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Pithia N, Grogan T, Garg M, Kesavan K, Calkins KL. A Pilot Single-Site Randomized Control Trial: Investigating the Use of Donor Milk in Late Preterm and Term Infants in the Neonatal Intensive Care Unit. Am J Perinatol 2024; 41:e2427-e2435. [PMID: 37647913 DOI: 10.1055/s-0043-1771261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
OBJECTIVE We aimed to study donor milk (DM) supplementation when mother's own milk (MOM) was unavailable in term and late preterm infants (LPIs) admitted to the neonatal intensive care unit (NICU). We hypothesized that this study would be feasible, defined by the rate of consent, diet adherence, and study completion. We further hypothesized that compared with formula supplementation, DM supplementation, for no longer than 7 days from birth, would be associated with an increase in breastfeeding attempts and the percentage of MOM (MOM%) without adversely affecting growth. Breastfeeding attempts and MOM% were assessed over 48 hours at the end of the intervention, which was defined as NICU discharge or at the end of supplementation, whichever came sooner. STUDY DESIGN This was a pilot study (n = 32). Infants with a gestational age > 34 weeks admitted to the NICU were included. Infants were randomized to one of two groups: human milk (MOM + DM) or formula (MOM + F). RESULTS The consent rate was 52%. Adherence to the study diet was 97%, and completion was 100%. When the MOM + DM group was compared with the MOM + F group, there was no difference in breastfeeding attempts (median [interquartile range]: 3.5 [1.5-6] vs. 1.5 [0.5-4] times, p = 0.1) or MOM% (60 vs. 59%, p = 0.9). Weight and length at multiple time points were similar when the groups were compared. CONCLUSION A study randomizing term and LPIs in the NICU to DM or formula when MOM was unavailable is feasible. It remains unclear if DM improves breastfeeding success in this population. KEY POINTS · A study that randomizes term and late preterm infants in the NICU to DM or formula supplementation when mother's own milk is not available is feasible.. · It remains unclear if DM compared to formula supplementation improves direct breastfeeding.. · In general, growth was similar in infants who received DM or formula as a supplement..
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Affiliation(s)
- Neema Pithia
- Division of Neonatology and Developmental Biology, Department of Pediatrics, Neonatal Research Center of the University of California Los Angeles Children's Discovery and Innovation Institute, University of California Los Angeles, Los Angeles, California
| | - Tristan Grogan
- Department of Medicine, Statistics Core, University of California Los Angeles, Los Angeles, California
| | - Meena Garg
- Division of Neonatology and Developmental Biology, Department of Pediatrics, Neonatal Research Center of the University of California Los Angeles Children's Discovery and Innovation Institute, University of California Los Angeles, Los Angeles, California
| | - Kalpashri Kesavan
- Division of Neonatology and Developmental Biology, Department of Pediatrics, Neonatal Research Center of the University of California Los Angeles Children's Discovery and Innovation Institute, University of California Los Angeles, Los Angeles, California
| | - Kara L Calkins
- Division of Neonatology and Developmental Biology, Department of Pediatrics, Neonatal Research Center of the University of California Los Angeles Children's Discovery and Innovation Institute, University of California Los Angeles, Los Angeles, California
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Pithia N, Grogan T, Garg M, Kesavan K, Calkins K. A Pilot Single-Site Randomized Control Trial: Investigating the Use of Donor Milk in the Late Preterm and Term Infant in the Neonatal Intensive Care Unit. RESEARCH SQUARE 2023:rs.3.rs-2540272. [PMID: 36798190 PMCID: PMC9934751 DOI: 10.21203/rs.3.rs-2540272/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Objective : We aimed to study the use of donor milk (DM) in term and late preterm infants (LPIs) when mother’s own milk (MOM) was unavailable. We hypothesized this study would be feasible and breastfeeding attempts and the percentage of MOM (MOM%) would increase with DM without adversely affecting growth. Study Design : This was a pilot study (n=32). Infants with gestational age >34 weeks admitted to the neonatal intensive care unit were included. Infants were randomized to: the human milk (MOM+DM) or formula (MOM+F) groups. Result : Consent rate was 52%. Breastfeeding attempts increased significantly over time in the MOM+DM group compared to the MOM+F group (group p=0.41, time p =0.02, group*time p=0.01) . Growth at multiple time points was similar when the two groups were compared. Conclusion : A study randomizing term infants and LPIs to DM or formula when MOM is unavailable is feasible. DM may increase breastfeeding attempts without compromising growth.
