition, when the infant was able to be held out of bed, the mother was able to resume breastfeeding both of her children simultaneously. Despite the critical nature of this child's illness, the mother was able to provide 100% human milk diet to her child during the 68-day hospital stay. With assistance and support of nursing staff the mother was ultimately able to resume breastfeeding both children simultaneously.
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Affiliation(s)
- Lisa G Dell
- Staff Nurse & Chair of Unit Based Human Milk Committee, Newborn/Infant Intensive Care Unit, Children's Hospital of Philadelphia, USA
| | - Diane L Spatz
- Professor of Perinatal Nursing & the Helen M. Shearer Profession of Nutrition, The University of Pennsylvania School of Nursing, Nurse Scientist-Lactation, The Center for Pediatric Nursing Research & Evidence Based Practice, Children's Hospital of Philadelphia, USA.
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Bochner RE, Kuroki R, Lui K, Russell CJ, Rackovsky E, Piper L, Ban K, Yang K, Mandal P, Mackintosh L, Mirzaian CB, Gross E. Variations in Care for Breastfed Infants Admitted to US Children's Hospitals: A Multicenter Survey of Inpatient Providers. Hosp Pediatr 2019; 10:70-75. [PMID: 31826917 DOI: 10.1542/hpeds.2019-0199] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Studies have revealed an association between hospitalization of breastfed infants and weaning posthospitalization. It is unknown what steps inpatient providers at children's hospitals are currently taking to support breastfeeding mothers of hospitalized infants, their comfort providing breastfeeding counseling, and what training they receive. METHODS We conducted a multicenter survey study of pediatric providers who care for infants hospitalized at 3 urban, tertiary-care children's hospitals over a 12-month period. A convenience sample of nurses, residents, and attending physicians agreed to participate. Participants completed a 24-question questionnaire addressing provider practices, comfort with breastfeeding counseling, and previous breastfeeding education. Data were summarized as medians (interquartile ranges) and frequencies (percentages). Kruskal-Wallis and χ2 tests were used to compare between provider types. RESULTS A total of 361 out of 1097 (33%) eligible providers completed the survey: 133 (21%) nurses, 166 (45%) residents, and 62 (63%) attending physicians. Provider practices varied by provider type. We observed a general trend that providers do not routinely review breastfeeding techniques, directly observe feeds, or use standardized breastfeeding assessment tools. Residents and attending physicians were more likely than nurses to feel comfortable with breastfeeding counseling (P = .02). Residents were more likely than nurses and attending physicians to have received breastfeeding education in the last 3 years (P < .001). CONCLUSIONS Practices, comfort, and previous education varied by provider type. There was a general pattern that providers do not routinely perform certain practices. Further studies are needed to determine if inpatient provider practices affect weaning posthospitalization and if inpatient quality improvement initiatives will help mothers continue breastfeeding posthospitalization.
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Affiliation(s)
- Risa E Bochner
- Department of Pediatrics, University Hospital of Brooklyn, State University of New York Downstate Medical Center and Kings County Hospital Center, Brooklyn, New York;
| | - Robyn Kuroki
- Department of Pediatrics, Children's Hospital Los Angeles and Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Karen Lui
- Department of Pediatrics, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas
| | - Christopher J Russell
- Department of Pediatrics, Children's Hospital Los Angeles and Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Elia Rackovsky
- Department of Pediatrics, Children's Hospital at Montefiore and Albert Einstein College of Medicine, Bronx, New York
| | - Laura Piper
- Department of Pediatrics, Cincinnati Children's Hospital and College of Medicine, University of Cincinnati, Cincinnati, Ohio; and
| | - Kathryn Ban
- Department of Pediatrics, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas
| | - Katharine Yang
- Department of Internal Medicine, Los Angeles County + University of Southern California Medical Center and Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Purnima Mandal
- Department of Pediatrics, Children's Hospital Los Angeles and Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Liza Mackintosh
- Department of Pediatrics, Children's Hospital Los Angeles and Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Christine B Mirzaian
- Department of Pediatrics, Children's Hospital Los Angeles and Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Elissa Gross
- Department of Pediatrics, Children's Hospital at Montefiore and Albert Einstein College of Medicine, Bronx, New York
