1
|
Schwab I, Dresbach T, Ohnhäuser T, Horenkamp-Sonntag D, Scholten N. Pressure to provide milk among mothers of very low birth weight infants: an explorative study. BMC Pregnancy Childbirth 2024; 24:134. [PMID: 38350865 PMCID: PMC10863276 DOI: 10.1186/s12884-024-06315-3] [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: 07/24/2023] [Accepted: 02/02/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND Pump-dependent mothers of very low birth weight (VLBW, < 1500g) infants experience specific challenges achieving sufficient milk supply in the neonatal intensive care unit (NICU) and are therefore less frequently able to achieve (exclusive) breast milk feeding. Stress due to the limitations on participating in the infant's care may contribute to this problem. Some explorative studies suggest that pressure to provide milk may be an additional stressor in mothers. However, the type of pressure to provide milk perceived by mothers of VLBW infants has rarely been examined. METHODS A retrospective and anonymous questionnaire was conducted with mothers of VLBW infants aged 6 to 24 months at the time of data collection. Quantitative data and written comments were used to examine the mothers' perceptions. Descriptive and bivariate tests (Spearman´s rho, Pearson's chi2) were performed to show correlations between pressure to provide breast milk, parental stress (PSS:NICU: role alteration subscale), milk volume, and maternal factors. Pressure to provide milk was measured through two self-developed single items to differentiate between internal and external pressures. RESULTS Data of n = 533 mothers of VLBW infants was analysed. More than 70% of the mothers agreed that they pressured themselves to provide milk for their infant. In contrast, 34% of the mothers agreed that they felt pressure from outside to provide milk. Higher milk volume 14 days post-partum was significantly correlated with higher internal (Spearman´s rho = 0.2017, p = 0.000) and higher external pressure to provide milk (Spearman´s rho = 0.2991; p = 0.000). Higher PSS:NICU parental role alteration scores were significantly correlated with more internal (Spearman´s rho = -0.2865, p = 0.000) and more external pressure to provide milk (Spearman´s rho = -0.1478; p = 0.002). Milk volume 14 days post-partum and the PSS:NICU were not significantly correlated (Spearman´s rho = -0.0190; p = 0.701). Qualitative analyses highlighted these results and enhanced the bidirectional relationships between maternal pressure to provide milk and milk volume. CONCLUSIONS Especially internal pressure to provide milk is perceived by many mothers, being mutually dependent on milk supply and parental stress. Pressure to provide milk may be an important factor to decrease maternal stress in the NICU and, therefore, lead to more positive pumping and breastfeeding experiences. More research and validated instruments are needed to adequately measure pressure to provide milk with its different psychological, social, and environmental dimensions.
Collapse
Affiliation(s)
- Isabella Schwab
- Institute of Medical Sociology, Health Services Research, and Rehabilitation Science, Health Services Research University of Cologne, Faculty of Medicine and University Hospital Cologne, Eupener Straße 129, Cologne, 50933, Germany.
| | - Till Dresbach
- Department of Neonatology and Pediatric Intensive Care, Children's Hospital, University of Bonn, Venusberg-Campus 1, Bonn, 53127, Germany
| | - Tim Ohnhäuser
- Institute of Medical Sociology, Health Services Research, and Rehabilitation Science, Health Services Research University of Cologne, Faculty of Medicine and University Hospital Cologne, Eupener Straße 129, Cologne, 50933, Germany
| | | | - Nadine Scholten
- Institute of Medical Sociology, Health Services Research, and Rehabilitation Science, Health Services Research University of Cologne, Faculty of Medicine and University Hospital Cologne, Eupener Straße 129, Cologne, 50933, Germany
| |
Collapse
|
2
|
Parker LA, Hoban R, Bendixen MM, Medina-Poeliniz C, Johnson TJ, Meier PP. Milk Biomarkers of Secretory Activation in Breast Pump-Dependent Mothers of Preterm Infants: An Integrative Review. Breastfeed Med 2024; 19:3-16. [PMID: 38241129 PMCID: PMC10818056 DOI: 10.1089/bfm.2023.0107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2024]
Abstract
Background: Lack of mother's own milk (MOM) at discharge from the neonatal intensive care unit (NICU) is a global problem and is often attributable to inadequate MOM volume. Evidence suggests that the origins of this problem are during the first 14 days postpartum, a time period that includes secretory activation (SA; lactogenesis II, milk coming in). Objectives: To describe and summarize evidence regarding use of MOM biomarkers (MBMs) as a measure of SA in pump-dependent mothers of preterm infants in the NICU and to identify knowledge gaps requiring further investigation. Methods: An integrative review was conducted using Whittemore and Knafl methodology incorporating the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) checklist. A search using electronic databases MEDLINE (through PubMed) and CINAHL (Cumulative Index to Nursing and Allied Health Literature) and reference lists of included articles was conducted. Results: Of the 40 articles retrieved, 6 met the criteria for inclusion. Results revealed the following five findings: (1) Achievement of SA defined by MBMs is delayed and/or impaired in mothers of preterm infants. (2) MBMs are associated with pumped MOM volume. (3) Achievement of SA defined by MBMs is associated with pumping frequency. (4) Delayed and/or impaired achievement of SA defined by MBMs may be exacerbated by maternal comorbidities. (5) There is a lack of consensus as to which MBM(s) and analysis techniques should be used in research and practice. Conclusions: MBMs hold tremendous potential to document and monitor achievement of SA in mothers of preterm infants, with multiple implications for research and clinical practice.
Collapse
Affiliation(s)
- Leslie A. Parker
- College of Nursing, University of Florida, Gainesville, Florida, USA
| | - Rebecca Hoban
- Department of Pediatrics, Seattle Children's Hospital, University of Washington, Seattle, Washington, USA
| | | | | | - Tricia J. Johnson
- Department of Health Systems Management, Rush University Medical Center, Chicago, Illinois, USA
| | - Paula P. Meier
- Department of Pediatrics and Nursing, Rush University Medical Center, Chicago, Illinois, USA
| |
Collapse
|
3
|
Levene I, Adams E. The Interaction of Early Exclusive Mother's Milk Feeding and Ethnic Background with Ultimate Feeding Outcomes After Very Preterm Birth. Breastfeed Med 2023; 18:842-848. [PMID: 37971374 DOI: 10.1089/bfm.2023.0150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
Background: Mothers of very preterm infants (born under 32 weeks' gestation) have specific lactation challenges. There is little literature related to the influences on exclusive maternal milk provision. Method: An observational cohort using prospectively entered clinical data in a single tertiary neonatal unit in the United Kingdom over a 2-year period 2019-2021. There were 112 infants born under 32 weeks' gestation who fulfilled inclusion criteria. Results: Average gestation was 27.9 ± 2.6 weeks at birth and 37.3 ± 3.3 at discharge. On day 4 after birth, 29% (31/107) received exclusive maternal milk. At discharge, 54% (60/112) received exclusive maternal milk. Exclusive maternal milk at day 4 was associated with exclusive maternal milk at discharge (adjusted relative risk 2.3, 95% confidence interval 1.5-3.6, p < 0.001). Mothers from "white other," Asian, and mixed/multiple ethnic backgrounds were more likely than white British mothers to give exclusive maternal milk at discharge. This association emerged only after adjustment for exclusive maternal milk at day 4 after birth. Conclusions: The association of minority ethnic background with feeding outcomes that has previously been noted in the United Kingdom general population was also found in this very preterm cohort. The relationship was strengthened after adjustment for exclusive maternal milk at day 4. This may suggest that establishing early milk supply is a universal barrier to later exclusive maternal milk in this population and that once milk supply is established, standard social and cultural experiences come to bear on infant feeding decisions.
Collapse
Affiliation(s)
- Ilana Levene
- Newborn Care, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, United Kingdom
| | - Eleri Adams
- Newborn Care, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, United Kingdom
| |
Collapse
|
4
|
Ajayi KV, Garney WR. Understanding the Domains of Experiences of Black Mothers with Preterm Infants in the United States: A Systematic Literature Review. J Racial Ethn Health Disparities 2023; 10:2453-2469. [PMID: 36199006 DOI: 10.1007/s40615-022-01425-0] [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: 08/03/2022] [Revised: 09/26/2022] [Accepted: 09/27/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To report the domains of Black mothers' experiences with preterm infants in the neonatal intensive care unit (NICU) and to determine the frameworks used. METHODS A systematic review of the literature using the PRISMA guideline was performed. An electronic database search of published literature between 2000 and 2022 was conducted based on predetermined search terms and parameters. RESULTS Twenty-seven articles met the inclusion and exclusion criteria. Eleven articles focused on feeding practices, ten reported on nursing/maternal care experiences, five reported mental health/social support, and only one focused on mother-infant relationships. Only five papers reported using any frameworks, comprising grounded theory framework (n = 2), theory of planned behavior (n = 1), research justice framework (n = 1), and the patient and public engagement protocol (n = 1). DISCUSSION A holistic approach to understanding the multifactorial experiences of Black mothers with preterm infants needs to be socio-culturally competent to ensure their diverse intersections and identities are accurately represented and understood. Rigorous research at the intersection of Black maternal health and the NICU hold promises for advancing maternal health equity in the United States.
Collapse
Affiliation(s)
- Kobi V Ajayi
- Department of Health Behavior, School of Public Health Texas A&M University, College Station, TX, 77843, USA.
