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Parker L. The need for high quality research regarding donor human milk supplementation in moderately-late preterm and early-term infants. Pediatr Res 2024:10.1038/s41390-024-03549-x. [PMID: 39242934 DOI: 10.1038/s41390-024-03549-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2024] [Accepted: 08/19/2024] [Indexed: 09/09/2024]
Affiliation(s)
- Leslie Parker
- Department of Biobehavioral Nursing Science, University of Florida College of Nursing, Health Professions Nursing and Pharmacy Building, Gainesville, FL, USA.
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Parker LA. Use of Donor Human Milk in Populations Other than Preterm Very Low Birthweight Infants: Where Are We Now? J Perinat Neonatal Nurs 2024; 38:238-240. [PMID: 39074319 DOI: 10.1097/jpn.0000000000000854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/31/2024]
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Gartley T, Bass J, Kleinman R. Perspective: Supporting Maternal Efforts to Provide Optimal Infant Nutrition in the Post-Partum Setting. Adv Nutr 2024; 15:100183. [PMID: 38309530 PMCID: PMC10907527 DOI: 10.1016/j.advnut.2024.100183] [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: 11/28/2023] [Revised: 01/26/2024] [Accepted: 01/26/2024] [Indexed: 02/05/2024] Open
Abstract
Supporting optimal newborn nutrition and the positive maternal-infant relationship while encouraging safe sleep practices are essential components of maternal and newborn care in the hospital setting following birth. Breastfeeding is widely recognized as the best practice to support the nutritional needs and well-being of the infant, and recommendations have been developed by the WHO, the American Academy of Pediatrics (AAP), and the United States Centers for Disease Control to encourage and successfully support breastfeeding efforts before hospital discharge. The 10 Steps to Successful Breastfeeding, developed and promoted by the WHO, form the basis of the Baby-Friendly Hospital Initiative (BFHI) and have become the international framework for public health initiatives to promote breastfeeding. An evaluation of hospital performance implementing the 10 steps through the process of "Baby-Friendly Designation" (BFD) has been suggested by many breastfeeding advocates as the optimal pathway to attain the goals of the BFHI. However, the WHO has recognized that BFD may not be an appropriate goal in all settings, and indicated, as part of their updated 2018 guidance, that "facilities may make changes in their policies and procedures to obtain the designation, but these changes are not always sustainable, especially when there are no regular monitoring systems in place." In addition, unintended associated issues regarding newborn safety and maternal dissatisfaction with some of the 10 steps have emerged. This perspective discusses the challenges faced by hospitals attempting to implement the BFHI 10 steps and suggests potential solutions to make progress in those efforts with or without BFD and also the efforts needed to support formula feedings when appropriate.
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Affiliation(s)
- Tina Gartley
- Department of Pediatrics, Newton-Wellesley Hospital, Newton, MA, United States.
| | - Joel Bass
- Department of Pediatrics, Massachusetts General Hospital, Boston, MA, United States
| | - Ronald Kleinman
- Department of Pediatrics, Massachusetts General Hospital, Boston, MA, United States
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Jackson F, Obeng CS, Greene AR, Dennis BK, Wright BN. Untold Narratives: Perceptions of Human Milk Banking and Donor Human Milk Among Ghanaian Immigrant Women Living in the United States. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01860-7. [PMID: 37966692 DOI: 10.1007/s40615-023-01860-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 10/30/2023] [Accepted: 11/02/2023] [Indexed: 11/16/2023]
Abstract
BACKGROUND Donor human milk (DHM) though primarily administered in the NICU setting is increasingly being offered in well baby nurseries to promote exclusive breastfeeding. Despite the evidence supporting the use of DHM as a preferred supplement when mother's own milk (MOM) is unavailable or insufficient, foreign-born non-Hispanic black women are less likely to use DHM. Recognizing the cultural diversity and uniqueness among foreign-born non-Hispanic black communities in the USA, this exploratory study sought to understand perceptions of DHM and human milk banking (HMB) as well as factors influencing decision-making toward DHM among Ghanaian immigrant women living in the USA. METHODS Semi-structured interviews were conducted with 16 Ghanaian women living in the USA. Using a narrative thematic approach, interview transcripts were coded, analyzed, and organized into categories and themes. RESULTS Findings indicate mixed sentiments toward DHM/HMB among Ghanaian immigrant women. Regarding decision-making toward DHM utilization and donation, four themes were identified: (1) women's decision-making which is informed by external influences, (2) health provider's role in promoting human milk utilization, (3) the importance of addressing barriers to human milk utilization and donation, and (4) superstition and spirituality. CONCLUSIONS Maternal perceptions of DHM/HMB are influenced by individual-, interpersonal-, and community-level factors. It is imperative that health promotion efforts adopt multi-level approaches to addressing the disparities in DHM access and utilization as well as factors that impact milk donation in order to ensure optimum health outcomes for neonates of foreign-born non-Hispanic black populations.
