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Mills M, Nommsen-Rivers L, Kaplan HC, Liu C, Ehrlich S, Ward L. Predictors of Direct Breastfeeding in Preterm Infants. Breastfeed Med 2024. [PMID: 39093849 DOI: 10.1089/bfm.2024.0052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/04/2024]
Abstract
Objective: Rates of mother's own milk (MOM) provision in the neonatal intensive care unit (NICU) vary widely, despite acceptance as the gold standard for nutrition in preterm infants. Direct breastfeeding (DBF) supports long-term provision of MOM, but factors that support DBF in preterm infants are unknown. The purpose of this study was to identify factors that predict DBF at oral feeding initiation and at NICU discharge. Methods: This was a retrospective cohort study of preterm infants born at ≤ 32 weeks who were receiving MOM at 32 weeks corrected gestational age (cohort 1) and at discharge to home (cohort 2). The primary outcomes were rates of DBF at oral feeding initiation (cohort 1) and at hospital discharge (cohort 2). We examined bivariate associations between infant characteristics, maternal sociodemographic factors, and hospital practices (e.g., lactation visit timing and frequency) with DBF outcomes and then built logistic regression models to determine the adjusted odds ratio and 95% confidence interval ([adjusted odds ratio [aOR] [95%CI]) for independent predictors of the DBF outcomes. Results: Sixty-four percent of eligible infants initiated DBF, and 51% were DBF at discharge. Sociodemographic, NICU, and lactation support factors were associated with both outcomes. Post hoc analysis showed that similar factors also influenced lactation support provision. Conclusions: Lactation support, NICU and sociodemographic variables influence DBF initiation and DBF at discharge. Interventions that optimize efficient use of available lactation support, address bias, and provide ample opportunity for DBF practice could improve rates.
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Affiliation(s)
- Manisha Mills
- Division of Neonatology, Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | | | - Heather C Kaplan
- Division of Neonatology, Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Chunyan Liu
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Shelley Ehrlich
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Environmental Health, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
| | - Laura Ward
- Division of Neonatology, Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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2
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Kinoshita M, White MJ, Doolan A. Clinical assessment of breastfeeding in preterm infants. Eur J Clin Nutr 2024:10.1038/s41430-024-01471-3. [PMID: 38982131 DOI: 10.1038/s41430-024-01471-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 06/22/2024] [Accepted: 07/01/2024] [Indexed: 07/11/2024]
Abstract
Breastmilk confers empirical benefits for preterm infants, however direct breastfeeding rates in this population remain low. For preterm infants, it may be useful to assess the volume of breastmilk transferred from mother to baby when breastfeeding, particularly during transition to oral feeding when breastfeeding attrition is high. Establishing breastfeeding in preterm infants is complex and without knowledge of milk intake during breastfeeds there is risk of inaccurate feed supplementation with subsequent effects on growth and nutrition. Here we review the evidence for clinical assessments of breastfeeding in preterm infants including test weighing, use of isotope labelled water and clinical observation tools designed to estimate adequacy of breastfeeds. Test weighing is a validated measurement, however requires rigorous protocols and further investigation in small infants. Use of isotope labelled water is a validated technique but, due to sampling requirements, reflects intake over days and weeks instead of individual feeds. Clinical observation tools assessed in preterm infants, have not been shown to reflect volumes of breastmilk intake. While current methods have limitations, the goal is to identify measurement tools to be used as temporary aids to facilitate transition to direct breastfeeding while minimising risk of inaccurate supplementation.
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Affiliation(s)
- Meredith Kinoshita
- The Coombe Hospital, Dublin, Ireland.
- Royal College of Surgeons Ireland, Dublin, Ireland.
| | - Martin J White
- The Coombe Hospital, Dublin, Ireland
- Royal College of Surgeons Ireland, Dublin, Ireland
| | - Anne Doolan
- The Coombe Hospital, Dublin, Ireland
- University College Dublin, Dublin, Ireland
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3
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Cunha CMC, Lima EDFA, Galvão DMPG, Brito APA, Fonseca LMM, Primo CC. Breastfeeding assistance for preterm and low birth weight infants: best practices implementation project. Rev Esc Enferm USP 2024; 58:e20230380. [PMID: 38949512 PMCID: PMC11216164 DOI: 10.1590/1980-220x-reeusp-2023-0380en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 04/16/2024] [Indexed: 07/02/2024] Open
Abstract
OBJECTIVE To describe the process of best practices implementation for breastfeeding assistance for preterm and low birth weight infants. METHOD Participatory research that used the evidence implementation methodology of the JBI, held at a university hospital in southeastern Brazil, with the participation of a multidisciplinary team and managers. STAGES Situational diagnosis, baseline audit and feedback, protocol development, training, implementation, and monitoring. RESULTS Seven audit criteria were defined. In the baseline audit, three criteria were met, with eleven barriers to be resolved being listed. The strategies carried out were protocol development and multidisciplinary and intersectoral training. After the training, compliance was achieved with the seven criteria audited in the first follow-up audit and five in the second, emphasizing the increase in compliance after the implementation of the outlined strategies. CONCLUSION The project achieved the objective of improving evidence-based practice, and allowed the implementation of the institution's first breastfeeding protocol. However, it shows the need to maintain training for adherence and enculturation of new practices.