- Laboratory for Community Health Evaluation and Systems Science, Department of Health Behavior, School of Public Health Texas A&M University, College Station, TX, 77843, USA.
| | - Whitney R Garney
- Department of Health Behavior, School of Public Health Texas A&M University, College Station, TX, 77843, USA
- Laboratory for Community Health Evaluation and Systems Science, Department of Health Behavior, School of Public Health Texas A&M University, College Station, TX, 77843, USA
| |
Collapse
|
5
|
Johnson TJ, Meier PP, Robinson DT, Suzuki S, Kadakia S, Garman AN, Patel AL. The Role of Work as a Social Determinant of Health in Mother's Own Milk Feeding Decisions for Preterm Infants: A State of the Science Review. CHILDREN (BASEL, SWITZERLAND) 2023; 10:416. [PMID: 36979974 PMCID: PMC10046918 DOI: 10.3390/children10030416] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 12/28/2022] [Accepted: 02/15/2023] [Indexed: 02/24/2023]
Abstract
In the United States, 10% of infants are born preterm (PT; <37 weeks gestational age) each year and are at higher risk of complications compared to full term infants. The burden of PT birth is borne disproportionately by Black versus non-Black families, with Black mothers significantly more likely to give birth to a PT infant. One proven strategy to improve short- and long-term health outcomes in PT infants is to feed mother's own milk (MOM; breast milk from the mother). However, mothers must make decisions about work and MOM provision following PT birth, and more time spent in paid work may reduce time spent in unpaid activities, including MOM provision. Non-Black PT infants are substantially more likely than Black PT infants to receive MOM during the birth hospitalization, and this disparity is likely to be influenced by the complex decisions mothers of PT infants make about allocating their time between paid and unpaid work. Work is a social determinant of health that provides a source of income and health insurance coverage, and at the same time, has been shown to create disparities through poorer job quality, lower earnings, and more precarious employment in racial and ethnic minority populations. However, little is known about the relationship between work and disparities in MOM provision by mothers of PT infants. This State of the Science review synthesizes the literature on paid and unpaid work and MOM provision, including: (1) the complex decisions that mothers of PT infants make about returning to work, (2) racial and ethnic disparities in paid and unpaid workloads of mothers, and (3) the relationship between components of job quality and duration of MOM provision. Important gaps in the literature and opportunities for future research are summarized, including the generalizability of findings to other countries.
Collapse
Affiliation(s)
- Tricia J. Johnson
- Department of Health Systems Management, Rush University, Chicago, IL 60612, USA
| | - Paula P. Meier
- College of Nursing, Rush University, Chicago, IL 60612, USA
- Department of Pediatrics, Rush University Medical Center, Chicago, IL 60612, USA
| | - Daniel T. Robinson
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Sumihiro Suzuki
- Department of Family and Preventive Medicine, Rush University Medical Center, Chicago, IL 60612, USA
| | - Suhagi Kadakia
- Department of Pediatrics, Rush University Medical Center, Chicago, IL 60612, USA
| | - Andrew N. Garman
- Department of Health Systems Management, Rush University, Chicago, IL 60612, USA
| | - Aloka L. Patel
- Department of Pediatrics, Rush University Medical Center, Chicago, IL 60612, USA
| |
Collapse
|
6
|
A quality improvement initiative to reduce necrotizing enterocolitis in high-risk neonates. J Perinatol 2023; 43:97-102. [PMID: 35915215 DOI: 10.1038/s41372-022-01476-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 07/14/2022] [Accepted: 07/21/2022] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Prompted by an acute increase in necrotizing enterocolitis (NEC) rates, we aimed to decrease the rate of stage 2 or greater NEC in infants born at <1500 grams or <30 weeks gestational age from 19.5% to less than 9.7% (a 50% reduction) within 18 months, without adversely affecting central line-associated bloodstream infection (CLABSI) rates. STUDY DESIGN We utilized Define, Measure, Analyze, Improve, and Control (DMAIC) as our improvement model. Informed by our key driver diagram and root cause analyses, six Plan-Do-Study-Act cycles were completed. RESULTS 147 infants in the QI initiative had a median gestational age of 28.1 weeks and a median birthweight of 1070 grams. NEC rates decreased from the QI baseline of 19.5% to 6% (p = 0.03). Oral care administration increased, and maximal gavage tube dwell time decreased. CONCLUSION NEC rates decreased during this QI initiative through a combination of multidisciplinary interventions aimed at reducing dysbiosis.
Collapse
|
7
|
Bhasin M, Nangia S, Kumar G, Parihar A, Goel S. Sequential interventions to maintain the safety and service provisions of human milk banking in India: keeping up with the call to action in response to the COVID-19 pandemic. Int Breastfeed J 2022; 17:85. [PMID: 36517901 PMCID: PMC9748401 DOI: 10.1186/s13006-022-00525-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 12/03/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND WHO recommends donor milk as the next best choice if Mothers' own milk (MOM) is unavailable. At our milk bank, during the COVID 19 pandemic, we observed a steep decline in the collection of donor milk, while Pasteurised Donor human milk (PDHM) demand increased. This called for active intervention. METHODS We employed the quasi-experimental quality improvement initiative. During September 2020 (baseline period) the team members identified modifiable bottlenecks and suggested interventions (using WhatsApp to increase follow up, telehealth and digital tools) which were implemented in October 2020 and the impact was evaluated till March 2021. The SMART aim was "to meet the demand (estimated as 15,000 ml/month) of donor milk for adjoining 80-bedded NICU". Process measures were; daily amount of donor milk collected, pasteurized donor milk disbursed to NICU, number of donors and frequency of donations. The balancing measure was that the collection of donor milk should not undermine the provision of freshly expressed MOM for babies. RESULTS Collection of donor milk increased by 180% from baseline during the Intervention phase. This was sustained throughout the sustenance phase (November 2020 and March 2021) with an average monthly collection of 16,500 ml. Strikingly, the increased follow-up of mothers with emphasis on MOM decreased the NICU's donor milk requirement from 13,300 ml (baseline) to 12,500 ml (intervention) to 8,300 ml (sustenance). Monitoring of daily MOM used in the NICU revealed a 32% surge from 20,000 ml (baseline) to 27,000 ml (intervention) sustained at 25,000 ml per month. CONCLUSION By improving the provisions of human milk banks, near-exclusive human milk feeding can be ensured even during the pandemic time.
Collapse
Affiliation(s)
- Maheshwar Bhasin
- Vatsalya Maatri Amrit Kosh, National Comprehensive Lactation Management Centre, Lady Hardinge Medical College, Connaught Circle, New Delhi, India
| | - Sushma Nangia
- Vatsalya Maatri Amrit Kosh, National Comprehensive Lactation Management Centre, Lady Hardinge Medical College, Connaught Circle, New Delhi, India.
- Department of Neonatology, Lady Hardinge Medical College, Kalawati Saran Children's Hospital, New Delhi, India.
| | - Gunjana Kumar
- Department of Neonatology, Lady Hardinge Medical College, Kalawati Saran Children's Hospital, New Delhi, India
| | - Abha Parihar
- Vatsalya Maatri Amrit Kosh, National Comprehensive Lactation Management Centre, Lady Hardinge Medical College, Connaught Circle, New Delhi, India
| | - Srishti Goel
- Department of Neonatology, Lady Hardinge Medical College, Kalawati Saran Children's Hospital, New Delhi, India
| |
Collapse
|
8
|
Parker MG, Stellwagen LM, Noble L, Kim JH, Poindexter BB, Puopolo KM. Promoting Human Milk and Breastfeeding for the Very Low Birth Weight Infant. Pediatrics 2021; 148:peds.2021-054272. [PMID: 34635582 DOI: 10.1542/peds.2021-054272] [Citation(s) in RCA: 86] [Impact Index Per Article: 28.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Provision of mother's own milk for hospitalized very low birth weight (VLBW) (≤1500 g) infants in the NICU provides short- and long-term health benefits. Mother's own milk, appropriately fortified, is the optimal nutrition source for VLBW infants. Every mother should receive information about the critical importance of mother's own milk to the health of a VLBW infant. Pasteurized human donor milk is recommended when mother's own milk is not available or sufficient. Neonatal health care providers can support lactation in the NICU and potentially reduce disparities in the provision of mother's own milk by providing institutional supports for early and frequent milk expression and by promoting skin-to-skin contact and direct breastfeeding, when appropriate. Promotion of human milk and breastfeeding for VLBW infants requires multidisciplinary and system-wide adoption of lactation support practices.
Collapse
Affiliation(s)
- Margaret G Parker
- Department of Pediatrics, Boston Medical Center, School of Medicine, Boston University, Boston, Massachusetts
| | - Lisa M Stellwagen
- University of California Health Milk Bank, San Diego, California.,Department of Pediatrics, University of California, San Diego, Health, San Diego, California
| | - Lawrence Noble
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York.,New York City Health + Hospitals/Elmhurst
| | - Jae H Kim
- Division of Neonatology, Perinatal Institute, Cincinnati Children's Hospital Medical Center and College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Brenda B Poindexter
- Children's Healthcare of Atlanta and School of Medicine, Emory University, Atlanta, Georgia
| | - Karen M Puopolo
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, and Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | |
Collapse
|
9
|
Patel AL, Johnson TJ, Meier PP. Racial and socioeconomic disparities in breast milk feedings in US neonatal intensive care units. Pediatr Res 2021; 89:344-352. [PMID: 33188286 PMCID: PMC7662724 DOI: 10.1038/s41390-020-01263-y] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 10/01/2020] [Accepted: 10/04/2020] [Indexed: 02/06/2023]
Abstract
Very low birth weight (VLBW; <1500 g birth weight) infants are substantially more likely to be born to black than to non-black mothers, predisposing them to potentially preventable morbidities that increase the risk for costly lifelong health problems. Mothers' own milk (MOM) may be considered the ultimate "personalized medicine" since milk composition and bioactive components vary among mothers and multiple milk constituents provide specific protection based on shared exposures between mother and infant. MOM feedings reduce the risks and associated costs of prematurity-associated morbidities, with the greatest reduction afforded by MOM through to NICU discharge. Although black and non-black mothers have similar lactation goals and initiation rates, black VLBW infants are half as likely to receive MOM at NICU discharge in the United States. Black mothers are significantly more likely to be low-income, single heads of household and have more children in the home, increasing the burden of MOM provision. Although rarely considered, the out-of-pocket and opportunity costs associated with providing MOM for VLBW infants are especially onerous for black mothers. When MOM is not available, the NICU assumes the costs of inferior substitutes for MOM, contributing further to disparate outcomes. Novel strategies to mitigate these disparities are urgently needed. IMPACT: Mother's own milk exemplifies personalized medicine through its unique biologic activity. Hospital factors and social determinants of health are associated with mother's own milk feedings for very low-birth-weight infants in the neonatal intensive care unit. Notably, out-of-pocket and opportunity costs associated with providing mother's own milk are borne by mothers. Conceptualizing mother's own milk feedings as an integral part of NICU care requires consideration of who bears the costs of MOM provision-the mother or the NICU?
