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Froh EB, Schwarz J, Spatz DL. Lactation Outcomes Among Dyads Following Participation in a Model of Group Prenatal Care for Patients with Prenatally Diagnosed Fetal Anomalies. Breastfeed Med 2020; 15:698-702. [PMID: 32589454 DOI: 10.1089/bfm.2020.0061] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Introduction: MamaCare is an adaptation of the CenteringPregnancy group prenatal care model designed to support women when the pregnancy has been complicated by the presence of known congenital anomalies. The lactation-related outcomes of participants were unknown. Materials and Methods: This is a retrospective descriptive cohort study describing the lactation-related outcomes of participants of MamaCare over 43 months. Data collection included abstraction of maternal demographic data, maternal group prenatal care session participation data, maternal pregnancy and delivery data, as well as documented lactation and breastfeeding data. Results: The total cohort consisted of 92 dyads. Of the 81 women who received an individualized prenatal nutrition consultation, 65 (80.2%) voiced a prenatal feeding goal of human milk and breastfeeding only, while the remaining 16 (19.8%) expressed goals of combination feeding (human milk and infant formula). For the surviving 85 infants, 91.8% of the mothers initiated lactation on the delivery day and the remaining 7 women initiated lactation on postpartum day 1. Also at the time of discharge from the initial intensive care unit stay, 87.1% of infants were receiving maternal human milk. Discussion: For families who participate in MamaCare, not only do they form a sense of community and learn about human milk and breastfeeding before delivery, the MamaCare facilitators and presenters normalize their experience to help MamaCare participants best meet their personal breastfeeding goals as well.
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Affiliation(s)
- Elizabeth B Froh
- Nursing and Clinical Care Services, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jessica Schwarz
- Nursing and Clinical Care Services, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Diane L Spatz
- Nursing and Clinical Care Services, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Takako H, Mizue M, Izumi H, Chie O, Harue T, Uchida M, Spatz DL. Improving Human Milk and Breastfeeding Rates in a Perinatal Hospital in Japan: A Quality Improvement Project. Breastfeed Med 2020; 15:538-545. [PMID: 32678705 DOI: 10.1089/bfm.2019.0298] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The leadership team at the Center for Maternal, Fetal and Neonatal Medicine, Saitama Medical Center, Saitama Medical University in Tokyo, Japan sought to improve our human milk (HM) and breastfeeding rates for vulnerable infants. This article describes the quality improvement (QI) initiative, which involved the implementation of the first three steps of the Spatz 10-step model for HM and breastfeeding in vulnerable infants. Our main objectives were to ensure that: (1) families were making informed feeding decisions about HM and breastfeeding as a medical intervention; (2) mothers were pumping early and often; (3) the staff implemented HM management; and (4) the proportion of infants who received HM at 1 month of life increased. Using a QI approach led by a nursing team, we were able to achieve all our goals. Our prenatal education was effective at having more families choose HM and breastfeeding versus formula. Our time to first milk expression improved as did the mothers' adherence with pumping early and often. We purchased physical resources to ensure that all milk was efficiently delivered to the infant in appropriate storage containers. At the initiation of this QI project, exclusive HM rates at discharge were only 15%. In only a 4 months time frame, the HM rate at discharge increased threefold to 47%. During the entire year, the portion of mothers selecting formula continued to decrease and HM rates continued to rise.
