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Aydin C, Aytekin Ozdemir A, Kahveci H. The Effect of Supplemental Feeding Tube Device on Time to Transition to Exclusive Breastfeeding and Discharge: A Randomized Controlled Trial with Preterm Infants. Breastfeed Med 2024; 19:707-714. [PMID: 38904090 DOI: 10.1089/bfm.2024.0084] [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: 06/22/2024]
Abstract
Aim: This study investigated the effect of supplemental feeding tube device (SFTD) method on time to transition to exclusive breastfeeding and discharge time in preterm infants. Methods: This randomized controlled trial was conducted in the neonatal intensive care unit of a public hospital in Turkey (Clinical Trial Number: NCT05815706). The sample consisted of 65 preterm infants randomized into a control (n = 32) and an experimental (n = 33) group. The experimental group participants were SFTD-fed until they switched to exclusive breastfeeding. The control group participants were fed according to the routine procedure. Data were collected using a questionnaire, a Preterm Infant Monitoring Form, and the LATCH Breastfeeding Assessment Tool. The data were analyzed using numbers, percentage distributions, means, standard deviations, Pearson's chi-square test, and independent samples t-test. The study was approved by an Ethics Committee. Permission was obtained from the hospital. Informed consent was obtained from all parents. Results: The experimental group (123.64 ± 63.25 hours) demonstrated an earlier transition to exclusive breastfeeding compared with the control group (187.50 ± 95.30 hours) (p < 0.05). The experimental group (361.45 ± 110.46 hours) had significantly shorter hospital stays than the control group (479.25 ± 163.17 hours). The experimental group (35.33 ± 1.14 weeks) had a significantly younger gestational age at discharge than the control group (35.97 ± 1.03 weeks). Conclusion: The SFTD is an alternate supportive feeding method that helps preterm infants switch to exclusive breastfeeding sooner, have shorter hospital stays, and have a younger gestational age at discharge than their bottle-fed counterparts.
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Affiliation(s)
- Ciler Aydin
- Clinics of Neonatology, İzmir Katip Çelebi University Atatürk Training and Research Hospital, İzmir, Turkey
| | - Aynur Aytekin Ozdemir
- Department of Nursing, Faculty of Health Sciences, Istanbul Medeniyet University, Istanbul, Turkey
| | - Hasan Kahveci
- Clinics of Neonatology, Erzurum City Hospital, Erzurum, Turkey
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Bergman NJ. New policies on skin-to-skin contact warrant an oxytocin-based perspective on perinatal health care. Front Psychol 2024; 15:1385320. [PMID: 39049943 PMCID: PMC11267429 DOI: 10.3389/fpsyg.2024.1385320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 06/10/2024] [Indexed: 07/27/2024] Open
Abstract
Background In 2023, the World Health Organization (WHO) published a Global Position Paper on Kangaroo Mother Care (KMC), which is applicable to all countries worldwide: from the moment of birth, every "small and sick" newborn should remain with mother in immediate and continuous skin-to-skin contact (SSC), receiving all required clinical care in that place. This was prompted by the startling results of a randomized controlled trial published in 2021: in which 1,609 infants receiving immediate SSC were compared with 1,602 controls that were separated from their mothers but otherwise received identical conventional state-of-the-art care. The intervention infants showed a 25% reduction in mortality after 28 days. New perspectives The new WHO guidelines are a significant change from earlier guidance and common clinical practice. The author presents that separating mothers and babies is assumed to be "normal" (a paradigm) but actually puts newborns at increased risk for morbidity and mortality. The author presents arguments and ethical perspectives for a new perspective on what is "normal," keeping newborns with their mothers is the infant's physiological expectation and critical requirement for healthy development. The author reviews the scientific rationale for changing the paradigm, based on synchronous interactions of oxytocin on both mother and infant. This follows a critique of the new policies that highlights the role of immediate SSC. Actionable recommendations This critique strengthens the case for implementing the WHO guidelines on KMC for small and sick babies. System changes will be necessary in both obstetric and neonatal settings to ensure seamless perinatal care. Based on the role of oxytocin, the author identifies that many current routine care practices may actually contribute to stress and increased vulnerability to the newborn. WHO has actionable recommendations about family involvement and presence in newborn intensive care units. Discussion The concepts of resilience and vulnerability have specific definitions well known in perinatal care: the key outcome of care should be resilience rather than merely the absence of vulnerability. Newborns in all settings and contexts need us to re-evaluate our paradigms and adopt and implement the new WHO guidelines on KMC in perinatal care.
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Affiliation(s)
- Nils J. Bergman
- Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
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Terefe A, Demtse A, Abebe F, Mislu E, Tachbele E. Predictors of time to full enteral feeding in low birth weight neonates admitted to neonatal intensive care unit: a prospective follow up study. BMC Pediatr 2024; 24:64. [PMID: 38245699 PMCID: PMC10799381 DOI: 10.1186/s12887-024-04545-0] [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] [Received: 04/10/2023] [Accepted: 01/09/2024] [Indexed: 01/22/2024] Open
Abstract
BACKGROUND Survival of LBW infants has increased in recent years because of novel perinatal interventions, but the introduction and advancement of enteral feeds for low birth weight infants is challenging. In Ethiopia the proportion of low birth weight infants is thought to be 17.3%. The purpose of this study was to determine the time to full enteral feeding (FEF) and its predictors in LBW neonates admitted to neonatal intensive care unit in selected hospitals of Addis Ababa, Ethiopia. METHOD An institutional based prospective follow up study was conducted from March 15 to June 15, 2022 among 282 LBW neonates admitted to six randomly selected hospitals. Both primary and secondary data was used by interviewing mothers and prospective medical chart review of neonates. The Cox regression model was used and variables having a p-value less than 0.05 with 95% CIs in a multivariable analysis were declared as statistically significant association with time to full enteral feeding. RESULT Out of 282 neonates involved in this study, 211 (74.8%) of them reached at FEF. The overall median time to full enteral feeding was 5 days. Predictors significantly associated with time to full enteral feeding were educational level, birth weight, cesarean delivery, hospital acquired infection, being on antibiotics, age at initiation of trophic feeding, routine gastric residual evaluation and NICU location (hospital). CONCLUSIONS This study demonstrated the difficulty of understanding which low birth weight neonate will attain FEF in a timely manner and factors that affect time to FEF. There is a delay in full enteral feeding achievement among low birth weight neonates and there is a great deal of heterogeneity of practice among health care providers regarding feeding of infants as it was evidenced by a variation in feeding practice among hospitals. Nutrition should be considered as part of the management in neonatal intensive care units since low birth weight neonates are developing edematous malnutrition while they are in the NICU. There should be standard feeding protocol to avoid heterogeneity of practice and additional study should be conducted for each categories of GA and BW with long follow up time.
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Affiliation(s)
- Abraraw Terefe
- Midwifery Department, College of Health Science, Woldia University, Weldiya, Ethiopia.
| | - Asrat Demtse
- College of Medical Science, Addis Ababa University, Addis Ababa, Ethiopia
| | - Fikertemariam Abebe
- College of Health Science, School of Nursing, Addis Ababa University, Addis Ababa, Ethiopia
| | - Esuyawkal Mislu
- Midwifery Department, College of Health Science, Woldia University, Weldiya, Ethiopia
| | - Erdaw Tachbele
- Nursing & Midwifery, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Arshadi Bostanabad M, Hosseinzadeh M, Molazemi Z, Namdar Areshtanab H. Emotional intelligence and stress and their relationship with breastfeeding self-efficacy in mothers of premature infants. BMC Womens Health 2024; 24:15. [PMID: 38172831 PMCID: PMC10765695 DOI: 10.1186/s12905-023-02849-4] [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: 02/10/2023] [Accepted: 12/15/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Premature infants need to be hospitalized in the neonatal intensive care unit (NICU) for long periods of time, which can increase anxiety and stress in their mothers. Additionally, the breastfeeding rate is lower among preterm infants. This study aimed to determine stress levels and emotional intelligence in mothers of preterm infants and their relationship with breastfeeding self-efficacy. METHODS This descriptive-correlational study was performed with a convenience sampling of 210 mothers of premature infants admitted to the neonatal intensive care unit in Tabriz, Iran in 2021. Data collection tools included socio-demographic checklist, perceived stress scale (PSS14), Dennis' breastfeeding self-efficacy scale, and the Schering emotional intelligence questionnaire. Data were analyzed using SPSS software version 16 via descriptive and inferential statistics (Pearson correlation and one-way ANOVA and modified general linear model). RESULTS Study findings demonstrated that most of the mothers had low stress (75.2%) and high breastfeeding self-efficacy (61.9%). The mean (SD) of emotional intelligence of the participants was 88.18 (16.60), ranging from 33 to 165. The results of the general linear model by modifying the demographic characteristics showed that the variables of emotional intelligence (B = 0.23, P = 0.03), stress (B=-0.56, P = 0.01), gestational age (B = 2.81, P < 0.001) and number of deliveries (B = 9.41, P < 0.001) were predictors of breastfeeding self-efficacy. CONCLUSION The findings showed that mothers of preterm infants had low emotional intelligence, and the majority of them had low perceived stress and high breastfeeding self-efficacy. Findings highlight the importance of addressing maternal stress and enhancing emotional intelligence to promote successful breastfeeding in mothers of preterm infants. Healthcare providers and managers are encouraged to offer support and educational programs to mothers of preterm infants, aiming to enhance their emotional intelligence. Further research and interventions focusing on these factors are warranted to improve the overall well-being of both mothers and infants in the neonatal intensive care unit.
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Affiliation(s)
- Mohammad Arshadi Bostanabad
- Department of Pediatric Nursing, Nursing and Midwifery Faculty, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mina Hosseinzadeh
- Department of Community Health Nursing, Nursing and Midwifery Faculty, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Zahra Molazemi
- Department of Mental Health and Psychiatric Nursing, Nursing and Midwifery Faculty, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hossein Namdar Areshtanab
- Department of Mental Health and Psychiatric Nursing, Nursing and Midwifery Faculty, Tabriz University of Medical Sciences, Tabriz, Iran.
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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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Tran HT, Luu HM, Le TD, Pham NTQ, Sobel HL, Murray JCS. Factors associated with high exclusive breastfeeding rates among preterm infants under 34 weeks of gestation in Da Nang, Vietnam: A retrospective cohort study. J Glob Health 2023; 13:04121. [PMID: 37934970 PMCID: PMC10630854 DOI: 10.7189/jogh.13.04121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2023] Open
Abstract
Background Preterm infants have higher mortality than full-term infants. While breastfeeding dramatically reduces preterm death, it is limited by biological and practice barriers, particularly for babies born before 34 weeks gestational age. Da Nang Hospital for Women and Children developed a quality improvement approach to improve breastfeeding of preterm infants by strengthening feeding support, non-separation, and kangaroo mother care (KMC). Methods To determine breastfeeding outcomes following discharge and explore factors associated with improved feeding, mothers of infants under 34 weeks gestational age born October 2021 to March 2022 and discharged alive were interviewed at six months and their medical records were reviewed. Results Out of 104 preterm infants included, all were exclusively breastfed at discharge and one month, 86.5% at three months, and 63.5% at six months; 47.1% received immediate skin-to-skin contact, 31.7% immediate and continuous KMC, and the remaining 68.3% continuous KMC beginning at a median of three days. Exclusive breastfeeding at six months was associated with the mother antenatally seeking breastfeeding information (odds ratio (OR) = 14.5; 95% confidence interval (CI) = 1.2-173.6), avoiding bottle-feeding at home (OR = 7.7; 95% CI = 1.7-33.7) and reduced with each day delay between birth and full breastfeeding (OR = 0.8; 95% CI = 0.6-0.9). Conclusions Hospital environments that limit mother-baby separations and feeding delays, including rooming-in of mothers and infants, KMC, and breastfeeding support from birth, enabled 100% of preterm infants born before 34 weeks gestational age to breastfeed exclusively with continued rates higher than previously reported. Addressing antenatal and post-natal factors limiting practice can further improve longer-term breastfeeding outcomes. The approach can be adapted to achieve high exclusive breastfeeding rates, regardless of gestational age.
