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Santoli CMA, Taylor-Cho IA, Darling AJ, Montoya MN, Gilner JB, Wheeler SM, Dotters-Katz SK. Predictors of Breastfeeding among Patients Admitted with Preterm Prelabor Rupture of Membranes. Am J Perinatol 2024; 41:e3196-e3201. [PMID: 37967869 DOI: 10.1055/a-2211-1787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2023]
Abstract
OBJECTIVE We sought to describe rates of breastmilk feeding (BF) at hospital discharge and 6 weeks postpartum and to identify risk factors for noninitiation or cessation among pregnancies complicated by preterm prelabor rupture of membranes (PPROM). STUDY DESIGN Retrospective cohort study of pregnant persons with PPROM admitted to a single tertiary center (2013-2019). Patients with deliveries complicated by intrauterine or neonatal demise or with incomplete BF data were excluded. Demographic, antepartum, and delivery characteristics were evaluated. Primary analysis identified rate of BF initiation at maternal discharge and factors associated with noninitiation. Secondary analysis evaluated BF continuation and factors associated with cessation at 6 weeks postpartum. Bivariate statistics were used to compare characteristics and logistic regression was used to estimate adjusted odds ratios (aOR). RESULTS Of 397 patients with PPROM, 342(86%) initiated BF prior to discharge. Those reporting tobacco use in pregnancy were less likely to initiate BF (aOR: 0.32; 95% confidence interval [CI]: 0.16, 0.64). In contrast, private insurance (aOR: 2.53; 95% CI: 1.19, 5.37) and pregnancy latency ≥ 14 days (aOR: 3.02; 95% CI: 1.09, 8.38) were associated with BF initiation at hospital discharge. Of the 293 patients with postpartum follow-up, only 214 (73%) had BF continuation at 6 weeks postpartum. Maternal age <20 years (aOR: 0.07; 95% CI: 0.01, 0.68) and multiparity (aOR: 0.54; 95% CI: 0.29, 0.99) were associated with BF cessation. Patients with private insurance were observed to have increased odds of BF continuation (aOR: 2.10; 95% CI: 1.07, 4.12). CONCLUSION Among patients with PPROM, tobacco use may be associated with noninitiation of BF prior to discharge, whereas age < 20 years and multiparity were associated with cessation by 6 weeks postpartum. Longer pregnancy latency ≥ 14 days was associated with BF initiation prior to discharge. Private insurance was associated with increased rates of BF initiation and continuation postpartum. BF education and support should be offered to all patients admitted for PPROM. KEY POINTS · Tobacco use may be associated with BF noninitiation.. · Young age and multiparity are linked with BF cessation.. · Private insurance resulted in BF initiation and continuation..
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Affiliation(s)
- Carmen M A Santoli
- Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, North Carolina
| | - Ian A Taylor-Cho
- Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, North Carolina
| | - Alice J Darling
- Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, North Carolina
| | - Melissa N Montoya
- Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, North Carolina
| | - Jennifer B Gilner
- Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, North Carolina
| | - Sarahn M Wheeler
- Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, North Carolina
| | - Sarah K Dotters-Katz
- Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, North Carolina
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Boone N, Bohara B, Rohrer A, Gros M, Gregoski MJ, Lee K, Wagner CL, Chetta K. Multi-prong quality improvement approach for increasing mother's own milk use for very low birth weight infants. J Perinatol 2024; 44:671-679. [PMID: 38123800 DOI: 10.1038/s41372-023-01835-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 11/08/2023] [Accepted: 11/16/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVE Evaluate a single center quality improvement (QI) collaborative designed to increase the provision of mother's own milk (MOM) at discharge to premature infants through evidence-based practices while targeting perinatal health disparities. DESIGN This QI initiative was designed for preterm infants admitted to a single-center NICU within 24 h of life. Interventions were implemented between March 2022 and June 2022. MOM provision rates were compared between baseline (August 2021-February 2022), and after interventions (March 2022-December 2022). RESULTS The percentage of mothers who discontinued pumping during the infant hospitalization decreased from 49% to 35% (p < 0.01). Infant discharge diet with MOM improved from 36% to 58% (p < 0.001). Pump frequency at two weeks increased from 4.0 ± 2.6 to 5.1 ± 2.4 (p = 0.026). CONCLUSION Our collaborative increased the percentage of preterm infants receiving MOM at discharge and reduced the number of mothers who discontinue pumping during the NICU hospitalization.
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Affiliation(s)
- Neal Boone
- Division of Neonatology, Department of Pediatrics, Shawn Jenkins Children's Hospital, Medical University of South Carolina, Charleston, SC, USA.
| | - Beth Bohara
- Division of Neonatology, Department of Pediatrics, Shawn Jenkins Children's Hospital, Medical University of South Carolina, Charleston, SC, USA
| | - Allison Rohrer
- Department of Clinical Nutrition, Shawn Jenkins Children's Hospital, Medical University of South Carolina, Charleston, SC, USA
| | - Molly Gros
- Department of Lactation Services, Medical University of South Carolina, Charleston, SC, USA
| | - Mathew J Gregoski
- Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Kimberly Lee
- Division of Neonatology, Department of Pediatrics, Shawn Jenkins Children's Hospital, Medical University of South Carolina, Charleston, SC, USA
| | - Carol L Wagner
- Division of Neonatology, Department of Pediatrics, Shawn Jenkins Children's Hospital, Medical University of South Carolina, Charleston, SC, USA
- Darby Children's Research Institute, Medical University of South Carolina, Charleston, SC, USA
| | - Katherine Chetta
- Division of Neonatology, Department of Pediatrics, Shawn Jenkins Children's Hospital, Medical University of South Carolina, Charleston, SC, USA
- Darby Children's Research Institute, Medical University of South Carolina, Charleston, SC, USA
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Rosen-Carole CB, Greenman S, Wang H, Sonawane S, Misra R, O'Connor T, Järvinen K, D'Angio C, Young BE. Association between maternal stress and premature milk cortisol, milk IgA, and infant health: a cohort study. Front Nutr 2024; 11:1270523. [PMID: 38533463 PMCID: PMC10964987 DOI: 10.3389/fnut.2024.1270523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 02/06/2024] [Indexed: 03/28/2024] Open
Abstract
Background Maternal stress is pervasive in the neonatal intensive care unit (NICU). Maternal stress is associated with changes in human milk (HM) immunomodulatory agents, which may impact neonatal health. We sought to determine the association between maternal stress, HM immunoglobulin A (IgA) and cortisol, and to assess how these milk components correlate with infant immune and neurodevelopmental outcomes. We then compared how these associations persist over time. Methods The study design involved a cohort study of exclusively breastfeeding mothers and their singleton moderately preterm (28-34 weeks) infants admitted to the NICU. We collected maternal serum, maternal saliva, and first-morning whole milk samples, and administered maternal stress questionnaires at 1 and 5 weeks postpartum. We analyzed the samples for HM IgA (using a customized immunoassay in skim milk) and for HM and salivary cortisol (using a chemiluminescent immunoassay). Infant illness was assessed using the Score for Neonatal Acute Physiology II (SNAP II) and SNAP II with Perinatal Extension (SNAPPE II), and infant neurodevelopment were assessed using the Test of Infant Motor Performance. We analyzed changes in HM IgA and cortisol over time using paired t-tests. Furthermore, we performed correlation and regression analyses after adjusting for gestational age (GA), corrected GA, and infant days of life. Results In our study, we enrolled 26 dyads, with a mean maternal age of 28.1 years, consisting of 69% white, 19% Black, and 8% Hispanic. Cortisol: Salivary and HM cortisol were closely associated in week 1 but not in week 5. Though mean salivary cortisol remained stable over time [2.41 ng/mL (SD 2.43) to 2.32 (SD 1.77), p = 0.17], mean HM cortisol increased [1.96 ng/mL (SD 1.93) to 5.93 ng/mL (SD 3.83), p < 0.001]. Stress measures were inversely associated with HM cortisol at week 1 but not at week 5. IgA: HM IgA decreased over time (mean = -0.14 mg/mL, SD 0.53, p < 0.0001). High maternal stress, as measured by the Parental Stressor Scale: neonatal intensive care unit (PSS:NICU), was positively associated with HM IgA at week 5 (r = 0.79, P ≤ 0.001). Higher IgA was associated with a lower (better) SNAP II score at week 1 (r = -0.74, p = 0.05). No associations were found between maternal stress, salivary cortisol, HM cortisol, or HM IgA and neurodevelopment at discharge (as assessed using the TIMP score). Furthermore, these relationships did not differ by infant sex. Conclusion Maternal stress showed associations with HM cortisol and HM IgA. In turn, HM IgA was associated with lower measures of infant illness.
