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Richter A, Gonzalez-Nahm S, Benjamin-Neelon S. Do Breastfeeding Policies and Practices in Neonatal Intensive Care Units Differ by Baby-Friendly Hospital Initiative Status? Breastfeed Med 2024. [PMID: 39155861 DOI: 10.1089/bfm.2024.0015] [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: 08/20/2024]
Abstract
Background: The Baby-Friendly Hospital Initiative (BFHI) was launched in 1991 by the World Health Organization and United Nations International Children's Emergency Fund to promote and support breastfeeding within hospitals. Prior studies have assessed the associations between BFHI and breastfeeding, but there is limited evidence examining the policies and practices in neonatal intensive care units (NICUs) that, in turn, may influence breastfeeding. Objective: The goal of this analysis was to assess whether BFHI status was associated with breastfeeding policies and practices in NICUs in a sample of U.S.-based hospitals. Methods: A cross-sectional survey was sent to hospital administrators at 1,285 facilities (817 BFHI and 468 non-BFHI) throughout all regions of the United States and assessed whether hospitals were implementing breastfeeding support policies and practices in NICUs. Pearson's chi-squared and Fisher's exact tests were performed to assess associations between BFHI status and reported 6 breastfeeding policies and 11 breastfeeding practices. Results: Among all 259 respondents (BFHI: 68/102 [67%], non-BFHI: 73/157 [47%]), Baby-Friendly® status was significantly associated with having specific breastfeeding practices in the NICU (67% versus 47%, p = 0.001). More BFHI compared with non-BFHI hospitals reported assessing milk supply of mothers (90% versus 75%, p = 0.026) and communicating the medical benefits of breastfeeding (91% versus 75%, p = 0.012) to new parents. There were, however, no differences by BFHI status in the other breastfeeding policies and practices.
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Affiliation(s)
- Alexandria Richter
- Johns Hopkins Bloomberg School of Public Health, Department of Health, Behavior and Society, Baltimore, Maryland, USA
| | - Sarah Gonzalez-Nahm
- University of Massachusetts Amherst, School of Public Health and Health Sciences, Amherst, Massachusetts, USA
| | - Sara Benjamin-Neelon
- Johns Hopkins Bloomberg School of Public Health, Department of Health, Behavior and Society, Baltimore, Maryland, USA
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Levene I, Quigley MA, Fewtrell M, O'Brien F. Does extremely early expression of colostrum after very preterm birth improve mother's own milk quantity? A cohort study. Arch Dis Child Fetal Neonatal Ed 2024; 109:475-480. [PMID: 38442953 PMCID: PMC11347236 DOI: 10.1136/archdischild-2023-326784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 02/16/2024] [Indexed: 03/07/2024]
Abstract
OBJECTIVE Assess the relationship of time to first expression after very preterm birth and mothers' own milk quantity. DESIGN A cohort study (nested within a randomised trial). SETTING Four neonatal units in the UK. PATIENTS 132 mothers of single or twin infants born at 23+0 to 31+6 weeks postmenstrual age. EXPOSURES Time to the first attempt to express after birth. PRIMARY OUTCOMES 24-hour mother's own milk yield on days 4, 14 and 21 after birth. RESULTS Median time to first expression attempt was 6 hours. 51.7% expressed within 6 hours of birth (62/120) and 48.3% expressed more than 6 hours after birth (58/120). Expressing within 6 hours of birth was associated with higher milk yield on day 4 (88.3 g, 95% CI 7.1 to 169.4) and day 14 (155.7 g, 95% CI 12.2 to 299.3) but not on day 21 (73.6 g, 95% CI -91.4 to 238.7). There was an interaction between expressing frequency and time to first expression (p<0.005), with increased expressing frequency being associated with higher yield only in those who expressed within 6 hours. Expressing within 2 hours of birth was not associated with further milk yield increase. CONCLUSIONS Mothers who expressed within 6 hours of birth had higher milk yield, and a greater yield per expressing session, in the first 3 weeks after birth. This information will be highly motivating for families and the clinicians supporting them. There was no evidence of further benefit of extremely early expression (first 2 hours after birth). TRIAL REGISTRATION NUMBER ISRCTN 16356650.