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Affiliation(s)
- Hoang Thi Tran
- Neonatal Unit, Da Nang Hospital for Women and Children, Da Nang, Vietnam
- Department of Paediatrics, School of Medicine and Pharmacy, Da Nang University, Vietnam
| | - Hanh My Luu
- Neonatal Unit, Da Nang Hospital for Women and Children, Da Nang, Vietnam
- Department of Paediatrics, School of Medicine and Pharmacy, Da Nang University, Vietnam
| | - Thao Dieu Le
- Neonatal Unit, Da Nang Hospital for Women and Children, Da Nang, Vietnam
- Department of Paediatrics, School of Medicine and Pharmacy, Da Nang University, Vietnam
| | - Nga Thi Quynh Pham
- World Health Organization Representative Office in Viet Nam, Ha Noi, Vietnam
| | - Howard L Sobel
- World Health Organization Western Pacific Regional Office, United Nations Avenue, Manila, Philippines
| | - JCS Murray
- World Health Organization Western Pacific Regional Office, United Nations Avenue, Manila, Philippines
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Alemdar DK, İnal S, Bulut M. Clinical validation of the infant-driven feeding scales© in Turkey. J Pediatr Nurs 2022; 67:148-154. [PMID: 36122545 DOI: 10.1016/j.pedn.2022.09.007] [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] [Received: 02/04/2022] [Revised: 07/20/2022] [Accepted: 09/07/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Supporting the development of feeding skills among preterm infants is an important component of neonatal care. The selection of appropriate and supportive feeding interventions begins with a comprehensive assessment of the infant's skills. PURPOSE This study aimed to adapt the Infant-Driven Feeding Scales© (IDFS) to the Turkish language. METHODS This was a methodological, observational, single-center cross-sectional study. The study included 80 infants born at a gestational age ≥ 32 weeks, consecutively admitted to a tertiary Neonatal Intensive Care Unit (NICU). Research data were collected using a premature infant descriptive information form (IDIF), IDFS, and LATCH Score for Breastfeeding Assessment. For the Turkish validity-reliability of the IDF, the translate-back translate method was used with the content validity index (CVI) assessed. RESULTS The scale had CVI values between 0.90 and 1.00 with a mean CVI = 0.96. For measures 1 and 2, there were significant positive and high-level correlations between IFDS-R and IFDS-Q correlation values (r = 0.553-0.958; p = 0.001) and significant negative, low-level correlations between IFDS-R and IFDS-Q with the LATCH scale (r = 0.439-0.532; p = 0.001). According to inter-observer compatibility analyses, the kappa value was 0.94-1.00 for the first measure and 0.96-1.00 for the second measure (p = 0.001). There were negative significant correlations between IDFS-R points with gestational age and postmenstrual age (PMA) (p = 0.001), and gestational age and PMA were explanatory factors for 13.8% of IDFS-R points (F = 7.30, p = 0.001). CONCLUSIONS The IDFS is recommended for use as a valid and reliable tool to ease the safe and successful development of oral feeding skills in preterm infants and to plan evidence-based interventions. IMPLICATIONS FOR PRACTICE The IDFS appears to be a beneficial measurement device for use in assessing the state of readiness of preterm infants for oral feeding and for early determination of risks that may occur due to delayed feeding independence of infants.
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Affiliation(s)
- Dilek Küçük Alemdar
- Associate Professor, Ordu University Faculty of Health Sciences, Department of Pediatric Nursing, Ordu, Turkey.
| | - Sevil İnal
- Professor, İstanbul-Cerrah Paşa University Faculty of Health Sciences, Department of Midwifery, İstanbul, Turkey
| | - Muhammet Bulut
- MD, Associate Professor, Giresun University Faculty of Medicine, Department of Pediatrics, Giresun, Turkey
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Encourage, Assess, Transition (EAT): A Quality Improvement Project Implementing a Direct Breastfeeding Protocol for Preterm Hospitalized Infants. Adv Neonatal Care 2022; 23:107-119. [PMID: 36037212 DOI: 10.1097/anc.0000000000001037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The opportunity to establish a direct breastfeeding (DBF) relationship with a preterm infant, if desired by the mother or lactating parent, is a known driver of positive healthcare experiences. Preterm birth is an independent risk factor for early human milk (HM) cessation, and DBF at the first oral meal promotes continued DBF during hospitalization and HM duration beyond discharge. While the Spatz 10-step model for protecting and promoting HM and breastfeeding in vulnerable infants provides best practices, lack of standardized implementation results in missed opportunities to meet parents' DBF goals. PURPOSE To standardize clinical practices to increase DBF at the first oral meal, total DBF meals during hospitalization, and use of test weighing to measure milk transfer for preterm infants. METHODS Quality improvement methods were used to develop and implement Encourage, Assess, Transition (EAT): a DBF protocol for infants less than 37 weeks gestation at birth, in a level II neonatal intensive care unit. RESULTS Thirty-eight (45%) infants from 27.7 to 36.7 weeks of gestation initiated the protocol. The proportion of infants' DBF at first oral meal increased from 22% to 54%; mean DBF meals during hospitalization increased from 13.3 to 20.3; and use of test weighing increased by 166%. IMPLICATIONS FOR PRACTICE AND RESEARCH Standardizing DBF practices with the EAT protocol increased DBF during hospitalization-a known driver of patient experience-and HM duration beyond discharge, in hospitalized preterm infants. Researchers should validate the reported benefits of EAT (increased DBF during hospitalization, use of test weighing, and improved patient experience), methods to promote passive dissemination of evidence, and sustain change.Video abstract available at: https://journals.na.lww.com/advancesinneonatalcare/pages/videogallery.aspx?autoPlay=false&videoId=61.
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Chang YJ, Hao G, Ni A, Layton T, Huang JY, Yang SF, Chen SC. Preterm oral feeding scale to assist in deciding initial oral feeding of preterm infants in neonatal intensive care units. Pediatr Neonatol 2022; 63:269-275. [PMID: 35305927 DOI: 10.1016/j.pedneo.2021.12.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 11/28/2021] [Accepted: 12/06/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The inconsistency in decisions to commence oral feeding indicates that health professionals require clearer guidelines to determine when to initiate oral feeding in preterm infants. This study applied the Taiwan version of Preterm Oral Feeding Readiness Assessment Scale (TW-POFRAS) to clinical decision-making, especially for preterm infants with a birth weight less than 1,500 g or gestational age (GA) less than 32 weeks. METHODS This was a single-center observational cross-sectional study and 81 preterm infants were recruited. Lengths of stay from admission to initial one-meal oral feeding, to one-day all-meal oral feeding, and to discharge were analyzed. Scale scores, physician orders, and smooth oral intake of 5 mL of milk were analyzed. Kappa coefficients were examined to determine concordances within the results. RESULTS At least moderate concordance was evident (k = 0.492). Most preterm infants can begin to consume one meal of the least 5 mL of milk smoothly and proceed to consume a full day of meals with a week; they are typically discharged from the hospital within a month, except for those with a birth weight less than 1,500 g or a GA less than 32 weeks. For 17 of 81 participants, assessment results for physician orders, 5-mL milk consumption, and scale scores were inconsistent. Participants with a birth weight less than 1,500 g or GA less than 32 weeks were able to meet the 5-mL standard by the postmenstrual age of 35 weeks, at latest. CONCLUSION We recommend that TW-POFRAS should be used in conjunction with physicians' clinical decision-making for oral feeding readiness for preterm infants in the NICU.
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Affiliation(s)
- Yu-Jung Chang
- Institute of Medicine, Chung Shan Medical University, No. 110, Section 1, Jianguo N. Rd., Taichung, 402367, Taiwan; Department of Speech Language Pathology and Audiology, Chung Shan Medical University, No. 110, Section 1, Jianguo N. Rd., Taichung, 402367, Taiwan; Speech and Language Therapy Room, Chung Shan Medical University Hospital, No. 110, Section 1, Jianguo N. Rd., Taichung, 402367, Taiwan
| | - Grace Hao
- Department of Communication Sciences and Disorders, North Carolina Central University, 1801 Fayetteville St, Durham, NC, 27707, USA
| | - Anpin Ni
- Department of Communication Sciences and Disorders, North Carolina Central University, 1801 Fayetteville St, Durham, NC, 27707, USA
| | - Thomas Layton
- Talk and Total Communication Services, 5727 Williamsburg Way, Durham, NC, 27713, USA
| | - Jing-Yang Huang
- Institute of Medicine, Chung Shan Medical University, No. 110, Section 1, Jianguo N. Rd., Taichung, 402367, Taiwan; Center for Health Data Science, Chung Shan Medical University Hospital, Taichung, 402367, Taiwan
| | - Shun-Fa Yang
- Institute of Medicine, Chung Shan Medical University, No. 110, Section 1, Jianguo N. Rd., Taichung, 402367, Taiwan
| | - Shiuan-Chih Chen
- Institute of Medicine, Chung Shan Medical University, No. 110, Section 1, Jianguo N. Rd., Taichung, 402367, Taiwan; School of Medicine, Chung Shan Medical University, No. 110, Section 1, Jianguo N. Rd., Taichung, 402367, Taiwan; Department of Family and Community Medicine, Chung Shan Medical University Hospital, No. 110, Section 1, Jianguo N. Rd., Taichung, 402367, Taiwan.
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10
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Dawson JA, Foster JP, Jacobs SE, Myers L, Burns E. Cradle hold versus alternate positions for bottle feeding preterm infants. Hippokratia 2022. [DOI: 10.1002/14651858.cd013933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Jennifer A Dawson
- Neonatal Services; The Royal Women's Hospital; Melbourne Australia
- Murdoch Children's Research Institute; Melbourne Australia
- The University of Melbourne; Melbourne Australia
| | - Jann P Foster
- School of Nursing and Midwifery; Western Sydney University; Penrith DC Australia
- Ingham Research Institute; Liverpool Australia
- NSW Centre for Evidence Based Health Care: A JBI Affiliated Group; Western Sydney University; Penrith Australia
| | - Susan E Jacobs
- Neonatal Services; The Royal Women's Hospital; Melbourne Australia
- Murdoch Children's Research Institute; Melbourne Australia
- The University of Melbourne; Melbourne Australia
| | - Leanne Myers
- Neonatal Services; The Royal Women's Hospital; Melbourne Australia
| | - Elaine Burns
- School of Nursing and Midwifery; Western Sydney University; Penrith DC Australia
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Elsedawi BF, Samson N, Nadeau C, Vanhaverbeke K, Nguyen N, Alain C, Fortin-Pellerin E, Praud JP. Safety of Bottle-Feeding Under Nasal Respiratory Support in Preterm Lambs With and Without Tachypnoea. Front Physiol 2022; 12:785086. [PMID: 35046837 PMCID: PMC8762202 DOI: 10.3389/fphys.2021.785086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 12/06/2021] [Indexed: 11/19/2022] Open
Abstract
Aim: Convalescing preterm infants often require non-invasive respiratory support, such as nasal continuous positive airway pressure or high-flow nasal cannulas. One challenging milestone for preterm infants is achieving full oral feeding. Some teams fear nasal respiratory support might disrupt sucking–swallowing–breathing coordination and induce severe cardiorespiratory events. The main objective of this study was to assess the safety of oral feeding of preterm lambs on nasal respiratory support, with or without tachypnoea. Methods: Sucking, swallowing and breathing functions, as well as electrocardiogram, oxygen haemoglobin saturation, arterial blood gases and videofluoroscopic swallowing study were recorded in 15 preterm lambs during bottle-feeding. Four randomly ordered conditions were studied: control, nasal continuous positive airway pressure (6 cmH2O), high-flow nasal cannulas (7 L•min–1), and high-flow nasal cannulas at 7 L•min–1 at a tracheal pressure of 6 cmH2O. The recordings were repeated on days 7–8 and 13–14 to assess the effect of maturation. Results: None of the respiratory support impaired the safety or efficiency of oral feeding, even with tachypnoea. No respiratory support systematically impacted sucking–swallowing–breathing coordination, with or without tachypnoea. No effect of maturation was found. Conclusion: This translational physiology study, uniquely conducted in a relevant animal model of preterm infant with respiratory impairment, shows that nasal respiratory support does not impact the safety or efficiency of bottle-feeding or sucking–swallowing–breathing coordination. These results suggest that clinical studies on bottle-feeding in preterm infants under nasal continuous positive airway pressure and/or high-flow nasal cannulas can be safely undertaken.