Collapse
Affiliation(s)
- Aloka L. Patel
- grid.262743.60000000107058297Department of Pediatrics, Rush University Children’s Hospital, Chicago, IL USA
| | - Tricia J. Johnson
- grid.262743.60000000107058297Departments of Health Systems Management, Rush University, Chicago, IL USA
| | - Paula P. Meier
- grid.262743.60000000107058297Department of Pediatrics, Rush University Children’s Hospital, Chicago, IL USA ,grid.240684.c0000 0001 0705 3621College of Nursing, Rush University Medical Center, Chicago, IL USA
| |
Collapse
|
10
|
Carroll C, Booth A, Campbell F, Relton C. Qualitative evidence synthesis of values and preferences to inform infant feeding in the context of non-HIV transmission risk. PLoS One 2020; 15:e0242669. [PMID: 33259512 PMCID: PMC7707527 DOI: 10.1371/journal.pone.0242669] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 11/06/2020] [Indexed: 12/16/2022] Open
Abstract
Background Breastfeeding is recommended by many organisations, but feeding choices can take on complexity against a backdrop of a transmissible infection risk. The aim of this synthesis is to explore what is known about the values and preferences of pregnant women, mothers, family members and health practitioners, policy makers and providers (midwives) concerning feeding when there is a risk of Mother-to-Child transmission [MTCT] of an infectious disease (other than HIV/AIDS) to infants (0–2 years of age). Methods A qualitative evidence synthesis and GRADE CERQual assessment of relevant studies of values and preferences regarding infant feeding options in the context of non-HIV MTCT risk. Results The synthesis included eight qualitative studies. Four studies focussed on human T-cell lymphotropic virus type 1 (HTLV-1), three studies on Ebola, and one study on influenza vaccination. Mothers reported feeling sadness and guilt at not breastfeeding, while recognising that it was important for the health of their baby not to breastfeed. Mothers were reportedly appreciative of the provision of appropriate facilities, and the advice of those health professionals who knew about the diseases, but felt other professionals lacked knowledge about the transmission risk of conditions such as HTLV-1. All groups expressed concerns about social perceptions of not breastfeeding, as well as the alternatives. The evidence was coherent and relevant, but there were serious concerns about adequacy and methodological limitations, such as potential social desirability bias in some studies. Conclusions This synthesis describes the reported values and preferences of pregnant women, mothers, and others concerning feeding when there is a risk of Mother-to-Child transmission (MTCT) of an infectious disease (other than HIV/AIDS) to an infant when breastfeeding. However, the evidence in the peer-reviewed literature is limited both in quality and quantity.
Collapse
Affiliation(s)
- Christopher Carroll
- Health Economics & Decision Science Section, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, United Kingdom
- * E-mail:
| | - Andrew Booth
- Health Economics & Decision Science Section, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, United Kingdom
| | - Fiona Campbell
- Health Economics & Decision Science Section, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, United Kingdom
| | - Clare Relton
- Institute of Population Health Sciences, Queen Mary University of London, London, United Kingdom
| |
Collapse
|
11
|
Abstract
High-dose mother's own milk (MOM) feedings during the first 14 days post birth reduce the risk of necrotizing enterocolitis in very low birthweight (VLBW; <1500 g birthweight). However, high-dose MOM feedings are only possible if mothers provide sufficient quantities of MOM in a timely manner, and data indicate that the lack of MOM during the early post-birth period is a global problem. This paper reviews the modifiable and unmodifiable barriers to accessing adequate quantities of MOM during the early post-birth period and proposes evidence-based strategies to increase and improve the use of MOM during the neonatal intensive care unit (NICU) hospitalization with an emphasis on the critical first 2 weeks post birth.
Collapse
|
12
|
Brunton G, Webbe J, Oliver S, Gale C. Adding value to core outcome set development using multimethod systematic reviews. Res Synth Methods 2020; 11:248-259. [PMID: 31834675 DOI: 10.1002/jrsm.1391] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 11/25/2019] [Accepted: 12/04/2019] [Indexed: 11/10/2022]
Abstract
Trials evaluating the same interventions rarely measure or report identical outcomes. This limits the possibility of aggregating effect sizes across studies to generate high-quality evidence through systematic reviews and meta-analyses. To address this problem, core outcome sets (COS) establish agreed sets of outcomes to be used in all future trials. When developing COS, potential outcome domains are identified by systematically reviewing the outcomes of trials, and increasingly, through primary qualitative research exploring the experiences of key stakeholders, with relevant outcome domains subsequently determined through transdisciplinary consensus development. However, the primary qualitative component can be time consuming with unclear impact. We aimed to examine the potential added value of a qualitative systematic review alongside a quantitative systematic review of trial outcomes to inform COS development in neonatal care using case analysis methods. We compared the methods and findings of a scoping review of neonatal trial outcomes and a scoping review of qualitative research on parents', patients', and professional caregivers' perspectives of neonatal care. Together, these identified a wider range and greater depth of health and social outcome domains, some unique to each review, which were incorporated into the subsequent Delphi process and informed the final set of core outcome domains. Qualitative scoping reviews of participant perspectives research, used in conjunction with quantitative scoping reviews of trials, could identify more outcome domains for consideration and could provide greater depth of understanding to inform stakeholder group discussion in COS development. This is an innovation in the application of research synthesis methods.
Collapse
Affiliation(s)
- Ginny Brunton
- Faculty of Health Sciences, OntarioTech University, Oshawa, Ontario, Canada.,Evidence for Policy and Practice Information and Coordinating (EPPI-) Centre, UCL Institute of Education, University College London, London, UK
| | - James Webbe
- Neonatal Medicine, School of Public Health, Faculty of Medicine, Chelsea and Westminster Hospital Campus, Imperial College London, London, UK
| | - Sandy Oliver
- Evidence for Policy and Practice Information and Coordinating (EPPI-) Centre, UCL Institute of Education, University College London, London, UK.,Africa Centre for Evidence, Faculty of the Humanities, University of Johannesburg, Johannesburg, South Africa
| | - Chris Gale
- Neonatal Medicine, School of Public Health, Faculty of Medicine, Chelsea and Westminster Hospital Campus, Imperial College London, London, UK
| |
Collapse
|
13
|
|
14
|
Palmquist AEL, Perrin MT, Cassar-Uhl D, Gribble KD, Bond AB, Cassidy T. Current Trends in Research on Human Milk Exchange for Infant Feeding. J Hum Lact 2019; 35:453-477. [PMID: 31206310 DOI: 10.1177/0890334419850820] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Breastfeeding is critical for the healthy growth and development of infants. A diverse range of infant-feeding methods are used around the world today. Many methods involve feeding infants with expressed human milk obtained through human milk exchange. Human milk exchange includes human milk banking, human milk sharing, and markets in which human milk may be purchased or sold by individuals or commercial entities. In this review, we examine peer-reviewed scholarly literature pertaining to human milk exchange in the social sciences and basic human milk sciences. We also examine current position and policy statements for human milk sharing. Our review highlights areas in need of future research. This review is a valuable resource for healthcare professionals and others who provide evidence-based care to families about infant feeding.
Collapse
Affiliation(s)
- Aunchalee E L Palmquist
- 1 Department of Maternal and Child Health, Carolina Global Breastfeeding Institute, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Maryanne T Perrin
- 2 Department of Nutrition, University of North Carolina Greensboro, Greensboro, NC, USA
| | - Diana Cassar-Uhl
- 3 Maternal and Child Health Program, School of Public Health, University of Maryland, Cornwall, NY, USA
| | - Karleen D Gribble
- 4 School of Nursing and Midwifery, Western Sydney University, Penrith, NSW, AUS
| | - Angela B Bond
- 5 Center for Evolution and Medicine, Arizona State University, Phoenix, AZ, USA
| | - Tanya Cassidy
- 6 Dublin City University, School of Nursing and Human Sciences, Glasnevin Campus, Dublin 9, Ireland
| |
Collapse
|
15
|
Abu Bakar SA, Muda SM, Mohd Arifin SR, Ishak S. Breast milk expression for premature infant in the neonatal intensive care unit: A review of mothers' perceptions. ENFERMERIA CLINICA 2019. [PMID: 31337573 DOI: 10.1016/j.enfcli.2019.06.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To identify the existing literature on mothers' perception towards the impact of expressing breast milk for their premature infant in the neonatal intensive care unit. METHOD Guided by the PRISMA Statement review checklist, a systematic review of the Scopus and Web of Science database has identified 10 related studies. The articles were assessed and analyzed after evaluated using The Joanna Briggs Institute Critical Appraisal tools (JBI). Thematic analysis was obtained after using Nvivo software as a tool for data analysis by author. RESULT Further review of these articles resulted in three main themes-maternal changes during expressing breast milk, pumping challenges and impact of motivation factors to initiating lactation. CONCLUSION Expressing breast milk should be recognized as an important way to restructure motherhood with a preterm infant in NICU. However, maintaining expressed breast milk during preterm infants' treatment period in NICU may increase stress and difficulties for some mothers. Some recommendations are emphasized in relation to the need for more qualitative studies in this issue, which is to have a specific and standard systematic review method for guide research synthesis in context of climate change adaptation.
Collapse
Affiliation(s)
| | - Siti Mariam Muda
- Kulliyyah of Nursing, International Islamic University, Pahang, Malaysia.
| | | | - Shareena Ishak
- Neonatal Intensive Care Unit, National University of Malaysia Medical Centre (UKMMC), Kuala Lumpur, Malaysia
| |
Collapse
|
16
|
Levene I, O'Brien F. Fifteen-minute consultation: Breastfeeding in the first 2 weeks of life-a hospital perspective. Arch Dis Child Educ Pract Ed 2019; 104:20-26. [PMID: 29848502 DOI: 10.1136/archdischild-2017-314633] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Revised: 04/21/2018] [Accepted: 04/29/2018] [Indexed: 11/04/2022]
Abstract
The beneficial health and economic impacts of breastfeeding are considerable. However the majority of babies in the UK are not exclusively breastfeeding by 6 weeks of age. The first few weeks of life are therefore a critical period to facilitate breastfeeding. Health professionals must have a thorough knowledge of normal breastfeeding patterns in order to minimise unnecessary interference, and an understanding of how to protect the breastfeeding relationship when medical problems occur.