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Affiliation(s)
| | - Eliane de Fátima Almeida Lima
- Universidade Federal do Espírito Santo, Centro de Ciências da Saúde, Departamento de Enfermagem, Vitória, ES, Brazil
| | - Dulce Maria Pereira Garcia Galvão
- Escola Superior de Enfermagem de Coimbra, UCP Enfermagem de Saúde da Criança e do Adolescente, Unidade de Investigação em Ciências da Saúde: Enfermagem, Coimbra, Portugal
| | - Ana Paula Almeida Brito
- Universidade de São Paulo, Hospital Universitário, São Paulo, SP, Brazil
- Centro Brasileiro para o Cuidado à Saúde Baseada em Evidência: Centro de Excelência do JBI, São Paulo, SP, Brazil
| | | | - Cândida Caniçali Primo
- Universidade Federal do Espírito Santo, Centro de Ciências da Saúde, Departamento de Enfermagem, Vitória, ES, Brazil
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4
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Leong M, Obaid M, Fernandez Ramos MC, Eichenberger R, John A, Krumholtz-Belkin P, Roeder T, Parvez B. Skilled lactation support using telemedicine in the neonatal intensive care unit. J Perinatol 2024; 44:687-693. [PMID: 38341485 DOI: 10.1038/s41372-024-01894-7] [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: 11/21/2023] [Revised: 01/19/2024] [Accepted: 01/23/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND NICU mothers face unique challenges in initiating and sustaining breastfeeding, but previous studies have focused on outpatient breastfeeding support. We conducted a retrospective study of NICU breastfeeding outcomes before and after implementing telelactation. METHODS Pre-Telemedicine mothers received in-person support by NICU lactation consultants, while Telemedicine mothers received solely telemedicine consults after maternal discharge. RESULTS Exclusive breastmilk feeding at discharge increased in the Telemedicine group. Notably, babies in the Telemedicine cohort who were fed any formula on admission experienced significant improvement in exclusive breastmilk feeding at discharge, and those whose mothers received at least one NICU lactation consult had the greatest improvement in exclusive breastfeeding rates at discharge. CONCLUSIONS This study is the first to validate the use of telemedicine as a means of maintaining access to skilled lactation support in the NICU when in-person consults are not feasible. Incorporating telemedicine can ensure access and continuity of skilled lactation support, and sustain breastfeeding rates.
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Affiliation(s)
- Melanie Leong
- Division of Neonatology, Maria Fareri Children's Hospital, Valhalla, New York, USA.
- Westchester Medical Center, Valhalla, New York, USA.
- Department of Pediatrics, New York Medical College, Valhalla, New York, USA.