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Affiliation(s)
- Basma Fathi Elsedawi
- Neonatal Respiratory Research Unit, Department of Pediatrics, Department of Physiology, University of Sherbrooke, Sherbrooke, QC, Canada
- Department of Human Anatomy and Embryology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Nathalie Samson
- Neonatal Respiratory Research Unit, Department of Pediatrics, Department of Physiology, University of Sherbrooke, Sherbrooke, QC, Canada
| | - Charlène Nadeau
- Neonatal Respiratory Research Unit, Department of Pediatrics, Department of Physiology, University of Sherbrooke, Sherbrooke, QC, Canada
| | - Kristien Vanhaverbeke
- Neonatal Respiratory Research Unit, Department of Pediatrics, Department of Physiology, University of Sherbrooke, Sherbrooke, QC, Canada
- Laboratory of Experimental Medicine and Pediatrics, Infla-Med Centre of Excellence, University of Antwerp, Antwerp, Belgium
- Department of Pediatrics, Antwerp University Hospital, Edegem, Belgium
| | - Nam Nguyen
- Neonatal Respiratory Research Unit, Department of Pediatrics, Department of Physiology, University of Sherbrooke, Sherbrooke, QC, Canada
- Faculty of Human Medicine, Paracelsus Medical University, Nuremberg, Germany
| | - Charles Alain
- Neonatal Respiratory Research Unit, Department of Pediatrics, Department of Physiology, University of Sherbrooke, Sherbrooke, QC, Canada
| | - Etienne Fortin-Pellerin
- Neonatal Respiratory Research Unit, Department of Pediatrics, Department of Physiology, University of Sherbrooke, Sherbrooke, QC, Canada
| | - Jean-Paul Praud
- Neonatal Respiratory Research Unit, Department of Pediatrics, Department of Physiology, University of Sherbrooke, Sherbrooke, QC, Canada
- *Correspondence: Jean-Paul Praud,
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McFadden A, Fitzpatrick B, Shinwell S, Tosh K, Donnan P, Wallace LM, Johnson E, MacGillivray S, Gavine A, Farre A, Mactier H. Cue-based versus scheduled feeding for preterm infants transitioning from tube to oral feeding: the Cubs mixed-methods feasibility study. Health Technol Assess 2021; 25:1-146. [PMID: 34878383 DOI: 10.3310/hta25740] [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: 11/22/2022] Open
Abstract
BACKGROUND There is a lack of evidence of the effect of cue-based feeding compared with scheduled feeding on important outcomes for preterm infants. OBJECTIVES The objectives were as follows: (1) to describe the characteristics, components, theoretical basis and outcomes of approaches to feeding preterm infants transitioning from tube to oral feeding; (2) to identify operational policies, barriers and facilitators, and staff and parents' educational needs in neonatal units implementing cue-based feeding; (3) to co-produce an intervention for feeding preterm infants in response to feeding cues; (4) to appraise the willingness of parents and staff to implement and sustain the intervention; (5) to assess associated costs of implementing cue-based feeding; (6) to determine the feasibility and acceptability of a future trial; (7) to scope existing data-recording systems and potential outcome measures; and (8) to determine stakeholders' views of whether or not a randomised controlled trial of this approach is feasible. DESIGN This was a mixed-methods intervention development and feasibility study comprising (1) a systematic review, case studies, qualitative research and stakeholder consensus; (2) the co-production of the intervention; (3) a mixed-methods feasibility study; and (4) an assessment of stakeholder preferences for a future evaluation. SETTING Three neonatal units in the UK (two level 3 units and one level 2 unit). PARTICIPANTS Developmentally normal, clinically stable preterm infants receiving enteral feeds (n = 50), parents (n = 15 pre intervention development; n = 14 in the feasibility study) and health-care practitioners (n = 54 pre intervention development; n = 16 in the feasibility study). INTERVENTION An evidence-informed multicomponent intervention comprising training, a feeding protocol, feeding assessment tools, supplementary training materials [including posters, a film and a narrated PowerPoint (Microsoft Corporation, Redmond, WA, USA) presentation] and the 'Our Feeding Journey' document. MAIN OUTCOME MEASURES The main outcome measures were recruitment and screening rates, infant weight gain, duration of the intervention, feeding outcomes, implementation outcomes (contextual facilitators and barriers, acceptability, adoption, appropriateness and fidelity) and stakeholder preferences for a future evaluation. RESULTS The systematic review of 25 studies concluded that evidence in favour of cue-based feeding should be treated cautiously. The case studies and qualitative research highlighted contextual barriers to and facilitators of the implementation of cue-based feeding. The telephone survey found that many neonatal units are considering implementing cue-based feeding. We recruited 37% of eligible infants, and there was good retention in the study until discharge but a high loss to follow-up at 2 weeks post discharge. The mean number of days from intervention to transition to full oral feeding was 10.8, and the mean daily change in weight gain was 25 g. The intervention was acceptable to parents and staff, although there was dissatisfaction with the study documentation. Intervention training did not reach all staff. A cluster-randomised design with a composite outcome was suggested by stakeholders for a future study. LIMITATIONS The intervention was available only in English. Intervention training did not reach all staff. There was low recruitment to qualitative interviews and observations. Only a small number of medical staff engaged in either the training or the interviews. CONCLUSIONS It is feasible to implement a cue-based feeding intervention with improved training and documentation. Further work is needed to assess the feasibility of a future trial, noting evidence of existing lack of equipoise. FUTURE WORK The next steps are to digitalise the intervention and conduct a survey of all neonatal units in the UK. STUDY REGISTRATION This study is registered as PROSPERO CRD42018097317 and ISRCTN13414304. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 74. See the NIHR Journals Library website for further project information.
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Affiliation(s)
| | | | - Shona Shinwell
- School of Health Sciences, University of Dundee, Dundee, UK
| | - Karen Tosh
- School of Health Sciences, University of Dundee, Dundee, UK
| | - Peter Donnan
- Tayside Clinical Trials Unit, University of Dundee, Dundee, UK
| | - Louise M Wallace
- School of Health, Wellbeing and Social Care, The Open University, Milton Keynes, UK
| | | | | | - Anna Gavine
- School of Health Sciences, University of Dundee, Dundee, UK
| | - Albert Farre
- School of Health Sciences, University of Dundee, Dundee, UK
| | - Helen Mactier
- Princess Royal Maternity, NHS Greater Glasgow and Clyde, Glasgow, UK
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Li L, Wang L, Niu C, Liu C, Lv T, Ji F, Yu L, Yan W, Dou YL, Wang Y, Cao Y, Huang G, Hu X. Early skin contact combined with mother's breastfeeding to shorten the process of premature infants ≤ 30 weeks of gestation to achieve full oral feeding: the study protocol of a randomized controlled trial. Trials 2021; 22:637. [PMID: 34535164 PMCID: PMC8447630 DOI: 10.1186/s13063-021-05605-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 09/05/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Most hospitalized preterm infants experience difficulties in transitioning from tube feeding to full oral feeding. Interventions to promote full oral feeding in preterm infants in the neonatal intensive care unit (NICU) are limited to pacifier use or bottle-feeding exercises. Skin contact has been shown to be beneficial to start and maintain lactation and provide preterm infants with the opportunity to suck on the mother's breast, which may promote further development of the preterm infant's suckling patterns. The objective of this study is to compare and evaluate the effects of skin contact combined with breastfeeding (suck on the mother's empty breast) as compared to the routine pacifier suckling training model in achieving full oral feeding for infants whose gestational age are ≤ 30 weeks. METHODS This is a single-center, randomized controlled clinical trial conducted in the NICU and designed according to the SPIRIT Statement. The subjects included in the study are premature infants born between April 2020 and July 2021 with a gestational age of ≤30 weeks, birth weight of <1500 g, admission age of <72 h, and absence of congenital malformations. Those with oxygenation indices of >40 and those born to mothers with poor verbal communication skills will be excluded. A sample of 148 infants is needed. The infants will be randomized to the intervention (skin contact combined with mother's breastfeeding model) or control group (routine pacifier sucking training model). The primary outcome is the time required to achieve full oral feeding. The secondary outcomes are the breastfeeding abilities of preterm infants as assessed by the Preterm Infant Breastfeeding Behavior Scale (PIBBS), breastfeeding rates at 3 and 6 months corrected gestational age, complication rates, duration of oxygen requirement, days of hospital stay, and satisfaction of parents. DISCUSSION This paper describes the first single-center, open-label, randomized clinical trial on this topic and will provide crucial information to support the implementation of skin contact combined with the breastfeeding model in the NICU setting. TRIAL REGISTRATION ClinicalTrials.gov NCT04283682. Registered on 8 February 2020.
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Affiliation(s)
- Liling Li
- Children's Hospital of Fudan University, 399 Wan Yuan Road, Shanghai, 201102, China
| | - Li Wang
- Children's Hospital of Fudan University, 399 Wan Yuan Road, Shanghai, 201102, China
| | - Conway Niu
- King Edward Memorial Hospital, Western Australia, Subiaco, Australia
| | - Chan Liu
- Children's Hospital of Fudan University, 399 Wan Yuan Road, Shanghai, 201102, China
| | - Tianchan Lv
- Children's Hospital of Fudan University, 399 Wan Yuan Road, Shanghai, 201102, China
| | - Futing Ji
- Children's Hospital of Fudan University, 399 Wan Yuan Road, Shanghai, 201102, China
| | - Ling Yu
- Children's Hospital of Fudan University, 399 Wan Yuan Road, Shanghai, 201102, China
| | - Weili Yan
- Children's Hospital of Fudan University, 399 Wan Yuan Road, Shanghai, 201102, China
| | - Ya Lan Dou
- Children's Hospital of Fudan University, 399 Wan Yuan Road, Shanghai, 201102, China
| | - Yin Wang
- Children's Hospital of Fudan University, 399 Wan Yuan Road, Shanghai, 201102, China
| | - Yun Cao
- Children's Hospital of Fudan University, 399 Wan Yuan Road, Shanghai, 201102, China
| | - Guoying Huang
- Children's Hospital of Fudan University, 399 Wan Yuan Road, Shanghai, 201102, China
| | - Xiaojing Hu
- Children's Hospital of Fudan University, 399 Wan Yuan Road, Shanghai, 201102, China.
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Simplified models to assess newborn gestational age in low-middle income countries: findings from a multicountry, prospective cohort study. BMJ Glob Health 2021; 6:e005688. [PMID: 34518201 PMCID: PMC8438948 DOI: 10.1136/bmjgh-2021-005688] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 07/25/2021] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Preterm birth is the leading cause of child mortality. This study aimed to develop and validate programmatically feasible and accurate approaches to estimate newborn gestational age (GA) in low resource settings. METHODS The WHO Alliance for Maternal and Newborn Health Improvement (AMANHI) study recruited pregnant women from population-based cohorts in five countries (Bangladesh, Ghana, Pakistan, Tanzania and Zambia). Women <20 weeks gestation by ultrasound-based dating were enrolled. Research staff assessed newborns for: (1) anthropometry, (2) neuromuscular/physical signs and (3) feeding maturity. Machine-learning techniques were used to construct ensemble models. Diagnostic accuracy was assessed by areas under the receiver operating curve (AUC) and Bland-Altman analysis. RESULTS 7428 liveborn infants were included (n=536 preterm, <37 weeks). The Ballard examination was biased compared with ultrasound dating (mean difference: +9 days) with 95% limits of agreement (LOA) -15.3 to 33.6 days (precision ±24.5 days). A model including 10 newborn characteristics (birth weight, head circumference, chest circumference, foot length, breast bud diameter, breast development, plantar creases, skin texture, ankle dorsiflexion and infant sex) estimated GA with no bias, 95% LOA ±17.3 days and an AUC=0.88 for classifying the preterm infant. A model that included last menstrual period (LMP) with the 10 characteristics had 95% LOA ±15.7 days and high diagnostic accuracy (AUC 0.91). An alternative simpler model including birth weight and LMP had 95% LOA of ±16.7 and an AUC of 0.88. CONCLUSION The best machine-learning model (10 neonatal characteristics and LMP) estimated GA within ±15.7 days of early ultrasound dating. Simpler models performed reasonably well with marginal increases in prediction error. These models hold promise for newborn GA estimation when ultrasound dating is unavailable.
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Zhang B, Duan Z, Zhao Y, Williams S, Wall S, Huang L, Zhang X, Wu W, Yue J, Zhang L, Liu J, Zhao G. Intermittent kangaroo mother care and the practice of breastfeeding late preterm infants: results from four hospitals in different provinces of China. Int Breastfeed J 2020; 15:64. [PMID: 32680538 PMCID: PMC7367356 DOI: 10.1186/s13006-020-00309-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 07/09/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND China has an extremely low exclusive breastfeeding rate. Kangaroo mother care (KMC) has been shown to increase the exclusive breastfeeding rate among infants born extremely or very preterm. However, there is limited evidence surrounding intermittent KMC and exclusive breastfeeding in late preterm infants. In our study we investigated the association between the provision of intermittent KMC and breastfeeding practice for late preterm infants in four hospitals in different provinces of China. METHODS Intermittent KMC was recommended to the mothers of all preterm infants admitted to the postnatal wards of participating hospitals between March 2018 and March 2019. Those who agreed to practice KMC were enrolled in the "KMC group", those who did not were enrolled in the "No KMC group". Basic maternal socio-demographic information was collected, feeding practice; outcome and method, were recorded daily whilst in hospital. A follow-up survey of feeding practice was conducted 42 days after discharge. Calculations for feeding practice were performed separately for both groups. Logistics regression was used to analyze the association between KMC and feeding outcome and method, adjusting for socio-demographic covariates. RESULTS Among the 844 mothers participating in the study, 627 (74.3%) chose to perform KMC. More of the mothers who provided KMC were exclusively breast milk feeding their infants in the 24 h before hospital discharge (54.6%) and at follow-up (57.3%), compared to mothers who did not provide KMC (34.6% at discharge and 33.2% at follow-up,). Mothers in the KMC group were more likely to be breastfeeding (method) than mothers in the No KMC group (65.3% vs. 52.1% at discharge, and 83.1% vs. 67.3% at follow up). Logistic regression indicated that compared with the No KMC group, mothers who provided KMC were twice as likely to be exclusively breast milk feeding their infants at discharge (OR = 2.15 (95% CI 1.53, 3.02)), use breastfeeding method at discharge as opposed to other means such as bottle or cup feeding (OR = 1.61 (95% CI 1.15, 2.25)), be exclusive breast milk feeding at follow-up (OR = 2.55 (95% CI 1.81, 3.61)), and use breastfeeding method at follow-up (OR = 2.09 (95% CI 1.44, 3.02)). CONCLUSIONS Intermittent KMC was associated with a nearly doubled increase in exclusive breast milk feeding (outcome) and breastfeeding (method) at both discharge and 42 days after discharge for late preterm infants. This is especially important in China where exclusive breastfeeding rates are low, intermittent KMC provides a feasible means to increase the likelihood of these vulnerable infants receiving the benefits of exclusive breastmilk.