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Affiliation(s)
- Ilana Levene
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, Oxford University, Oxford, UK
| | - Maria A Quigley
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, Oxford University, Oxford, UK
| | - Mary Fewtrell
- UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Frances O'Brien
- Neonatal Unit, John Radcliffe Hospital, Oxford, Oxfordshire, UK
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Levene I, Fewtrell M, Quigley MA, O'Brien F. The relationship of milk expression pattern and lactation outcomes after very premature birth: A cohort study. PLoS One 2024; 19:e0307522. [PMID: 39074108 DOI: 10.1371/journal.pone.0307522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 07/07/2024] [Indexed: 07/31/2024] Open
Abstract
INTRODUCTION Mothers of very premature infants often have difficulties expressing breastmilk, which can cause distress and potential negative impact on infant health. Clinical recommendations on breastmilk expression are extrapolated from term infants' breastfeeding patterns. This study's objective was to analyse the association of expressing pattern with lactation outcomes after very premature birth. METHODS 132 participants were recruited after birth between 23+0 and 31+6 weeks' gestation. Participants recorded the milk expressed in several 24-hour periods in the three weeks after birth. RESULTS Expressing frequency was positively associated with 24-hour milk yield, with an adjusted 30.5g increase per expressing session on day four (95% CI 15.7 to 45.3) and 94.4g on day 21 (95% CI 62.7 to 126.2). Expressing ≥8 times per day was associated with higher adjusted milk yield than expressing <6 times (on day four, 146.8g, 95% CI 47.4 to 246.1), but not in comparison to expressing 6-7 times (on day four, 82.1g, 95% CI -25.9 to 190.1). Participants with six months or more prior breastmilk feeding experience had a higher adjusted milk yield than others (on day four, 204.3g, 95% CI 125.2 to 283.3). Night-time (2300-0700 hours) expressing sessions were not associated with increased milk yield after adjustment for time since the prior session. On average, participants who had a longest gap between expressions of less than six hours achieved the UK target of 750g breastmilk, whereas those with a longer gap did not. CONCLUSION Expressing frequency was an important determinant of milk yield. Clinical recommendations to express ≥8 times per day were supported but for some, 6-7 times was sufficient. This was particularly likely for those with six months or more of prior breastmilk feeding experience. A need to express during the night-time hours appeared to be related to minimising the gap between expressions rather than an inherent value of night-time expression.
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Affiliation(s)
- Ilana Levene
- Nuffield Department of Public Health, National Perinatal Epidemiology Unit, University of Oxford, Oxford, United Kingdom
| | - Mary Fewtrell
- Institute of Child Health, University College London, London, United Kingdom
| | - Maria A Quigley
- Nuffield Department of Public Health, National Perinatal Epidemiology Unit, University of Oxford, Oxford, United Kingdom
| | - Frances O'Brien
- Newborn Care, John Radcliffe Hospital, Oxford, United Kingdom
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Doughty KN, Nichols C, Henry C, Shabanova V, Taylor SN. Maternal stress and breastfeeding outcomes in the NICU couplet care experience: a prospective cohort study. J Perinatol 2024:10.1038/s41372-024-02000-7. [PMID: 38755256 DOI: 10.1038/s41372-024-02000-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 05/01/2024] [Accepted: 05/02/2024] [Indexed: 05/18/2024]
Abstract
OBJECTIVE Couplet care is an innovative approach to provide postpartum care in the neonatal intensive care unit (NICU) with little known about its impact on infant feeding outcomes and maternal stress. STUDY DESIGN We compared breastfeeding outcomes and maternal NICU-related stress among mother-infant dyads based on exposure to couplet care in a prospective cohort study. RESULT Among 19 couplet-care exposed (CCE) dyads and 19 traditional postpartum care dyads, CCE mothers had lower self-reported stress related to parent-infant relationship as compared to traditional care (P < 0.001). CCE infants received relatively more feeds at the breast (P < 0.001), more breastmilk feeds (P = 0.002), and fewer feeds by staff (P < 0.001). Adjusted for gestational age, marital status, and infant length of stay, couplet care was associated with being in a higher tertile of percent breastmilk feeds (aOR 7.29, 95% CI 1.45-36.65). CONCLUSION NICU couplet care was associated with improved parental stress and breastfeeding outcomes during hospitalization.