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Sokou R, Parastatidou S, Ioakeimidis G, Tavoulari EF, Makrogianni A, Isaakidou E, Iacovidou N, Konstantinidi A. Breastfeeding in Neonates Admitted to an NICU: 18-Month Follow-Up. Nutrients 2022; 14:nu14183841. [PMID: 36145216 PMCID: PMC9500865 DOI: 10.3390/nu14183841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 09/12/2022] [Accepted: 09/13/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction: The admission of neonates to Neonatal Intensive Care Units (NICUs) has been identified as a primary inhibiting factor in the establishment of breastfeeding. The aims of this study were to (1) estimate the prevalence and duration of breastfeeding in infants/toddlers who had been admitted to an NICU in Greece and (2) to investigate factors, associated with the NICU stay, which affected the establishment and maintenance of breastfeeding in infants/toddlers previously admitted to the NICU. Materials and methods: Data for this cohort study were retrieved from interviews with mothers of infants/toddlers who had been admitted to our NICU as neonates during the period of 2017−2019. Interviews were conducted based on a questionnaire regarding the child’s nutrition from birth to the day of the interview, including previous maternal experience with breastfeeding. Information related to the prenatal period, gestation age, delivery mode, duration of NICU stay, and neonatal feeding strategies during their hospital stay were recorded. Results: The response rate to the telephone interviews was 57%, resulting in 279 mother−infant pairs being included in this study. The results showed that 78.1% of children received maternal milk during their first days of life. Of all infants, 58.1% were exclusively breastfed during their first month, with a gradual decrease to 36.9% and 19.4% by the end of the third and sixth months of life, respectively. The prevalence of breastfed children reached 14.7% and 7.5% at the ages of twelve and eighteen months, respectively. In the multivariate analysis, prematurity emerged as an independent prognostic factor for the duration of exclusive and any breastfeeding (aHR 1.64, 95% CI: 1.03−2.62; and 1.69, 95% CI: 1.05−2.72, respectively; p < 0.05). Additionally, the nationality of the mother, NICU breastfeeding experience, the administration of maternal milk during neonatal hospital stay, and previous breastfeeding experience of the mother were independent prognostic factors for the duration of breastfeeding. Conclusions: Although breastfeeding is a top priority in our NICU, the exclusive-breastfeeding rates at 6 months were quite low for the hospitalized neonates, not reaching World Health Organization (WHO) recommendations. Mothers/families of hospitalized neonates should receive integrated psychological and practical breastfeeding support and guidance.
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Affiliation(s)
- Rozeta Sokou
- Neonatal Intensive Care Unit, “Agios Panteleimon” General Hospital of Nikea, 3 D. Mantouvalou Str., Nikea, 18454 Piraeus, Greece
- Neonatal Department, Aretaieio Hospital, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece
- Correspondence: ; Tel.: +30-2132077346 or +30-2132077000
| | - Stavroula Parastatidou
- Neonatal Intensive Care Unit, “Agios Panteleimon” General Hospital of Nikea, 3 D. Mantouvalou Str., Nikea, 18454 Piraeus, Greece
| | - Georgios Ioakeimidis
- Neonatal Intensive Care Unit, “Agios Panteleimon” General Hospital of Nikea, 3 D. Mantouvalou Str., Nikea, 18454 Piraeus, Greece
| | - Evangelia-Filothei Tavoulari
- Neonatal Intensive Care Unit, “Agios Panteleimon” General Hospital of Nikea, 3 D. Mantouvalou Str., Nikea, 18454 Piraeus, Greece
| | - Athanasia Makrogianni
- Neonatal Intensive Care Unit, “Agios Panteleimon” General Hospital of Nikea, 3 D. Mantouvalou Str., Nikea, 18454 Piraeus, Greece
| | - Elina Isaakidou
- Neonatal Intensive Care Unit, “Agios Panteleimon” General Hospital of Nikea, 3 D. Mantouvalou Str., Nikea, 18454 Piraeus, Greece
| | - Nicoletta Iacovidou
- Neonatal Department, Aretaieio Hospital, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece
| | - Aikaterini Konstantinidi
- Neonatal Intensive Care Unit, “Agios Panteleimon” General Hospital of Nikea, 3 D. Mantouvalou Str., Nikea, 18454 Piraeus, Greece
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Prevalence and patterns of gestational parent's own milk feeds among infants with major congenital surgical anomalies in the NICU. J Perinatol 2021; 41:2782-2788. [PMID: 34331003 DOI: 10.1038/s41372-021-01176-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 07/07/2021] [Accepted: 07/21/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To describe the prevalence and patterns of gestational parent's own milk (GPOM) feedings among infants undergoing major surgery during their neonatal intensive care unit (NICU) admission. STUDY DESIGN We analyzed de-identified electronic medical records of all infants admitted to a regional NICU 2014-2015 who underwent surgery for a gastrointestinal, cardiac, or other major organ system defect(s). RESULTS Of 79 infants, 85% received any GPOM during the NICU hospitalization. The median proportion of GPOM feeds was 66%. There was a trend toward decreassing proportions of GPOM with progressive months in NICU. The rate of any and exclusive GPOM feeds at NICU discharge was 49% and 29%, respectively. Infants who had a GI anomaly were more likely than infants with a cardiac anomaly to be discharged from NICU receiving GPOM. CONCLUSION Barriers to the exclusive and continued provision of GPOM in this population require further study and intervention.