| | - Maria Obaid
- Division of Neonatology, Maria Fareri Children's Hospital, Valhalla, New York, USA
- Westchester Medical Center, Valhalla, New York, USA
| | - Maria Cristina Fernandez Ramos
- Division of Neonatology, Maria Fareri Children's Hospital, Valhalla, New York, USA
- Westchester Medical Center, Valhalla, New York, USA
| | | | - Annamma John
- Westchester Medical Center, Valhalla, New York, USA
| | | | - Tina Roeder
- Westchester Medical Center, Valhalla, New York, USA
| | - Boriana Parvez
- Division of Neonatology, Maria Fareri Children's Hospital, Valhalla, New York, USA
- Westchester Medical Center, Valhalla, New York, USA
- Department of Pediatrics, New York Medical College, Valhalla, New York, USA
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5
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Sweet L, Hughes J, Rasheed A, Vasilevski V. An innovative low-cost breast pump-hire program to enhance breastfeeding rates in a neonatal intensive care unit. J Adv Nurs 2024. [PMID: 38558479 DOI: 10.1111/jan.16180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 03/13/2024] [Accepted: 03/20/2024] [Indexed: 04/04/2024]
Abstract
AIM To evaluate the outcomes of a low-cost hospital-grade breast pump hire program for women experiencing financial hardship with infants in neonatal intensive care. DESIGN A multi-method evaluation including data audits and surveys. METHODS Twenty-four electric breast pumps were purchased and rented to mothers at a cost of $1/day. To be eligible, mothers needed to have given birth to an infant <32 weeks and/or <1500 g and self-identified as experiencing financial hardship. Data were collected by (1) a retrospective audit to evaluate infant feeding and clinical outcomes at hospital discharge; (2) prospective telephone surveys to evaluate women's satisfaction with the program; and (3) analysis of the breast pump register to determine any loss or damages. RESULTS Twenty-four mothers of 26 infants participated in the program. More than half of the infants were exclusively breastmilk fed at hospital discharge, and more than three-quarters were fed a combination of breastmilk and formula. Women who intended to formula feed were supported to provide breastmilk to their infants in the first few weeks of life. Most participants were highly satisfied with the program. Women reported that accessibility to a hospital-grade breast pump improved their ability to provide expressed breastmilk to their infants. Most participants were 'extremely satisfied' with the performance of the breast pump. One-quarter of the women reported that they would have exclusively formula-fed if they did not have access to the breast pump hire program. The audit of the equipment register showed no reported technical issues, loss or damages. CONCLUSION The findings suggested that the low-cost breast pump hire program supported equitable care, increasing women's ability to provide expressed breastmilk for their infants. IMPACT Providing access to low-cost hospital-grade breast pumps to mothers of vulnerable infants is likely to prevent poor infant clinical outcomes and improve women's care satisfaction. PUBLIC OR PATIENT CONTRIBUTION Nil.
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Affiliation(s)
- Linda Sweet
- School of Nursing and Midwifery, Faculty of Health, Deakin University, Burwood, Victoria, Australia
- Centre for Quality and Patient Safety Research, Western Health Partnership, Institute for Health Transformation, St Albans, Victoria, Australia
| | - Jessica Hughes
- Tweddle Child and Family Health Service, Wyndam, Victoria, Australia
| | | | - Vidanka Vasilevski
- School of Nursing and Midwifery, Faculty of Health, Deakin University, Burwood, Victoria, Australia
- Centre for Quality and Patient Safety Research, Western Health Partnership, Institute for Health Transformation, St Albans, Victoria, Australia
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Harahsheh MM, Mukattash TL, Al-Shatnawi S, Abu-Farha R, Abuhammad S, D'Arcy D, Jarab A. Community Pharmacists' Current Practice and Educational Needs in Breastfeeding Support in Jordan: A Cross-Sectional Study. J Hum Lact 2024; 40:132-142. [PMID: 37994528 DOI: 10.1177/08903344231206394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2023]
Abstract
BACKGROUND Improving breastfeeding practices is a worldwide priority. Pharmacists have the opportunity to actively promote breastfeeding and educate parents as well as the general public about its benefits. RESEARCH AIMS The aims of this study are to investigate Jordanian pharmacists' present breastfeeding support practices and perceptions regarding their need for education and training in breastfeeding support. METHODS To examine sociodemographic characteristics of community pharmacists in Jordan and their current breastfeeding support practices and educational needs, a descriptive cross-sectional online (self-report) survey was conducted. Through social media, pharmacists working in community pharmacies in Jordan were recruited between August 2021 and February 2022. The level of breastfeeding support participants had been provided with was measured using eight items in a 5-point Likert scale ranging from 5 (Always) to 1 (Never). Each participant self-reported the frequency of advice/information given to breastfeeding women in each of these areas. Univariate and multivariable linear regression models were used to identify factors associated with the level of breastfeeding support. RESULTS Participants (N = 381) reported a high level of breastfeeding support, but expressed a need for training and education for further improvement. The breastfeeding support score of female participants was found to be 0.12 higher than that of males (Beta = 0.12, p = .02), 0.16 higher in married participants compared to non-married participants (Beta = 0.16, p = .03), and 0.10 higher in participants working in rural areas compared to those working in urban areas (Beta = 0.10, p = .04). CONCLUSION While community pharmacists generally report a high level of breastfeeding support, our findings revealed demographic differences. Attention to specific areas of need might enhance what pharmacists could offer; however, additional research would be required to guide the specific educational content.