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Affiliation(s)
- Frederica Jackson
- Department of Applied Health Science, Indiana University School of Public Health, Bloomington, IN, USA.
| | - Cecilia S Obeng
- Department of Applied Health Science, Indiana University School of Public Health, Bloomington, IN, USA
| | - Alison R Greene
- Department of Applied Health Science, Indiana University School of Public Health, Bloomington, IN, USA
| | - Barbara K Dennis
- W.W. Wright School of Education, Department of Counseling and Educational Psychology, Indiana University, Bloomington, IN, USA
| | - Brittanni N Wright
- Department of Applied Health Science, Center for Sexual Health Promotion, Indiana University School of Public Health, Bloomington, IN, USA
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Miller ER, Hudak ML. Medicaid and newborn care: challenges and opportunities. J Perinatol 2023; 43:1072-1078. [PMID: 37438483 DOI: 10.1038/s41372-023-01714-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 05/30/2023] [Accepted: 06/21/2023] [Indexed: 07/14/2023]
Abstract
Since its creation in 1965, Medicaid has operated as a federal-state partnership that provides a robust set of medical benefits to low-income families, including pregnant people and infants. In many ways, Medicaid has met its initial promise. However, medical benefits, provider payments, and key administrative procedures regarding eligibility, enrollment, and access to care vary substantially among state Medicaid programs. These variations have created profound inequities across states in the care of parents and children, particularly during pregnancy and in the postpartum and neonatal periods. Here we review select aspects of the Medicaid program pertinent to newborns and infants that contribute to eligibility and enrollment gaps, variations in benefits coverage and payment rates, and racial disparities in both access to healthcare and infant health outcomes. We outline a number of structural reforms of the Medicaid program that can improve newborn and infant access to care and outcomes and redress existing inequities.
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Affiliation(s)
- Emily R Miller
- Division of Neonatology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
- Department of Pediatrics, University of Cincinnati, Cincinnati, OH, USA.
| | - Mark L Hudak
- Department of Pediatrics, Division of Neonatology, University of Florida College of Medicine - Jacksonville, Jacksonville, FL, USA
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Neonatal abstinence syndrome and mother's own milk at discharge. J Perinatol 2022; 42:1044-1050. [PMID: 35725804 DOI: 10.1038/s41372-022-01430-5] [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: 06/24/2021] [Revised: 06/01/2022] [Accepted: 06/08/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To describe factors impacting receipt of mother's own milk (MOM) at discharge among California infants diagnosed with neonatal abstinence syndrome (NAS). STUDY DESIGN Cohort study of the California Perinatal Quality Care Collaborative's Maternal Substance Exposure Database for infants with NAS and gestational age ≥ 34 weeks from 2019 to 2020. RESULT 245 infants with NAS were identified. Variables with an increased likelihood of being discharged on MOM included maternal medication assisted treatment (p = 0.001), use of maternal addiction services (p < 0.001), receiving donor human milk (p = 0.001), being treated in the well baby unit (p < 0.001), rooming-in (p < 0.001), and kangaroo care (p < 0.001). Among infants with NAS for whom MOM was recommended (n = 84), rooming-in was the only factor associated with being discharged on MOM (p = 0.002); receiving formula was the only inversely associated factor (p < 0.001). CONCLUSION Results suggest supporting the mother-infant dyad and using non-pharmacologic treatment methods, such as rooming-in, increase receipt of MOM at discharge.