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Hatamleh R, Abujilban S, Abuhammad S, Ariag DMA, Joseph RA. Effect of the Helping Babies Breathe Training Program: An Experimental Study on Jordanian Midwives' Knowledge and Skills. J Perinat Neonatal Nurs 2021; 35:E11-E17. [PMID: 32804875 DOI: 10.1097/jpn.0000000000000485] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The Helping Babies Breathe (HBB) training program trains providers in effective resuscitation of infants in developing countries. This study evaluated the effectiveness of the HBB training program on midwives' knowledge and skills in Northern Jordan. Using a nonequivalent control group design, 50 midwives (control, n = 25; experimental, n = 25) from 3 public hospitals in Northern Jordan were recruited and their knowledge and skills were evaluated before and after the training. The program has 3 aspects: 2 hours of teaching, 1 hour of testing, and 25 minutes of skills assessment per participant. The skills were tested individually for each participant, and they were reevaluated at 8 months after. The control and experimental groups significantly differed in posttest scores on knowledge, Objective Structured Clinical Examination A and B skills, and bag-mask application after adjusting for covariates. The HBB training program significantly enhanced knowledge of midwives in the experimental group (P < .05) and demonstrated skills. The HBB training program was helpful in improving midwives' knowledge and practices on immediate care of a newborn baby. Therefore, training midwives using the HBB training program can improve their knowledge and skills and thereby improve infant outcomes in Jordan.
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Affiliation(s)
- Reem Hatamleh
- Faculty of Nursing (Dr Hatamleh) and Maternal and Child Health Department (Dr Abuhammad), Jordan University of Science and Technology, Irbid, Jordan; Faculty of Nursing, Hashemite University, Zarqa, Jordan (Dr Abujilban); Jordan University of Science and Technology, Irbid, Jordan (Mr Ariag); and Liberty University, Lynchburg, Virginia (Dr Joseph)
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Parker LA, Sullivan S, Kruger C, Mueller M. Timing of milk expression following delivery in mothers delivering preterm very low birth weight infants: a randomized trial. J Perinatol 2020; 40:1236-1245. [PMID: 32461626 DOI: 10.1038/s41372-020-0688-z] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 04/03/2020] [Accepted: 05/07/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To determine the effect of timing of expression initiation on mother's own milk production and time to secretory activation in mothers of preterm infants. STUDY DESIGN 180 mothers delivering infants ≤1500 grams and ≤32 weeks gestation were randomized to begin expression within 60 (early), 61-180 (intermediate) or 181-360 (late) minutes following delivery. Milk volume was measured on days 1-7 and weekly for 6 weeks. Time to secretory activation was determined through self-report. RESULTS The late group produced more milk than the early group in the first 3 days (p = 0.015-0.031) and over 6 weeks (p = 0.045). The late group had more expressions on day 1 (early: p = 0.049; intermediate; p = 0.048). CONCLUSION Initiation of expression at 181-360 min following delivery was associated with increased milk production for 6 weeks following delivery. Further research is needed to determine the effect of expression frequency on milk production in the first days following birth.
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Yang Y, Brandon D, Lu H, Cong X. Breastfeeding experiences and perspectives on support among Chinese mothers separated from their hospitalized preterm infants: a qualitative study. Int Breastfeed J 2019; 14:45. [PMID: 31695726 PMCID: PMC6824106 DOI: 10.1186/s13006-019-0242-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 10/14/2019] [Indexed: 12/19/2022] Open
Abstract
Background Chinese mothers of preterm infants often face obstacles to breastfeeding and commonly experience prolonged maternal-infant separation when their high-risk infants are hospitalized in a Neonatal Intensive Care Unit (NICU). This separation hinders mother-infant attachment and the establishment of breastfeeding. Currently, little is known about Chinese mothers’ experiences breastfeeding their preterm infants, or their support needs. The aim of this study was to develop an understanding of mothers’ experiences breastfeeding a hospitalized preterm infant and the support needed to establish a milk supply during the period separation from their infants. Methods A qualitative descriptive study was conducted in Beijing in 2017. A total of 11 Chinese mothers were individually interviewed while separated from their infants. The interviews were audio-recorded and transcribed verbatim. A thematic analysis involving a seven-step protocol identified key themes. Results Mothers of preterm infants reported physically and mentally challenging breastfeeding experiences during the period they were separated from their babies. They viewed expressing breast milk as integral to their maternal role, even though some found expressing breastmilk exhausting. With little professional support available, the mothers depended upon nonprofessionals to establish breastfeeding. Conclusions The study identified the difficulties mothers experienced establishing a milk supply while separated from their preterm infants, and the importance of access to health professional support.