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Affiliation(s)
- Mea'ad M Harahsheh
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | - Tareq L Mukattash
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | - Samah Al-Shatnawi
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | - Rana Abu-Farha
- Clinical Pharmacy and Therapeutics Department, Faculty of Pharmacy, Applied Science Private University, Amman, Jordan
| | - Sawsan Abuhammad
- Department of Maternal and Child Health, Faculty of Nursing, Jordan University of Science and Technology, Irbid, Jordan
| | - Deirdre D'Arcy
- School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, Dublin, Ireland
| | - Anan Jarab
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
- Collage of Pharmacy, Al-Ain University, Abu Dhabi, United Arab of Emirates
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7
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Tomlinson C, Haiek LN. Breastfeeding and human milk in the NICU: From birth to discharge. Paediatr Child Health 2023; 28:510-526. [PMID: 38638537 PMCID: PMC11022875 DOI: 10.1093/pch/pxad034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 04/20/2022] [Indexed: 04/20/2024] Open
Abstract
It is well recognized that human milk is the optimal nutritive source for all infants, including those requiring intensive care. This statement reviews evidence supporting the importance of breastfeeding and human milk for infants, and why breastfeeding practices should be prioritized in the neonatal intensive care unit (NICU). It also reviews how to optimally feed infants based on their stability and maturity, and how to support mothers to establish and maintain milk production when their infants are unable to feed at the breast.
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Affiliation(s)
- Christopher Tomlinson
- Canadian Paediatric Society, Nutrition and Gastroenterology Committee, Ottawa, Ontario, Canada
| | - Laura N Haiek
- Canadian Paediatric Society, Nutrition and Gastroenterology Committee, Ottawa, Ontario, Canada
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8
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Davis JA, Glasser M, Spatz DL, Scott P, Demirci JR. First Feed Type Is Associated With Birth/Lactating Parent's Own Milk Use During NICU Stay Among Infants Who Require Surgery. Adv Neonatal Care 2022; 22:578-588. [PMID: 35421040 PMCID: PMC9556699 DOI: 10.1097/anc.0000000000000981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Early exclusive birth/lactating parent's own milk (B/LPOM) feeds have been associated with longer duration of B/LPOM use for infant feedings in healthy term and hospitalized preterm infants. This relationship has not been explored in infants undergoing neonatal surgery (surgical infants). PURPOSE To evaluate the relationship between early exclusive B/LPOM feeds and cumulative B/LPOM patterns during surgical infants' neonatal intensive care unit (NICU) hospitalization. METHODS A secondary cross-sectional analysis was performed using the electronic health record data of surgical infants admitted to a level IV NICU between January 2014 and March 2015. Multiple linear regression and Fisher's exact test were used to examine the associations between first NICU feed type and total percentage of diet composed of B/LPOM during NICU stay and continuation of any or exclusive B/LPOM feedings at NICU discharge, respectively. RESULTS The analysis included 59 infants who required surgery for gastrointestinal, cardiac, or multisystem defects or pregnancy-related complications. Receipt of B/LPOM as the first NICU feed was associated with higher percentage of B/LPOM feeds ( P < .001) throughout NICU stay, as well as continuation of any or exclusive B/LPOM feedings at NICU discharge ( P = .03). IMPLICATIONS FOR PRACTICE Early exclusive B/LPOM feeds may be an important predictor for continuation of any B/LPOM use throughout the NICU stay and at NICU discharge. Continued efforts to identify and address gaps in prenatal and postpartum lactation support for parents of surgical infants are needed. IMPLICATIONS FOR RESEARCH Powered studies are needed to corroborate these findings and to explore the potential impact of other factors on duration and exclusivity of B/LPOM use. VIDEO ABSTRACT AVAILABLE AT https://journals.lww.com/advancesinneonatalcare/Pages/videogallery.aspx .