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Affiliation(s)
- Casey B. Rosen-Carole
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States
| | - Susan Greenman
- Swedish First Hill Family Medicine, Seattle, WA, United States
| | - Hongyue Wang
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States
| | - Sharvari Sonawane
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States
| | - Ravi Misra
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States
| | - Tom O'Connor
- Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States
| | - Kirsi Järvinen
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States
| | - Carl D'Angio
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States
| | - Bridget E. Young
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States
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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.
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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
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Jain S, Bansal A, Khurana S, Chawla D. Quality improvement initiative for a sustained increase in human milk donation during the hospital stay. BMJ Open Qual 2023; 12:e002133. [PMID: 37863506 PMCID: PMC10603414 DOI: 10.1136/bmjoq-2022-002133] [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: 10/06/2022] [Accepted: 10/05/2023] [Indexed: 10/22/2023] Open
Abstract
BACKGROUND The demand for donors' human milk is much more than the availability of the same due to the myriad challenges faced during the collection process. METHODS Baseline milk volume donation done in a human milk bank facility located in tertiary care government institute in a low-middle income country was assessed. It was initially aimed to increase the absolute quantity of milk volume donation by 30% over a period of 6 months, which was subsequently continued following COVID-19 emergence (over another 12 months) along with a particular emphasis on the sustenance of milk donation activities. INTERVENTIONS Counselling of both the healthcare workers and stakeholders, standardising the timing of milk donation and other policies, equipment in proportion to demand and supply and addition of human resource were done as a multiprong approach to have sustained increase in human milk donation. RESULTS The median control line (MCL) showed a shift of 27.8%; from a baseline of 5032 mL to 6971 mL during intervention phase I comprising of five plan do study act cycles spread over a period of 6 months. During the sustenance phase I even though the monthly collection was non-uniform, there was a further 16% upward shift in MCL to 8122 mL. During the second intervention phase, each component of the Ishikawa diagram was worked on (people, policy, place, procedure) resulting in a more than 100% increase from sustenance phase I taking the MCL to 17 181 mL with an overall increase of 3.41 times from the baseline. CONCLUSION Dedicated counselling and constant motivation have been conventionally considered as the utmost measure to increase milk volume donation in milk bank. Our study highlights the need to introduce scheduled timings along with sufficient equipment and manpower to overcome the shortage of milk donation in human milk bank facilities.
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Berns M, Bayramova S, Kusztrich A, Metze B, Bührer C. Trend over 25 years of risk factors of mother's own milk provision to very low birth weight infants at discharge. Early Hum Dev 2023; 177-178:105730. [PMID: 36822127 DOI: 10.1016/j.earlhumdev.2023.105730] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 02/11/2023] [Accepted: 02/12/2023] [Indexed: 02/18/2023]
Abstract
BACKGROUND Feeding mother's own milk (MOM) is associated with reduced morbidity of very low birth weight (VLBW) infants (<1500 g), but not all mothers are able to provide pumped breast milk or breastfeed until discharge. AIMS To investigate the duration of MOM feeding and identify risk factors for cessation. STUDY DESIGN Single-center retrospective cohort study. SUBJECTS 307 VLBW infants born 2012 and 2019 surviving beyond 7 days of life. OUTCOME MEASURES Analysis of MOM feeding at discharge, including comparison with a historical cohort of infants born 1992-1994. RESULTS MOM feeding was initiated in 178/180 infants (98.9 %) born in 2012 and in 123/127 infants (96.9 %) born in 2019 (p = 0.132), as compared to 73/89 (82 %) infants born 1992-1994 (p < 0.001). Median [range] duration of MOM feeding was similar for infants born in 2012 (45 [0-170] days) and 2019 (50 [0-190] days) (p = 0.396), but much longer than in the historical cohort (36 [0-152] days) (p < 0.001). The overall breastfeeding rate increased up to 69.2 % and 77.2 %. Factors associated with cessation of MOM feeding were smoking during pregnancy, single-mother status, short (<12 years) duration of maternal or paternal school education (all p ≤ 0.001), natural conception, birth weight ≥ 1000 g, and gestational age ≥ 29 weeks (p < 0.05). In Cox proportional hazard multivariate analysis, smoking during pregnancy and single-mother status remained independent risk factors. CONCLUSIONS Duration of MOM feeding and breastfeeding rates of VLBW infants during hospital stay have increased significantly during the last 30 years, while smoking and indicators of low socioeconomic status remain dominant predictors of cessation of MOM feeding.