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Affiliation(s)
- Yuanyuan Yang
- 1Peking University School of Nursing, 38 Xueyuan Road, Haidian District, Beijing, 100191 China
| | - Debra Brandon
- 2Duke University School of Nursing, 307 Trent Drive, Durham, NC 27710 USA
| | - Hong Lu
- 1Peking University School of Nursing, 38 Xueyuan Road, Haidian District, Beijing, 100191 China
| | - Xiaomei Cong
- 3University of Connecticut School of Nursing, 231 Glenbrook Road, Storrs, CT 06269-4026 USA
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Factors Associated with Successful First High-Risk Infant Clinic Visit for Very Low Birth Weight Infants in California. J Pediatr 2019; 210:91-98.e1. [PMID: 30967249 DOI: 10.1016/j.jpeds.2019.03.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 02/11/2019] [Accepted: 03/08/2019] [Indexed: 02/04/2023]
Abstract
OBJECTIVES To determine rates of at least 1 high-risk infant follow-up (HRIF) visit by 12 months corrected age, and factors associated with successful first visit among very low birth weight (VLBW) infants in a statewide population-based setting. STUDY DESIGN We used the linked California Perinatal Quality of Care Collaborative and California Perinatal Quality of Care Collaborative-California Children's Services HRIF databases. Multivariable logistic regression examined independent associations of maternal, sociodemographic, neonatal clinical, and HRIF program factors with a successful first HRIF visit among VLBW infants born in 2010-2011. RESULTS Among 6512 VLBW children referred to HRIF, 4938 (76%) attended a first visit. Higher odds for first HRIF visit attendance was associated with older maternal age (OR, 1.48; 95% CI, 1.27-1.72; 30-39 vs 20-29 years), lower birth weight (OR, 2.11; 95% CI, 1.69-2.65; ≤750 g vs 1251-1499 g), private insurance (OR, 1.65; 95% CI, 1.19-2.31), a history of severe intracranial hemorrhage (OR, 1.61; 95% CI, 1.12-2.30), 2 parents as primary caregivers (OR, 1.18, 95% CI 1.03-1.36), and higher HRIF program volume (OR, 2.62; 95% CI, 1.88-3.66; second vs lowest quartile); and lower odds with maternal race African American or black (OR, 0.65; 95% CI, 0.54-0.78), and greater distance to HRIF program (OR, 0.69; 95% CI, 0.57-0.83). Rates varied substantially across HRIF programs, which remained after risk adjustment. CONCLUSIONS In a population-based California VLBW cohort, maternal, sociodemographic, and home- and program-level disparities were associated with HRIF non-attendance. These findings underscore the need to identify challenges in access and resource risk factors during hospitalization in the neonatal intensive care unit, provide enhanced education about the benefits of HRIF, and create comprehensive neonatal intensive care unit-to-home transition approaches.
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Joseph R, Wellings A, Votta G. Mindfulness-Based Strategies: A Cost-Effective Stress Reduction Method for Parents in the NICU. Neonatal Netw 2019; 38:135-143. [PMID: 31470380 DOI: 10.1891/0730-0832.38.3.135] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Stress in parents who have an infant in the NICU is well documented in literature. Prematurity and related comorbid conditions, high-tech NICU environments, presence of multidisciplinary health care professionals, altered parenting roles, and concerns of health outcomes in the infant are common stress factors. Further, inadequate management of stress can result in poor parent-infant bonding, poor infant outcome, and postpartum depression in parents. Effective stress management strategies may help parents adapt to their parental role thereby improving infant outcomes. Research has shown mindfulness-based strategies help reduce stress in the general population. Can this strategy be applied in the context of parents of infants in the NICU? Literature is scant on the impact of mindfulness-based strategies on parents of infants in the NICU and on the infant's health outcomes. This article explores the application of mindfulness-based strategies to reduce stress in parents of infants in the NICU.
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Romaine A, Clark RH, Davis BR, Hendershot K, Kite V, Laughon M, Updike I, Miranda ML, Meier PP, Patel AL, Smith PB, Cotten CM, Benjamin DK, Greenberg RG. Predictors of Prolonged Breast Milk Provision to Very Low Birth Weight Infants. J Pediatr 2018; 202:23-30.e1. [PMID: 30170862 PMCID: PMC6203611 DOI: 10.1016/j.jpeds.2018.07.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 05/16/2018] [Accepted: 07/02/2018] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To identify factors associated with prolonged maternal breast milk (BM) provision in very low birth weight (VLBW) infants. STUDY DESIGN This was a cohort study of VLBW infants who initially received maternal BM and were born at one of 197 neonatal intensive care units managed by the Pediatrix Medical Group from 2010 to 2012. We used multivariable logistic regression to identify demographic, clinical, and maternal factors associated with provision of maternal BM on day of life (DOL) 30 and at discharge. RESULTS Median gestational age for all infants was 28 weeks (25th, 75th percentiles: 26, 30), and median maternal age was 28 years (23, 33). Of 8806 infants, 6261 (71%) received maternal BM on DOL 30, and 4003 of 8097 (49%) received maternal BM at discharge to home. Predictors of maternal BM provision at DOL 30 included increased maternal age, white maternal race, absence of history of necrotizing enterocolitis or late-onset sepsis, higher household income, lower education level, lack of donor BM exposure, and lower gestational age. CONCLUSIONS Our results suggest that maternal-infant demographic and clinical factors and household neighborhood socioeconomic characteristics were associated with provision of maternal BM at 30 postnatal days to VLBW infants. Identification of these factors allows providers to anticipate mothers' needs and develop tailored interventions designed to improve rates of prolonged maternal BM provision and infant outcomes.
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Affiliation(s)
- Andrew Romaine
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | | | - Briana R Davis
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - Kaitlin Hendershot
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - Vance Kite
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - Madeleine Laughon
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - Isaac Updike
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | | | - Paula P Meier
- Department of Pediatrics, Rush University Medical Center, Chicago, IL
| | - Aloka L Patel
- Department of Pediatrics, Rush University Medical Center, Chicago, IL
| | - P Brian Smith
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC; Department of Pediatrics, Duke University School of Medicine, Durham, NC
| | - C Michael Cotten
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC; Department of Pediatrics, Duke University School of Medicine, Durham, NC
| | - Daniel K Benjamin
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC; Department of Pediatrics, Duke University School of Medicine, Durham, NC
| | - Rachel G Greenberg
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC; Department of Pediatrics, Duke University School of Medicine, Durham, NC.