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Affiliation(s)
- Bo Zhang
- Peking University First Hospital, 1 Xi'anmen St, Xicheng, Beijing, China
| | - Zhiying Duan
- Peking University First Hospital, 1 Xi'anmen St, Xicheng, Beijing, China
| | - Yingxi Zhao
- University of Oxford Nuffield Department of Medicine, Oxford, UK
| | | | - Stephen Wall
- Save the Children Saving Newborn Lives, Washington, DC, USA
| | - Limin Huang
- Hunan Provincial Maternal and Child Health Hospital, Changsha, Hunan, China
| | - Xiaoqin Zhang
- Northwest Women & Children Hospital Department of Obstetrics, Xi'an, Shaanxi, China
| | - Wenli Wu
- Linyi Maternity and Child Health Hospital, Linyi, Shandong, China
| | - Jieya Yue
- Peking University First Hospital, 1 Xi'anmen St, Xicheng, Beijing, China
| | | | - Jun Liu
- Peking University First Hospital, 1 Xi'anmen St, Xicheng, Beijing, China.
| | - Gengli Zhao
- Peking University First Hospital, 1 Xi'anmen St, Xicheng, Beijing, China.
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16
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Bergman NJ. Birth practices: Maternal-neonate separation as a source of toxic stress. Birth Defects Res 2019; 111:1087-1109. [PMID: 31157520 DOI: 10.1002/bdr2.1530] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 05/15/2019] [Indexed: 12/26/2022]
Abstract
Maternal-neonate separation for human newborns has been the standard of care since the last century; low birth weight and preterm infants are still routinely separated from their mothers. With advanced technology, survival is good, but long-term developmental outcomes are very poor for these especially vulnerable newborns. The poor outcomes are similar to those described for adversity in childhood, ascribed to toxic stress. Toxic stress is defined as the absence of the buffering protection of adult support. Parental absence has been strictly enforced in neonatal care units for many reasons and could lead to toxic stress. The understanding of toxic stress comes from discoveries about our genome and epigenetics, the microbiome, developmental neuroscience and the brain connectome, and life history theory. The common factor is the early environment that gives (a) signals to epigenes, (b) sensory inputs to neural circuits, and (c) experiences for reproductive fitness. For human newborns that environment is direct skin-to-skin contact from birth. Highly conserved neuroendocrine behaviors determined by environment are described in this review. The scientific rationale underlying skin-to-skin contact is presented: autonomic development and regulation of the physiology leads to emotional connection and achieving resilience. Maternal-neonate separation prevents these critical neural processes from taking place, but also channel development into an alternative developmental strategy. This enables better coping in a stressful environment in the short term, but with permanently elevated stress systems that negatively impact mental and physical health in the long term. This may explain the increasing incidence of developmental problems in childhood, and also Developmental Origins of Health and Disease. Arguments are presented that maternal-neonate separation is indeed a source of toxic stress, and some suggestions are offered toward a "zero separation" paradigm.
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Affiliation(s)
- Nils J Bergman
- Department of Neonatology, Karolinska Institute, Stockholm, Sweden
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18
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John HB, Suraj C, Padankatti SM, Sebastian T, Rajapandian E. Nonnutritive Sucking at the Mother's Breast Facilitates Oral Feeding Skills in Premature Infants: A Pilot Study. Adv Neonatal Care 2019; 19:110-117. [PMID: 30102620 DOI: 10.1097/anc.0000000000000545] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Premature infants have difficulties in transitioning from gavage to breastfeeding. Targeted interventions to support breastfeeding in premature infants in the neonatal intensive care unit are scarce. PURPOSE This pilot study evaluates the effectiveness of nonnutritive sucking at the mother's breast in premature infants to facilitate breastfeeding performance and exclusive breastfeeding. METHODS The study design constituted a single-blinded randomized control trial, with 9 participants randomly allocated into experimental (n = 4) and control (n = 5) groups. The intervention, nonnutritive sucking at the mother's breast thrice a day for 5 minutes, till nutritive breastfeeding was started, was done in addition to standard care, which was nonnutritive sucking on a finger during gavage feeds. The control group received only standard care. Nonnutritive sucking was assessed using "Stages of Nonnutritive Sucking Scale," and breastfeeding performance was assessed using the "Preterm Infant Breastfeeding Behavior Scale" by a blinded assessor unaware of the infants' allocation. RESULTS Five infants in the control arm and 4 in the intervention arm completed the study. The infants in the intervention group showed faster transition to mature stages of nonnutritive sucking (P = .05) and had longer sucking bursts during breastfeeding (P = .06) than those in the control group. There was no difference in the rates of exclusive breastfeeding at 6 months in the intervention and control groups. IMPLICATIONS FOR PRACTICE Early initiation of nonnutritive sucking at the mother's breast in very preterm infants is a safe and effective intervention to facilitate maturation of oral feeding and breastfeeding behavior. IMPLICATIONS FOR RESEARCH Nonnutritive sucking at the mother's breast can be explored as an intervention, with a larger sample, to facilitate exclusive breastfeeding and to establish intervention fidelity.
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Affiliation(s)
- Hima B John
- Departments of Neonatology (Ms John), Physical Medicine and Rehabilitation (Ms Suraj), Occupational Therapy (Messrs Padankatti and Rajapandian), and Biostatistics (Ms Sebastian), Christian Medical College, Vellore, Tamil Nadu, India
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Picaud JC, Buffin R, Gremmo‐Feger G, Rigo J, Putet G, Casper C. Review concludes that specific recommendations are needed to harmonise the provision of fresh mother's milk to their preterm infants. Acta Paediatr 2018; 107:1145-1155. [PMID: 29412475 PMCID: PMC6032854 DOI: 10.1111/apa.14259] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2017] [Revised: 01/02/2018] [Accepted: 01/30/2018] [Indexed: 01/27/2023]
Abstract
AIM There are no specific recommendations for using a mother's fresh milk for her preterm infant. We reviewed the available evidence on its collection, storage and administration. METHODS The working group of the French Neonatal Society on fresh human milk use in preterm infants searched the MEDLINE database and Cochrane Library up to June 2017 for papers published in English or French. They specifically analysed 282 papers providing information on prospective, retrospective and clinical studies and examined guidelines from various countries. RESULTS The review concluded that fresh mother's own milk should be favoured in accordance with the latest recommendations. However, it must be carried out under stringent conditions so that the expected benefits are not offset by risks related to different practices. The working group has summarised the best conditions for feeding preterm infants with human milk, balancing high nutritional and immunological quality with adequate virological and bacteriological safety. Professionals must provide parents with the necessary conditions to establish breastfeeding, together with specific and strong support. CONCLUSION Based on their review, the working group has made specific recommendations for using fresh mother's own milk under careful conditions, so that the expected benefits are not offset by risks related to practices.
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Affiliation(s)
- JC Picaud
- Neonatal UnitHôpital de la Croix RousseHospices Civils de LyonLyonFrance
- Faculté de médecine Lyon‐Sud Charles MérieuxUniversité Claude Bernard Lyon 1VilleurbanneFrance
| | - R Buffin
- Neonatal UnitHôpital de la Croix RousseHospices Civils de LyonLyonFrance
| | - G Gremmo‐Feger
- Neonatal UnitPôle de la Femme, de la Mère et de l'EnfantCHU BrestBrestFrance
| | - J Rigo
- Neonatal UnitChU Liège Hopital de la CitadelleUniversité de LiègeLiègeBelgium
| | - G Putet
- Neonatal UnitHôpital de la Croix RousseHospices Civils de LyonLyonFrance
| | - C Casper
- Neonatal UnitPaul Sabatier UniversityToulouseFrance
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20
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Dietary Protein Intake, Breast Feeding and Growth in Human Milk Fed Preterm Infants. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15061196. [PMID: 29880727 PMCID: PMC6025124 DOI: 10.3390/ijerph15061196] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 06/01/2018] [Accepted: 06/05/2018] [Indexed: 01/06/2023]
Abstract
Protein intakes of preterm infants are frequently below recommendations, but few studies report accurate intakes due to the difficulty of analysing human milk clinically. This observational analysis from a randomised trial of infants born <31 weeks’ gestation, investigating two levels of protein fortification, reports protein intakes compared with requirements and determines the association of direct breastfeeding on growth. Ninety-two infants (median gestational age 28 weeks, Interquartile range (IQR) 26–29; mean birth weight 1040 g, SD 300 g) were studied. Infants born weighing <1000 g were underfed protein compared with recommendations (median (IQR) intake of 3.0 (2.0–3.7) g/kg/day in week 2 versus recommendation of 4–4.5 g/kg/day), while those born weighing ≥1000 g met recommended protein intakes after the first week of life (median (IQR) intake of 3.7 (3.0–4.0) g/kg/day in week 2 versus recommendation of 3.5–4.5 g/kg/day). A moderate, negative correlation between the mean number of breast feeds and change in rate of weight gain (r = −0.37, p = 0.001) was found. Protein intakes of infants <1000 g did not meet recommendations and all infants were underfed protein and energy in the first week of life. Current protein fortification is inadequate for infants born <1000 g. Exploratory analysis showed faltering rate weight gain associated with increasing number of breast feeds and these results warrant confirmation.
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Gerges A, Gelfer P, Kennedy K. Randomized trial of earlier versus later oral feeding in very premature infants. J Perinatol 2018; 38:687-692. [PMID: 29453433 DOI: 10.1038/s41372-018-0058-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 12/13/2017] [Accepted: 01/17/2018] [Indexed: 11/09/2022]
Abstract
OBJECTIVES To ascertain if earlier oral feeding initiation results in earlier attainment of full oral feedings/hospital discharge in very premature infants. STUDY DESIGN Eligible infants born at <29 weeks' gestation were randomized at 30 weeks' postmenstrual age (PMA) to initiate oral feedings at 30 weeks' PMA (Earlier Oral Feeding Group) versus 33 weeks' PMA (Later Oral Feeding Group). RESULTS Thirty-four infants were randomized to the Earlier Oral Feeding Group and 32 to the Later Oral Feeding Group. There were no significant differences in our primary outcomes of PMA at full oral feedings (mean difference -0.5 weeks, 95% CI: -2.2 to +1.2 weeks) or hospital discharge (mean difference -0.2 weeks, 95% CI: -1.8 to +1.4 weeks). CONCLUSIONS Initiating oral feeding attempts in very premature infants at 30 weeks' PMA does not result in earlier attainment of full oral feedings or discharge but is safe for infants who are not severely tachypneic or receiving positive pressure.