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Affiliation(s)
- Monika Berns
- Department of Neonatology, Charité - Universitätsmedizin Berlin, Berlin, Germany.
| | - Sabahat Bayramova
- Department of Neonatology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Ariane Kusztrich
- Department of Neonatology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Boris Metze
- Department of Neonatology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Christoph Bührer
- Department of Neonatology, Charité - Universitätsmedizin Berlin, Berlin, Germany
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Pereira EL, Estabrooks PA, Arjona A, Cotton-Curtis W, Lin JCP, Saetermoe CL, Blackman KCA. A systematic literature review of breastfeeding interventions among Black populations using the RE-AIM framework. Int Breastfeed J 2022; 17:86. [PMID: 36528606 PMCID: PMC9758845 DOI: 10.1186/s13006-022-00527-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 10/15/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Lactation support resources are less likely to be located in close proximity to where Black families live and there is a systemic racist health care belief that Black women prefer bottle feeding (with infant formula) over breastfeeding. Together, these lead to lower reported breastfeeding rates of Black babies compared to other racial / ethnic groups. It is imperative to have a deeper understanding of the cultural aspects as well as the underlying limitations that prevent Black women / persons from being supported to breastfeed. There is a need to know how effective breastfeeding interventions are in reaching the intended population; how well they work in promoting breastfeeding initiation and continuation; and how successful they are when implemented at the setting and staff level. The purpose of this investigation was to establish the level of internal and external validity that was reported by breastfeeding intervention studies among Black communities. METHODS Studies on breastfeeding interventions on Black people that were published between the years 1990 and 2019 were carefully examined through PubMed, EBSCOhost, Web of Science, and OneSearch. A total of 31 studies fulfilled the requirements to be included for this evaluation. In order to extract the information from the articles, the reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) framework extraction tool was utilized. RESULTS On average, the proportion of studies that reported across reach, effectiveness, adoption, implementation, and maintenance indicators was 54, 35, 19, 48, and 9%, respectively. Across core RE-AIM indicators only sample size (100%) and breastfeeding outcomes (90%) were reported consistently. External validity indicators related to representativeness of participants (16%) and sites (3%) were rarely reported. Similarly, adherence to intervention protocol, and indicator of internal validity, was reported in a small proportion of articles (19%). CONCLUSION This body of literature under-reported on aspects associated to both internal and external validity across all RE-AIM domains. The reporting of the individual level of representativeness; the setting level of representativeness; the intervention's adherence to the protocol; the expenses; and the factors of sustainability would benefit from improvement in future research.
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Affiliation(s)
| | - Paul A Estabrooks
- Department of Health & Kinesiology, University of Utah, Salt Lake City, USA
| | - Alejandro Arjona
- Department of Family & Consumer Sciences, California State University Northridge, Northridge, USA
| | - Wyconda Cotton-Curtis
- Department of Health Sciences, California State University Northridge, Northridge, USA
| | - Judith C P Lin
- The Health Equity Research and Education Center, California State University Northridge, Northridge, USA
| | - Carrie L Saetermoe
- The Health Equity Research and Education Center, California State University Northridge, Northridge, USA
| | - Kacie C A Blackman
- Department of Health Sciences, California State University Northridge, Northridge, USA.
- The Health Equity Research and Education Center, California State University Northridge, Northridge, USA.
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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] [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.
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Affiliation(s)
- Maheshwar Bhasin
- grid.415723.60000 0004 1767 727XVatsalya Maatri Amrit Kosh, National Comprehensive Lactation Management Centre, Lady Hardinge Medical College, Connaught Circle, New Delhi, India
| | - Sushma Nangia
- grid.415723.60000 0004 1767 727XVatsalya Maatri Amrit Kosh, National Comprehensive Lactation Management Centre, Lady Hardinge Medical College, Connaught Circle, New Delhi, India ,grid.415723.60000 0004 1767 727XDepartment of Neonatology, Lady Hardinge Medical College, Kalawati Saran Children’s Hospital, New Delhi, India
| | - Gunjana Kumar
- grid.415723.60000 0004 1767 727XDepartment of Neonatology, Lady Hardinge Medical College, Kalawati Saran Children’s Hospital, New Delhi, India
| | - Abha Parihar
- grid.415723.60000 0004 1767 727XVatsalya Maatri Amrit Kosh, National Comprehensive Lactation Management Centre, Lady Hardinge Medical College, Connaught Circle, New Delhi, India
| | - Srishti Goel
- grid.415723.60000 0004 1767 727XDepartment of Neonatology, Lady Hardinge Medical College, Kalawati Saran Children’s Hospital, New Delhi, India
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Gavine A, Shinwell SC, Buchanan P, Farre A, Wade A, Lynn F, Marshall J, Cumming SE, Dare S, McFadden A. Support for healthy breastfeeding mothers with healthy term babies. Cochrane Database Syst Rev 2022; 10:CD001141. [PMID: 36282618 PMCID: PMC9595242 DOI: 10.1002/14651858.cd001141.pub6] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND There is extensive evidence of important health risks for infants and mothers related to not breastfeeding. In 2003, the World Health Organization recommended that infants be breastfed exclusively until six months of age, with breastfeeding continuing as an important part of the infant's diet until at least two years of age. However, current breastfeeding rates in many countries do not reflect this recommendation. OBJECTIVES 1. To describe types of breastfeeding support for healthy breastfeeding mothers with healthy term babies. 2. To examine the effectiveness of different types of breastfeeding support interventions in terms of whether they offered only breastfeeding support or breastfeeding support in combination with a wider maternal and child health intervention ('breastfeeding plus' support). 