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What Is the Evidence for Use of a Supplemental Feeding Tube Device as an Alternative Supplemental Feeding Method for Breastfed Infants? Adv Neonatal Care 2018; 18:31-37. [PMID: 29373347 DOI: 10.1097/anc.0000000000000446] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND According to the Healthy People 2020 goals, the sustainability of breastfeeding duration rates within the United States has not been achieved. To increase these rates, it is important that women with breastfeeding difficulties receive the support needed to continue breastfeeding. When supplementation occurs, it is essential that the breastfeeding relationship be preserved. Various methods of supplementation are often recommended including use of the supplemental feeding tube device (SFTD). PURPOSE The question guiding this brief is "What evidence exists to support the use of an SFTD as a method of supplementation for breastfed infants?" SEARCH STRATEGY The PubMed and CINAHL databases were queried for original research published in English from 1990 through July 2016. Search terms included "supplemental feeding tube," "breastfeeding," "term infants," "premature infants," "Supplemental Nursing System," "Lact-aid," and "supply line." FINDINGS Very limited research exists on the use of SFTDs as a method of supplementation for breastfed infants; however, existing research suggests that an SFTD may be useful as a supplementation method for breastfed infants. High-quality research is needed to evaluate the efficacy of using an SFTD for supporting exclusive and all breastfeeding rates. IMPLICATIONS FOR PRACTICE Nurses and providers need to be educated and trained in the use of SFTDs as well as all supplemental feeding methods. Information on efficacy and SFTD use should also be included in policies related to breastfeeding and human milk use. IMPLICATIONS FOR RESEARCH Further research should determine best methods of supplementation for breastfed infants and should examine differences in breastfeeding rates when using the SFTD for supplementation.
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Froh EB, Hallowell S, Spatz DL. The use of technologies to support human milk & breastfeeding. J Pediatr Nurs 2015; 30:521-3. [PMID: 25666206 DOI: 10.1016/j.pedn.2015.01.023] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Accepted: 01/18/2015] [Indexed: 11/28/2022]
Abstract
The application of lactation technologies is not limited to the NICU or the hospital setting. These technologies can be implemented within the home or hospital setting to promote the use of human milk and protect the breastfeeding relationship. Through the use of breast pumps, scales, and nipple shields, women can be supported to achieve their personal breastfeeding and lactation goals.
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Affiliation(s)
| | - Sunny Hallowell
- The University of Pennsylvania School of Nursing, Philadelphia, PA
| | - Diane L Spatz
- The Children's Hospital of Philadelphia, Philadelphia, PA; The University of Pennsylvania School of Nursing, Philadelphia, PA
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Pound CM, Moreau K, Rohde K, Barrowman N, Aglipay M, Farion KJ, Plint AC. Lactation support and breastfeeding duration in jaundiced infants: a randomized controlled trial. PLoS One 2015; 10:e0119624. [PMID: 25747308 PMCID: PMC4351896 DOI: 10.1371/journal.pone.0119624] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2014] [Accepted: 01/23/2015] [Indexed: 11/18/2022] Open
Abstract
Objectives Neonatal jaundice is the most common problem in full-term infants during the immediate post-natal period. We examined the effect of a lactation support intervention on breastfeeding duration in hospitalized jaundiced infants. Study Design We conducted a randomized controlled trial with a qualitative component involving mothers of hospitalized jaundiced breastfed infants <4 weeks of age. Mothers receiving the intervention met with an International Board-Certified Lactation Consultant in hospital and 1–3 times post discharge. Both groups received the standard care for jaundice. The primary outcome was exclusive breastfeeding at 3 months. To the exception of research assistants enrolling participants and completing qualitative interviews, all research staff, investigators and statisticians were blinded to group assignment. Qualitative interviews elicited feedback on breastfeeding experiences for both groups. Results 99 participants were recruited, and 86 analyzed for primary outcome. There was no difference in exclusive breastfeeding at 3 months between groups (RR 0.84, 95% CI 0.56–1.24, p = 0.40) or in the secondary outcomes. 31 participants were included in the qualitative analysis. Participants in the intervention group described an increase in comfort and confidence levels with breastfeeding. Participants in the control group reported limited lactation support. Conclusions Our hospital-based lactation support program did not result in a higher proportion of mothers exclusively breastfeeding at 3 months compared to current hospital standard care. Qualitative feedback from the intervention group suggests that mothers’ confidence was increased, which is linked to breastfeeding duration. The decision to breastfeed is multifactorial and hospital-based lactation support may be only a small piece of the puzzle in hospitalized jaundiced infants. Further studies may be needed to fully elucidate the impact of an in-hospital lactation support program on successful breastfeeding for these infants. Trial Registration ClinicalTrials.gov NCT00966719 https://www.clinicaltrials.gov/ct2/show/NCT00966719?term=Lactation+Support+and+Breastfeeding+Duration+in+Jaundiced+Infants%3A+a+Randomized+Controlled+Trial&rank=1