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Affiliation(s)
- Kimberly N Doughty
- Egan School of Nursing and Health Studies, Department of Public Health, Fairfield University, Fairfield, CT, USA
| | - Caitlin Nichols
- Yale School of Medicine, Department of Pediatrics, New Haven, CT, USA
| | - Christine Henry
- Yale School of Medicine, Department of Pediatrics, New Haven, CT, USA
| | | | - Sarah N Taylor
- Yale School of Medicine, Department of Pediatrics, New Haven, CT, USA.
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Bensouda B, Mandel R, Mejri A, Tordjman L, St-Hilaire M, Ali N. Supine versus Prone Position during Delayed Cord Clamping in Infants ≥36 Weeks: A Randomized Trial. Am J Perinatol 2024; 41:e2799-e2803. [PMID: 37726014 DOI: 10.1055/s-0043-1775563] [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: 09/21/2023]
Abstract
OBJECTIVE There is no recommendation in the literature on optimal positioning of the newborn immediately at birth during delayed cord clamping. To evaluate if prone positioning on the mother's chest at birth during delayed cord clamping leads to a higher hematocrit at 30 hours of life compared to supine positioning. STUDY DESIGN A randomized unblinded trial comparing prone and supine position of the newborn before umbilical cord clamping. Healthy newborns ≥36 weeks gestational age and born vaginally with cephalic presentation were included. The newborn was randomized to prone or supine position. Umbilical cord clamping was delayed in both groups to 1 minute after birth. The primary outcome was hematocrit at 30 hours of life. As a secondary outcome, cerebral tissue oxygenation (CrSO2) values were compared between both groups by near infrared spectroscopy. RESULTS There was no difference in hematocrit at 30 hours of life between supine and prone positions with a mean at 52 and 53.1, respectively, mean difference -1.1 (95% confidence interval:-2.7, 0.5), p = 0.17. Newborns in supine and prone positions had comparable level of CrSO2 at 30 hours of life with a mean at 84.1 and 82.2, respectively, mean difference 1.9 (-0.2, 4.0), p = 0.07. There was no correlation between hematocrit and CrSO2 at 30 hours of life (r = 0.14). CONCLUSION There was no difference between prone and supine positioning immediately after birth during delayed cord clamping on hematocrit at 30 hours of life. In the absence of clear findings, further studies with assessment of the effect of position on breastfeeding success in the case room, on maternal satisfaction and outcome beyond 30 hours are needed to make adequate recommendations on positioning. KEY POINTS · Delayed cord clamping at 60 seconds is recommended at birth, but optimal positioning is unknown.. · A randomized trial was conducted to compare hematocrit at 36 hours of life of prone versus supine position.. · No difference in hematocrit was found in prone versus supine position during delayed cord clamping..