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Affiliation(s)
- Jessica A Davis
- University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania (Ms Davis and Drs Glasser, Scott, and Demirci); and University of Pennsylvania School of Nursing, Philadelphia, and The Children's Hospital of Philadelphia (CHOP), Philadelphia, and Children's Hospital of Philadelphia's Mothers' Milk Bank, Philadelphia, Pennsylvania (Dr Spatz)
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9
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Broom M, Youseman ME, Kent AL. Impact of introducing a lactation consultant into a neonatal unit. J Paediatr Child Health 2022; 58:636-640. [PMID: 34713946 DOI: 10.1111/jpc.15799] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 10/05/2021] [Accepted: 10/06/2021] [Indexed: 11/30/2022]
Abstract
AIM Benefits of mothers' own milk (MOM) for premature and sick neonates are well documented. To increase access, many neonatal units have a lactation consultant (LC) on staff. This study aimed to assess the impact of a permanent LC on (i) maternal access to LC support; (ii) staff confidence in providing Breast Feeding (BF) education and (iii) provision of MOM. METHODS Study included a staff survey and chart audit. Questions provided feedback on access to lactation support and meeting maternal needs. Audit data included: gestational age, birthweight, intention to breastfeed, documentation of LC appointment, provision of MOM at 12 hours, days 3, 7, 28 and discharge. Student's t-tests were used for numerical data and chi-squared tests for categorical variables. RESULTS Ninety-one staff surveys were returned, (pre 35/75 (47%), post 56/85 (66%) with staff reporting organising an LC appointment was significantly easier (P < 0.0001). Staff perceived maternal lactation needs and confidence to breastfeed post-discharge had significantly improved post-LC. The chart audit showed a significant increase in maternal access to LC appointments (15% vs. 80%; P < 0.01), breast pump education by day 3 (65% vs. 81%; P < 0.01), and an increase in MOM provision by 12 h (46% vs. 61%; P < 0.01) post-LC but not at days 7, 28 or discharge. CONCLUSION A dedicated LC increases staff and maternal access to lactation education and support, improving provision of early MOM. Further research is required to assess the effect of LCs in improving breastfeeding rates in neonatal units.
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Affiliation(s)
- Margaret Broom
- Centenary Hospital for Women and Children, Canberra Hospital, Canberra, Australian Capital Territory, Australia.,SYNERGY: Nursing and Midwifery Research Centre, University of Canberra and ACT Health, Canberra, Australian Capital Territory, Australia
| | - Mary-Ellen Youseman
- Centenary Hospital for Women and Children, Canberra Hospital, Canberra, Australian Capital Territory, Australia
| | - Alison L Kent
- University of Rochester, Dept of Pediatrics, Golisano Children's Hospital, Rochester, New York, United States.,Australian National University, College of Health and Medicine, Canberra, Australian Capital Territory, Australia
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10
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Abstract
BACKGROUND Mother's milk improves outcomes. Referral neonatal intensive care units face unique lactation challenges with maternal-infant separation and maternal pump dependency. Little is known about lactation resource allocation in this high-risk population. RESEARCH AIMS To determine differences in human milk outcomes, (1) the proportion of infants fed exclusive or any mother's milk and (2) recorded number and volume of pumped mothers' milk bottles, between two models of lactation care in a referral neonatal intensive care unit. METHODS This retrospective, longitudinal, two-group comparison study utilized medical record individual feeding data for infants admitted at ≤ Day 7 of age and milk room storage records from reactive and proactive care model time periods (April, 2017-March, 2018; May, 2018-April, 2019). The reactive care model (n = 509 infants, 58% male, median birth weight and gestational age of 37 weeks,) involved International Board Certified Lactation Consultant referral for identified lactation problems; whereas, the proactive model (n = 472 infants, 56% male, median birth weight and gestational age 37 weeks) increased International Board Certified Lactation Consultant staffing, who then saw all admissions. Comparisons were performed using chi square, Mann Whitney, and t-tests. RESULTS A proactive lactation approach was associated with an increase in the receipt of any mother's milk from 74.3% to 80.2% (p = .03) among participants in the proactive model group. Additionally, their milk room mean monthly bottle storage increased from 5153 (SD 788) to 6620 (SD 1314) bottles (p < .01). CONCLUSIONS In this retrospective study at a tertiary referral neonatal intensive care unit, significant improvement inhuman milk outcomes suggests that increased resources for proactive lactation care may improve mother's milk provision for a high-risk population.