Collapse
Affiliation(s)
- Ilana Levene
- Neonatal Unit, John Radcliffe Hospital, Oxford, UK
| | | |
Collapse
|
17
|
Improving Access to Lactation Consultation and Early Breast Milk Use in an Outborn NICU. Pediatr Qual Saf 2019; 4:e130. [PMID: 30937412 PMCID: PMC6426487 DOI: 10.1097/pq9.0000000000000130] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 11/26/2018] [Indexed: 11/26/2022] Open
Abstract
Introduction Increasing the use of breast milk in critically ill neonates is an important priority to improve neonatal care. Lactation consultants (LCs) educate mothers about evidence-based benefits of breast milk and provide technical support. LC support can lead to increased breastfeeding initiation. The project aim was to improve access to lactation services for mothers of patients admitted at <48 hours after birth to an exclusively outborn level III/IV neonatal intensive care unit (NICU). Methods The interventions included (1) implementation of an automatic electronic admission order for a lactation consult, (2) initiation of a daily lactation team notification, (3) assignment of a consistent NICU LC, and (4) targeted education. The percent of mothers who received lactation consults, the time to the first consultation, and the percent of patients receiving breast milk at 7 days of age were measured over 32 months and analyzed using statistical process control charts. Results The lactation consultation rate increased significantly from 74% to 88% with a shift in the mean by statistical process control chart analysis that was sustained over time. Concurrently, the time to first lactation consultation significantly decreased from hospital days 5 to 3.3, and variation decreased. Rates of breast milk use at 7 days of age also significantly increased from 75.6% to 89.6%. Conclusions Targeted quality improvement interventions led to an increased rate of lactation consultations, decreased time to first lactation consult, and increased rate of breast milk use at 7 days of age. These interventions could feasibly be implemented in similar referral NICU settings.
Collapse
|
18
|
Bagga N, Nadipineni R, Mohamed A, Poddutoor P, Chirla DK. A quality initiative to improve exclusive breast milk feeding in preterm neonates. Int J Pediatr Adolesc Med 2018; 5:131-134. [PMID: 30805548 PMCID: PMC6363261 DOI: 10.1016/j.ijpam.2018.12.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 11/26/2018] [Accepted: 12/06/2018] [Indexed: 11/09/2022]
Abstract
Background and Objective Preterm babies thrive well on exclusive breastfeeding with fewer complications. In a retrospective analysis, challenges were noticed in the form of delayed first milk expression and frequency of expression, which was limited to 2–3 times a day. A quality improvement initiative was designed to increase the exclusive breast milk feeding rates in admitted preterm babies. The purpose of the present study is to evaluate the proportion of preterm neonates receiving mother's own milk by day 7 of life after such an initiative. Methods The quality improvement initiative was conducted at a level 3 neonatal intensive care unit from May 10, 2018, to August 10, 2018. Inborn preterm neonates <34 weeks with a minimum hospital stay of 7 days were included. Neonates of critically sick mothers and neonates having major congenital malformations were excluded. Mothers were given structured antenatal counseling regarding expressing breast milk (EBM). Postnatal visits were conducted to provide information through a video and a leaflet and formation of breastfeeding support group. Results A total of 30 babies were recruited during a period of 3 months and compared to historical controls. The median age of the first EBM improved from 2.5 days to 1.16 days, and the amount of EBM on the first day improved from 0.24 ml to 2.6 ml (p = .002). The proportion of babies receiving EBM on the first day improved from 24% to 80% (p = .0001), and at the end of 7 days, it increased to 73% from 46% (p = .02). The factors time to reach full enteral feeds, time to regain birth weight, rate of necrotizing enterocolitis, rate of sepsis, and proportion of babies on exclusive mother's milk during discharge appear comparable in both the groups. Conclusions A simple quality improvement approach through the formation of breastfeeding support group, antenatal counseling, and postnatal support for breast milk expression has made a significant improvement in milk expression from mothers delivered prematurely. It reflects on a team approach using the available resources.
Collapse
Affiliation(s)
- Nitasha Bagga
- Neonatalogy, Rainbow Children's Hospital, Hyderabad, India
| | | | - Ashik Mohamed
- Ophthalmic Biophysics, L V Prasad Eye Institute, Hyderabad, India
| | | | | |
Collapse
|
19
|
Aydemir O, Cakık Saglık A, Sekili Z, Tekin AN. Employing a Nutrition Nurse in Neonatal Intensive Care Unit Improved Nutrition and Growth Outcomes in Preterm Neonates. Nutr Clin Pract 2018; 34:616-622. [DOI: 10.1002/ncp.10216] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Ozge Aydemir
- Department of Neonatology; Eskişehir Osmangazi University Faculty of Medicine; Eskişehir Turkey
| | - Adviye Cakık Saglık
- Department of Neonatology; Eskişehir Osmangazi University Faculty of Medicine; Eskişehir Turkey
| | - Zekiye Sekili
- Department of Neonatology; Eskişehir Osmangazi University Faculty of Medicine; Eskişehir Turkey
| | - Ayşe Neslihan Tekin
- Department of Neonatology; Eskişehir Osmangazi University Faculty of Medicine; Eskişehir Turkey
| |
Collapse
|
20
|
Campbell AG, Miranda PY. Breastfeeding Trends Among Very Low Birth Weight, Low Birth Weight, and Normal Birth Weight Infants. J Pediatr 2018; 200:71-78. [PMID: 29784514 DOI: 10.1016/j.jpeds.2018.04.039] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 04/03/2018] [Accepted: 04/17/2018] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To examine the change in breastfeeding behaviors over time, among low birth weight (LBW), very low birth weight (VLBW), and normal birth weight (NBW) infants using nationally representative US data. STUDY DESIGN Univariate statistics and bivariate logistic models were examined using the Early Child Longitudinal Study-Birth Cohort (2001) and National Study of Children's Health (2007 and 2011/2012). RESULTS Breastfeeding behaviors improved for infants of all birth weights from 2007 to 2011/2012. In 2011/2012, a higher percentage of VLBW infants were ever breastfed compared with LBW and NBW infants. In 2011/2012, LBW infants had a 28% lower odds (95% CI, 0.57-0.92) of ever breastfeeding and a 52% lower odds (95% CI, 0.38-0.61) of breastfeeding for ≥6 months compared with NBW infants. Among black infants, a larger percentage of VLBW infants were breastfed for ≥6 months (26.2%) compared with LBW infants (14.9%). CONCLUSIONS Breastfeeding rates for VLBW and NBW infants have improved over time. Both VLBW and NBW infants are close to meeting the Healthy People 2020 ever breastfeeding goal of 81.9%. LBW infants are farther from this goal than VLBW infants. The results suggest a need for policies that encourage breastfeeding specifically among LBW infants.
Collapse
|
21
|
Supports and Barriers to the Provision of Human Milk by Mothers of African American Preterm Infants. Adv Neonatal Care 2018; 18:179-188. [PMID: 29799821 DOI: 10.1097/anc.0000000000000477] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Mother's own milk (MOM) provides significant health benefits to very low birth-weight infants (VLBW, ≤1500 g). However, 60% of African American (AA) women initiate lactation, and less than 35% provide MOM 6 months following the birth of their infant. Previous research focuses on term infants and is not specific to AA mothers of VLBW infants. PURPOSE To qualitatively describe supports and barriers experienced by AA mothers while providing MOM for their VLBW infants. METHODS In this qualitative, descriptive study, we conducted semistructured interviews with AA mothers who provided MOM for their VLBW infant. Interviews were transcribed and manually coded concurrently with enrollment until theoretical saturation was achieved. Infant charts were reviewed for demographics, and triangulation with notes from the medical record by bedside nurse lactation consultants and other providers was performed to increase validity. Member checks were completed to ensure true meaning of responses. RESULTS Theoretical saturation was achieved after 9 interviews. Themes perceived to support provision of MOM included (1) Being a Mother; (2) Neonatal intensive care unit environment; (3) Community support; and (4) Useful resources. Themes that emerged as barriers to the provision of MOM were: (1) Maternal illness; (2) Milk expression; (3) Challenging home environment; and (4) Emotional distress. IMPLICATIONS FOR PRACTICE African American mothers report supports similar to published data but faced challenges not previously reported. These factors warrant attention by professionals who support lactation in this population. IMPLICATIONS FOR RESEARCH Future research will address perceived barriers to improve provision of MOM and the quality of the lactation journey of AA mothers of preterm infants.
Collapse
|
22
|
Karimi-Shahanjarini A, Rahmani F, Roshanei G, Mahdi Hazavehei SM. Assessment of Salient Beliefs Affecting Mothers' Intention to Adherence to Dietary Diversity in their Children's Complementary Feeding. Int J Prev Med 2017; 8:28. [PMID: 28479970 PMCID: PMC5404635 DOI: 10.4103/ijpvm.ijpvm_64_16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 02/21/2017] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Providing a variety of foods has been emphasized as one of the most important features of optimal complementary feeding. This study investigated key beliefs that guide mothers' intention to adherence to dietary diversity in their 1-2-year-old children's complementary feeding. METHODS This was a cross-sectional study involving 290 mothers (mean age = 27, standard deviation = 5.32) with child 1-2-year-old attending maternal and child health section of health centers in Rasht, Iran. To represent the socioeconomic status of the participants, 6 centers out of 15 were selected from three different socioeconomic areas (low-, middle-, and high-income areas). Mothers completed a questionnaire assessing intention and belief-based items of theory of planned behavior. Correlations and multiple regression analyses were performed. RESULTS The mean age of mothers was 27 ± 5.33 (27-43 years). Regression analyses revealed that among behavioral beliefs, the perception that adherence to dietary diversity would lead to improve children's growth was the significant predictor of intention (β = 0.13, P = 0.04). Regarding normative beliefs, perceived social pressure from health-care professionals to adherence to dietary diversity significantly predicted intention (β = 0.15, P = 0.01). Among control beliefs, the perception that daily pressures made difficult adherence to dietary diversity was the key determinant (β = 0.19, P = 0.01). CONCLUSIONS Findings of this study represent the important beliefs that can be addressed in development planning aimed at modifying mothers' child complementary feeding practices.