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Affiliation(s)
- Hara Takako
- Center for Maternal, Fetal and Neonatal Medicine (CMFNM), Saitama Medical Center, Saitama Medical University, Tokyo, Japan
| | - Matsumoto Mizue
- Center for Maternal, Fetal and Neonatal Medicine (CMFNM), Saitama Medical Center, Saitama Medical University, Tokyo, Japan
| | - Hosotani Izumi
- Center for Maternal, Fetal and Neonatal Medicine (CMFNM), Saitama Medical Center, Saitama Medical University, Tokyo, Japan
| | - Ozawa Chie
- Center for Maternal, Fetal and Neonatal Medicine (CMFNM), Saitama Medical Center, Saitama Medical University, Tokyo, Japan
| | - Tanishima Harue
- Center for Maternal, Fetal and Neonatal Medicine (CMFNM), Saitama Medical Center, Saitama Medical University, Tokyo, Japan
| | - Mieko Uchida
- Center for Maternal, Fetal and Neonatal Medicine (CMFNM), Saitama Medical Center, Saitama Medical University, Tokyo, Japan
| | - Diane L Spatz
- Perinatal Nursing and the Helen M. Shearer Professor of Nutrition at the University of Pennsylvania School of Nursing and Nurse Scientist for the Lactation Program at Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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Baumgartel K, Deem MJ. Promoting the use of pasteurized human donor milk in the NICU. Nursing 2020; 49:11-13. [PMID: 31764866 DOI: 10.1097/01.nurse.0000604728.66073.f7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Kelley Baumgartel
- Kelley Baumgartel is an assistant professor at the Duquesne University School of Nursing in Pittsburgh, Pa., and Michael J. Deem is an assistant professor in the School of Nursing and Center for Healthcare Ethics at Duquesne University
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To Consent, or Not to Consent, That Is the Question: Ethical Issues of Informed Consent for the Use of Donor Human Milk in the NICU Setting. Adv Neonatal Care 2019; 19:371-375. [PMID: 31651471 DOI: 10.1097/anc.0000000000000651] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Evidence supports the superiority of mother's own milk (MOM) in reducing the comorbidities common to prematurity and very low birth weight. In situations where an insufficient amount of MOM is available or maternal contraindications prevent its use, pasteurized donor human milk (DHM) is a viable substitution. When DHM is deemed best, a common practice in many neonatal intensive care units (NICUs) is for parents to provide their consent. However, no universal mandate for informed consent exists. Often, healthcare providers present and obtain the consent for DHM use prior to delivery or shortly after birth and this consent may be "bundled" along with other standardized NICU treatment consents. This approach is likely less than ideal since it provides insufficient time for decision making and often precedes the mother's ability to initiate the expression of her own milk. PURPOSE To review the history of DHM use and the ethics surrounding the consenting process including the ethical principles involved in infant feeding decision making. We argue for the standardization and consistent use of informed consent for DHM in the NICU and offer clinical practice implications. FINDINGS/RESULTS/IMPLICATIONS FOR PRACTICE AND RESEARCH Providers face several challenges in the consenting process for the use of DHM in the NICU setting. These include limited time to support parents and educate them appropriately during the decision-making process. Standardized and consistent use of informed consent is essential to address the ethical concerns surrounding the use of DHM in the NICU setting.
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Human Milk and Infants With Congenital Heart Disease: A Summary of Current Literature Supporting the Provision of Human Milk and Breastfeeding. Adv Neonatal Care 2019; 19:212-218. [PMID: 30694819 DOI: 10.1097/anc.0000000000000582] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Human milk is a life-saving medical intervention. Infants with congenital heart disease are at an increased risk for necrotizing enterocolitis, chylothorax, feeding difficulties, and growth failure. In the absence of evidence-based care, their mothers are also at risk for low milk supply and/or poor breastfeeding outcomes. PURPOSE Summarize the role of human milk and clinical outcomes for infants with congenital heart disease (CHD). Summarize methods of ideal breastfeeding support. METHODS/SEARCH STRATEGY PubMed, Cochrane Library, and CINAHL were the databases used. The terms used for the search related to CHD and necrotizing enterocolitis were "human milk" and "necrotizing enterocolitis" and "congenital heart disease." This resulted in a total of 17 publications for review. FINDINGS Infants receiving exclusive human milk diet are at a lower risk for necrotizing enterocolitis and will have improved weight gain. Infants with chylothorax who receive skimmed human milk have higher weight-for-age scores than formula-fed infants. Maternal breastfeeding education correlates with decreased risk of poor breastfeeding outcomes. IMPLICATIONS FOR PRACTICE Human milk is the ideal source of nutrition for infants with CHD and should be encouraged by the care team. Evidence-based lactation education and care must be provided to mothers and families prenatally and continue throughout the infant's hospitalization. If a mother's goal is to directly breastfeed, this should be facilitated during the infant's hospital stay. IMPLICATIONS FOR RESEARCH Evaluate the role between human milk and the incidence of necrotizing enterocolitis, feeding difficulties, and clinical outcomes in the population of infants with CHD.