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Affiliation(s)
- Rebecca Hoban
- 7979 Department of Paediatrics, Division of Neonatology, The Hospital for Sick Children, Toronto, Canada
| | - Laura McLean
- Department of Clinical Dietetics, The Hospital for Sick Children, Toronto, Canada
| | - Samantha Sullivan
- Department of Clinical Dietetics, The Hospital for Sick Children, Toronto, Canada
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11
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Sankar MN, Weiner Y, Chopra N, Kan P, Williams Z, Lee HC. Barriers to optimal breast milk provision in the neonatal intensive care unit. J Perinatol 2022; 42:1076-1082. [PMID: 34815522 PMCID: PMC8610106 DOI: 10.1038/s41372-021-01275-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 10/19/2021] [Accepted: 11/10/2021] [Indexed: 11/13/2022]
Abstract
OBJECTIVE This study examines comprehensive patient and process factors that influence breast milk use in the NICU setting. STUDY DESIGN We examined the association of maternal, neonatal, and family factors and lactation support systems to identify gaps in breast milk use in a retrospective study of 865 infants born in 23-41 weeks gestation admitted to the NICU. RESULTS Breast milk at discharge for all infants was 89.3%, for extremely preterm 82.3%, moderately preterm 91.4%, late preterm 86.5%, and term 92.7%. Prematurity (OR 0.31 [0.17-0.56]), low birth weight, morbidities, Black maternal race (OR 0.20 [0.07-0.57]) and public insurance (OR 0.54 [0.34-0.85]) were associated with decreased breast milk use. Early initiation of feeds was associated with increased breast milk use. CONCLUSIONS There is a need to increase social as well as hospital support systems to address gaps in breast milk use in the NICU.
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Affiliation(s)
- Meera N. Sankar
- grid.168010.e0000000419368956Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA USA
| | - Ya’el Weiner
- grid.168010.e0000000419368956Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA USA ,grid.512564.1California Perinatal Quality Care Collaborative, Stanford, CA USA
| | - Neha Chopra
- grid.168010.e0000000419368956Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA USA ,grid.512564.1California Perinatal Quality Care Collaborative, Stanford, CA USA
| | - Peiyi Kan
- grid.168010.e0000000419368956Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA USA ,grid.512564.1California Perinatal Quality Care Collaborative, Stanford, CA USA
| | - Zakiyah Williams
- grid.414123.10000 0004 0450 875XLactation services, Lucile Packard Children’s Hospital, Stanford, CA USA
| | - Henry C. Lee
- grid.168010.e0000000419368956Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA USA ,grid.512564.1California Perinatal Quality Care Collaborative, Stanford, CA USA
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12
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Wang H, Li QF, Xu XF, Hu XL. Study on improving collection feeding safety and quality of colostrum for very (extremely) low birth weight infants. Front Pediatr 2022; 10:1069719. [PMID: 36866084 PMCID: PMC9972579 DOI: 10.3389/fped.2022.1069719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 12/21/2022] [Indexed: 02/17/2023] Open
Abstract
OBJECTIVE This study aims to explore the difficulties related to fresh colostrum feeding for very (extremely) low birth weight infants (VLBWI/ELBWI) and optimize the colostrum administration process. METHODS The VLBWI/ELBWI who were admitted in the neonatal intensive care unit from January to December 2021, were enrolled as the experimental group, and an optimized colostrum feeding process was adopted. The VLBWI/ELBWI admitted from January to December 2020 were enrolled as the control group, and a conventional feeding process was adopted. The general situation of colostrum supply, number of adverse feeding events, maternal breastfeeding rate at the critical time points. RESULTS There were no significant differences between the baseline charatcteristics of the 2 groups. In the experimental group, compared with the control group, the time to first colostrum collection was significantly shorter (64.8% vs. 57.8% p < 0.05), and the rates of colostrum feeding (44.1% vs. 70.5% p < 0.001), and of maternal breastfeeding at 2 weeks after birth (56.1% vs. 46.7%, p < 0.05) and on the day of discharge (46.2% vs. 37.8%, p < 0.05) were significantly higher. Before and after process optimization, the average total time required for the time for nurses to receive the colostrum in the NICU reduced from 7.5 min/time to 2 min/time, and no feeding-related adverse events occurred. CONCLUSION Fresh colostrum feeding process optimization for VLBWI/ELBWI, improves the colostrum feeding rate, shortens the time to first colostrum collection, saves the working time of nurses, and improves the maternal breastfeeding rate at key time points.
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Affiliation(s)
- Hua Wang
- Department of NICU, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Qiu-Fang Li
- Department of Nursing, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xin-Fen Xu
- Department of Nursing, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiao-Li Hu
- Department of Obstetrics, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
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13
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Abstract
The regionalization of neonatal care was implemented with an overarching goal to improve neonatal outcomes.1 This led to centralized neonatal care in urban settings that jeopardized the sustainability of the community level 2 and level 3 Neonatal Intensive Care Units (NICU) in medically underserved areas.2 Coupled with pediatric subspecialist and allied health professional workforce shortages, regionalization resulted in disparate and limited access to subspecialty care.3-6 Innovative telemedicine technologies may offer an alternative and powerful care model for infants in geographically isolated and underserved areas. This chapter describes how telemedicine offerings of remote pediatric subspecialty and specialized programs may bridge gaps of access to specialized care and maintain the clinical services in community NICUs.