Collapse
Affiliation(s)
- Akram Karimi-Shahanjarini
- Department of Public Health, School of Public Health, Social Determinants of Health Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Fatemeh Rahmani
- Department of Public Health, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Ghodratollah Roshanei
- Department of Biostatistics, School of Public Health, Modeling of Noncommunicable Diseases Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Seyyed M Mahdi Hazavehei
- Department of Public Health, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
| |
Collapse
|
23
|
Abstract
This review will provide an overview of quality improvement methods that have been used to improve human milk use (mother's own milk and donor milk) for very low-birth-weight infants in the hospital setting in the last decade. We will review the following: (1) evidence-based practices known to increase mother's own milk for very low-birth-weight infants; (2) individual hospitals with exemplary lactation programs and past and current US-based statewide quality improvement collaboratives focused on increasing mother's own milk; and (3) existing quality metrics for human milk and gaps in metrics. Finally, we will provide practical examples of key driver diagrams and change concepts that may be used to inform quality improvement for mother's own milk for very low-birth-weight infants.
Collapse
Affiliation(s)
- Margaret G Parker
- Department of Pediatrics, Boston Medical Center, Boston University School of Medicine, 88 E Newton St, Vose Hall, 3rd Floor, Boston, MA 02118.
| | - Aloka L Patel
- Department of Pediatrics, Rush University Medical Center, Chicago, IL
| |
Collapse
|
24
|
Meier PP, Johnson TJ, Patel AL, Rossman B. Evidence-Based Methods That Promote Human Milk Feeding of Preterm Infants: An Expert Review. Clin Perinatol 2017; 44:1-22. [PMID: 28159199 PMCID: PMC5328421 DOI: 10.1016/j.clp.2016.11.005] [Citation(s) in RCA: 106] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Best practices translating the evidence for high-dose human milk (HM) feeding for preterm infants during neonatal intensive care unit (NICU) hospitalization have been described, but their implementation has been compromised. Although the rates of any HM feeding have increased over the last decade, efforts to help mothers maintain HM provision through to NICU discharge have remained problematic. Special emphasis should be placed on prioritizing the early lactation period of coming to volume so that mothers have sufficient HM volume to achieve their personal HM feeding goals. Donor HM does not provide the same risk reduction as own mother's HM.
Collapse
Affiliation(s)
- Paula P Meier
- Rush University Medical Center, 1653 West Congress Parkway, Chicago, IL 60612, USA.
| | - Tricia J Johnson
- Rush University Medical Center, 1653 West Congress Parkway, Chicago, IL 60612, USA
| | - Aloka L Patel
- Rush University Medical Center, 1653 West Congress Parkway, Chicago, IL 60612, USA
| | - Beverly Rossman
- Rush University Medical Center, 1653 West Congress Parkway, Chicago, IL 60612, USA
| |
Collapse
|
25
|
Rossman B, Meier PP, Janes JE, Lawrence C, Patel AL. Human Milk Provision Experiences, Goals, and Outcomes for Teen Mothers with Low-Birth-Weight Infants in the Neonatal Intensive Care Unit. Breastfeed Med 2017; 12:351-358. [PMID: 28557525 PMCID: PMC5512322 DOI: 10.1089/bfm.2017.0035] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
INTRODUCTION Breastfeeding rates are virtually unknown for teen mothers whose low-birth-weight (LBW; <2500 gm) infants are hospitalized in the neonatal intensive care unit (NICU). The objective was to examine the infant feeding experiences, goals, and outcomes of teen mothers of LBW infants. METHODS We conducted a multimethod study using a qualitative research design, survey, and infant medical records. The primary data source was individual interviews conducted with teen mothers of LBW infants hospitalized in a tertiary NICU. Content analysis and descriptive statistics were used for data analysis. RESULTS All 15 teen mothers (12 black, 3 Hispanic) wanted what was best for their infants and initiated lactation by breast pump. However, maintaining lactation was challenging and the following barriers were identified: fear of being judged; body image issues; influence of the maternal grandmother; and disorganized thought processes about combining pumping with returning to school or work. Despite these barriers, 50% of the teen mothers met their goals for human milk provision at NICU discharge. CONCLUSION Most of the teen mothers' lactation barriers reflected their adolescent developmental stage. Potential interventions are identified and include focus groups with teen mothers and maternal grandmothers and lactation support by NICU-based teen breastfeeding peer counselors.
Collapse
Affiliation(s)
| | - Paula P Meier
- 2 Department of Pediatrics, Rush University Children's Hospital , Chicago, Illinois.,3 Department of Pediatrics, Rush University Medical Center , Chicago, Illinois
| | - Judy E Janes
- 2 Department of Pediatrics, Rush University Children's Hospital , Chicago, Illinois
| | - Christie Lawrence
- 1 Rush University College of Nursing , Chicago, Illinois.,2 Department of Pediatrics, Rush University Children's Hospital , Chicago, Illinois
| | - Aloka L Patel
- 2 Department of Pediatrics, Rush University Children's Hospital , Chicago, Illinois.,3 Department of Pediatrics, Rush University Medical Center , Chicago, Illinois
| |
Collapse
|
26
|
Alves E, Magano R, Amorim M, Nogueira C, Silva S. Factors Influencing Parent Reports of Facilitators and Barriers to Human Milk Supply in Neonatal Intensive Care Units. J Hum Lact 2016; 32:695-703. [PMID: 27563012 DOI: 10.1177/0890334416664071] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Successful human milk supply in neonatal intensive care units (NICUs) requires the development of family-centered services. OBJECTIVE This study aimed to assess parent perceptions of factors that help or hinder providing human milk to very preterm infants (VPI) in the NICU according to sociodemographic, reproductive, and obstetric characteristics. METHODS This cross-sectional quantitative study included 120 mothers and 91 fathers of VPI hospitalized in a level 3 NICU located in the Northern Health Region of Portugal (July 2013-June 2014). Interviewers administered structured questionnaires regarding parent characteristics and the provision and perception of factors that help or hinder human milk supply in the NICU, 15 to 22 days after birth. RESULTS The main facilitators of human milk supply were its contribution to infant growth and well-being (51.4%) and parents' knowledge of breastfeeding benefits (27.6%). The main barriers were worries related to inadequate milk supply (35.7%), difficulties with expressing breast milk (24.8%), and physical separation from infants (24.3%). Fathers referred less frequently to the contribution of human milk to infant growth and well-being (odds ratio [OR] = 0.57; 95% confidence interval [CI], 0.32-1.00) but more frequently to knowledge of breastfeeding benefits as facilitators (OR = 2.31; 95% CI, 1.23-4.32). Participants with > 12 years of education (OR = 1.91; 95% CI, 1.05-3.47) and those with an extremely low birth weight infant (OR = 1.90; 95% CI, 1.02-3.54) highlighted worries related to inadequate milk supply. Fathers (OR = 2.16; 95% CI, 1.11-4.19) and participants with ≤ 12 years of education (OR = 0.25; 95% CI, 0.11-0.57) more frequently reported difficulties with expressing as the main barrier. CONCLUSION The parent's gender and education and the infant's birth weight are crucial considerations for establishing optimal practices for supporting breastfeeding.
Collapse
Affiliation(s)
- Elisabete Alves
- 1 ISPUP-EPIUnit, Universidade do Porto, Rua das Taipas, no. 135, 4050-600 Porto, Portugal
| | - Raquel Magano
- 2 Faculdade de Medicina, Universidade do Porto, Rua Doutor Plácido da Costa, 4200-450 Porto, Portugal
| | - Mariana Amorim
- 1 ISPUP-EPIUnit, Universidade do Porto, Rua das Taipas, no. 135, 4050-600 Porto, Portugal.,3 Global Public Health Doctoral Programme, Institute of Public Health of University of Porto, Porto, Portugal
| | - Conceição Nogueira
- 4 Center for Psychology at University of Porto, Faculty of Psychology and Educational Sciences of the University of Porto, Porto, Portugal
| | - Susana Silva
- 1 ISPUP-EPIUnit, Universidade do Porto, Rua das Taipas, no. 135, 4050-600 Porto, Portugal
| |
Collapse
|
27
|
Cricco-Lizza R. Infant Feeding Beliefs and Day-to-Day Feeding Practices of NICU Nurses. J Pediatr Nurs 2016; 31:e91-8. [PMID: 26601732 PMCID: PMC4769936 DOI: 10.1016/j.pedn.2015.10.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Revised: 10/16/2015] [Accepted: 10/17/2015] [Indexed: 10/22/2022]
Abstract
UNLABELLED The purpose is to examine the infant feeding beliefs and day-to-day feeding practices of NICU nurses with the goal of identifying ways to improve breastfeeding promotion. DESIGN AND METHODS An ethnographic approach incorporated 14 months of participant observation and interviewing. General informants consisted of 114 purposively selected NICU nurses from a northeastern, level-IV NICU, pediatric hospital. From this group, 18 nurses served as key informants. There was an average of 13 interactions with each key informant and 3.5 with each general informant. Audio taped interviews and observational field notes were gathered for descriptions of beliefs and practices. Data were coded and analyzed for patterns and themes with the aid of NUD*IST. RESULTS 1. The nurses identified health benefits of breastfeeding, but spoke in greater detail and with more emotion about day-to-day challenges of breastfeeding in the NICU. 2. Formula feeding evoked less emotion and most nurses viewed it as safe and convenient. 3. Despite infant feeding challenges in the NICU, nurses who had breastfeeding continuing education and/or some positive experiences with breastfeeding: identified evidence based breastfeeding benefits for mothers and babies; emphasized the health-based differences between breast milk and formula; and were more committed to working through difficulties with breastfeeding. CONCLUSIONS Breastfeeding promotion interventions should include every NICU nurse and incorporate both evidence-based and affective components to overcome day-to-day feeding practice challenges. PRACTICE IMPLICATIONS Breastfeeding promotion interventions must address conflicting and emotionally evocative infant feeding beliefs of NICU nurses. Effective interventions must be integrated within the realities of bedside feeding practices.