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Affiliation(s)
- Ann Gerges
- Children's Memorial Hermann Hospital, Houston, TX, USA. .,Department of Neonatal-Perinatal Medicine, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA.
| | - Polina Gelfer
- Children's Memorial Hermann Hospital, Houston, TX, USA.,Department of Neonatal-Perinatal Medicine, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Kathleen Kennedy
- Children's Memorial Hermann Hospital, Houston, TX, USA.,Department of Neonatal-Perinatal Medicine, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
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Ericson J, Eriksson M, Hoddinott P, Hellström-Westas L, Flacking R. Breastfeeding and risk for ceasing in mothers of preterm infants-Long-term follow-up. MATERNAL AND CHILD NUTRITION 2018; 14:e12618. [PMID: 29733102 PMCID: PMC6175451 DOI: 10.1111/mcn.12618] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 03/12/2018] [Accepted: 03/15/2018] [Indexed: 12/04/2022]
Abstract
Breastfeeding is challenging for mothers of preterm infants. The aim of this paper is to describe risk factors for ceasing breastfeeding and methods of feeding until 12 months postnatal age in mothers who breastfed their preterm infants at discharge from neonatal intensive care units (NICUs). The data come from a randomised controlled trial, which evaluated the effectiveness on exclusive breastfeeding at 8 weeks of proactive telephone support compared with reactive support offered to mothers of preterm infants following discharge from NICU. Six NICUs across Sweden randomised a total of 493 mothers. We used regression and survival analyses to assess the risk factors for ceasing breastfeeding and the long‐term outcomes of the intervention. The results showed that 305 (64%) of the infants were breastfed at 6 months and 49 (21%) at 12 months. Partial breastfeeding at discharge, low maternal educational level, and longer length of stay in the NICU increased the risk for ceasing breastfeeding during the first 12 months. Furthermore, the Kaplan–Meier analysis showed that the proportion of mothers who ceased breastfeeding did not differ between the intervention (n = 231) and controls (n = 262) during the first 12 months (log‐rank test p = .68). No difference was found between groups on method of feeding. More than 85% of the infants were fed directly at the breast. These findings provide important insights for health professionals who are supporting mothers of preterm infants to breastfeed long term. Registered in http://www.clinicaltrials.gov (NCT01806480).
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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, Falun, Sweden.,Department of Paediatrics, Falu Hospital, Falun, Sweden.,School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
| | - Mats Eriksson
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden
| | - Pat Hoddinott
- Nursing, Midwifery and Allied Health Professionals Research Unit, University of Stirling, Stirling, UK
| | | | - Renée Flacking
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
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Pike M, Kritzinger A, Krüger E. Breastfeeding Characteristics of Late-Preterm Infants in a Kangaroo Mother Care Unit. Breastfeed Med 2017; 12:637-644. [PMID: 28930483 DOI: 10.1089/bfm.2017.0055] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To describe the breastfeeding characteristics of late-preterm infants (LPIs) in a kangaroo mother care (KMC) unit. MATERIALS AND METHODS In a 20-bed KMC unit, the breastfeeding of 73 purposively-selected LPIs' (mean gestational age: 34.8 weeks) was observed once-off, using the Preterm Infant Breastfeeding Behavior Scale. Participants' mean age was 9.5 days, mean number of days in the unit was 3.1 days, and mean number of days breastfeeding was 7.5 on observation. RESULTS Only 13.7% of participants were directly breastfeeding without supplementary naso- or orogastric feeding/cup-feeding and 86.3% received supplementary cup-feeding of expressed breast milk. Most participants did not exhibit obvious rooting (83.5%) and although most latched-on (97.3%), those who did, latched shallowly (93%). The mean longest sucking burst was 18.8 (standard deviation: 10.5) and approximately half the participants swallowed repeatedly (53.4%). The mean breastfeeding session duration was 17.8 minutes, but most participants breastfed for less than 10 minutes (76.7%). No statistically significant differences in breastfeeding characteristics were detected between participants of different chronological ages. A general trend toward more mature behaviors in participants' breastfeeding for more days was present for many breastfeeding characteristics. More infants exhibited the most mature behavior for each breastfeeding characteristic when the environment was quiet, rather than noisy and disturbing, except for depth of latching (quiet: 0%, disturbance: 15.2%). CONCLUSION LPIs in this sample presented with subtle breastfeeding difficulties, highlighting their need for breastfeeding support. Further research is required to examine the effect of KMC on breastfeeding in LPIs.
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Affiliation(s)
- Melissa Pike
- Department of Speech-Language Pathology and Audiology, University of Pretoria , Pretoria, South Africa
| | - Alta Kritzinger
- Department of Speech-Language Pathology and Audiology, University of Pretoria , Pretoria, South Africa
| | - Esedra Krüger
- Department of Speech-Language Pathology and Audiology, University of Pretoria , Pretoria, South Africa
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Nasal continuous positive airway pressure influences bottle-feeding in preterm lambs. Pediatr Res 2017; 82:926-933. [PMID: 28700565 DOI: 10.1038/pr.2017.162] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Accepted: 04/26/2017] [Indexed: 11/08/2022]
Abstract
BackgroundIn preterm infants, the time from initiation to full oral feeding can take weeks, which represents a very worrisome problem in neonatal medicine. Although current knowledge suggests that oral feeding should be introduced early, this is often delayed due to the need for prolonged nasal continuous positive airway pressure (nCPAP). Indeed, most caregivers fear that nCPAP could disrupt sucking-swallowing-breathing coordination and induce tracheal aspiration. The goal of the present study was to assess the impact of nCPAP delivered by the Infant Flow System on the physiology of sucking-swallowing-breathing coordination during bottle-feeding in preterm lambs over 24 h.MethodsSeventeen lambs (8 control, 9 nCPAP of 6 cmH2O) born 14 days prematurely were instrumented to record sucking, swallowing, respiration, ECG, and oxygenation. They were fed via a nasogastric tube for the first 5 days of life until introduction of bottle-feeding every 4 h for 24 h.ResultsnCPAP increased the feeding efficiency while maintaining higher oxygenation without any deleterious cardiorespiratory events. However, coughs were observed in lambs under nCPAP immediately following bottle-feeding and may be related to the high milk flow in preterm lambs.ConclusionFurther studies documenting tracheal aspirations are needed, especially in preterm lambs under nCPAP for moderate respiratory difficulties, to further inform future clinical studies.
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Baqui A, Ahmed P, Dasgupta SK, Begum N, Rahman M, Islam N, Quaiyum M, Kirkwood B, Edmond K, Shannon C, Newton S, Hurt L, Jehan F, Nisar I, Hussain A, Nadeem N, Ilyas M, Zaidi A, Sazawal S, Deb S, Dutta A, Dhingra U, Ali SM, Hamer DH, Semrau KEA, Straszak–Suri M, Grogan C, Bemba G, Lee ACC, Wylie BJ, Manu A, Yoshida S, Bahl R. Development and validation of a simplified algorithm for neonatal gestational age assessment - protocol for the Alliance for Maternal Newborn Health Improvement (AMANHI) prospective cohort study. J Glob Health 2017; 7:021201. [PMID: 29163937 PMCID: PMC5665676 DOI: 10.7189/jogh.07.021201] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE The objective of the Alliance for Maternal and Newborn Health Improvement (AMANHI) gestational age study is to develop and validate a programmatically feasible and simple approach to accurately assess gestational age of babies after they are born. The study will provide accurate, population-based rates of preterm birth in different settings and quantify the risks of neonatal mortality and morbidity by gestational age and birth weight in five South Asian and sub-Saharan African sites. METHODS This study used on-going population-based cohort studies to recruit pregnant women early in pregnancy (<20 weeks) for a dating ultrasound scan. Implementation is harmonised across sites in Ghana, Tanzania, Zambia, Bangladesh and Pakistan with uniform protocols and standard operating procedures. Women whose pregnancies are confirmed to be between 8 to 19 completed weeks of gestation are enrolled into the study. These women are followed up to collect socio-demographic and morbidity data during the pregnancy. When they deliver, trained research assistants visit women within 72 hours to assess the baby for gestational maturity. They assess for neuromuscular and physical characteristics selected from the Ballard and Dubowitz maturation assessment scales. They also measure newborn anthropometry and assess feeding maturity of the babies. Computer machine learning techniques will be used to identify the most parsimonious group of signs that correctly predict gestational age compared to the early ultrasound date (the gold standard). This gestational age will be used to categorize babies into term, late preterm and early preterm groups. Further, the ultrasound-based gestational age will be used to calculate population-based rates of preterm birth. IMPORTANCE OF THE STUDY The AMANHI gestational age study will make substantial contribution to improve identification of preterm babies by frontline health workers in low- and middle- income countries using simple evaluations. The study will provide accurate preterm birth estimates. This new information will be crucial to planning and delivery of interventions for improving preterm birth outcomes, particularly in South Asia and sub-Saharan Africa.
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Affiliation(s)
- AMANHI (Alliance for Maternal and Newborn Health Improvement)
- AMANHI Gestational Age Study Group, Bangladesh (Sylhet)
- AMANHI Gestational Age Study Group, Ghana
- AMANHI Gestational Age Study Group, Pakistan (Karachi)
- AMANHI Gestational Age Study Group, Tanzania (Pemba)
- AMANHI Gestational Age Study Group, Zambia
- Brigham & Women’s Hospital, Massachusetts General Hospital, Boston, Massachusetts, USA
- World Health Organization (MCA/MRD), Geneva, Switzerland
| | | | - Parvez Ahmed
- AMANHI Gestational Age Study Group, Bangladesh (Sylhet)
| | | | - Nazma Begum
- AMANHI Gestational Age Study Group, Bangladesh (Sylhet)
| | | | - Nasreen Islam
- AMANHI Gestational Age Study Group, Bangladesh (Sylhet)
| | | | | | | | | | | | - Lisa Hurt
- AMANHI Gestational Age Study Group, Ghana
| | - Fyezah Jehan
- AMANHI Gestational Age Study Group, Pakistan (Karachi)
| | - Imran Nisar
- AMANHI Gestational Age Study Group, Pakistan (Karachi)
| | - Atiya Hussain
- AMANHI Gestational Age Study Group, Pakistan (Karachi)
| | - Naila Nadeem
- AMANHI Gestational Age Study Group, Pakistan (Karachi)
| | | | - Anita Zaidi
- AMANHI Gestational Age Study Group, Pakistan (Karachi)
| | - Sunil Sazawal
- AMANHI Gestational Age Study Group, Tanzania (Pemba)
| | - Saikat Deb
- AMANHI Gestational Age Study Group, Tanzania (Pemba)
| | - Arup Dutta
- AMANHI Gestational Age Study Group, Tanzania (Pemba)
| | - Usha Dhingra
- AMANHI Gestational Age Study Group, Tanzania (Pemba)
| | | | | | | | | | | | | | - Anne CC Lee
- Brigham & Women’s Hospital, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Blair J Wylie
- Brigham & Women’s Hospital, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Alexander Manu
- World Health Organization (MCA/MRD), Geneva, Switzerland
| | | | - Rajiv Bahl
- World Health Organization (MCA/MRD), Geneva, Switzerland
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Giannì ML, Sannino P, Bezze E, Plevani L, Esposito C, Muscolo S, Roggero P, Mosca F. Usefulness of the Infant Driven Scale in the early identification of preterm infants at risk for delayed oral feeding independency. Early Hum Dev 2017; 115:18-22. [PMID: 28843138 DOI: 10.1016/j.earlhumdev.2017.08.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 08/18/2017] [Accepted: 08/18/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Very preterm infants frequently experience difficulties in achieving feeding independency. The availability of feeding assessment instruments has been recommended to evaluate an infant's readiness for oral feeding and enable preterm infants' caregivers to document each infant's feeding readiness and advancements. AIMS To investigate the implementation of the Infant Driven Scale in neonatal intensive care units and to identify a cut off value associated with delayed feeding independency. STUDY DESIGN Prospective, observational, single-centre study. SUBJECTS A total of 47 infants born at a gestational age≤32weeks, consecutively admitted to a tertiary neonatal unit between July 2015 and March 2016. OUTCOMES MEASURES The infant's feeding readiness and the postmenstrual age at achievement of feeding independency. RESULTS Mean postmenstrual age at feeding independency was 35.6±1.34weeks. A linear regression analysis showed that a score≤8 at 32weeks of postmenstrual age was associated with a delay of 1.8weeks in achieving feeding independency. CONCLUSION The Infant Driven Scale appears to be a useful additional instrument for the assessment of preterm infants' oral feeding readiness and the early identification of the infants at risk for delayed feeding independency.
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Affiliation(s)
- Maria Lorella Giannì
- Fondazione I.R.C.C.S. Ca Granda Ospedale Maggiore Policlinico, Neonatal Intensive Care Unit, Department of Clinical Science and Community Health, University of Milan, Via Commenda 12, 20122 Milano, Italy.
| | - Patrizio Sannino
- Fondazione I.R.C.C.S. Ca Granda Ospedale Maggiore Policlinico, S.I.T.R.A. Basic Education Sector, Via Francesco Sforza 28, 20122 Milan, Italy.
| | - Elena Bezze
- Fondazione I.R.C.C.S. Ca Granda Ospedale Maggiore Policlinico, S.I.T.R.A. Basic Education Sector, Via Francesco Sforza 28, 20122 Milan, Italy.
| | - Laura Plevani
- Fondazione I.R.C.C.S. Ca Granda Ospedale Maggiore Policlinico, Neonatal Intensive Care Unit, Department of Clinical Science and Community Health, University of Milan, Via Commenda 12, 20122 Milano, Italy.
| | - Chiara Esposito
- Fondazione I.R.C.C.S. Ca Granda Ospedale Maggiore Policlinico, Neonatal Intensive Care Unit, Department of Clinical Science and Community Health, University of Milan, Via Commenda 12, 20122 Milano, Italy.
| | - Salvatore Muscolo
- Fondazione I.R.C.C.S. Ca Granda Ospedale Maggiore Policlinico, Neonatal Intensive Care Unit, Department of Clinical Science and Community Health, University of Milan, Via Commenda 12, 20122 Milano, Italy.
| | - Paola Roggero
- Fondazione I.R.C.C.S. Ca Granda Ospedale Maggiore Policlinico, Neonatal Intensive Care Unit, Department of Clinical Science and Community Health, University of Milan, Via Commenda 12, 20122 Milano, Italy.
| | - Fabio Mosca
- Fondazione I.R.C.C.S. Ca Granda Ospedale Maggiore Policlinico, Neonatal Intensive Care Unit, Department of Clinical Science and Community Health, University of Milan, Via Commenda 12, 20122 Milano, Italy.