3. To examine the effectiveness of the following intervention characteristics on breastfeeding support: a. type of support (e.g. face-to-face, telephone, digital technologies, group or individual support, proactive or reactive); b. intensity of support (i.e. number of postnatal contacts); c. person delivering the intervention (e.g. healthcare professional, lay person); d. to examine whether the impact of support varied between high- and low-and middle-income countries. SEARCH METHODS We searched Cochrane Pregnancy and Childbirth's Trials Register (which includes results of searches of CENTRAL, MEDLINE, Embase, CINAHL, ClinicalTrials.gov, WHO International Clinical Trials Registry Platform (ICTRP)) (11 May 2021) and reference lists of retrieved studies. SELECTION CRITERIA Randomised or quasi-randomised controlled trials comparing extra support for healthy breastfeeding mothers of healthy term babies with usual maternity care. Support could be provided face-to-face, over the phone or via digital technologies. All studies had to meet the trustworthiness criteria. DATA COLLECTION AND ANALYSIS: We used standard Cochrane Pregnancy and Childbirth methods. Two review authors independently selected trials, extracted data, and assessed risk of bias and study trustworthiness. The certainty of the evidence was assessed using the GRADE approach. MAIN RESULTS This updated review includes 116 trials of which 103 contribute data to the analyses. In total more than 98,816 mother-infant pairs were included. Moderate-certainty evidence indicated that 'breastfeeding only' support probably reduced the number of women stopping breastfeeding for all primary outcomes: stopping any breastfeeding at six months (Risk Ratio (RR) 0.93, 95% Confidence Interval (CI) 0.89 to 0.97); stopping exclusive breastfeeding at six months (RR 0.90, 95% CI 0.88 to 0.93); stopping any breastfeeding at 4-6 weeks (RR 0.88, 95% CI 0.79 to 0.97); and stopping exclusive breastfeeding at 4-6 (RR 0.83 95% CI 0.76 to 0.90). Similar findings were reported for the secondary breastfeeding outcomes except for any breastfeeding at two months and 12 months when the evidence was uncertain if 'breastfeeding only' support helped reduce the number of women stopping breastfeeding. The evidence for 'breastfeeding plus' was less consistent. For primary outcomes there was some evidence that 'breastfeeding plus' support probably reduced the number of women stopping any breastfeeding (RR 0.94, 95% CI 0.91 to 0.97, moderate-certainty evidence) or exclusive breastfeeding at six months (RR 0.79, 95% CI 0.70 to 0.90). 'Breastfeeding plus' interventions may have a beneficial effect on reducing the number of women stopping exclusive breastfeeding at 4-6 weeks, but the evidence is very uncertain (RR 0.73, 95% CI 0.57 to 0.95). The evidence suggests that 'breastfeeding plus' support probably results in little to no difference in the number of women stopping any breastfeeding at 4-6 weeks (RR 0.94, 95% CI 0.82 to 1.08, moderate-certainty evidence). For the secondary outcomes, it was uncertain if 'breastfeeding plus' support helped reduce the number of women stopping any or exclusive breastfeeding at any time points. There were no consistent findings emerging from the narrative synthesis of the non-breastfeeding outcomes (maternal satisfaction with care, maternal satisfaction with feeding method, infant morbidity, and maternal mental health), except for a possible reduction of diarrhoea in intervention infants. We considered the overall risk of bias of trials included in the review was mixed. Blinding of participants and personnel is not feasible in such interventions and as studies utilised self-report breastfeeding data, there is also a risk of bias in outcome assessment. We conducted meta-regression to explore substantial heterogeneity for the primary outcomes using the following categories: person providing care; mode of delivery; intensity of support; and income status of country. It is possible that moderate levels (defined as 4-8 visits) of 'breastfeeding only' support may be associated with a more beneficial effect on exclusive breastfeeding at 4-6 weeks and six months. 'Breastfeeding only' support may also be more effective in reducing women in low- and middle-income countries (LMICs) stopping exclusive breastfeeding at six months compared to women in high-income countries (HICs). However, no other differential effects were found and thus heterogeneity remains largely unexplained. The meta-regression suggested that there were no differential effects regarding person providing support or mode of delivery, however, power was limited. AUTHORS' CONCLUSIONS: When 'breastfeeding only' support is offered to women, the duration and in particular, the exclusivity of breastfeeding is likely to be increased. Support may also be more effective in reducing the number of women stopping breastfeeding at three to four months compared to later time points. For 'breastfeeding plus' interventions the evidence is less certain. Support may be offered either by professional or lay/peer supporters, or a combination of both. Support can also be offered face-to-face, via telephone or digital technologies, or a combination and may be more effective when delivered on a schedule of four to eight visits. Further work is needed to identify components of the effective interventions and to deliver interventions on a larger scale.
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Affiliation(s)
- Anna Gavine
- Mother and Infant Research Unit, School of Health Sciences, University of Dundee, Dundee, UK
| | - Shona C Shinwell
- Mother and Infant Research Unit, School of Health Sciences, University of Dundee, Dundee, UK
| | | | - Albert Farre
- Mother and Infant Research Unit, School of Health Sciences, University of Dundee, Dundee, UK
| | - Angela Wade
- Centre for Paediatric Epidemiology and Biostatistics, Institute of Child Health, London, UK
| | - Fiona Lynn
- School of Nursing and Midwifery, Medical Biology Centre, Queen's University Belfast, Belfast, UK
| | - Joyce Marshall
- Division of Maternal Health, University of Huddersfield, Huddersfield, UK
| | - Sara E Cumming
- Mother and Infant Research Unit, School of Health Sciences, University of Dundee, Dundee, UK
- Mother and Infant Research Unit, University of Dundee, Dundee, UK
| | - Shadrach Dare
- Mother and Infant Research Unit, School of Health Sciences, University of Dundee, Dundee, UK
| | - Alison McFadden
- Mother and Infant Research Unit, School of Health Sciences, University of Dundee, Dundee, UK
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Lewis EL, Smoots AN, Woodworth KR, Olsen EO, Roth NM, Yazdy M, Shephard H, Sizemore L, Wingate H, Dzimira P, Reynolds B, Lush M, Fuchs EL, Ojo K, Siebman S, Hall AJ, Azziz-Baumgartner E, Perrine C, Hsia J, Ellington S, Tong VT, Gilboa SM. Breast Milk Feeding of Infants at Birth Among People With Confirmed SARS-CoV-2 Infection in Pregnancy: SET-NET, 5 States, March 29, 2020-December 31, 2020. Am J Public Health 2022; 112:S787-S796. [PMID: 36288521 PMCID: PMC9612185 DOI: 10.2105/ajph.2022.307023] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2022] [Indexed: 11/04/2022]
Abstract
Objectives. To describe prevalence of breast milk feeding among people with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection during pregnancy and examine associations between breast milk feeding, timing of maternal infection before delivery, and rooming-in status during delivery hospitalization. Methods. We performed a retrospective cohort study using data from Massachusetts, Minnesota, Nebraska, Pennsylvania, and Tennessee of whether people with confirmed SARS-CoV-2 infection during pregnancy in 2020 initiated breast milk feeding at birth. Results. Among 11 114 (weighted number) people with SARS-CoV-2 infection in pregnancy, 86.5% (95% confidence interval [CI] = 82.4%, 87.6%) initiated breast milk feeding during birth hospitalization. People with infection within 14 days before delivery had significantly lower prevalence of breast milk feeding (adjusted prevalence ratio [APR] = 0.88; 95% CI = 0.83, 0.94) than did those with infection at least 14 days before delivery. When stratified by rooming-in status, the association between timing of infection and breast milk feeding remained only among infants who did not room in with their mother (APR = 0.77; 95% CI = 0.68, 0.88). Conclusions. Pregnant and postpartum people with SARS-CoV-2 infection should have access to lactation support and be advised about the importance of breast milk feeding and how to safely feed their infants in the same room. (Am J Public Health. 2022;112(S8):S787-S796. https://doi.org/10.2105/AJPH.2022.307023).