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Cost and Use of Pasteurized Donor Human Milk at a Children’s Hospital. J Obstet Gynecol Neonatal Nurs 2018; 47:583-588. [DOI: 10.1016/j.jogn.2017.11.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2017] [Indexed: 11/18/2022] Open
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Facilitating Milk Donation in the Context of Perinatal Palliative Care. J Obstet Gynecol Neonatal Nurs 2018; 47:564-570. [DOI: 10.1016/j.jogn.2017.11.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2017] [Indexed: 01/30/2023] Open
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Thibeau S, Ginsberg HG. Bioethics in Practice: The Ethics Surrounding the Use of Donor Milk. Ochsner J 2018; 18:17-19. [PMID: 29559863 PMCID: PMC5855414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023] Open
Affiliation(s)
- Shelley Thibeau
- Mothers' Milk Bank of Louisiana, Ochsner Baptist Medical Center, New Orleans, LA
| | - Harley G Ginsberg
- Mothers' Milk Bank of Louisiana, Ochsner Baptist Medical Center, New Orleans, LA
- Department of Neonatology, Ochsner Baptist Medical Center, New Orleans, LA
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Spatz DL. SPN Position Statement: The Role of Pediatric Nurses in the Promotion and Protection of Human Milk and Breastfeeding. J Pediatr Nurs 2017; 37:136-139. [PMID: 29122273 DOI: 10.1016/j.pedn.2017.08.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Diane L Spatz
- University of Pennsylvania School of Nursing, Nurse Researcher & Manager of Lactation Program, The Children's Hospital of Philadelphia.
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Hurlimann T, Peña-Rosas JP, Saxena A, Zamora G, Godard B. Ethical issues in the development and implementation of nutrition-related public health policies and interventions: A scoping review. PLoS One 2017; 12:e0186897. [PMID: 29073186 PMCID: PMC5658098 DOI: 10.1371/journal.pone.0186897] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 09/19/2017] [Indexed: 12/24/2022] Open
Abstract
Background The limited integration of ethics in nutrition-related public health policies and interventions is one major concern for those who have the task of implementing them. Ethical challenges that are overlooked during the development of such interventions could raise serious ethical issues during their implementation and even after. As a result, these decision makers need technical support and ethical guidance for adaptation of interventions to local (cultural, social, economic, etc.) contexts. Aim The goal of this scoping review is to delineate and “map” the range of ethical issues in nutrition-related public health interventions, as well as the range of the various fields in which they may arise. Methods A scoping review of empirical research and conceptual literature was conducted following the framework of Arksey and O’Malley. Searches using PubMed with Medical Subject Headings (MeSH) categories and Advanced Search Builder as well as in the Global Health Library were performed. The final sample consists of 169 publications. Results The ethics of public health prevention or treatment of obesity and non-communicable diseases is the most explicitly and frequently discussed subject. In comparison, ethical issues raised by public health interventions in the fields of undernutrition, breastfeeding, vitamin/mineral supplementation and food fortification, food security, food sustainability and food safety are addressed in a lower proportion of the sample. The results illustrate the various natures, types, and scopes of existing public health nutrition-related interventions, and the various ethical issues that may be raised by these interventions, in addition to the numerous and different contexts in which they may be implemented. Discussion The ethical issues faced in the development and implementation of nutrition-related public health interventions are varied and cannot be equated with, nor generalized about, when dealing with specific activities in this field. More importantly, these ethical issues cannot be managed without a careful consideration for the complexity of contexts in which nutrition-related interventions are expected to be implemented. These interventions engage a variety of actors with diverse perspectives and interests. We discuss these challenges and also comment on the importance of considering ethical impacts in the monitoring and evaluation of such interventions. Conclusion General ethical frameworks or recommendations–although useful–cannot be expected to provide policy makers, implementators and other public health personnel with sufficient practical ethical guidance as they cannot consider and anticipate the particularities of all specific nutrition-related public health interventions and the complexity of the contexts in which they are implemented. Further research is needed in order to develop more targeted ethical frameworks.