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Affiliation(s)
- Brahim Bensouda
- Department of Pediatrics, Maisonneuve-Rosemont Hospital and University of Montreal, Montréal, Quebec, Canada
| | - Romain Mandel
- Department of Pediatrics, Maisonneuve-Rosemont Hospital and University of Montreal, Montréal, Quebec, Canada
| | - Abdelwaheb Mejri
- Department of Pediatrics, Maisonneuve-Rosemont Hospital and University of Montreal, Montréal, Quebec, Canada
| | - Laurent Tordjman
- Department of Obstetrics and Gynecology, Maisonneuve-Rosemont Hospital and University of Montreal, Montréal, Quebec, Canada
| | - Marie St-Hilaire
- Department of Pediatrics, Maisonneuve-Rosemont Hospital and University of Montreal, Montréal, Quebec, Canada
| | - Nabeel Ali
- Department of Pediatrics, Maisonneuve-Rosemont Hospital and University of Montreal, Montréal, Quebec, Canada
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Grande J, Liu J, Nemerofsky S. Exclusive Breastfeeding in the Bronx-Successes and Shortcomings. Am J Perinatol 2024; 41:e2600-e2605. [PMID: 37451285 DOI: 10.1055/a-2129-8773] [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: 07/18/2023]
Abstract
OBJECTIVE Despite efforts to encourage breastfeeding, exclusive breastfeeding (EBF) rates in the Bronx remain suboptimal. Hospital restrictions and uncertainty surrounding the side effects of coronavirus disease 2019 (COVID-19) greatly impacted the mother-infant dyad during the postpartum hospitalization. Preliminary studies found an initial decrease in EBF, but lasting effects remain unknown. This study aimed to investigate the effect of the COVID-19 pandemic on birth hospitalization EBF rates among a high-risk urban patient population. STUDY DESIGN A retrospective chart review was conducted on all newborns admitted to the newborn nursery at an urban medical center between 2019 and 2021. Patients were separated into prepandemic and pandemic cohorts. Patient demographics, maternal comorbidities, length of stay, feeding method, and newborn characteristics, including status as high risk for hypoglycemia, were collected. EBF was defined as receiving only mother's milk during the birth hospitalization. Descriptive statistics and bivariate analysis were used to examine the data. RESULTS A total of 630 prepandemic and 643 pandemic newborns were included. The cohorts did not differ in baseline maternal characteristics. Prepandemic newborns were less likely to be high risk (23.3 vs. 29.4%, p = 0.01), more likely to see the hospital lactation consultant (53.2 vs. 24.0%, p < 0.001), and had a longer average length of stay (63.4 vs. 54.5 hours, p < 0.001). Most infants in both cohorts received some breastmilk during the hospitalization (97.6 vs. 94.6%, not significant). There was no difference in EBF between cohorts among all newborns (9.5 vs. 11.4%, p = 0.29) or among nonhigh-risk newborns (12.2 vs. 15.0%, p = 0.22). CONCLUSION EBF rates in the Bronx, NY did not change during the pandemic period, despite an increase in high-risk newborns. Further investigation into the effect of lactation consultation, maternal race, ethnicity, and primary language should be further explored to understand the implications of health care disparities on the mother-infant dyad. KEY POINTS · The COVID-19 pandemic disrupted many aspects of the mother-infant dyad.. · EBF rates at an urban institution in the Bronx did not change during the COVID-19 pandemic.. · Further investigation is warranted to better understand the barriers to EBF in this population..
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Affiliation(s)
- Julia Grande
- Medical Program, Albert Einstein College of Medicine, Bronx, New York
| | - Jianyou Liu
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York
| | - Sheri Nemerofsky
- Department of Neonatology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
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Jiang X, Jiang H, Shan SS, Huang R. Breastfeeding experience of postnatal mothers separated from preterm infants after discharge: a phenomenology qualitative approach. BMC Pregnancy Childbirth 2024; 24:28. [PMID: 38178032 PMCID: PMC10765664 DOI: 10.1186/s12884-023-06230-z] [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] [Received: 03/02/2023] [Accepted: 12/27/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND Breastfeeding practices are influenced by the maternal-infant bond relationship. Mothers of preterm infants in the puerperium face many challenges and support is needed to maintain breastfeeding after hospital discharge. This study explored the breastfeeding experiences among mothers of preterm infants and challenges that influenced their breastfeeding practices. METHODS A qualitative phenomenological approach was used involving the mothers of preterm infants during the puerperium in Shanghai who fulfilled the inclusion criteria and consented to participate in the study. The mothers were recruited using purposive sampling. Eighteen participants were interviewed using semi-structured in-depth interviews. All interviews were recorded in digital audio, transcribed verbatim, and analyzed using thematic analysis. FINDINGS The breastfeeding experience among mothers of preterm infants included four themes: breastfeeding motivation, breastfeeding challenges, breastfeeding support and education, and response to parental stress. Breastfeeding challenges included perceived insufficient milk, bottle preference, and maternal-infant separation. Two sub-themes of breastfeeding support included breastfeeding knowledge and approach. CONCLUSION To overcome breastfeeding challenges and improve the breastfeeding rate of preterm infants after discharge, medical professionals must develop individualized breastfeeding plans based on a comprehensive assessment of the needs of mothers who delivered a preterm infant.