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Tshamala D, Pelecanos A, Davies MW. Factors associated with infants receiving their mother's own breast milk on discharge from hospital in a unit where pasteurised donor human milk is available. J Paediatr Child Health 2018; 54:1016-1022. [PMID: 29806873 DOI: 10.1111/jpc.14062] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 02/08/2018] [Accepted: 03/18/2018] [Indexed: 11/29/2022]
Abstract
AIM To determine the proportion of very preterm infants who were exclusively fed breast milk at the time of discharge home, before and after the availability of pasteurised donor human milk (PDHM). METHODS This was an observational retrospective cohort study with historical comparison, comparing two cohorts (<32 weeks gestational age or very low birthweight) before and after the availability of donor human milk. The main explanatory variable was the PDHM cohort: pre-PDHM or post-PDHM. The primary dichotomous outcome variable was defined as whether the baby was being fed with breast milk only at the time of discharge home, compared with those fed with artificial formula alone or mixed feeding (artificial formula and breast milk). RESULTS There were 1088 babies in the pre-PDHM cohort and 330 in the post-PDHM cohort (total n = 1418). Following the introduction of PDHM, 56% (185/330) were exclusively fed breast milk at the time of hospital discharge and 57% (620/1088) in the pre-PDHM cohort. The availability of PDHM is not a significant predictor of feeding outcome upon discharge (P = 0.45) when adjusted for maternal age, log-transformed post-natal age at discharge home and any congenital abnormality. CONCLUSIONS The availability of donor human milk in our unit is not associated with a decrease in the number of very preterm infants receiving mother's own breast milk at time of discharge home. Other factors that positively impact the successful establishment of breastfeeding in preterm babies were older maternal age, the absence of any congenital abnormality and a shorter duration of hospital stay.
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Affiliation(s)
- Didier Tshamala
- Neonatal Intensive Care Unit, Mater Mother's Newborn Care Services, Mater Mothers' Hospital, Brisbane, Queensland, Australia
| | - Anita Pelecanos
- Statistics Unit, Queensland Institute of Medical Research, Brisbane, Queensland, Australia
| | - Mark W Davies
- Department of Neonatology, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
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Winging it: maternal perspectives and experiences of breastfeeding newborns with complex congenital surgical anomalies. J Perinatol 2018; 38:708-717. [PMID: 29487350 PMCID: PMC6030460 DOI: 10.1038/s41372-018-0077-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 01/22/2018] [Accepted: 01/29/2018] [Indexed: 12/02/2022]
Abstract
OBJECTIVE To describe the experience of breastfeeding (inclusive of breast milk expression/pumping, provision of breast milk via devices, and at-breastfeeding) among mothers of newborns with complex congenital surgical anomalies and the contexts under which pro-breastfeeding behaviors and attitudes are facilitated or compromised. STUDY DESIGN We used qualitative description to analyze 23 interviews conducted with 15 mothers of newborns undergoing surgery for gastrointestinal, cardiac, or neural tube defects. RESULTS Breastfeeding experiences were characterized by naivety regarding the importance and rationale for exclusive breast milk feedings and best practices to facilitate milk supply maintenance and transition to at-breast feeds. Maternal breastfeeding views and behaviors were impacted by indeterminate prenatal plans to breastfeed/provide breast milk, limited prior breastfeeding exposure and knowledge, and gaps in postnatal lactation support. CONCLUSION Future research should investigate methods to improve exclusive breast milk feeding and facilitate transitions to at-breast feeds among mothers of newborns with surgical congenital anomalies, with consideration of identified barriers.
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Shim M, Yang S, Messina CR, Mintzer JP. Discharge breastmilk feeding rates in asymptomatic term newborns admitted to the neonatal intensive care unit for maternal chorioamnionitis. J Matern Fetal Neonatal Med 2018. [PMID: 29526120 DOI: 10.1080/14767058.2018.1446078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
PURPOSE To compare discharge breastmilk feeding rates among asymptomatic term newborns receiving 48-hour versus >48-hour antibiotics in the neonatal intensive care unit (NICU) and a cohort of well-baby nursery (WBN) newborns. MATERIALS AND METHODS This retrospective review included asymptomatic term neonates admitted to the NICU due to maternal chorioamnionitis and a comparison group of WBN neonates between January 2012 and December 2015. Demographic, birth, feeding, and lactation consultant visit data were analyzed in univariate and multivariate models. RESULTS Among 272 NICU neonates, 237 (87%) received 48-hour antibiotics versus 35 (13%) who received >48-hour (h) antibiotics; a cohort of 428 WBN neonates was studied for comparison. Exclusive breastmilk feeding was seen in 14% of NICU versus 35% of WBN neonates (p < .01). Among NICU newborns, 48 h versus >48 h antibiotics was not associated with altered discharge breastmilk feeding (14 versus 14%; p = .89). On multivariate logistic regression analysis among NICU subjects, older maternal age (p < .01), lower parity (p = .02), first-feed breastmilk (p < .01), and more lactation consultant visits (p = .012) were associated with increased discharge breastmilk feeding. CONCLUSIONS NICU admission for presumed early-onset sepsis due to maternal chorioamnionitis was associated with reduced discharge breastmilk feeding in asymptomatic term neonates, but prolonged antibiotic exposure was not. We speculate that demographic factors, such as maternal age and parity, may aid in focusing lactation consultant efforts to potentially improve NICU exclusive discharge breastmilk feeding rates.