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Affiliation(s)
- Catherine M. Pound
- Department of Pediatrics, Children’s Hospital of Eastern Ontario, Ottawa, Ontario, Canada
- Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
- * E-mail:
| | - Katherine Moreau
- Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
| | - Kristina Rohde
- Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
- Clinical Research Unit, Children’s Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Nick Barrowman
- Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
| | - Mary Aglipay
- Clinical Research Unit, Children’s Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Ken J. Farion
- Department of Pediatrics, Children’s Hospital of Eastern Ontario, Ottawa, Ontario, Canada
- Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
| | - Amy C. Plint
- Department of Pediatrics, Children’s Hospital of Eastern Ontario, Ottawa, Ontario, Canada
- Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
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Hallowell SG, Spatz DL. The relationship of brain development and breastfeeding in the late-preterm infant. J Pediatr Nurs 2012; 27:154-62. [PMID: 22341194 DOI: 10.1016/j.pedn.2010.12.018] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2010] [Revised: 12/16/2010] [Accepted: 12/27/2010] [Indexed: 11/30/2022]
Abstract
Late-preterm infants (34 0/7-36 6/7 weeks gestation) are physiologically and developmentally immature at birth. The relationship between brain development and feeding is important since adequate oral intake is imperative to prevent feeding-related morbidity and mortality associated with being late preterm. One third of brain growth occurs in the last 6-8 weeks of gestation. The ontogeny of coordinated oral feeding appears to follow a chronological, predictable pattern in preterm neonates. This suggests that neurodevelopmental maturation, rather than experience or learned behavior, is largely responsible for feeding behaviors. The aim of this article is to provide a review of the literature that establishes the relationship between brain development and feeding in the late-preterm infant.
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Affiliation(s)
- Sunny G Hallowell
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, PA, USA.
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Abstract
This case study presents a maternal-infant dyad, both of whom bring risk factors to the breastfeeding relationship. The mother had true glandular hypoplasia that was not detected in the antenatal period or during her hospital stay. In addition, the infant was a late preterm infant, bringing the risks of poor feeding behavior and ineffective removal of milk from the breast as well as limited body reserves. Through the use of breastfeeding technology, including test weights, use of a hospital grade double electric breast pump and use of a nipple shield, in addition to a pharmacologic intervention, in which Domperidone was administered, this mother was able to maximize her milk yield and the infant was able to receive human milk for 6 months. This case report highlights the need for a thorough assessment of the breasts as well as the breastfeeding process in all breastfeeding dyads.
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Affiliation(s)
- Melissa S Duran
- The Children’s Hospital of Philadelphia, Philadelphia, PA 19104-4217, USA
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Alex M, Gallant DP. Toward understanding the connections between infant jaundice and infant feeding. J Pediatr Nurs 2008; 23:429-38. [PMID: 19026911 DOI: 10.1016/j.pedn.2007.12.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2007] [Revised: 12/05/2007] [Accepted: 12/06/2007] [Indexed: 11/15/2022]
Abstract
Parents face a paradox when they are told: Breast is best; bottle-feeding is hazardous to health. But breast-fed babies are more likely to become severely jaundiced than bottle-fed babies, and severe jaundice can lead to brain damage. This article will explore the natural physiology of jaundice with a focus on breast-feeding-associated jaundice, primary prevention of hyperbilirubinemia, and current evidence-based recommendations about feeding jaundice breast-fed infants.
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Affiliation(s)
- Marion Alex
- St. Francis Xavier University, Antigonish, Nova Scotia, Canada.
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