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Affiliation(s)
- Elizabeth L Lewis
- Elizabeth L. Lewis, Ashley N. Smoots, Kate R. Woodworth, Emily O'Malley Olsen, Nicole M. Roth, Aron J. Hall, Eduardo Azziz-Baumgartner, Cria Perrine, Jason Hsia, Sascha Ellington, Van T. Tong, and Suzanne M. Gilboa are with the Centers for Disease Control and Prevention (CDC) COVID-19 Response, Atlanta, GA. Mahsa Yazdy and Hanna Shephard are with the Massachusetts Department of Public Health, Boston. Lindsey Sizemore and Heather Wingate are with the Tennessee Department of Health, Nashville. Paula Dzimira and Bethany Reynolds are with the Pennsylvania Department of Health, Pittsburgh. Mamie Lush is with the Division of Public Health, Nebraska Department of Health and Human Services, Lincoln. Erika L. Fuchs is with the Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, GA. Kristen Ojo and Sam Siebman are with the Minnesota Department of Health, St. Paul
| | - Ashley N Smoots
- Elizabeth L. Lewis, Ashley N. Smoots, Kate R. Woodworth, Emily O'Malley Olsen, Nicole M. Roth, Aron J. Hall, Eduardo Azziz-Baumgartner, Cria Perrine, Jason Hsia, Sascha Ellington, Van T. Tong, and Suzanne M. Gilboa are with the Centers for Disease Control and Prevention (CDC) COVID-19 Response, Atlanta, GA. Mahsa Yazdy and Hanna Shephard are with the Massachusetts Department of Public Health, Boston. Lindsey Sizemore and Heather Wingate are with the Tennessee Department of Health, Nashville. Paula Dzimira and Bethany Reynolds are with the Pennsylvania Department of Health, Pittsburgh. Mamie Lush is with the Division of Public Health, Nebraska Department of Health and Human Services, Lincoln. Erika L. Fuchs is with the Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, GA. Kristen Ojo and Sam Siebman are with the Minnesota Department of Health, St. Paul
| | - Kate R Woodworth
- Elizabeth L. Lewis, Ashley N. Smoots, Kate R. Woodworth, Emily O'Malley Olsen, Nicole M. Roth, Aron J. Hall, Eduardo Azziz-Baumgartner, Cria Perrine, Jason Hsia, Sascha Ellington, Van T. Tong, and Suzanne M. Gilboa are with the Centers for Disease Control and Prevention (CDC) COVID-19 Response, Atlanta, GA. Mahsa Yazdy and Hanna Shephard are with the Massachusetts Department of Public Health, Boston. Lindsey Sizemore and Heather Wingate are with the Tennessee Department of Health, Nashville. Paula Dzimira and Bethany Reynolds are with the Pennsylvania Department of Health, Pittsburgh. Mamie Lush is with the Division of Public Health, Nebraska Department of Health and Human Services, Lincoln. Erika L. Fuchs is with the Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, GA. Kristen Ojo and Sam Siebman are with the Minnesota Department of Health, St. Paul
| | - Emily O'Malley Olsen
- Elizabeth L. Lewis, Ashley N. Smoots, Kate R. Woodworth, Emily O'Malley Olsen, Nicole M. Roth, Aron J. Hall, Eduardo Azziz-Baumgartner, Cria Perrine, Jason Hsia, Sascha Ellington, Van T. Tong, and Suzanne M. Gilboa are with the Centers for Disease Control and Prevention (CDC) COVID-19 Response, Atlanta, GA. Mahsa Yazdy and Hanna Shephard are with the Massachusetts Department of Public Health, Boston. Lindsey Sizemore and Heather Wingate are with the Tennessee Department of Health, Nashville. Paula Dzimira and Bethany Reynolds are with the Pennsylvania Department of Health, Pittsburgh. Mamie Lush is with the Division of Public Health, Nebraska Department of Health and Human Services, Lincoln. Erika L. Fuchs is with the Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, GA. Kristen Ojo and Sam Siebman are with the Minnesota Department of Health, St. Paul
| | - Nicole M Roth
- Elizabeth L. Lewis, Ashley N. Smoots, Kate R. Woodworth, Emily O'Malley Olsen, Nicole M. Roth, Aron J. Hall, Eduardo Azziz-Baumgartner, Cria Perrine, Jason Hsia, Sascha Ellington, Van T. Tong, and Suzanne M. Gilboa are with the Centers for Disease Control and Prevention (CDC) COVID-19 Response, Atlanta, GA. Mahsa Yazdy and Hanna Shephard are with the Massachusetts Department of Public Health, Boston. Lindsey Sizemore and Heather Wingate are with the Tennessee Department of Health, Nashville. Paula Dzimira and Bethany Reynolds are with the Pennsylvania Department of Health, Pittsburgh. Mamie Lush is with the Division of Public Health, Nebraska Department of Health and Human Services, Lincoln. Erika L. Fuchs is with the Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, GA. Kristen Ojo and Sam Siebman are with the Minnesota Department of Health, St. Paul
| | - Mahsa Yazdy
- Elizabeth L. Lewis, Ashley N. Smoots, Kate R. Woodworth, Emily O'Malley Olsen, Nicole M. Roth, Aron J. Hall, Eduardo Azziz-Baumgartner, Cria Perrine, Jason Hsia, Sascha Ellington, Van T. Tong, and Suzanne M. Gilboa are with the Centers for Disease Control and Prevention (CDC) COVID-19 Response, Atlanta, GA. Mahsa Yazdy and Hanna Shephard are with the Massachusetts Department of Public Health, Boston. Lindsey Sizemore and Heather Wingate are with the Tennessee Department of Health, Nashville. Paula Dzimira and Bethany Reynolds are with the Pennsylvania Department of Health, Pittsburgh. Mamie Lush is with the Division of Public Health, Nebraska Department of Health and Human Services, Lincoln. Erika L. Fuchs is with the Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, GA. Kristen Ojo and Sam Siebman are with the Minnesota Department of Health, St. Paul
| | - Hanna Shephard
- Elizabeth L. Lewis, Ashley N. Smoots, Kate R. Woodworth, Emily O'Malley Olsen, Nicole M. Roth, Aron J. Hall, Eduardo Azziz-Baumgartner, Cria Perrine, Jason Hsia, Sascha Ellington, Van T. Tong, and Suzanne M. Gilboa are with the Centers for Disease Control and Prevention (CDC) COVID-19 Response, Atlanta, GA. Mahsa Yazdy and Hanna Shephard are with the Massachusetts Department of Public Health, Boston. Lindsey Sizemore and Heather Wingate are with the Tennessee Department of Health, Nashville. Paula Dzimira and Bethany Reynolds are with the Pennsylvania Department of Health, Pittsburgh. Mamie Lush is with the Division of Public Health, Nebraska Department of Health and Human Services, Lincoln. Erika L. Fuchs is with the Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, GA. Kristen Ojo and Sam Siebman are with the Minnesota Department of Health, St. Paul
| | - Lindsey Sizemore