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Affiliation(s)
- Miry Shim
- a Department of Pediatrics , Stony Brook Children's Hospital , Stony Brook , NY , USA
| | - Sara Yang
- b Stony Brook University School of Medicine , Stony Brook , NY , USA
| | - Catherine R Messina
- c Department of Family , Population and Preventive Medicine, Stony Brook University Hospital , Stony Brook , NY , USA
| | - Jonathan P Mintzer
- d Department of Pediatrics, Division of Neonatal-Perinatal Medicine , Stony Brook Children's Hospital , Stony Brook , NY , USA
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Chinese women's experiences, emotions and expectations of breast-feeding in public: a qualitative study. Public Health Nutr 2018; 21:1565-1572. [PMID: 29386081 DOI: 10.1017/s1368980017003937] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To explore Chinese mothers' experiences, emotions and expectations of breast-feeding in public places. DESIGN Exploratory qualitative study. Purposive sampling was used to recruit participants and face-to-face interviews were conducted. Themes were identified by content analysis. SETTING Two different geographical communities in Wuhan, Hubei Province, central China, March-May 2016. SUBJECTS A total of twenty-seven mothers aged 23-33 years, who had one child under 3 years of age and had experience of breast-feeding in public places. RESULTS Seven themes emerged from the interviews: struggling to balance infant's needs and personal feelings; embarrassed or natural emotion regarding breast-feeding in public places; effect of cultural and social norms; internalized concerns going beyond actual social reaction; measures to make breast-feeding in public places easier; desire for more public facilities; and expecting emotional support from society members. CONCLUSIONS More positive social support, favourable policies and necessary facilities were desired to enable mothers to breast-feed in an appropriate public location. Women expected increased public acceptance of breast-feeding practices and support from government health officials to ensure women's success in breast-feeding in public settings.
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Fleurant E, Schoeny M, Hoban R, Asiodu IV, Riley B, Meier PP, Bigger H, Patel AL. Barriers to Human Milk Feeding at Discharge of Very-Low-Birth-Weight Infants: Maternal Goal Setting as a Key Social Factor. Breastfeed Med 2017; 12:20-27. [PMID: 27906557 PMCID: PMC5220570 DOI: 10.1089/bfm.2016.0105] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND While black mothers initiate human milk (HM) provision at lower rates than non-black mothers in the United States, some neonatal intensive care units (NICUs) report similar initiation rates regardless of race/ethnicity for mothers of very-low-birth-weight (VLBW) infants. However, racial disparity frequently becomes evident in the proportion of black infants who continue to receive HM feedings at NICU discharge. Since social factors have been associated with differences in HM provision for term infants, we sought to identify differences in social factors associated with HM feeding at discharge based on race/ethnicity. MATERIALS AND METHODS A prospective cohort study of racially diverse mothers of VLBW infants measured social factors including maternal education, breastfeeding support, return to work/school, HM feeding goal, previous breastfeeding, or formula experience. Multivariate logistic regression modeling was applied to social factors to predict HM feeding at discharge. Additional regression models were created for racial/ethnic subgroups to identify differences. RESULTS For all 362 mothers, WIC (Special Supplemental Nutrition Program for Women, Infants, and Children) eligibility and maternal goal near time of discharge of providing any HM negatively and positively predicted HM feeding at discharge, respectively. Perceived breastfeeding support from the infant's maternal grandmother negatively predicted HM feeding at discharge for black mothers. CONCLUSIONS Future interventions to increase duration of HM provision in VLBW infants should focus on the establishment and maintenance of maternal HM feeding goals. Further studies of the familial support system of black mothers are warranted to determine multigenerational impact and potential interventions.