Collapse
|
28
|
Esquerra-Zwiers A, Rossman B, Meier P, Engstrom J, Janes J, Patel A. "It's Somebody Else's Milk": Unraveling the Tension in Mothers of Preterm Infants Who Provide Consent for Pasteurized Donor Human Milk. J Hum Lact 2016; 32:95-102. [PMID: 26590179 PMCID: PMC4959541 DOI: 10.1177/0890334415617939] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 10/22/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND Pasteurized donor human milk (DHM), rather than preterm infant formula, is recommended for premature infants when mother's milk is not available. OBJECTIVE This study explored the maternal decision-making process in providing consent for DHM feedings. METHODS In-depth semistructured interviews were conducted with 20 mothers of premature (mean gestational age = 27 weeks, birth weight = 942 grams) infants hospitalized in the neonatal intensive care unit (NICU) in this qualitative, descriptive study. Conventional content analysis was used to analyze the data. RESULTS Although only 1 mother had any previous knowledge of DHM, all mothers provided consent for DHM because they "wanted what is best for my baby." Mothers trusted that DHM was better than formula when their infant's feeding requirements exceeded their own milk supply. However, most mothers described a tension between wanting their infants to receive only "their" milk and DHM being "somebody else's milk." This desire to be the only provider of human milk was more common than concerns about the quality and safety of DHM. The mothers' tension was mediated by trusting the NICU clinicians' recommendations, having adequate time to make an informed decision, observing the positive outcomes of DHM, and feeling empowered that they made the best decision for their infant. CONCLUSION The experiences of these mothers reflect the importance of approaching mothers for consent only when DHM is needed, respecting mothers' beliefs and values about DHM, and providing help in mediating any tension with regard to their infants receiving "somebody else's milk."
Collapse
Affiliation(s)
- Anita Esquerra-Zwiers
- Department of Women, Children, and Family Nursing, Rush University, Chicago, IL, USA
| | - Beverly Rossman
- Department of Women, Children, and Family Nursing, Rush University, Chicago, IL, USA
| | - Paula Meier
- Department of Women, Children, and Family Nursing, Rush University, Chicago, IL, USA Pediatrics, Section of Neonatology, Rush University Medical Center, Chicago, IL, USA
| | - Janet Engstrom
- Department of Women, Children, and Family Nursing, Rush University, Chicago, IL, USA
| | - Judy Janes
- Pediatrics, Section of Neonatology, Rush University Medical Center, Chicago, IL, USA
| | - Aloka Patel
- Department of Women, Children, and Family Nursing, Rush University, Chicago, IL, USA Pediatrics, Section of Neonatology, Rush University Medical Center, Chicago, IL, USA
| |
Collapse
|
29
|
Tully KP, Holditch-Davis D, White-Traut RC, David R, O'Shea TM, Geraldo V. A Test of Kangaroo Care on Preterm Infant Breastfeeding. J Obstet Gynecol Neonatal Nurs 2016; 45:45-61. [PMID: 26815798 PMCID: PMC4730116 DOI: 10.1016/j.jogn.2015.10.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2015] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To test the effects of kangaroo care (KC) on breastfeeding outcomes in preterm infants compared with two control groups and to explore whether maternal-infant characteristics and the mother's choice to use KC were related to breastfeeding measures. DESIGN Secondary analysis of a multisite, stratified, randomized three-arm trial. The treatment groups used KC, auditory-tactile-visual-vestibular (ATVV) intervention, or received preterm infant care information. SETTING Neonatal intensive care units from 4 hospitals in the United States from 2006 to 2011. PARTICIPANTS Racially diverse mothers (N = 231) and their preterm infants born weighing less than 1,750 g. METHODS Mothers and their infants were enrolled once the infants were no longer critically ill, weighed at least 1,000 g, and could be safely held outside the incubator by parents. Participants were instructed by study nurses; those allocated to the KC or ATVV groups were asked to engage in these interactions with their infants for a minimum of 3 times a week in the hospital and at home until their infants reached age 2 months adjusted for prematurity. RESULTS Feeding at the breast during hospitalization, the duration of postdischarge breastfeeding, and breastfeeding exclusivity after hospital discharge did not differ statistically among the treatment groups. Regardless of group assignment, married, older, and more educated women were more likely to feed at the breast during hospitalization. Mothers who practiced KC, regardless of randomly allocated group, were more likely to provide their milk than those who did not practice KC. Breastfeeding duration was greatest among more educated women. CONCLUSION As implemented in this study, assignment to the KC group did not appear to influence the measured breastfeeding outcomes.
Collapse
|
30
|
Hallowell SG, Rogowski JA, Spatz DL, Hanlon AL, Kenny M, Lake ET. Factors associated with infant feeding of human milk at discharge from neonatal intensive care: Cross-sectional analysis of nurse survey and infant outcomes data. Int J Nurs Stud 2016; 53:190-203. [PMID: 26518107 PMCID: PMC4784116 DOI: 10.1016/j.ijnurstu.2015.09.016] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Revised: 09/26/2015] [Accepted: 09/29/2015] [Indexed: 02/01/2023]
Abstract
CONTEXT Nurses are principal caregivers in the neonatal intensive care unit and support mothers to establish and sustain a supply of human milk for their infants. Whether an infant receives essential nutrition and immunological protection provided in human milk at discharge is an issue of health care quality in this setting. OBJECTIVES To examine the association of the neonatal intensive care unit work environment, staffing levels, level of nurse education, lactation consultant availability, and nurse-reported breastfeeding support with very low birth weight infant receipt of human milk at discharge. DESIGN AND SETTING Cross sectional analysis combining nurse survey data with infant discharge data. PARTICIPANTS A national sample of neonatal intensive care units (N=97), nurses (N=5614) and very low birth weight infants (N=6997). METHODS Sequential multivariate linear regression models were estimated at the unit level between the dependent variable (rate of very low birth weight infants discharged on "any human milk") and the independent variables (nurse work environment, nurse staffing, nursing staff education and experience, lactation consultant availability, and nurse-reported breastfeeding support). RESULTS The majority of very low birth weight infants (52%) were discharged on formula only. Fewer infants (42%) received human milk mixed with fortifier or formula. Only 6% of infants were discharged on exclusive human milk. A 1 SD increase (0.25) in the Practice Environment Scale of the Nursing Work Index composite score was associated with a four percentage point increase in the fraction of infants discharged on human milk (p<0.05). A 1 SD increase (0.15) in the fraction of nurses with a bachelor's degree in nursing was associated with a three percentage point increase in the fraction infants discharged on human milk (p<0.05). The acuity-adjusted staffing ratio was marginally associated with the rate of human milk at discharge (p=.056). A 1 SD increase (7%) in the fraction of infants who received breastfeeding support was associated with an eight percentage point increase in the fraction of infants discharged on human milk (p<0.001). CONCLUSIONS Neonatal intensive care units with better work environments, better educated nurses, and more infants who receive breastfeeding support by nurses have higher rates of very low birth weight infants discharged home on human milk. Investments by nurse administrators to improve work environments and support educational preparation of nursing staff may ensure that the most vulnerable infants have the best nutrition at the point of discharge.
Collapse
Affiliation(s)
- Sunny G Hallowell
- Center for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing, Fagin Hall, 418 Curie Boulevard, Philadelphia, PA 19104-4217, United States; Leonard Davis Institute of Health Economics, University of Pennsylvania, Colonial Penn Center, 3641 Locust Walk, Philadelphia, PA 19104-6218, United States.
| | - Jeannette A Rogowski
- Rutgers School of Public Health, Rutgers, The State University of New Jersey, SPH-Center for Health Economics, 683 Hoes Lane West, Piscataway, NJ 08854-8021, United States; Leonard Davis Institute of Health Economics, University of Pennsylvania, Colonial Penn Center, 3641 Locust Walk, Philadelphia, PA 19104-6218, United States.
| | - Diane L Spatz
- University of Pennsylvania School of Nursing, Room 413, Fagin Hall, 418 Curie Boulevard, Philadelphia, PA 19104-4217, United States and The Children's Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104-5127, United States.
| | - Alexandra L Hanlon
- University of Pennsylvania School of Nursing, Room 479, Fagin Hall, 418 Curie Boulevard, Philadelphia, PA 19104-4217, United States.
| | - Michael Kenny
- Vermont Department of Health, Burlington District Office, 108 Cherry Street, Burlington, VT 05401-4295, United States.
| | - Eileen T Lake
- Center for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing, Room 302, Fagin Hall, 418 Curie Boulevard Room, Philadelphia, PA 10104-4217, United States; Leonard Davis Institute of Health Economics, University of Pennsylvania, Colonial Penn Center, 3641 Locust Walk, Philadelphia, PA 19104-6218, United States.
| |
Collapse
|
31
|
|
32
|
Hoban R, Bigger H, Patel AL, Rossman B, Fogg LF, Meier P. Goals for Human Milk Feeding in Mothers of Very Low Birth Weight Infants: How Do Goals Change and Are They Achieved During the NICU Hospitalization? Breastfeed Med 2015; 10:305-11. [PMID: 26110439 PMCID: PMC4523097 DOI: 10.1089/bfm.2015.0047] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Little is known about human milk (HM) feeding goals for mothers of very low birth weight (VLBW) (<1,500 g birth weight) infants, especially for black mothers, for whom rates of VLBW birth are higher and lactation rates lower. This study examined the establishment, modification, and achievement of HM feeding goals during neonatal intensive care unit (NICU) hospitalization for mothers of VLBW infants and the influence of maternal race and income. MATERIALS AND METHODS A prospective cohort study measured maternal HM feeding goals (exclusive [EHM], partial, none) predelivery and during three time intervals: day of life (DOL) 1-14, 15-28, and 29-72. Goal achievement compared the goal for the time interval with the proportion of HM feedings received by the infant. Goal establishment, modification, and achievement were examined using chi-squared and contingency tables. RESULTS Three hundred fifty-two mother-infant dyads (53% black; 70% low-income; mean birth weight, 1,048 g) were studied. Predelivery, 55% of mothers planned to provide EHM; fewer black and low-income mothers chose EHM. During DOL 1-14, 63% of mothers chose EHM, and predelivery racial differences disappeared. Only 10% of mothers chose exclusive at-breast EHM feedings. EHM feeding goals decreased during NICU hospitalization, especially for black mothers. Whereas most mothers met their HM feeding goals initially, achievement rates declined during hospitalization. Mothers' EHM goal achievement was not influenced by race or income. CONCLUSIONS Mothers changed their predelivery HM feeding goals after birth of a VLBW infant. Longitudinally, HM feeding goals and achievement reflected less HM use, highlighting the need to target lactation maintenance in this population.