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Gray K, Ryan S, Churchill M, Harder VS. The Association Between Type of Supplementation in the Newborn Nursery and Breastfeeding Outcomes at 2 and 6 Months of Age. J Hum Lact 2022; 39:245-254. [PMID: 35730582 DOI: 10.1177/08903344221105810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Supplementation in the newborn nursery has been associated with shorter breastfeeding duration. However, supplementation may at times be necessary. RESEARCH AIM To determine the association between type of supplementation in the newborn nursery (mother's own milk, formula, donor human milk) and breastfeeding outcomes at 2 and 6 months of age. METHODS This was a prospective, longitudinal, observational multi-group cohort study. In total, 2,343 surveys were sent to parents who, prior to delivery, indicated intent to exclusively breastfeed. Participants were grouped by type of nursery supplementation. Surveys asked about breastfeeding outcomes when infants were 2 and 6 months old. Our final analytic sample included data from 1,111 healthy newborns ≥ 35 weeks. We used multiple logistic regression to compare future breastfeeding outcomes for infants who were exclusively directly breastfed or who received supplementation during their birth hospitalization. RESULTS Both the donor human milk and formula groups had decreased breastfeeding at 2 and 6 months compared to the exclusively directly breastfed group. Notably, for infants who received formula compared to donor human milk, the odds of breastfeeding at 2 and 6 months were 74% and 58% lower, respectively (OR = 0.26, 95% CI [0.12, 0.56] at 2 months; OR = 0.42, 95% CI [0.19, 0.94] at 6 months). The donor human milk group had lower odds of breastfeeding at both follow up times compared to the mother's own milk group. CONCLUSION Among those who intend to breastfeed, supplementation with donor human milk instead of formula in the newborn nursery may support longer breastfeeding.
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Affiliation(s)
- Karin Gray
- The Robert Larner, M. D. College of Medicine, University of Vermont, Burlington, VT, USA.,The University of Vermont Children's Hospital, University of Vermont Medical Center, Burlington, VT, USA
| | - Stephanie Ryan
- The Robert Larner, M. D. College of Medicine, University of Vermont, Burlington, VT, USA.,Legacy Randall Children's Hospital, Portland, OR, USA
| | - Martha Churchill
- The Robert Larner, M. D. College of Medicine, University of Vermont, Burlington, VT, USA
| | - Valerie S Harder
- The Robert Larner, M. D. College of Medicine, University of Vermont, Burlington, VT, USA
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Gomez J, Wardell D, Cron S, Hurst N. Relationship Between Maternal COVID-19 Infection and In-Hospital Exclusive Breastfeeding for Term Newborns. J Obstet Gynecol Neonatal Nurs 2022; 51:517-525. [PMID: 35661652 PMCID: PMC9120128 DOI: 10.1016/j.jogn.2022.05.002] [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] [Accepted: 05/10/2022] [Indexed: 12/01/2022] Open
Abstract
Objective To evaluate the relationship between maternal COVID-19 infection and the odds of in-hospital exclusive breastfeeding for term newborns. Design Retrospective descriptive quantitative. Setting A large, urban hospital with more than 6,000 births annually. Sample Term newborns born between March 1, 2020, and March 31, 2021 (N = 6,151). Methods We retrospectively extracted data from electronic health records to evaluate the relationship of maternal COVID-19 infection with the odds of in-hospital exclusive breastfeeding using univariate analysis and logistic regression models. The covariates included insurance type, race/ethnicity, glucose gel administration, length of stay, newborn gestational age, newborn birth weight, and maternal COVID-19 infection. Results Maternal COVID-19 infection was not significantly related to the odds of in-hospital exclusive breastfeeding (p = .138) after adjustment for covariates in the logistic regression model. However, when newborns who received pasteurized donor human milk supplementation were excluded from the logistic regression model, maternal COVID-19 infection significantly decreased the odds of in-hospital exclusive breastfeeding (p = .043). Conclusion Maternal COVID-19 infection was not significantly related to the odds of in-hospital exclusive breastfeeding when newborns received donor human milk supplementation. Access to donor human milk for supplementation for term newborns may protect the odds of in-hospital exclusive breastfeeding.
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US state policies for Medicaid coverage of donor human milk. J Perinatol 2022; 42:829-834. [PMID: 35379899 PMCID: PMC8979482 DOI: 10.1038/s41372-022-01375-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 12/22/2021] [Accepted: 03/17/2022] [Indexed: 01/23/2023]
Abstract
Donor human milk is recommended by the American Academy of Pediatrics for high-risk infants when mother's own milk is absent or insufficient in quantity. Several factors may contribute to the inequitable use of or access to donor human milk, including a limited knowledge of its effects, cost, reimbursement, and regulatory barriers. The American Academy of Pediatrics and the United States Surgeon General have called for investigating barriers that prevent use of donor human milk for high-risk infants and for changes to public policy known to improve availability and affordability. We review the current legislative, regulatory, and economic landscape surrounding donor human milk use in the United States, as well as suggest state- and federal-level solutions to increase access to donor human milk.
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