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Affiliation(s)
- Erin Fleurant
- 1 Rush University Medical College , Chicago, Illinois
| | - Michael Schoeny
- 2 Department of Pediatrics, Rush University Children's Hospital, Chicago, Illinois
| | - Rebecca Hoban
- 2 Department of Pediatrics, Rush University Children's Hospital, Chicago, Illinois.,3 Department of Pediatrics, Rush University Medical Center , Chicago, Illinois
| | | | - Brittany Riley
- 5 College of Nursing, Nationwide Children's Hospital , Columbus, Ohio
| | - Paula P Meier
- 2 Department of Pediatrics, Rush University Children's Hospital, Chicago, Illinois.,3 Department of Pediatrics, Rush University Medical Center , Chicago, Illinois
| | - Harold Bigger
- 3 Department of Pediatrics, Rush University Medical Center , Chicago, Illinois
| | - Aloka L Patel
- 2 Department of Pediatrics, Rush University Children's Hospital, Chicago, Illinois.,3 Department of Pediatrics, Rush University Medical Center , Chicago, Illinois
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Changes in the Immune Components of Preterm Human Milk and Associations With Maternal and Infant Characteristics. J Obstet Gynecol Neonatal Nurs 2016; 45:639-48. [PMID: 27477269 DOI: 10.1016/j.jogn.2016.04.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2016] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE To describe difference in cytokines, chemokines, and growth factors (CCGFs) and secretory immunoglobulin A (sIgA) in the breast milk of mothers who gave birth preterm and maternal or infant characteristics related to these immune components. DESIGN A prospective, repeated-measures, one-group design. SETTING Data were collected at an 82-bed NICU in West Central Florida. PARTICIPANTS Seventy-six very-low-birth-weight infants weighing less than 1,500 g and their mothers. METHODS Daily aliquots of breast milk from mothers of preterm infants were collected from the daily infants' feedings and pooled at the end of each week, and CCGFs and sIgA were measured weekly with MagPix multiplexing (Luminex, Austin, TX) and enzyme-linked immunosorbent assay. RESULTS The CCGFs showed high individual variability, but the levels of most CCGFs and sIgA fell over time. Immune variables were generally greater in milk from mothers of infants smaller than 1,000 g. The breast milk of mothers of male preterm infants had significantly greater sIgA than the breast milk of mothers of female preterm infants. We found relationships between age, body mass index, parity, sIgA, and some of the CCGFs in the breast milk of women who gave birth preterm. CONCLUSION Immune molecules declined in concentration over time in the breast milk of mothers who give birth preterm during the NICU stay, and maternal and infant factors appeared to play some role in the levels of these immune molecules. Further exploration of this relationship is warranted.
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Purdy IB, Craig JW, Zeanah P. NICU discharge planning and beyond: recommendations for parent psychosocial support. J Perinatol 2015; 35 Suppl 1:S24-8. [PMID: 26597802 PMCID: PMC4660049 DOI: 10.1038/jp.2015.146] [Citation(s) in RCA: 98] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Accepted: 09/18/2015] [Indexed: 11/16/2022]
Abstract
Parents will interact with a multitude of teams from various disciplines during their child's admission to the neonatal intensive care unit. Recognition of the emotional stressors experienced by these parents is a first step in working to provide the crucial support and parenting skills needed for bonding and caring for their infant from admission through discharge and beyond. Family-centered care involves time-sensitive two-way communication between parents and the multidisciplinary team members who coordinate care transition by providing emotional, educational, medical and home visitor support for these families. To do this well, a thoughtful exchange of information between team members and parents is essential to identify psychosocial stress and ameliorate family concerns. Parents will need emotional and educational support and follow-up resources. Establishing individualized, flexible but realistic, pre- and post-discharge plans with parents is needed to start their healthy transition to home and community.
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Affiliation(s)
- I B Purdy
- Division of Neonatology, Department of Pediatrics, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, USA
| | - J W Craig
- School of Occupational Therapy, Brenau University, Gainesville, GA, USA
| | - P Zeanah
- Cecil Picard Center for Child Development and College of Nursing and Allied Sciences, University of Louisiana, Lafayette, LA, USA
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Rosenstock A, van Manen M. Adolescent parenting in the neonatal intensive care unit. J Adolesc Health 2014; 55:723-9. [PMID: 25287982 DOI: 10.1016/j.jadohealth.2014.08.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Revised: 07/16/2014] [Accepted: 08/01/2014] [Indexed: 11/26/2022]
Abstract
This review presents data from studies that report on adolescent parents as part of larger neonatal intensive care unit (NICU) parent populations, as well as studies where adolescent parents are given central consideration. A systematic search for English publications from 1990 onward relevant to adolescent parenting in the NICU was conducted. Most studies reporting on adolescent parents focus on parental stress or parenting practices in the NICU. A few studies examine parent-staff communication, parental needs, and parent intervention programs. One study presents a qualitative examination of teenage mothers' experiences in the NICU. Areas for further research include experiences of younger adolescent parents, adolescent fathers, and same-sex partners; issues unique to adolescent parents; and support programs for adolescent parents in the NICU.
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Affiliation(s)
- Amanda Rosenstock
- John Dossetor Health Ethics Centre, University of Alberta, Edmonton, Alberta, Canada
| | - Michael van Manen
- John Dossetor Health Ethics Centre, University of Alberta, Edmonton, Alberta, Canada; Neonatal-Perinatal Medicine, Department of Paediatrics, University of Alberta, Edmonton, Alberta, Canada.