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Affiliation(s)
- Abeer Azzuqa
- Division of Newborn Medicine, Department of Pediatrics, University of Pittsburgh School of Medicine and UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA.
| | - Abhishek Makkar
- Division of Newborn Medicine, Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Kerri Machut
- Division of Neonatology, Department of Pediatrics, Northwestern University Feinberg School of Medicine and Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
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14
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Nation H, Sanlorenzo L, Lebar K, Brandon D. A Quality Improvement Project to Increase Frequency of Skin-to-Skin Contact for Extreme Low-Birth-Weight Infants in the Neonatal Intensive Care Unit. J Perinat Neonatal Nurs 2021; 35:247-257. [PMID: 34330136 DOI: 10.1097/jpn.0000000000000556] [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] [Indexed: 11/27/2022]
Abstract
Benefits of skin-to-skin contact (SSC) are documented but often delayed in the extremely preterm population due to medical complexity and staff misconceptions about safety. This quality improvement initiative was designed to increase SSC utilization among infants born before 29 weeks' gestation regardless of respiratory support by addressing nursing barriers inhibiting SSC. A pre-/postsurvey evaluated comfort level performing and perceived barriers to SSC utilization. Implementation consisted of an updated unit-specific SSC protocol and tailored education specific to identified barriers. Evaluation included SSC rates and maternal human milk usage in the first 30 days of life. In total, 81 patients (22-28 weeks, 370-1410 g) were included. SSC rates ranged from 3.3% to 17.7% at baseline and increased to 33.2% to 39.1% postintervention. Maternal human milk utilization increased above target (≥75%) postintervention for days 7 and 14, but declined towards baseline on days 21 and 30. A statistically significant increase was observed in nursing comfort level when performing SSC for intubated infants as well as infants with a peripherally inserted central catheter or umbilical venous catheter. SSC rates increased with infants younger than 29 weeks requiring intubation and central line management, possibly as a result of greater nursing comfort surrounding with SSC.
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Affiliation(s)
- Helen Nation
- Duke University, Durham, North Carolina, and Monroe Carell Jr Children's Hospital at Vanderbilt, Nashville, Tennessee (Dr Nation); Division of Neonatology, Department of Pediatrics, Monroe Carell Jr Children's Hospital at Vanderbilt, Nashville, Tennessee (Dr Sanlorenzo); Women's and Children's Service Line, Philadelphia, Pennsylvania (Dr Lebar); and Duke University School of Nursing, Durham, North Carolina (Dr Brandon)
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15
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Abstract
Breast milk provides optimal nourishment for all infants and has special advantages in preterm infants. Breast milk is associated with lower rates of necrotizing enterocolitis and bronchopulmonary dysplasia and improved neurodevelopmental outcomes in the preterm population. Mothers in the NICU may experience multiple psychological, physical, and social/cultural barriers that impede successful breastfeeding. Professional lactation support is of crucial importance in this population. With the social distancing requirements of the pandemic, many clinicians have adopted novel methods of education and communication to ensure continued timely support for NICU mothers.
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Affiliation(s)
- Padma S Nandula
- Division of Neonatology, Department of Pediatrics, University of Florida College of Medicine, Jacksonville, FL
| | - Mark L Hudak
- Division of Neonatology, Department of Pediatrics, University of Florida College of Medicine, Jacksonville, FL
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16
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Gehl B, Brownell E, Power K, Feinn R, Haines K, Lussier M, Moore J, Lainwala S. Comparison of Types of Breast Milk Fortification at Discharge from the Neonatal Intensive Care Unit and Breast Milk Feeding Rates and Growth at 4 Months Corrected Age. Breastfeed Med 2020; 15:655-661. [PMID: 32865432 DOI: 10.1089/bfm.2020.0022] [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: 11/13/2022]
Abstract
Background: Effects of breast milk (BM) enhancement on long-term BM feeding in preterm infants discharged from the neonatal intensive care unit (NICU) have not been examined previously. This study compares any BM feeding rates at 4 months corrected age (CA) in preterm infants discharged from the NICU on BM enhancement by fortification of expressed BM with infant formula additives (BM-F) versus BM supplemented with infant formula feeds (BM-S). Subjects and Methods: We compared infants born between January 1, 2013, and December 31, 2017, with gestational age <32 weeks or birth weight <1500 g, discharged home on BM-F or BM-S from two NICUs and followed at 4 months CA. Multivariate logistic regression with propensity scoring estimated the adjusted associations between nutrition at discharge and any BM feeding at 4 months CA. Results: Two hundred eighty-five infants were followed at 4 months CA. Infants discharged on BM-F were more likely to have mothers with multiple gestation, private insurance and not Caucasian, initiate feeds of human milk, be discharged from NICU-1, and receive any BM at 4 months CA (p < 0.03). No significant difference in growth parameters <10th percentile at 4 months CA was observed between the two groups. After adjusting for confounding factors, discharge from the NICU on BM-F was significantly associated with BM feeding at 4 months CA (odds ratio: 3.89, 95% confidence interval 1.66-9.14, p = 0.002). Conclusion: In this observational study, preterm infants receiving BM fortified with formula powder additives at discharge from the NICU had better BM feeding outcomes without poor growth at 4 months CA relative to those infants receiving BM supplemented with infant formula feeds.