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Affiliation(s)
- Xin Jiang
- Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, 200092, China
| | - Hui Jiang
- Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, 200092, China.
| | - Shan Shan Shan
- Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, 200092, China
| | - Rong Huang
- Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, 200092, China
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Kuitunen I. Why do we fear bottles and pacifiers? Acta Paediatr 2023; 112:1392-1394. [PMID: 37277973 DOI: 10.1111/apa.16780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 03/28/2023] [Accepted: 03/29/2023] [Indexed: 06/07/2023]
Affiliation(s)
- Ilari Kuitunen
- Department of Pediatrics, Mikkeli Central Hospital, Mikkeli, Finland
- Institute of Clinical Medicine and Department of Pediatrics, University of Eastern Finland, Kuopio, Finland
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Mäkelä H, Axelin A, Kolari T, Niela-Vilén H. Exclusive breastfeeding, breastfeeding problems, and maternal breastfeeding attitudes before and after the baby-friendly hospital initiative: A quasi-experimental study. SEXUAL & REPRODUCTIVE HEALTHCARE 2023; 35:100806. [PMID: 36521260 DOI: 10.1016/j.srhc.2022.100806] [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: 06/30/2022] [Revised: 11/02/2022] [Accepted: 12/05/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Breastfeeding practices remain globally suboptimal despite many known maternal and neonatal health benefits and the Baby-Friendly Hospital Initiative as a global effort to support breastfeeding. OBJECTIVE We aimed to evaluate the effects of the implementation of the Baby-Friendly Hospital Initiative for a proportion of mothers who exclusively breastfed during a 6-month period, including breastfeeding problems, and maternal breastfeeding attitudes. METHODS Using a quasi-experimental non-equivalent two-group design, we recruited two independent samples of postpartum mothers in a maternity hospital to compare the situation before (N = 162) and after (N = 163) the implementation. We measured breastfeeding status and possible breastfeeding problems via text-message questions at 2 weeks, 1, 4 and 6 months after birth. We measured Mothers' attitudes toward breastfeeding at the maternity hospital and 4 months after birth using the Iowa Infant Feeding Attitude Scale. RESULTS The implementation of the Baby-Friendly Hospital Initiative had no effect on the proportion of mothers who exclusively breastfed, and we found no significant differences in exclusive breastfeeding at 6 months (41.3 % vs 52.9 %, p =.435). The intervention did not influence the reported number of breastfeeding problems (p =.260) or maternal breastfeeding attitudes (p =.354). More favourable breastfeeding attitudes (p <.001) and less problematic breastfeeding (p <.001) were associated positively with exclusive breastfeeding. CONCLUSION Exclusive breastfeeding rates did not increase after the intervention; however, the rates at baseline were already high. Ensuring the Baby-Friendly Hospital Initiative practices through pre- and postnatal periods and preparing mothers to manage common breastfeeding problems might improve breastfeeding rates. This trial was registered (0307-0041) with ClinicalTrials.gov on 03/03/2017.
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Affiliation(s)
- Heli Mäkelä
- University of Turku, Department of Nursing Science, Turku, Finland; Satakunta Hospital District, Satasairaala, Pori, Finland.
| | - Anna Axelin
- University of Turku, Department of Nursing Science, Turku, Finland
| | - Terhi Kolari
- University on Turku, Department of Biostatistics, University of Turku, Turku, Finland
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Vandenplas Y. Breastfeeding and its risk factors. J Pediatr (Rio J) 2022; 98:219-220. [PMID: 35120884 PMCID: PMC9432162 DOI: 10.1016/j.jped.2021.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 12/30/2021] [Indexed: 11/25/2022] Open
Affiliation(s)
- Yvan Vandenplas
- Vrije Universiteit Brussel (VUB), UZ Brussel, KidZ Health Castle, Belgium.
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