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Salvatori G, Foligno S, Occasi F, Pannone V, Valentini GB, Dall'Oglio I, Bagolan P, Dotta A. Human milk and breastfeeding in surgical infants. Breastfeed Med 2014; 9:491-3. [PMID: 25188874 DOI: 10.1089/bfm.2014.0097] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Human milk and breastfeeding represent the nutritional normative standards for term and preterm newborns. With the term "surgical infants" we refer to all newborns who undergo surgery during the first days of life and who are assisted in the neonatal intensive care unit during the postoperative period and then in the neonatal surgery unit. There are many obstacles to breastfeeding these newborns. The "barriers" include the unstable clinical conditions before and after surgery, the period of separation between the mother and child, and often the lack of attention to breastfeeding. Few studies have assessed if newborns with surgical diseases are breastfeed and if human milk is beneficial for their outcome. We believe that the best option is to offer them their own mother's milk through the promotion and support of breastfeeding. A specific program focused on the needs of these vulnerable children should be created. Furthermore the surgical and pediatric staff of the neonatal surgery unit should be informed and trained to increase such a program's feasibility.
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Affiliation(s)
- Guglielmo Salvatori
- 1 Department of Medical and Surgical Neonatology, Bambino Gesù Children's Hospital , Rome, Italy
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Craighead DV, Elswick R. The Influence of Early‐Term Birth on NICU Admission, Length of Stay, and Breastfeeding Initiation and Duration. J Obstet Gynecol Neonatal Nurs 2014; 43:409-21. [DOI: 10.1111/1552-6909.12472] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Briere C, McGrath J, Cong X, Cusson R. An Integrative Review of Factors that Influence Breastfeeding Duration for Premature Infants after NICU Hospitalization. J Obstet Gynecol Neonatal Nurs 2014; 43:272-81. [DOI: 10.1111/1552-6909.12297] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Ericson J, Eriksson M, Hellström-Westas L, Hagberg L, Hoddinott P, Flacking R. The effectiveness of proactive telephone support provided to breastfeeding mothers of preterm infants: study protocol for a randomized controlled trial. BMC Pediatr 2013; 13:73. [PMID: 23663521 PMCID: PMC3654949 DOI: 10.1186/1471-2431-13-73] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Accepted: 05/02/2013] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Although breast milk has numerous benefits for infants' development, with greater effects in those born preterm (at < 37 gestational weeks), mothers of preterm infants have shorter breastfeeding duration than mothers of term infants. One of the explanations proposed is the difficulties in the transition from a Neonatal Intensive Care Unit (NICU) to the home environment. A person-centred proactive telephone support intervention after discharge from NICU is expected to promote mothers' sense of trust in their own capacity and thereby facilitate breastfeeding. METHODS/DESIGN A multicentre randomized controlled trial has been designed to evaluate the effectiveness and cost-effectiveness of person-centred proactive telephone support on breastfeeding outcomes for mothers of preterm infants. Participating mothers will be randomized to either an intervention group or control group. In the intervention group person-centred proactive telephone support will be provided, in which the support team phones the mother daily for up to 14 days after hospital discharge. In the control group, mothers are offered a person-centred reactive support where mothers can phone the breastfeeding support team up to day 14 after hospital discharge. The intervention group will also be offered the same reactive telephone support as the control group. A stratified block randomization will be used; group allocation will be by high or low socioeconomic status and by NICU. Recruitment will be performed continuously until 1116 mothers (I: 558 C: 558) have been included. PRIMARY OUTCOME proportion of mothers exclusively breastfeeding at eight weeks after discharge. SECONDARY OUTCOMES proportion of breastfeeding (exclusive, partial, none and method of feeding), mothers satisfaction with breastfeeding, attachment, stress and quality of life in mothers/partners at eight weeks after hospital discharge and at six months postnatal age. Data will be collected by researchers blind to group allocation for the primary outcome. A qualitative evaluation of experiences of receiving/providing the intervention will also be undertaken with mothers and staff. DISCUSSION This paper presents the rationale, study design and protocol for a RCT providing person-centred proactive telephone support to mothers of preterm infants. Furthermore, with a health economic evaluation, the cost-effectiveness of the intervention will be assessed.
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Affiliation(s)
- Jenny Ericson
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
- Centre for Clinical Research Dalarna, Nissersväg 3, Falun, S-79182, Sweden
- Department of Pediatrics, Falu Hospital, Falun, Sweden
| | - Mats Eriksson
- School of Health and Medical Sciences, Örebro University, Örebro, Sweden
- Centre for Health Care Sciences, Örebro University Hospital, Örebro, Sweden
| | | | - Lars Hagberg
- School of Health and Medical Sciences, Örebro University, Örebro, Sweden
- Centre for Health Care Sciences, Örebro University Hospital, Örebro, Sweden
| | - Pat Hoddinott
- Nursing, Midwifery and Allied Health Professionals Research Unit, University of Stirling, Stirling, Scotland
| | - Renée Flacking
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
- School of Health and Social Studies, Dalarna University, Falun, Sweden
- Maternal and Infant Nutrition and Nurture Unit (MAINN), School of Health, University of Central Lancashire, Preston, Lancashire, UK
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Corrections to “Purdy, I. B., Singh, N., Le, C., Bell, C., Whiteside, C., and Collins, M. (2012). Biophysiologic and Social Stress Relationships with Breast Milk Feeding Pre- and Post-Discharge from the Neonatal Intensive Care Unit. Journal of Obstetric, Gynecologic, and Neonatal Nursing, 41, 347–357”. J Obstet Gynecol Neonatal Nurs 2012. [DOI: 10.1111/j.1552-6909.2012.01396_2.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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