- Elizabeth L. Lewis, Ashley N. Smoots, Kate R. Woodworth, Emily O'Malley Olsen, Nicole M. Roth, Aron J. Hall, Eduardo Azziz-Baumgartner, Cria Perrine, Jason Hsia, Sascha Ellington, Van T. Tong, and Suzanne M. Gilboa are with the Centers for Disease Control and Prevention (CDC) COVID-19 Response, Atlanta, GA. Mahsa Yazdy and Hanna Shephard are with the Massachusetts Department of Public Health, Boston. Lindsey Sizemore and Heather Wingate are with the Tennessee Department of Health, Nashville. Paula Dzimira and Bethany Reynolds are with the Pennsylvania Department of Health, Pittsburgh. Mamie Lush is with the Division of Public Health, Nebraska Department of Health and Human Services, Lincoln. Erika L. Fuchs is with the Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, GA. Kristen Ojo and Sam Siebman are with the Minnesota Department of Health, St. Paul
| | - Heather Wingate
- Elizabeth L. Lewis, Ashley N. Smoots, Kate R. Woodworth, Emily O'Malley Olsen, Nicole M. Roth, Aron J. Hall, Eduardo Azziz-Baumgartner, Cria Perrine, Jason Hsia, Sascha Ellington, Van T. Tong, and Suzanne M. Gilboa are with the Centers for Disease Control and Prevention (CDC) COVID-19 Response, Atlanta, GA. Mahsa Yazdy and Hanna Shephard are with the Massachusetts Department of Public Health, Boston. Lindsey Sizemore and Heather Wingate are with the Tennessee Department of Health, Nashville. Paula Dzimira and Bethany Reynolds are with the Pennsylvania Department of Health, Pittsburgh. Mamie Lush is with the Division of Public Health, Nebraska Department of Health and Human Services, Lincoln. Erika L. Fuchs is with the Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, GA. Kristen Ojo and Sam Siebman are with the Minnesota Department of Health, St. Paul
| | - Paula Dzimira
- Elizabeth L. Lewis, Ashley N. Smoots, Kate R. Woodworth, Emily O'Malley Olsen, Nicole M. Roth, Aron J. Hall, Eduardo Azziz-Baumgartner, Cria Perrine, Jason Hsia, Sascha Ellington, Van T. Tong, and Suzanne M. Gilboa are with the Centers for Disease Control and Prevention (CDC) COVID-19 Response, Atlanta, GA. Mahsa Yazdy and Hanna Shephard are with the Massachusetts Department of Public Health, Boston. Lindsey Sizemore and Heather Wingate are with the Tennessee Department of Health, Nashville. Paula Dzimira and Bethany Reynolds are with the Pennsylvania Department of Health, Pittsburgh. Mamie Lush is with the Division of Public Health, Nebraska Department of Health and Human Services, Lincoln. Erika L. Fuchs is with the Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, GA. Kristen Ojo and Sam Siebman are with the Minnesota Department of Health, St. Paul
| | - Bethany Reynolds
- Elizabeth L. Lewis, Ashley N. Smoots, Kate R. Woodworth, Emily O'Malley Olsen, Nicole M. Roth, Aron J. Hall, Eduardo Azziz-Baumgartner, Cria Perrine, Jason Hsia, Sascha Ellington, Van T. Tong, and Suzanne M. Gilboa are with the Centers for Disease Control and Prevention (CDC) COVID-19 Response, Atlanta, GA. Mahsa Yazdy and Hanna Shephard are with the Massachusetts Department of Public Health, Boston. Lindsey Sizemore and Heather Wingate are with the Tennessee Department of Health, Nashville. Paula Dzimira and Bethany Reynolds are with the Pennsylvania Department of Health, Pittsburgh. Mamie Lush is with the Division of Public Health, Nebraska Department of Health and Human Services, Lincoln. Erika L. Fuchs is with the Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, GA. Kristen Ojo and Sam Siebman are with the Minnesota Department of Health, St. Paul
| | - Mamie Lush
- Elizabeth L. Lewis, Ashley N. Smoots, Kate R. Woodworth, Emily O'Malley Olsen, Nicole M. Roth, Aron J. Hall, Eduardo Azziz-Baumgartner, Cria Perrine, Jason Hsia, Sascha Ellington, Van T. Tong, and Suzanne M. Gilboa are with the Centers for Disease Control and Prevention (CDC) COVID-19 Response, Atlanta, GA. Mahsa Yazdy and Hanna Shephard are with the Massachusetts Department of Public Health, Boston. Lindsey Sizemore and Heather Wingate are with the Tennessee Department of Health, Nashville. Paula Dzimira and Bethany Reynolds are with the Pennsylvania Department of Health, Pittsburgh. Mamie Lush is with the Division of Public Health, Nebraska Department of Health and Human Services, Lincoln. Erika L. Fuchs is with the Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, GA. Kristen Ojo and Sam Siebman are with the Minnesota Department of Health, St. Paul
| | - Erika L Fuchs
- Elizabeth L. Lewis, Ashley N. Smoots, Kate R. Woodworth, Emily O'Malley Olsen, Nicole M. Roth, Aron J. Hall, Eduardo Azziz-Baumgartner, Cria Perrine, Jason Hsia, Sascha Ellington, Van T. Tong, and Suzanne M. Gilboa are with the Centers for Disease Control and Prevention (CDC) COVID-19 Response, Atlanta, GA. Mahsa Yazdy and Hanna Shephard are with the Massachusetts Department of Public Health, Boston. Lindsey Sizemore and Heather Wingate are with the Tennessee Department of Health, Nashville. Paula Dzimira and Bethany Reynolds are with the Pennsylvania Department of Health, Pittsburgh. Mamie Lush is with the Division of Public Health, Nebraska Department of Health and Human Services, Lincoln. Erika L. Fuchs is with the Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, GA. Kristen Ojo and Sam Siebman are with the Minnesota Department of Health, St. Paul
| | - Kristen Ojo
- Elizabeth L. Lewis, Ashley N. Smoots, Kate R. Woodworth, Emily O'Malley Olsen, Nicole M. Roth, Aron J. Hall, Eduardo Azziz-Baumgartner, Cria Perrine, Jason Hsia, Sascha Ellington, Van T. Tong, and Suzanne M. Gilboa are with the Centers for Disease Control and Prevention (CDC) COVID-19 Response, Atlanta, GA. Mahsa Yazdy and Hanna Shephard are with the Massachusetts Department of Public Health, Boston. Lindsey Sizemore and Heather Wingate are with the Tennessee Department of Health, Nashville. Paula Dzimira and Bethany Reynolds are with the Pennsylvania Department of Health, Pittsburgh. Mamie Lush is with the Division of Public Health, Nebraska Department of Health and Human Services, Lincoln. Erika L. Fuchs is with the Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, GA. Kristen Ojo and Sam Siebman are with the Minnesota Department of Health, St. Paul
| | - Sam Siebman
- Elizabeth L. Lewis, Ashley N. Smoots, Kate R. Woodworth, Emily O'Malley Olsen, Nicole M. Roth, Aron J. Hall, Eduardo Azziz-Baumgartner, Cria Perrine, Jason Hsia, Sascha Ellington, Van T. Tong, and Suzanne M. Gilboa are with the Centers for Disease Control and Prevention (CDC) COVID-19 Response, Atlanta, GA. Mahsa Yazdy and Hanna Shephard are with the Massachusetts Department of Public Health, Boston. Lindsey Sizemore and Heather Wingate are with the Tennessee Department of Health, Nashville. Paula Dzimira and Bethany Reynolds are with the Pennsylvania Department of Health, Pittsburgh. Mamie Lush is with the Division of Public Health, Nebraska Department of Health and Human Services, Lincoln. Erika L. Fuchs is with the Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, GA. Kristen Ojo and Sam Siebman are with the Minnesota Department of Health, St. Paul
| | - Aron J Hall