Collapse
Affiliation(s)
- Rebecca Hoban
- 1 Section of Neonatology, Department of Pediatrics, Rush University Medical Center , Chicago, Illinois.,2 Department of Women, Children, and Family Nursing, Rush University Medical Center , Chicago, Illinois
| | - Harold Bigger
- 1 Section of Neonatology, Department of Pediatrics, Rush University Medical Center , Chicago, Illinois
| | - Aloka L Patel
- 1 Section of Neonatology, Department of Pediatrics, Rush University Medical Center , Chicago, Illinois.,2 Department of Women, Children, and Family Nursing, Rush University Medical Center , Chicago, Illinois
| | - Beverly Rossman
- 2 Department of Women, Children, and Family Nursing, Rush University Medical Center , Chicago, Illinois
| | - Louis F Fogg
- 2 Department of Women, Children, and Family Nursing, Rush University Medical Center , Chicago, Illinois
| | - Paula Meier
- 1 Section of Neonatology, Department of Pediatrics, Rush University Medical Center , Chicago, Illinois.,2 Department of Women, Children, and Family Nursing, Rush University Medical Center , Chicago, Illinois
| |
Collapse
|
33
|
Fugate K, Hernandez I, Ashmeade T, Miladinovic B, Spatz DL. Improving Human Milk and Breastfeeding Practices in the NICU. J Obstet Gynecol Neonatal Nurs 2015; 44:426-38; quiz E14-5. [DOI: 10.1111/1552-6909.12563] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
|
34
|
Kachoria R, Oza-Frank R. Trends in breastfeeding initiation in the NICU by gestational age in Ohio, 2006-2012. Birth 2015; 42:56-61. [PMID: 25594444 DOI: 10.1111/birt.12146] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/07/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND While breastfeeding in the United States is on the rise, trends among infants admitted to the Neonatal Intensive Care Unit (NICU) are less known. The objective of this study was to examine trends in breastfeeding initiation among NICU-admitted infants in Ohio from 2006 to 2012 and to determine differences in breastfeeding initiation trends by gestational age. METHODS Using Ohio Vital Statistics birth certificate data, the Cochran-Armitage test for trend was used to determine significant trends in breastfeeding by gestational age. Logistic regression was used to examine the association between breastfeeding initiation and gestational age by year. RESULTS From 2006 to 2012, 48,758 infants born in Ohio were admitted to the NICU, representing 5.6 percent of all newborns. Breastfeeding among NICU-admitted infants increased from 53.3 percent in 2006 to 63.8 percent in 2012 (p < 0.01). Increasing, significant trends in breastfeeding were also observed within each gestational age category over the 7 years. In 2011 and 2012, preterm infants were significantly more likely than term infants to be fed breastmilk in the NICU. DISCUSSION The gap between breastfeeding initiation among NICU-admitted and non-admitted infants appears to be narrowing, particularly for the most extreme gestational ages. While these increasing trends in breastfeeding among the most premature infants are encouraging, nearly 40 percent of mothers of term infants admitted to the NICU, the largest proportion of the NICU population, are still not initiating breastfeeding. More education and support specific to mothers of infants admitted to the NICU is needed.
Collapse
Affiliation(s)
- Rashmi Kachoria
- Center for Perinatal Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | | |
Collapse
|
35
|
Ikonen R, Liisa Aho A, Kaunonen M. Validity and reliability of breastfeeding advice and coping with breastfeeding instruments. Neonatal Netw 2014; 33:322-328. [PMID: 25391591 DOI: 10.1891/0730-0832.33.6.322] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
PURPOSE To pilot two instruments: Breastfeeding Advice and Coping with Breastfeeding in NICU settings. DESIGN Psychometric testing of the Breastfeeding Advice and Coping with Breastfeeding instruments. SAMPLE Mothers (N = 47) with singleton or twin preterm (≤36 + 6 gestation weeks) infant(s) (N = 55) at discharge collected from seven NICUs in Finland. MAIN OUTCOME VARIABLES The validity and reliability of two instruments: Breastfeeding Advice measuring the quality of breastfeeding counseling and Coping with Breastfeeding measuring the mothers' experienced ability to cope with breastfeeding issues. RESULTS Infants' mean gestation age was 32.5 weeks at birth. The items of the instruments were supported by previous studies, demonstrating content validity. There was a significant correlation (r = .72, p < .001) between Breastfeeding Advice and Coping with Breastfeeding, indicating constructor validity. Evidence for predictive validity was not found. Good reliability for internal consistency of the Breastfeeding Advice (Cronbach's α = .86) and Coping with Breastfeeding (Cronbach's α = .85) was found.
Collapse
|
36
|
Furthering our understanding of the needs of mothers who are pumping breast milk for infants in the NICU: an integrative review. Adv Neonatal Care 2014; 14:241-52. [PMID: 25075923 DOI: 10.1097/anc.0000000000000110] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The purpose of this integrative review was to uncover information regarding emotional and other types of support required by mothers providing breast milk for infants in the neonatal intensive care unit (NICU). These high-risk infants are often unable to directly breastfeed and, thus, mothers need to pump their breast milk for weeks to months, which can be both a pleasing experience that increases satisfaction and infant involvement, while at the same time being an uncomfortable and tiring endeavor. Understanding this notion is important because pumping at least 8 times each day is central to increasing or maintaining breast milk production. Articles were gathered using PubMed and CINAHL databases. Forty-four sources were chosen for inclusion in this review. Search terms included "breastfeeding," "pumping," "neonatal intensive care unit," "emotional support," and "breast milk." We identified that the emotional and practical support for NICU mothers is different from those of other breastfeeding mothers, especially around the development of early bonding behaviors. These mothers require significant ongoing emotional support from healthcare professionals and their partners and peers. Healthcare providers need to monitor breast milk production and provide educated encouragement that anticipates breastfeeding challenges, especially when the mother is pumping for an extended period of time while their infant is maturing in the NICU. Effective providers' support may be best provided by selectively bundling interventions to support pumping initiation and transition to direct breastfeeding.
Collapse
|
37
|
Oza-Frank R, Bhatia A, Smith C. Impact of peer counselors on breastfeeding outcomes in a nondelivery NICU setting. Adv Neonatal Care 2014; 14:E1-8. [PMID: 25000101 DOI: 10.1097/anc.0000000000000101] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Although the independent effects of lactation consultants and peer counselors have been shown to improve breastfeeding outcomes, the joint effects have yet to be considered, particularly in the neonatal intensive care unit (NICU) in nondelivery hospitals. Therefore, the objective of this study was to assess the effect of lactation staff type on breastfeeding outcomes during hospital stay after the addition of peer counselors to a NICU lactation program. SUBJECTS A total of 596 mother-infant pairs admitted to Nationwide Children's Hospital, Columbus, Ohio, pre- and postlactation program expansion. DESIGN A descriptive pre-/posttest study as conducted. MAIN OUTCOME MEASURES Differences in provision of any maternal breast milk, exclusive breast milk, or direct breastfeeding during NICU stay and at discharge were evaluated pre and postprogram implementation. Logistic regression was used to determine associations between lactation staff type and each outcome during hospital stay. RESULTS Infants receiving any breast milk during NICU stay increased from baseline to postprogram year 1 (63% vs 73%; P= 0.03). Direct breastfeeding increased from baseline to postprogram year 4 (42% vs 53%; P= 0.03). Mothers seen by only peer counselors were less likely to provide any breast milk at discharge, provide exclusive breast milk during stay or discharge, to be direct breastfeeding during stay or at discharge compared with mothers seen by both peer counselors and lactation consultants. CONCLUSIONS NICU lactation programs should consider including both peer counselors and lactation consultants to improve breastfeeding outcomes during hospital stay.
Collapse
|
38
|
Alves E, Rodrigues C, Fraga S, Barros H, Silva S. Parents' views on factors that help or hinder breast milk supply in neonatal care units: systematic review. Arch Dis Child Fetal Neonatal Ed 2013; 98:F511-7. [PMID: 23867708 DOI: 10.1136/archdischild-2013-304029] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To synthesise what is known about the parents' views on factors that help or hinder breast milk supply during their infants' hospitalisation in neonatal intensive care units (NICU). METHODS A systematic search of PubMed, ISI WoK, PsycINFO and SciELO, targeting studies presenting original empirical data that examined parents' perspectives regarding breast milk supply experiences in NICU, was performed. Based on content analysis, three independent researchers synthesised the findings of seven studies. Categories of facilitators and barriers were identified using quotations stated in the studies: parents' breast milk supply experience; parents-professionals relationships; characteristics of the NICU; and parents' social background and expectations. RESULTS The studies, five qualitative and two mixed methods, were published between 1994 and 2011. With heterogeneous study designs, fathers' perspectives were analysed in one article. Only one study defined breastfeeding. According to parents' perspectives, successful breast milk supply in NICU depends on coherent and accurate knowledge about its techniques and benefits, reinforcement of mothers' motivation and alignment between NICU's routines and parents' needs. Parents perceived issues related to their own current breast milk supply experience, simultaneously, as main facilitators and barriers. Parents-professionals relationship constituted the second group of facilitators, but the fourth of barriers. The characteristics of the NICU were more relevant as a barrier than as a facilitator. CONCLUSIONS Although parents' perspectives are grounded on individual child-focused experiences, their emphasis on learning and motivation guided by short-term goals opens room to the collective intervention of experts. This may facilitate the engagement of mothers, fathers and health professionals on family-centred care.
Collapse
Affiliation(s)
- Elisabete Alves
- Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, , Porto, Portugal
| | | | | | | | | |
Collapse
|
39
|
Meier PP, Engstrom JL, Rossman B. Breastfeeding peer counselors as direct lactation care providers in the neonatal intensive care unit. J Hum Lact 2013; 29:313-22. [PMID: 23563112 DOI: 10.1177/0890334413482184] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
In 2005, the Level III neonatal intensive care unit (NICU) at Rush University Medical Center initiated a demonstration project employing breastfeeding peer counselors, former parents of NICU infants, as direct lactation care providers who worked collaboratively with the NICU nurses. This article describes the conceptualization, implementation, and evaluation of this program and provides templates for other NICUs that wish to incorporate breastfeeding peer counselors with the goal of providing quality, evidence-based lactation care.