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Affiliation(s)
- Thierry Hurlimann
- Public Health Research Institute of the University of Montreal (IRSPUM), Montreal, Canada
| | - Juan Pablo Peña-Rosas
- Evidence and Programme Guidance, Department of Nutrition for Health and Development, World Health Organization, Geneva, Switzerland
| | - Abha Saxena
- Department of Information, Evidence and Research, World Health Organization, Geneva, Switzerland
| | - Gerardo Zamora
- Evidence and Programme Guidance, Department of Nutrition for Health and Development, World Health Organization, Geneva, Switzerland
| | - Béatrice Godard
- Public Health Research Institute of the University of Montreal (IRSPUM), Montreal, Canada
- * E-mail:
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Froh EB, Deatrick JA, Curley MAQ, Spatz DL. Mothers of Infants With Congenital Diaphragmatic Hernia Describe "Breastfeeding" in the Neonatal Intensive Care Unit: "As Long as It's My Milk, I'm Happy". J Hum Lact 2017; 33:524-532. [PMID: 28609176 DOI: 10.1177/0890334417709469] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Very little is known about the breastfeeding experience of mothers of infants born with congenital anomalies and cared for in the neonatal intensive care unit (NICU). Often, studies related to breastfeeding and lactation in the NICU setting are focused on the mothers of late preterm, preterm, low-birth-weight, and very-low-birth-weight infants. Congenital diaphragmatic hernia (CDH) is an anatomic malformation of the diaphragm and affects 1 in every 2,000 to 4,000 live births. Currently, there are no studies examining the health outcomes of infants with CDH and the effect of human milk. Research aim: This study aimed to describe the breastfeeding experience of mothers of infants with CDH cared for in the NICU. METHODS A prospective, longitudinal qualitative descriptive design was used. Phased interviews were conducted with a purposive sample of 11 CDH infant-mother dyads from a level 3 NICU in a children's hospital. RESULTS Six themes emerged from the data: (a) hopeful for breastfeeding, (b) latching on . . . to the pump, (c) we've already worked so hard, (d) getting the hang of it-it's getting easier, (e) a good safety net, and (f) finding a way that works for us. CONCLUSION For this population of CDH infant-mother dyads, the term breastfeeding is not exclusive to direct feeding at the breast and the mothers emphasized the significance of providing their own mother's milk through a combination of feeding mechanisms to their infants with CDH.
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Affiliation(s)
- Elizabeth B Froh
- 1 The University of Pennsylvania School of Nursing, Philadelphia, PA, USA.,2 The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Janet A Deatrick
- 1 The University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - Martha A Q Curley
- 1 The University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - Diane L Spatz
- 1 The University of Pennsylvania School of Nursing, Philadelphia, PA, USA.,2 The Children's Hospital of Philadelphia, Philadelphia, PA, USA
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Binns C, Lee MK, Kagawa M. Ethical Challenges in Infant Feeding Research. Nutrients 2017; 9:E59. [PMID: 28085057 PMCID: PMC5295103 DOI: 10.3390/nu9010059] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 12/23/2016] [Accepted: 01/09/2017] [Indexed: 01/14/2023] Open
Abstract
Infants have a complex set of nutrient requirements to meet the demands of their high metabolic rate, growth, and immunological and cognitive development. Infant nutrition lays the foundation for health throughout life. While infant feeding research is essential, it must be conducted to the highest ethical standards. The objective of this paper is to discuss the implications of developments in infant nutrition for the ethics of infant feeding research and the implications for obtaining informed consent. A search was undertaken of the papers in the medical literature using the PubMed, Science Direct, Web of Knowledge, Proquest, and CINAHL databases. From a total of 9303 papers identified, the full text of 87 articles that contained discussion of issues in consent in infant feeding trials were obtained and read and after further screening 42 papers were included in the results and discussion. Recent developments in infant nutrition of significance to ethics assessment include the improved survival of low birth weight infants, increasing evidence of the value of breastfeeding and evidence of the lifelong importance of infant feeding and development in the first 1000 days of life in chronic disease epidemiology. Informed consent is a difficult issue, but should always include information on the value of preserving breastfeeding options. Project monitoring should be cognisant of the long term implications of growth rates and early life nutrition.
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Affiliation(s)
- Colin Binns
- John Curtin Distinguished Emeritus Professor of Public Health, Curtin University, Perth 6845, Australia.
| | - Mi Kyung Lee
- Department, School of Health Professions, Murdoch University, Perth 6150, Australia.
| | - Masaharu Kagawa
- Institute of Nutrition Sciences, Kagawa Nutrition University, Saitama 350-0214, Japan.
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Cardin AD, Rens L, Stewart S, Danner-Bowman K, McCarley R, Kopsas R. Neuroprotective Core Measures 1–7: A Developmental Care Journey: Transformations in NICU Design and Caregiving Attitudes. ACTA ACUST UNITED AC 2015. [DOI: 10.1053/j.nainr.2015.06.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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