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Wilson E, Edstedt Bonamy AK, Bonet M, Toome L, Rodrigues C, Howell EA, Cuttini M, Zeitlin J. Room for improvement in breast milk feeding after very preterm birth in Europe: Results from the EPICE cohort. MATERNAL AND CHILD NUTRITION 2017; 14. [PMID: 28714111 DOI: 10.1111/mcn.12485] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 05/22/2017] [Accepted: 06/07/2017] [Indexed: 12/01/2022]
Abstract
Breast milk feeding (BMF) is associated with lower neonatal morbidity in the very preterm infant (<32 weeks gestation) and breastfeeding is beneficial for maternal health. Previous studies show large variations in BMF after very preterm birth and recognize the need for targeted breastfeeding support in the neonatal intensive care units (NICU). In a European collaboration project about evidence-based practices after very preterm birth, we examined the association between maternal, obstetric, and infant clinical factors; neonatal and maternal care unit policies; and BMF at discharge from the NICU. In multivariable analyses, covariates associated with feeding at discharge were first investigated as predictors of any BMF and in further analysis as predictors of exclusive or partial BMF. Overall, 58% (3,826/6,592) of the infants received any BMF at discharge, but there were large variations between regions (range 36-80%). Primiparity, administration of antenatal corticosteroids, first enteral feed <24 hr after birth, and mother's own milk at first enteral feed were predictors positively associated with any BMF at discharge. Vaginal delivery, singleton birth, and receiving mother's own milk at first enteral feed were associated with exclusive BMF at discharge. Units with a Baby Friendly Hospital accreditation improved any BMF at discharge; units with protocols for BMF and units using donor milk had higher rates of exclusive BMF at discharge. This study suggests that there is a high potential for improving BMF through policies and support in the NICU.
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Affiliation(s)
- Emilija Wilson
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Anna-Karin Edstedt Bonamy
- Department of Women's and Children's Health, and Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Mercedes Bonet
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé) and Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, Paris, France
| | - Liis Toome
- Department of Neonates and Infants, Tallinn Children's Hospital, Tallinn, and University of Tartu, Tartu, Estonia
| | | | - Elizabeth A Howell
- Departments of Population Health Science & Policy and Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Marina Cuttini
- Research Unit of Perinatal Epidemiology, Clinical Care and Management Innovation Research Area, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Jennifer Zeitlin
- INSERM, Obstetrical, Perinatal and Paediatric Epidemiology Research Team, Centre for Epidemiology and Biostatistics (U1153), Paris-Descartes University, Paris, France
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Benavente-Fernández I, Sánchez Redondo MD, Leante Castellanos JL, Pérez Muñuzuri A, Rite Gracia S, Ruiz Campillo CW, Sanz López E, Sánchez Luna M. Hospital discharge criteria for very low birth weight newborns. ANALES DE PEDIATRÍA (ENGLISH EDITION) 2017. [DOI: 10.1016/j.anpede.2016.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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[Hospital discharge criteria for very low birth weight newborns]. An Pediatr (Barc) 2017; 87:54.e1-54.e8. [PMID: 28063822 DOI: 10.1016/j.anpedi.2016.11.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Accepted: 11/24/2016] [Indexed: 01/31/2023] Open
Abstract
Hospital discharge criteria for the pre-term newborn are mainly based on physiological competences (thermoregulation, respiratory stability, and feeding skills), although family support and ability to care for the baby, as well as a well-planned discharge are also cornerstones to ensure a successful discharge. In this article, the Committee of Standards of the Spanish Society of Neonatology reviews the current hospital discharge criteria in order for it to be useful as a clinical guide in Spanish neonatal units.
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Flacking R, Dykes F. Perceptions and experiences of using a nipple shield among parents and staff - an ethnographic study in neonatal units. BMC Pregnancy Childbirth 2017; 17:1. [PMID: 28049520 PMCID: PMC5209800 DOI: 10.1186/s12884-016-1183-6] [Citation(s) in RCA: 102] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 12/07/2016] [Indexed: 11/10/2022] Open
Abstract
Background Preterm infants have an immature sucking behavior and the capacity to be exclusively breastfed may be reduced for a period of weeks or months, depending on gestational age. Nipple shields have been used, not only as a device to help mothers with sore nipples, but also to facilitate the infant’s latch on to the breast. However, the benefits of using nipple shields have been debated. The aim of this study was to explore perceptions and experiences of using a nipple shield among parents and staff in neonatal units in Sweden and England. Methods An ethnographic study was undertaken where observations and interviews were conducted in four neonatal units in Sweden and England. The data were analyzed using a thematic networks analysis. Result The global theme was developed and named, ‘Nipple shield in a liminal time’. This comprised of two organizing themes: ‘Relational breastfeeding’ and ‘Progression’. ‘Relational breastfeeding’ was underpinned by the basic themes, ‘good enough breast’, ‘something in between’ and ‘tranquil moment’. ‘Progression’ was underpinned by the basic themes, ‘learning quicker’, ‘short-term solution’ and ‘rescue remedy’. Although breastfeeding was seen primarily as a nutritive transaction, the relational aspects of breastfeeding were of crucial importance. These two organizing themes show the tension between acknowledging the relational aspects of breastfeeding and yet facilitating or supporting the progression of breastfeeding in the period from tube feeding or cup feeding to breastfeeding. It is a liminal time as mothers and their infants are “in between” phases and the outcome, in terms of breastfeeding, is yet to be realized. Conclusion This study demonstrates parents’ and staffs’ perceptions of the nipple shield as a short term solution to help initiation of breastfeeding but also as a barrier between the mother and infant. It is important that the mother and baby’s own particular needs are taken into account, in a person-centred way and on an ongoing basis. Furthermore, we need to emphasise the importance of the ‘relational’ whilst understanding the need for ‘progression’. Holding these in balance may be the key to appropriate use of the nipple shield.
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Affiliation(s)
- Renée Flacking
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden.
| | - Fiona Dykes
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden.,Maternal and Infant Nutrition and Nurture Unit (MAINN), School of Community Health and Midwifery, University of Central Lancashire, Preston, UK
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Bourin PF, Puech M, Woisard V. Pediatric Aspect of Dysphagia. Dysphagia 2017. [DOI: 10.1007/174_2017_138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Giannì ML, Bezze E, Sannino P, Stori E, Plevani L, Roggero P, Agosti M, Mosca F. Facilitators and barriers of breastfeeding late preterm infants according to mothers' experiences. BMC Pediatr 2016; 16:179. [PMID: 27821185 PMCID: PMC5100217 DOI: 10.1186/s12887-016-0722-7] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 10/28/2016] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Late preterm infants account for the majority of preterm births. They are at an increased risk of neonatal mortality and morbidity and are less likely to initiate breastfeeding and to be exclusively breastfed at discharge compared to infants born at term. The aim of this study was to identify the facilitators and barriers to breastfeeding during hospital stays according to the experiences of mothers of late preterm infants. METHODS We conducted a cross-sectional questionnaire survey. Mothers who intended to breastfeed and had given birth to a newborn admitted to level I and II care, with a gestational age of 34 0/7 to 36 6/7 weeks, were enrolled. Sociodemographic data, neonatal variables, mode of feeding and feeding status at discharge were also collected. RESULTS A total of 92 mothers who had given birth to 121 infants were enrolled. At discharge, any human milk was fed to 94 % of infants, with exclusively human milk being fed in 43 % of cases; exclusively formula was fed to 6 % of infants. In the multivariate analysis, having expressed breast milk was independently associated with an increased risk of being fed with either any human milk or formula only (OR = 2.73, 95 % CI 1.05-7.1, p = 0.039), whereas being encouraged to practice kangaroo mother care tended to have a protective effect (OR = 0.46, 95 % CI 0.2-1.06, p = 0.07). CONCLUSIONS Based on the present findings, health care professionals should strive to fully implement breastfeeding support for mothers of late preterm infants who intend to breastfeed, in particular optimizing breast milk expression and promoting kangaroo mother care. Further studies are needed to gain further insight into the complex interplay of the factors that modulate breastfeeding outcome in late preterm infants.
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Affiliation(s)
- Maria Lorella Giannì
- Fondazione I.R.C.C.S. Ca Granda Ospedale Maggiore Policlinico, Neonatal Intensive Care Unit Department of Clinical Science and Community Health, University of Milan, Via Commenda 12, 20122, Milan, Italy.
| | - Elena Bezze
- Fondazione I.R.C.C.S. Ca Granda Ospedale Maggiore Policlinico, S.I.T.R.A. Basic Education Sector, Via Francesco Sforza 28, 20122, Milan, Italy
| | - Patrizio Sannino
- Fondazione I.R.C.C.S. Ca Granda Ospedale Maggiore Policlinico, S.I.T.R.A. Basic Education Sector, Via Francesco Sforza 28, 20122, Milan, Italy
| | - Elena Stori
- Fondazione I.R.C.C.S. Ca Granda Ospedale Maggiore Policlinico, Neonatal Intensive Care Unit Department of Clinical Science and Community Health, University of Milan, Via Commenda 12, 20122, Milan, Italy
| | - Laura Plevani
- Fondazione I.R.C.C.S. Ca Granda Ospedale Maggiore Policlinico, Neonatal Intensive Care Unit Department of Clinical Science and Community Health, University of Milan, Via Commenda 12, 20122, Milan, Italy
| | - Paola Roggero
- Fondazione I.R.C.C.S. Ca Granda Ospedale Maggiore Policlinico, Neonatal Intensive Care Unit Department of Clinical Science and Community Health, University of Milan, Via Commenda 12, 20122, Milan, Italy
| | - Massimo Agosti
- Neonatologia e Terapia Intensiva Neonatale, Polo Universitario F. Del Ponte, Viale Borri 54, 21100, Varese, Italy
| | - Fabio Mosca
- Fondazione I.R.C.C.S. Ca Granda Ospedale Maggiore Policlinico, Neonatal Intensive Care Unit Department of Clinical Science and Community Health, University of Milan, Via Commenda 12, 20122, Milan, Italy
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Yu X, Sun H, Lin X, Liu X. Breastfeeding Evaluation Indicators System is a Promising Evaluation Tool for Preterm Infants in Neonatal Intensive Care Units (NICU). Med Sci Monit 2016; 22:4009-4016. [PMID: 27783574 PMCID: PMC5085543 DOI: 10.12659/msm.898519] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background Breast feeding can enhance preterm infants’ neurodevelopmental outcome, regulate immune function development. This study aims to develop breastfeeding evaluation indicators system in neonatal intensive care units (NICU) and to provide theoretical basis for all-round evaluation of breast feeding quality for hospitalized preterm infants. Material/Methods This study was performed based on Avedis Donabedian’s theory of medical care quality. Preterm infant breast feeding evaluation indicators system frame was initially formed by using literature review, clinical on-spot observation and expert consultation methods. By using specialists meeting method and Delphi method, evaluation indicators system for preterm infants breastfeeding was verified and established. Breastfeeding evaluation indicators system were performed in NICU of hospitals in Binzhou and Shanghai. Feasibility and usability of indicators system were examined. Results Breastfeeding evaluation indicators system for preterm infants comprise 3 levels, including level 1 (3 indicators), level 2 (7 indicators), and level 3 (18 indicators). Recognition rates of importance for level 2 and 3 range from 94.4% to 100.0% and 80.6% to 100.0%, respectively. Mean of Likert rating for level 2 and 3 range from 3.31 to 3.89 and 3.03 to 3.97, which are all higher than the average value of 2.50. Kendall’s coefficient and its significance test showed that consistency of experts’ opinion for indicators’ importance is high (P<0.001). This strategy of combining qualitative and quantitative methods could be used in overall evaluation of the breastfeeding quality in NICUs. Conclusions Indicators system is feasible and is a promising evaluation tool for continuously improving breastfeeding quality for preterm infants in NICUs.