Collapse
Affiliation(s)
- Paula P Meier
- Rush University Medical Center, Chicago, IL 60612, USA.
| | | | | |
Collapse
|
40
|
Smith H, Embleton ND. Improving expressed breast milk (EBM) provision in the neonatal unit: A rapid and effective quality improvement (QI) intervention. ACTA ACUST UNITED AC 2013. [DOI: 10.1016/j.jnn.2013.02.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
41
|
Lutsiv O, Pullenayegum E, Foster G, Vera C, Giglia L, Chapman B, Fusch C, McDonald SD. Women's intentions to breastfeed: a population-based cohort study. BJOG 2013; 120:1490-8. [DOI: 10.1111/1471-0528.12376] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2013] [Indexed: 11/28/2022]
Affiliation(s)
- O Lutsiv
- Department of Epidemiology, Biostatistics and Occupational Health; McGill University; Montreal QC Canada
| | - E Pullenayegum
- Department of Clinical Epidemiology & Biostatistics; McMaster University; Hamilton ON Canada
- Centre for Evaluation of Medicines; St Joseph's Healthcare; Hamilton ON Canada
| | - G Foster
- Department of Clinical Epidemiology & Biostatistics; McMaster University; Hamilton ON Canada
- Biostatistics Unit; Father Sean O'Sullivan Research Centre; St Joseph's Healthcare; Hamilton ON Canada
| | - C Vera
- Departmento de Obstetricia y Ginecologia; Escuela de Medicina; Pontificia Universidad Catolica de Chile; Santiago Chile
| | - L Giglia
- Division of General Pediatrics; Department of Pediatrics; McMaster University; Hamilton ON Canada
| | - B Chapman
- Better Outcomes Registry and Network (BORN) Ontario (formerly OPSS); Ottawa ON Canada
| | - C Fusch
- Division of Neonatology; Department of Pediatrics; McMaster University; Hamilton ON Canada
| | - SD McDonald
- Department of Clinical Epidemiology & Biostatistics; McMaster University; Hamilton ON Canada
- Division of Maternal-Fetal Medicine; Departments of Obstetrics & Gynecology and Diagnostic Imaging; McMaster University; Hamilton ON Canada
| |
Collapse
|
42
|
Meier PP, Patel AL, Bigger HR, Rossman B, Engstrom JL. Supporting breastfeeding in the neonatal intensive care unit: Rush Mother's Milk Club as a case study of evidence-based care. Pediatr Clin North Am 2013. [PMID: 23178066 DOI: 10.1016/j.pcl.2012.10.007] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The translation of the evidence for the use of human milk (HM) in the neonatal intensive care unit (NICU) into best practices, toolkits, policies and procedures, talking points, and parent information packets is limited, and requires use of evidence-based quality indicators to benchmark the use of HM, consistent messaging by the entire NICU team about the importance of HM for infants in the NICU, establishing procedures that protect maternal milk supply, and incorporating lactation technologies that take the guesswork out of HM feedings and facilitate milk transfer during breastfeeding.
Collapse
Affiliation(s)
- Paula P Meier
- Department of Pediatrics, Section of Neonatology, Rush University Medical Center, Chicago, IL 60612, USA.
| | | | | | | | | |
Collapse
|
43
|
Padovani FHP, Duarte G, Martinez FE, Linhares MBM. Perceptions of Breastfeeding in Mothers of Babies Born Preterm in Comparison to Mothers of Full-Term Babies. SPANISH JOURNAL OF PSYCHOLOGY 2013; 14:884-98. [DOI: 10.5209/rev_sjop.2011.v14.n2.35] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The purpose of the present study was: a) to describe the theme of verbalizations about breastfeeding in mothers' pre-term (M-PT) and full-term (M-FT) infants; b) to examine the association between these themes and mother's anxiety and depression indicators and socio-demographic characteristics and, neonatal characteristics of the infants. The sample consisted of 50 M-PT and 25 M-FT. The mothers were assessed through State-Trait Anxiety Inventory and Beck Depression Inventory and were interviewed using a Guide focusing breastfeeding issues. The M-PT group had significantly more mothers with clinical symptom of anxiety than the M-FT group. The M-PT reported more uncertainties and worries about breastfeeding and figured out more obstacles for the successful breastfeeding than the M-FT. These reports were associated positively with the infants' risk neonatal status; lower birth-weight, higher neonatal clinical risk, and more length time stay in NICU were associated with more mothers' worries and seeing obstacles for breastfeeding. In conclusion, the strategies to enhance the breastfeeding rate in the preterm population have to take into account the mothers' psychological status and their ideas in addition to offering information about the advantages of breastfeeding for child development.
Collapse
|
44
|
Ra JS, Chae SM. Breastfeeding Knowledge, Attitude, and Nursing Practice of Nurses in Neonatal Intensive Care Units. CHILD HEALTH NURSING RESEARCH 2013. [DOI: 10.4094/chnr.2013.19.2.76] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Jin-Suk Ra
- College of Nursing, Chungnam National University, Daejeon, Korea
| | - Sun-Mi Chae
- College of Nursing & The Research Institute of Nursing Science, Seoul National University, Seoul, Korea
| |
Collapse
|
45
|
Mothers' experiences expressing breast milk for their preterm infants: does NICU design make a difference? Adv Neonatal Care 2012. [PMID: 23187646 DOI: 10.1097/anc.0b013e318265b299] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE This study examined differences in outcomes of provision of mothers' milk before and after implementation of a single-family room (SFR) neonatal intensive care unit (NICU) and described issues related to long-term milk expression. SAMPLE The sample included 40 mothers (15 in the original NICU and 25 in the SFR NICU). DESIGN Descriptive comparative. METHODS Mothers were recruited 2 months before and 3 months after opening an SFR NICU. Nutritional data were collected throughout hospitalization. Mothers used a milk expression diary during hospitalization and completed a survey, "My Experiences With Milk Expression" immediately before infant discharge. RESULTS Seventy-five percent of mothers planned to express breast milk or breastfeed before delivery. The majority of the mothers (55%) were most comfortable pumping in their own homes because of the increased privacy. There were no statistically significant differences between the 2 groups regarding the place where they were most comfortable pumping or where they usually pumped, although more mothers pumped in their babies' rooms in the SFR NICU. The majority of the mothers reported concern about their milk supply at some time during hospitalization and 47.5% reported having breast problems. At discharge, 71.8% of the total group was providing some breast milk and 44.7% of the total group was providing breast milk exclusively. There were no significant differences between the groups in outcomes concerning the provision of breast milk. CONCLUSIONS Individual mother's needs for privacy need to be determined and interventions to support mothers' feeding plans throughout hospitalization and at discharge need to be developed.
Collapse
|
46
|
Ward L, Auer C, Smith C, Schoettker PJ, Pruett R, Shah NY, Kotagal UR. The human milk project: a quality improvement initiative to increase human milk consumption in very low birth weight infants. Breastfeed Med 2012; 7:234-40. [PMID: 22612658 DOI: 10.1089/bfm.2012.0002] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Human milk has well-established health benefits for preterm infants. We conducted a multidisciplinary quality improvement effort aimed at providing at least 500 mL of human milk/kg in the first 14 days of life to very low birth weight (VLBW) (< 1,500 g) infants in the neonatal intensive care unit. SUBJECTS AND METHODS Improvement activities included antenatal consults with at-risk mothers, staff and parent education, a breast pump loaner program for uninsured/underinsured mothers, pump logs, establishment of a donor milk program, and twice-daily physician evaluation of infants' ability to tolerate feedings. RESULTS The number of infants receiving at least 500 mL of human milk/kg in their first 14 days of life increased from 50% to 80% within 11 months of implementation, and this increase has been sustained for 4 years. Infants who met the feeding goal because they received donor milk increased each year. Since September 2007, infants have received, on average, 1,111 mL of human milk/kg. Approximately 4% of infants did not receive any human milk. Respiratory instability was the most frequent physiological reason given by clinicians for not initiating or advancing feedings in the first 14 days of life. CONCLUSIONS Our quality improvement initiative resulted in a higher consumption of human milk in VLBW infants in the first 14 days of life. Other clinicians can use these described quality improvement methods and techniques to improve their VLBW babies' consumption of human milk.
Collapse
Affiliation(s)
- Laura Ward
- Division of Neonatology and Pulmonary Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | | | | | | | | | | | | |
Collapse
|
47
|
Rossman B, Engstrom JL, Meier PP, Vonderheid SC, Norr KF, Hill PD. "They've walked in my shoes": mothers of very low birth weight infants and their experiences with breastfeeding peer counselors in the neonatal intensive care unit. J Hum Lact 2011; 27:14-24. [PMID: 21173423 DOI: 10.1177/0890334410390046] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The effectiveness of the breastfeeding peer counselor role is thought to be embedded in the relationship between new and experienced mothers. In this study, new mothers of very low birth weight infants emphasized that one of the most important aspects of their relationship with the breastfeeding peer counselors is the peer or shared experience of how difficult it can be to provide milk and breastfeed while coping with the emotional stress of having an infant in the neonatal intensive care unit. This study provides evidence for the promotion and facilitation of lactation for mothers of neonatal intensive care unit infants through the use of breastfeeding peer counselors who are peers by virtue of the shared experience of providing milk for an infant hospitalized in the neonatal intensive care unit.
Collapse
Affiliation(s)
- Beverly Rossman
- Department of Women, Children, and Family Nursing, Rush University Medical Center College of Nursing, Armour Academic Center, 674 Driftwood Lane, Northbrook, IL 60062, USA
| | | | | | | | | | | |
Collapse
|
48
|
Taylor C, Gribble K, Sheehan A, Schmied V, Dykes F. Staff Perceptions and Experiences of Implementing the Baby Friendly Initiative in Neonatal Intensive Care Units in Australia. J Obstet Gynecol Neonatal Nurs 2011; 40:25-34. [DOI: 10.1111/j.1552-6909.2010.01204.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
|
49
|
Engstrom JL. Promoting and Supporting Breastfeeding: Health Care Providers Make a Difference. J Midwifery Womens Health 2010; 52:543-4. [DOI: 10.1016/j.jmwh.2007.09.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
50
|
Walker M. International Breastfeeding Initiatives and their Relevance to the Current State of Breastfeeding in the United States. J Midwifery Womens Health 2010; 52:549-55. [DOI: 10.1016/j.jmwh.2007.06.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|