- Elizabeth L. Lewis, Ashley N. Smoots, Kate R. Woodworth, Emily O'Malley Olsen, Nicole M. Roth, Aron J. Hall, Eduardo Azziz-Baumgartner, Cria Perrine, Jason Hsia, Sascha Ellington, Van T. Tong, and Suzanne M. Gilboa are with the Centers for Disease Control and Prevention (CDC) COVID-19 Response, Atlanta, GA. Mahsa Yazdy and Hanna Shephard are with the Massachusetts Department of Public Health, Boston. Lindsey Sizemore and Heather Wingate are with the Tennessee Department of Health, Nashville. Paula Dzimira and Bethany Reynolds are with the Pennsylvania Department of Health, Pittsburgh. Mamie Lush is with the Division of Public Health, Nebraska Department of Health and Human Services, Lincoln. Erika L. Fuchs is with the Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, GA. Kristen Ojo and Sam Siebman are with the Minnesota Department of Health, St. Paul
| | - Eduardo Azziz-Baumgartner
- Elizabeth L. Lewis, Ashley N. Smoots, Kate R. Woodworth, Emily O'Malley Olsen, Nicole M. Roth, Aron J. Hall, Eduardo Azziz-Baumgartner, Cria Perrine, Jason Hsia, Sascha Ellington, Van T. Tong, and Suzanne M. Gilboa are with the Centers for Disease Control and Prevention (CDC) COVID-19 Response, Atlanta, GA. Mahsa Yazdy and Hanna Shephard are with the Massachusetts Department of Public Health, Boston. Lindsey Sizemore and Heather Wingate are with the Tennessee Department of Health, Nashville. Paula Dzimira and Bethany Reynolds are with the Pennsylvania Department of Health, Pittsburgh. Mamie Lush is with the Division of Public Health, Nebraska Department of Health and Human Services, Lincoln. Erika L. Fuchs is with the Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, GA. Kristen Ojo and Sam Siebman are with the Minnesota Department of Health, St. Paul
| | - Cria Perrine
- Elizabeth L. Lewis, Ashley N. Smoots, Kate R. Woodworth, Emily O'Malley Olsen, Nicole M. Roth, Aron J. Hall, Eduardo Azziz-Baumgartner, Cria Perrine, Jason Hsia, Sascha Ellington, Van T. Tong, and Suzanne M. Gilboa are with the Centers for Disease Control and Prevention (CDC) COVID-19 Response, Atlanta, GA. Mahsa Yazdy and Hanna Shephard are with the Massachusetts Department of Public Health, Boston. Lindsey Sizemore and Heather Wingate are with the Tennessee Department of Health, Nashville. Paula Dzimira and Bethany Reynolds are with the Pennsylvania Department of Health, Pittsburgh. Mamie Lush is with the Division of Public Health, Nebraska Department of Health and Human Services, Lincoln. Erika L. Fuchs is with the Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, GA. Kristen Ojo and Sam Siebman are with the Minnesota Department of Health, St. Paul
| | - Jason Hsia
- Elizabeth L. Lewis, Ashley N. Smoots, Kate R. Woodworth, Emily O'Malley Olsen, Nicole M. Roth, Aron J. Hall, Eduardo Azziz-Baumgartner, Cria Perrine, Jason Hsia, Sascha Ellington, Van T. Tong, and Suzanne M. Gilboa are with the Centers for Disease Control and Prevention (CDC) COVID-19 Response, Atlanta, GA. Mahsa Yazdy and Hanna Shephard are with the Massachusetts Department of Public Health, Boston. Lindsey Sizemore and Heather Wingate are with the Tennessee Department of Health, Nashville. Paula Dzimira and Bethany Reynolds are with the Pennsylvania Department of Health, Pittsburgh. Mamie Lush is with the Division of Public Health, Nebraska Department of Health and Human Services, Lincoln. Erika L. Fuchs is with the Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, GA. Kristen Ojo and Sam Siebman are with the Minnesota Department of Health, St. Paul
| | - Sascha Ellington
- Elizabeth L. Lewis, Ashley N. Smoots, Kate R. Woodworth, Emily O'Malley Olsen, Nicole M. Roth, Aron J. Hall, Eduardo Azziz-Baumgartner, Cria Perrine, Jason Hsia, Sascha Ellington, Van T. Tong, and Suzanne M. Gilboa are with the Centers for Disease Control and Prevention (CDC) COVID-19 Response, Atlanta, GA. Mahsa Yazdy and Hanna Shephard are with the Massachusetts Department of Public Health, Boston. Lindsey Sizemore and Heather Wingate are with the Tennessee Department of Health, Nashville. Paula Dzimira and Bethany Reynolds are with the Pennsylvania Department of Health, Pittsburgh. Mamie Lush is with the Division of Public Health, Nebraska Department of Health and Human Services, Lincoln. Erika L. Fuchs is with the Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, GA. Kristen Ojo and Sam Siebman are with the Minnesota Department of Health, St. Paul
| | - Van T Tong
- Elizabeth L. Lewis, Ashley N. Smoots, Kate R. Woodworth, Emily O'Malley Olsen, Nicole M. Roth, Aron J. Hall, Eduardo Azziz-Baumgartner, Cria Perrine, Jason Hsia, Sascha Ellington, Van T. Tong, and Suzanne M. Gilboa are with the Centers for Disease Control and Prevention (CDC) COVID-19 Response, Atlanta, GA. Mahsa Yazdy and Hanna Shephard are with the Massachusetts Department of Public Health, Boston. Lindsey Sizemore and Heather Wingate are with the Tennessee Department of Health, Nashville. Paula Dzimira and Bethany Reynolds are with the Pennsylvania Department of Health, Pittsburgh. Mamie Lush is with the Division of Public Health, Nebraska Department of Health and Human Services, Lincoln. Erika L. Fuchs is with the Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, GA. Kristen Ojo and Sam Siebman are with the Minnesota Department of Health, St. Paul
| | - Suzanne M Gilboa
- Elizabeth L. Lewis, Ashley N. Smoots, Kate R. Woodworth, Emily O'Malley Olsen, Nicole M. Roth, Aron J. Hall, Eduardo Azziz-Baumgartner, Cria Perrine, Jason Hsia, Sascha Ellington, Van T. Tong, and Suzanne M. Gilboa are with the Centers for Disease Control and Prevention (CDC) COVID-19 Response, Atlanta, GA. Mahsa Yazdy and Hanna Shephard are with the Massachusetts Department of Public Health, Boston. Lindsey Sizemore and Heather Wingate are with the Tennessee Department of Health, Nashville. Paula Dzimira and Bethany Reynolds are with the Pennsylvania Department of Health, Pittsburgh. Mamie Lush is with the Division of Public Health, Nebraska Department of Health and Human Services, Lincoln. Erika L. Fuchs is with the Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, GA. Kristen Ojo and Sam Siebman are with the Minnesota Department of Health, St. Paul