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Affiliation(s)
- Xiurong Yu
- Department of Gynecology and Obstetrics, Binzhou Medical University Hospital, Binzhou, Shandong, China (mainland)
| | - Hongying Sun
- Department of Gynecology and Obstetrics, Binzhou Medical University Hospital, Binzhou, Shandong, China (mainland)
| | - Xiangyun Lin
- Department of Gynecology and Obstetrics, Binzhou Medical University Hospital, Binzhou, Shandong, China (mainland)
| | - Xiuxiang Liu
- Neonatal Intensive Care Unit, Binzhou Medical University Hospital, Binzhou, Shandong, China (mainland)
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Oras P, Thernström Blomqvist Y, Hedberg Nyqvist K, Gradin M, Rubertsson C, Hellström-Westas L, Funkquist EL. Skin-to-skin contact is associated with earlier breastfeeding attainment in preterm infants. Acta Paediatr 2016; 105:783-9. [PMID: 27100380 DOI: 10.1111/apa.13431] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Revised: 02/07/2016] [Accepted: 04/07/2016] [Indexed: 11/28/2022]
Abstract
AIM This study investigated the effects of skin-to-skin contact on breastfeeding attainment, duration and infant growth in preterm infants, as this has not been sufficiently explored. METHODS A prospective longitudinal study on Kangaroo mother care was carried out, comprising 104 infants with a gestational age of 28 + 0 to 33 + 6 and followed up to one year of corrected age. Parents and staff recorded the duration of skin-to skin contact during the stay in the neonatal intensive care unit (NICU). Medical data were collected through patient records, and follow-up questionnaires were filled in by parents. RESULTS The 53 infants who attained full breastfeeding in the NICU did so at a median (range) of 35 + 0 (32 + 1 to 37 + 5) weeks of postmenstrual age, and skin-to-skin contact was the only factor that influenced earlier attainment in the regression analysis (R(2) 0.215 p < 0.001). The daily duration of skin-to-skin contact during the stay in the NICU did not affect the duration of breastfeeding or infant growth after discharge. Furthermore, infant growth was not affected by the feeding strategy of exclusive, partial breastfeeding or no breastfeeding. CONCLUSION A longer daily duration of skin-to-skin contact in the NICU was associated with earlier attainment of exclusive breastfeeding.
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Affiliation(s)
- Paola Oras
- Department of Women's and Children's Health; Uppsala University; Uppsala Sweden
| | | | | | - Maria Gradin
- Department of Paediatrics; Faculty of Medicine and Health; Örebro University; Örebro Sweden
| | | | | | - Eva-Lotta Funkquist
- Department of Women's and Children's Health; Uppsala University; Uppsala Sweden
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Dritsakou K, Liosis G, Valsami G, Polychronopoulos E, Souliotis K, Skouroliakou M. Mother's breast milk supplemented with donor milk reduces hospital and health service usage costs in low-birthweight infants. Midwifery 2016; 40:109-13. [PMID: 27428106 DOI: 10.1016/j.midw.2016.06.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2015] [Revised: 03/19/2016] [Accepted: 06/22/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE to compare hospital and health service usage costs of feeding low-birthweight (LBW) infants predominantly with their mother's milk, supplemented with donor milk, with donor milk and preterm formula. DESIGN prospective matching study. SETTING tertiary public perinatal centre, neonatal intensive care unit (NICU) and donor human milk bank. PARTICIPANTS 100LBW infants (Group I) fed predominantly with their mother's milk from the first hour of life, supplemented (mainly for the first week of life) with donor milk, were matched on a 1:1 basis with 100LBW infants (Group II) who were fed with donor milk for the first 3 weeks of life followed by preterm formula until hospital discharge. Individualised targeted fortification of human milk was implemented in both study groups. FINDINGS the costs of hospitalisation, doctor visits and prescription drugs for viral infections until 8 months of age were calculated for each infant. Infants fed predominantly with their mother's milk had significantly shorter hospital stays and lower hospitalisation costs. In Group I infants, the duration of enteral gavage feeding was shorter, resulting in significantly lower costs. Up to 8 months of age, Group I infants experienced fewer episodes of viral infections, and the cost of each doctor visit and drug prescription was lower for these infants. CONCLUSIONS feeding LBW infants predominantly with their mother's milk reduces hospital and health service usage costs. IMPLICATIONS FOR PRACTICE feeding LBW infants predominantly with their mother's milk, supplemented with donor milk, followed by exclusive breast feeding seems to result in potential savings in hospital and health service usage costs.
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Affiliation(s)
- Kalliopi Dritsakou
- Departments of Quality Control, Research and Continuing Education, Elena Venizelou Maternity Hospital, Athens, Greece.
| | - Georgios Liosis
- Human Milk Bank, Elena Venizelou Maternity Hospital, Athens, Greece
| | | | | | | | - Maria Skouroliakou
- Department of Science of Dietetics-Nutrition, Harokopeion University of Athens, Athens, Greece
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Ziadi M, Héon M, Aita M. A Critical Review of Interventions Supporting Transition from Gavage to Direct Breastfeeding in Hospitalized Preterm Infants. ACTA ACUST UNITED AC 2016. [DOI: 10.1053/j.nainr.2016.03.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Smith RL, Lucas R. Evaluation of nursing knowledge of early initiation of breastfeeding in preterm infants in a hospital setting. ACTA ACUST UNITED AC 2016. [DOI: 10.1016/j.jnn.2015.07.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Niela-Vilén H, Axelin A, Melender HL, Löyttyniemi E, Salanterä S. Breastfeeding preterm infants - a randomized controlled trial of the effectiveness of an Internet-based peer-support group. J Adv Nurs 2016; 72:2495-507. [DOI: 10.1111/jan.12993] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2016] [Indexed: 11/29/2022]
Affiliation(s)
| | - Anna Axelin
- Department of Nursing Science; University of Turku; Finland
| | | | | | - Sanna Salanterä
- Department of Nursing Science; University of Turku; Finland
- Turku University Hospital; Finland
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Niela-Vilén H, Melender HL, Axelin A, Löyttyniemi E, Salanterä S. Predictors of Breastfeeding Initiation and Frequency for Preterm Infants in the NICU. J Obstet Gynecol Neonatal Nurs 2016; 45:346-58. [DOI: 10.1016/j.jogn.2016.01.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/01/2016] [Indexed: 10/22/2022] Open
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Dalgleish SR, Kostecky LL, Blachly N. Eating in "SINC": Safe Individualized Nipple-Feeding Competence, a Quality Improvement Project to Explore Infant-Driven Oral Feeding for Very Premature Infants Requiring Noninvasive Respiratory Support. Neonatal Netw 2016; 35:217-227. [PMID: 27461200 DOI: 10.1891/0730-0832.35.4.217] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Oral feeding is a developmental task for all premature infants. often, independent nipple feeding is the last barrier to discharge home from the NICU. A relationship exists between consistent, infant-driven feeding management practices and improved feeding performance. Conversely, a random approach to feeding may contribute to poor short-term and long-term clinical outcomes. We report a quality improvement project that was undertaken across five NICUs in an urban setting. our aim was to safely initiate and advance nipple feeding for very preterm neonates (born at <32 weeks gestation) who had a respiratory morbidity requiring nasal continuous positive airway pressure therapy. A novel algorithm entitled "eating in SINC: Safe individualized nipple-Feeding Competence" was developed. Safe individualized nipple-feeding competence involves the baby, the parents, and the health care team by using infant-driven strategies, common language, and developmentally appropriate goals while supporting fragile neonates to be skilled feeders.
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Affiliation(s)
- Stacey R Dalgleish
- Foothills Medical Centre, NICU, 5th Floor, 1403 29 Street NW, Calgary, AB, T2N 2T9, Canada
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41
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Jackson BN, Kelly BN, McCann CM, Purdy SC. Predictors of the time to attain full oral feeding in late preterm infants. Acta Paediatr 2016; 105:e1-6. [PMID: 26408819 DOI: 10.1111/apa.13227] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Accepted: 09/22/2015] [Indexed: 11/28/2022]
Abstract
AIM The aim of this study was to determine the factors that predict the timing and age at which preterm infants (born 32-36 weeks gestation) commenced and attained full oral feeding. METHODS We conducted a retrospective review of medical records of 647 preterm infants born 2005-2011. Infants were from six neonatal intensive care units in New Zealand, all World Health Organisation Baby-friendly Hospital Initiative accredited. RESULTS Median time to the first oral feed offered was one day, and median time to the time of full oral feeding was 12 days. No infants attained full oral feeding before 33(+3) weeks postmenstrual age. Gestational age, birthweight, medical conditions and location of the neonatal unit were significantly associated with the time taken to commence and attain full oral feeding. CONCLUSION This study highlights the factors that are associated with the rate at which late preterm infants commence oral feeding and progress to full oral feeding. These findings offer important considerations not only for clinical practice but also discharge planning given the preference for preterm infants reaching full oral feeds before discharge from hospital. Prospective experimental research is required to confirm infant, maternal and environmental factors that influence feeding milestones in late preterm infants.
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Affiliation(s)
- Bianca N. Jackson
- Speech Science; School of Psychology; The University of Auckland; Auckland New Zealand
| | - Bronwen Noreen Kelly
- Speech Science; School of Psychology; The University of Auckland; Auckland New Zealand
| | - Clare Maria McCann
- Speech Science; School of Psychology; The University of Auckland; Auckland New Zealand
| | - Suzanne Carolyn Purdy
- Speech Science; School of Psychology; The University of Auckland; Auckland New Zealand
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Oras P, Blomqvist YT, Nyqvist KH, Gradin M, Rubertsson C, Hellström-Westas L, Funkquist EL. Breastfeeding Patterns in Preterm Infants Born at 28-33 Gestational Weeks. J Hum Lact 2015; 31:377-85. [PMID: 25956792 DOI: 10.1177/0890334415586406] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Accepted: 04/20/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Studies of breastfeeding patterns during preterm infants' first year of life are scarce but are important for providing breastfeeding mothers of preterm infants with optimal support. OBJECTIVE This study aimed to describe breastfeeding patterns in preterm infants up to 1 year of corrected age. METHODS As part of a larger study on kangaroo mother care in Sweden, a 24-hour breastfeeding diary was sent home after discharge from hospital, and at 2, 6, and 12 months of the infant's corrected age. Eighty-three mothers responded to the follow-up questionnaires, and the number of respondents to the breastfeeding diary was 48 at discharge, 43 at 2 months, 22 at 6 months, and 8 at 12 months. Infants were born at a median (range) gestational age of 32 (28-33) weeks. Breastfeeding patterns were analyzed according to durations, frequencies per 24 hours, and intervals between sessions. RESULTS In exclusively breastfed infants, the median (range) breastfeeding session frequency was 14 (8-26) times per 24 hours including 4 (1-9) times per night after discharge (n = 24) and 10 (6-25) times per 24 hours including 2 (0-5) times per night at 2 months (n = 23). In partially breastfed infants, the median (range) frequency was 5 (1-14) times per 24 hours including 2 (0-4) times per night at 6 months (n = 20) and 5.5 (1-12) times per 24 hours including 2 (0-3) times per night at 12 months (n = 8). CONCLUSION Mothers reported large variations in breastfeeding patterns, with higher median breastfeeding session frequencies than previously described in term infants in affluent settings.
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Affiliation(s)
- Paola Oras
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | | | | | - Maria Gradin
- Department of Paediatrics, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Christine Rubertsson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | | | - Eva-Lotta Funkquist
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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Fabiyi C, Rankin K, Norr K, Yoder JC, Vasa R, White-Traut R. The Association of Low Social Support with Breast Milk Expression in Low-Income Mother-Preterm Infant Dyads. J Hum Lact 2015; 31:490-7. [PMID: 25975943 DOI: 10.1177/0890334415586199] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Accepted: 04/18/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND Premature infants benefit from receiving expressed breast milk (BM), but expressing breast milk is difficult for new mothers. Little is known about mothers' social support and BM expression during the premature infant's hospital stay. OBJECTIVE We examined whether low maternal social support was associated with breast milk expression initiation and low breast milk expression among low-income mothers of premature infants. METHODS Maternal intake interview data and daily infant data on proportion of nutrition from BM during hospitalization were analyzed from a larger randomized trial testing a developmental intervention on 181 mother-premature infant dyads with at least 2 of 10 social-environmental risks. Multivariable modified Poisson regression was used to examine the relationship between social support (Personal Resources Questionnaire 2000; dichotomized as low for lowest quartile), initiation (any breast milk expressed vs none), and low breast milk expression (if BM was < 30% of infant total milk/formula intake during hospitalization). RESULTS Breast milk expression was initiated by 70.2% of mothers, and 32.3% of those mothers had low breast milk expression. In adjusted multivariable analyses, social support did not relate to the initiation of breast milk expression but was significantly associated with low breast milk expression among mothers who initiated (adjusted relative risk = 1.57; 95% confidence interval, 1.00-2.47). CONCLUSION Low social support was not associated with initiation but was associated with low breast milk expression during hospitalization. Interventions to enhance social support for mothers of premature infants, especially those reporting low social support from family and friends, may increase in-hospital expression and long-term breastfeeding.