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Affiliation(s)
- Brigitta Gehl
- Frank H. Netter MD School of Medicine, Quinnipiac University, North Haven, Connecticut, USA
| | - Elizabeth Brownell
- Frank H. Netter MD School of Medicine, Quinnipiac University, North Haven, Connecticut, USA.,Department of Pediatrics, School of Nursing, University of Texas Health Science Center, San Antonio, Texas, USA
| | - Kimberly Power
- Division of Neonatology, Connecticut Children's, Hartford, Connecticut, USA
| | - Richard Feinn
- Frank H. Netter MD School of Medicine, Quinnipiac University, North Haven, Connecticut, USA.,Department of Medical Sciences, Frank H. Netter MD School of Medicine, Quinnipiac University, North Haven, Connecticut, USA
| | - Kathleen Haines
- Department of Clinical Nutrition Services, Connecticut Children's, Hartford, Connecticut, USA
| | - Mary Lussier
- Division of Neonatology, Connecticut Children's, Hartford, Connecticut, USA
| | - James Moore
- Division of Neonatology, Connecticut Children's, Hartford, Connecticut, USA.,Department of Pediatrics, School of Medicine, University of Connecticut, Farmington, Connecticut, USA
| | - Shabnam Lainwala
- Frank H. Netter MD School of Medicine, Quinnipiac University, North Haven, Connecticut, USA.,Division of Neonatology, Connecticut Children's, Hartford, Connecticut, USA.,Department of Pediatrics, School of Medicine, University of Connecticut, Farmington, Connecticut, USA
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17
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Neonatal Intensive Care Unit-Specific Lactation Support and Mother's Own Breast Milk Availability for Very Low Birth-Weight Infants. Adv Neonatal Care 2019; 19:474-481. [PMID: 31764136 DOI: 10.1097/anc.0000000000000684] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Mother's own milk (MOM) is the preferred nutrition for premature infants, particularly for the very low birth-weight (VLBW) cohort. Benefits are well documented; yet, numerous barriers exist for provision of MOM in the neonatal intensive care unit (NICU). Lactation consultants (LCs) can optimize breastfeeding support for NICU mothers; however, understanding of the impact of NICU-dedicated LCs is limited. PURPOSE Evaluate the effectiveness of NICU-dedicated LCs in improving breastfeeding outcomes and MOM provision in VLBW infants. METHODS A retrospective chart review of 167 VLBW infants comparing breastfeeding outcomes between 2 NICUs, one with NICU-dedicated LCs (hospital A; n = 48) and one without (hospital B; n = 119). Primary outcome measures included feeding percentages of MOM received by infants at 3 intervals, throughout hospitalization, and number of direct breastfeeding events. Secondary outcome measures included number of days to first enteral feed, days to reach full feeds, days of nil per os, days on total parenteral nutrition, and length of stay. FINDINGS Neonatal intensive care unit-specific lactation support increased the number of direct breastfeeding events on day of discharge (P = .048). No statistical significance was found at each of the 3 time intervals, or throughout hospitalization (week 1: P = .18; midpoint: P = .40; discharge: P = .16; total hospitalization: P = .19). No statistical significance was demonstrated in secondary outcome measures (days to first enteral feed: P = .22; days to full feeds: P = .25; nil per os days: P = .27; total parenteral nutrition days: P = .34; length of stay: P = .01). Length of stay not found to be significant after correcting for confounding variables. IMPLICATION FOR PRACTICE Increased direct breastfeeding events on day of discharge with exposure to NICU-dedicated LCs in the VLBW population. IMPLICATION FOR RESEARCH Prospective studies regarding NICU-specific lactation support with larger samples are warranted.
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