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Affiliation(s)
- Camille Fabiyi
- Section of Family Planning and Contraception Research, Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL, USA Women, Children and Family Health Science, College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
| | - Kristin Rankin
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, IL, USA
| | - Kathleen Norr
- Women, Children and Family Health Science, College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
| | - Joseph C Yoder
- Women, Children and Family Health Science, College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
| | - Rohitkumar Vasa
- Mercy Hospital and Medical Center, Chicago, IL, USA Department of Pediatrics, University of Chicago, Chicago, IL, USA
| | - Rosemary White-Traut
- Women, Children and Family Health Science, College of Nursing, University of Illinois at Chicago, Chicago, IL, USA Children's Hospital of Wisconsin, Children's Research Institute, Milwaukee, WI, USA
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44
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Dritsakou K, Liosis G, Valsami G, Polychronopoulos E, Skouroliakou M. Improved outcomes of feeding low birth weight infants with predominantly raw human milk versus donor banked milk and formula. J Matern Fetal Neonatal Med 2015; 29:1131-8. [DOI: 10.3109/14767058.2015.1038232] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Ahnfeldt AM, Stanchev H, Jørgensen HL, Greisen G. Age and weight at final discharge from an early discharge programme for stable but tube-fed preterm infants. Acta Paediatr 2015; 104:377-83. [PMID: 25545824 DOI: 10.1111/apa.12917] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Accepted: 12/19/2014] [Indexed: 11/29/2022]
Abstract
AIM Preterm birth is often associated with prolonged hospitalisation, complicating the parent-child relationship and breastfeeding rates. As a result, an early discharge programme was implemented in the department of neonatology at Rigshospitalet. The infants were stable, but required tube feeding, and during the programme, they received home visits by neonatal nurses. We evaluated the programme, focusing on the infants' well-being, using weight gain, breastfeeding rates and total duration of hospitalisation as outcomes. METHODS Over an 11-year period, 500 infants participated in the programme and they constituted the early discharge group. They were compared with 400 infants discharged from the Naestved and Nykoebing Falster hospitals. RESULTS The early discharge group's length of hospitalisation was only three days shorter than the comparison group, but they were eight days younger when they joined the programme (p < 0.0001). Total admission was 21 days longer (p < 0.0001). There was no difference in weight-for-age at discharge (p = 0.15), but infants in the early discharge group were more frequently fully or partly breastfed (88% versus 80%, p < 0.005). CONCLUSION While recognising the limited comparability of the two groups, weight-for-age at discharge was similar, but the programme appeared to allow better breastfeeding success at the expense of a later final discharge.
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Affiliation(s)
- AM Ahnfeldt
- Department of Neonatology; Rigshospitalet; Copenhagen University; Copenhagen Denmark
| | - H Stanchev
- Department of Neonatology; Naestved Hospital; Naestved Denmark
| | - HL Jørgensen
- Department of Clinical Biochemistry; Bispebjerg Hospital; University of Copenhagen; Copenhagen Denmark
| | - G Greisen
- Department of Neonatology; Rigshospitalet; Copenhagen University; Copenhagen Denmark
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Abstract
BACKGROUND Breast milk is the gold standard of nutrition for preterm infants. Yet, initiation of direct breastfeeding before 32 weeks' postconceptional age (PCA) is not common practice in many neonatal intensive care units (NICUs). Our clinical question was, "In preterm infants, when is it safe to initiate breastfeeding in infants <32 weeks PCA receiving enteral feedings?" SEARCH STRATEGY A review of the literature was compiled between February 2013 and January 2015 by using the following databases: CINAHL, Cochrane Systematic Review, Scopus, and PubMed. Articles found were written in English and published after 1985. Key words were utilized during searches and references were hand checked. RESULTS Our review revealed that stable preterm infants maintain their physiological status during exposure to the breast as early as 27 to 28 weeks' PCA. Several studies demonstrated infants during breastfeeding compared with bottle-feeding experienced minimal variation in oxygen saturation and heart rate during feeding. Some infants exposed to the breast before 30 weeks' PCA were exclusively breastfeeding (direct breastfeeding and breast milk) at 32.8 weeks' PCA. Skin-to-skin mother-infant contact is crucial to the successful transition to direct breastfeeding. IMPLICATIONS FOR PRACTICE AND RESEARCH The transition from enteral feedings to direct, exclusive breastfeeding should involve frequent mother-infant skin-to-skin contact requiring support and guidance from the NICU staff. Future research should involve creating standard protocols within NICUs to facilitate breastfeeding transition and exploring barriers that may prevent the preterm infant from achieving direct, exclusive breastfeeding.
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Lima AH, Côrtes MG, Bouzada MCF, Friche AADL. Preterm newborn readiness for oral feeding: systematic review and meta-analysis. Codas 2015; 27:101-7. [DOI: 10.1590/2317-1782/20152014104] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Accepted: 12/12/2014] [Indexed: 11/21/2022] Open
Abstract
PURPOSE: To identify and systematize the main studies on the transition from enteral to oral feeding in preterm infants. RESEARCH STRATEGY: Articles that describe the transition from oral to enteral feeding in preterm infants were located in MEDLINE, LILACS, and SciELO databases. SELECTION CRITERIA: Original studies, with available abstract, published in the last 10 years were included. DATA ANALYSIS: Analysis of the methodology and the main results of the studies, and meta-analysis of the effects of sensory-motor-oral stimulation at the time of transition to full oral feeding and duration of hospitalization were conducted. RESULTS: Twenty-nine national and international publications were considered. Most studies were clinical trials (44.8%) and did not use rating scales to start the transition process (82.7%). In the meta-analysis, positive effect of stimulation of the sensory-motor-oral system was observed with respect to the transition time to oral diet (p=0.0000), but not in relation to the length of hospital stay (p=0.09). However, heterogeneity between studies was found both in the analysis of the transition time to full oral feeding (I2=93.98) and in the length of hospital stay (I2=82.30). CONCLUSION: The transition to oral feeding is an important moment, and various physical and clinical characteristics of preterm infants have been used to describe this process. Despite the impossibility of generalizing the results due to the heterogeneity of the studies, we have noted the importance of strategies for stimulation of sensory-motor-oral system to decrease the period of transition to full oral feeding system.
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Abstract
A literature search was conducted to answer the clinical question, "Do premature infants who breastfeed have different oral feeding outcomes compared with those who receive bottles?" The CINAHL, PubMed, and PsycInfo databases were queried for articles published in the past 10 years that reported original research available in English. Two studies specifically addressed a comparison between infants who received exclusive direct breastfeeding, mixed direct breast and bottle, and/or exclusive bottle-feeding. Additional studies were included that addressed oral feeding outcomes specific to either direct breastfeeding (n = 2) or those that grouped bottle and breastfeeding together (n = 3). The findings from these studies indicate that the statement that bottle-feeding leads to sooner discharge is not based in evidence. Although more data are needed to fully understand the differences between direct breastfeeding and bottle-feeding, neonatal intensive care unit staff should be aware of the message they send to breastfeeding families when they encourage the use of bottles over direct breastfeeding.
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Davanzo R, Strajn T, Kennedy J, Crocetta A, De Cunto A. From tube to breast: the bridging role of semi-demand breastfeeding. J Hum Lact 2014; 30:405-9. [PMID: 25172892 DOI: 10.1177/0890334414548697] [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] [Indexed: 11/15/2022]
Abstract
Determination of the optimal timing of breastfeeding initiation for preterm infants is still a challenge for health professionals. Often unjustified delays and restrictions of breastfeeding occur due to non-evidence-based current opinions about preterm infants' feeding capacity. Semi-demand feeding has been proposed for preterm infants during the transition from scheduled to full demand feeding, to promote the establishment of self-regulated oral feeding. Although semi-demand feeding has been shown to be safe and effective in reducing time to reaching oral feeding, the implementation of this feeding pattern for preterm infants in the neonatal intensive care unit (NICU) is still limited. We developed a protocol for the application of semi-demand feeding in preterm infants based on the existing knowledge of preterm infant neurodevelopment and NICU organization and staff experience. The protocol's aim is to attain successful transition from tube feeding to breastfeeding. In this article, we describe the protocol used in the neonatal unit of the Maternal and Child Health Institute of Trieste, a third level care center in northeastern Italy.
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Affiliation(s)
- Riccardo Davanzo
- Department of Perinatal Medicine, Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
| | - Tamara Strajn
- Department of Perinatal Medicine, Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
| | - Jacqueline Kennedy
- Department of Perinatal Medicine, Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
| | - Anna Crocetta
- Department of Perinatal Medicine, Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
| | - Angela De Cunto
- Department of Perinatal Medicine, Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
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Maastrup R, Hansen BM, Kronborg H, Bojesen SN, Hallum K, Frandsen A, Kyhnaeb A, Svarer I, Hallström I. Breastfeeding progression in preterm infants is influenced by factors in infants, mothers and clinical practice: the results of a national cohort study with high breastfeeding initiation rates. PLoS One 2014; 9:e108208. [PMID: 25251690 PMCID: PMC4177123 DOI: 10.1371/journal.pone.0108208] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Accepted: 08/20/2014] [Indexed: 11/19/2022] Open
Abstract
Background and Aim Many preterm infants are not capable of exclusive breastfeeding from birth. To guide mothers in breastfeeding, it is important to know when preterm infants can initiate breastfeeding and progress. The aim was to analyse postmenstrual age (PMA) at breastfeeding milestones in different preterm gestational age (GA) groups, to describe rates of breastfeeding duration at pre-defined times, as well as analyse factors associated with PMA at the establishment of exclusive breastfeeding. Methods The study was part of a prospective survey of a national Danish cohort of preterm infants based on questionnaires and structured telephone interviews, including 1,221 mothers and their 1,488 preterm infants with GA of 24–36 weeks. Results Of the preterm infants, 99% initiated breastfeeding and 68% were discharged exclusively breastfed. Breastfeeding milestones were generally reached at different PMAs for different GA groups, but preterm infants were able to initiate breastfeeding at early times, with some delay in infants less than GA 32 weeks. Very preterm infants had lowest mean PMA (35.5 weeks) at first complete breastfeed, and moderate preterm infants had lowest mean PMA at the establishment of exclusive breastfeeding (36.4 weeks). Admitting mothers to the NICU together with the infant and minimising the use of a pacifier during breastfeeding transition were associated with 1.6 (95% CI 0.4–2.8) and 1.2 days (95% CI 0.1–2.3) earlier establishment of exclusive breastfeeding respectively. Infants that were small for gestational age were associated with 5.6 days (95% CI 4.1–7.0) later establishment of exclusive breastfeeding. Conclusion Breastfeeding competence is not developed at a fixed PMA, but is influenced by multiple factors in infants, mothers and clinical practice. Admitting mothers together with their infants to the NICU and minimising the use of pacifiers may contribute to earlier establishment of exclusive breastfeeding.
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Affiliation(s)
- Ragnhild Maastrup
- Knowledge Centre for Breastfeeding Infants with Special Needs at Department of Neonatology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
- Danish National Panel of Experts on Breastfeeding Infants with Special Needs, Copenhagen, Denmark
- * E-mail:
| | - Bo Moelholm Hansen
- Department of Neonatology, Copenhagen University Hospital Herlev, Herlev, Denmark
| | - Hanne Kronborg
- Department of Public Health, Section of Nursing, University of Aarhus, Aarhus, Denmark
| | - Susanne Norby Bojesen
- Danish National Panel of Experts on Breastfeeding Infants with Special Needs, Copenhagen, Denmark
- Department of Neonatology, Copenhagen University Hospital Herlev, Herlev, Denmark
| | - Karin Hallum
- Danish National Panel of Experts on Breastfeeding Infants with Special Needs, Copenhagen, Denmark
- Department of Neonatology, Viborg Regional Hospital, Viborg, Denmark
| | - Annemi Frandsen
- Danish National Panel of Experts on Breastfeeding Infants with Special Needs, Copenhagen, Denmark
- Paediatric Department, Holbaek University Hospital, Holbaek, Denmark
| | - Anne Kyhnaeb
- Danish National Panel of Experts on Breastfeeding Infants with Special Needs, Copenhagen, Denmark
- Department of Neonatology, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Inge Svarer
- Danish National Panel of Experts on Breastfeeding Infants with Special Needs, Copenhagen, Denmark
- Department of Neonatology, Odense University Hospital, Odense, Denmark
| | - Inger Hallström
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
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