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Ozkaya M, Korukcu O. Breast milk expression as a challenge for mothers of premature infants. J OBSTET GYNAECOL 2022; 42:1962-1971. [PMID: 35616235 DOI: 10.1080/01443615.2022.2055454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The aim of this study was to examine the psychometric properties of the 11-item Breast Milk Expression Experience Scale and determine the level of breast milk expression experience of mothers after preterm delivery in Turkey. 165 mothers who agreed to participate between February 2019 and March 2020 used the Breast Milk Expression Experience Scale (BMEE-S). The general Cronbach alpha coefficient was 0.82 for the BMEE-S. The fit indices calculated by confirmatory factor analysis were χ2 (41) = 87.95, p = .00003, χ2/sd = 2.15, GFI = 0.91, NNFI = 0.93, CFI = 0.95, RMSEA = 0.08 and SRMR = 0.078. The BMEE-S three-factor structure was verified by the confirmatory factor analysis. The BMEE-S was a valid and reliable instrument for mothers of preterm infants. Multiparity and high-risk pregnancy history negatively affected the milk expression experience, whereas spousal support positively affected it.Impact statementWhat is already known on this subject? The risk of infectious diseases, obesity, diabetes, and impaired intellectual development increases in children who do not breast milk (Verduci et al. 2014). International breastfeeding guidelines recommend supporting all mothers to start breastfeeding within one hour of birth, and counselling mothers who are separated from their babies about expressing milk.What the results of this study add? The breast milk expression experience scale is a valid and reliable tool for women who give preterm birth and express milk. The experience of expressing breast milk can affect the amount of milk that passes from mother to baby. Multiparity and high risk pregnancy history of mothers negatively affects the milk expression experience while husband support positively affects the milk expression experience.What the implications are of these findings for clinical practice and/or further research? Our study provides a quantitative examination of the experiences of mothers who are separated from their babies. The BMEE-S should be adapted to different cultures and the experiences of mothers in this process should be determined.
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Affiliation(s)
- Meltem Ozkaya
- Faculty of Nursing, Akdeniz University, Antalya, Turkey
| | - Oznur Korukcu
- Faculty of Nursing, Akdeniz University, Antalya, Turkey
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Strategies to Improve Mother's Own Milk Expression in Black and Hispanic Mothers of Premature Infants. Adv Neonatal Care 2022; 22:59-68. [PMID: 33756497 DOI: 10.1097/anc.0000000000000866] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Mother's own milk (MOM) is the gold standard of nutrition for premature infants. Yet, Hispanic and Black preterm infants are less likely than their White counterparts to receive MOM feedings. Evidence is lacking concerning potential modifiable factors and evidence-based strategies that predict provision of MOM among minority mothers of premature infants. PURPOSE A review of the literature was conducted to answer the clinical question: "What evidence-based strategies encourage and improve mother's own milk expression in Black and Hispanic mothers of premature infants?" METHODS/SEARCH STRATEGY Multiple databases including PubMed, Cochrane, and CINAHL were searched for articles published in the past 10 years (2010 through May 2020), reporting original research and available in English. Initial search yielded zero articles specifically addressing the impact of lactation interventions on MOM provision in minority mothers. Additional studies were included and reviewed if addressed breastfeeding facilitators and barriers (n = 3) and neonatal intensive care unit breastfeeding support practices (n = 7). FINDINGS/RESULTS Current strategies used to encourage and improve MOM expression in minority mothers are based on or extrapolated from successful strategies developed and tested in predominantly White mothers. However, limited evidence suggests that variation in neonatal intensive care unit breastfeeding support practices may explain (in part) variation in disparities and supports further research in this area. IMPLICATIONS FOR PRACTICE Neonatal intensive care unit staff should consider implementing scaled up or bundled strategies showing promise in improving MOM milk expression among minorities while taking into consideration the cultural and racial norms influencing breastfeeding decisions and practice. IMPLICATIONS FOR RESEARCH Experimental studies are needed to evaluate the effectiveness of targeted and culturally sensitive lactation support interventions in Hispanic and Black mothers.
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Johnson TJ, Meier PP, Schoeny ME, Bucek A, Janes JE, Kwiek JJ, Zupancic JAF, Keim SA, Patel AL. Study protocol for reducing disparity in receipt of mother's own milk in very low birth weight infants (ReDiMOM): a randomized trial to improve adherence to sustained maternal breast pump use. BMC Pediatr 2022; 22:27. [PMID: 34996401 PMCID: PMC8739536 DOI: 10.1186/s12887-021-03088-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 12/22/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Black very low birth weight (VLBW; < 1500 g birth weight) and very preterm (VP, < 32 weeks gestational age, inclusive of extremely preterm, < 28 weeks gestational age) infants are significantly less likely than other VLBW and VP infants to receive mother's own milk (MOM) through to discharge from the neonatal intensive care unit (NICU). The costs associated with adhering to pumping maternal breast milk are borne by mothers and contribute to this disparity. This randomized controlled trial tests the effectiveness and cost-effectiveness of an intervention to offset maternal costs associated with pumping. METHODS This randomized control trial will enroll 284 mothers and their VP infants to test an intervention (NICU acquires MOM) developed to facilitate maternal adherence to breast pump use by offsetting maternal costs that serve as barriers to sustaining MOM feedings and the receipt of MOM at NICU discharge. Compared to current standard of care (mother provides MOM), the intervention bundle includes three components: a) free hospital-grade electric breast pump, b) pickup of MOM, and c) payment for opportunity costs. The primary outcome is infant receipt of MOM at the time of NICU discharge, and secondary outcomes include infant receipt of any MOM during the NICU hospitalization, duration of MOM feedings (days), and cumulative dose of MOM feedings (total mL/kg of MOM) received by the infant during the NICU hospitalization; maternal duration of MOM pumping (days) and volume of MOM pumped (mLs); and total cost of NICU care. Additionally, we will compare the cost of the NICU acquiring MOM versus NICU acquiring donor human milk if MOM is not available and the cost-effectiveness of the intervention (NICU acquires MOM) versus standard of care (mother provides MOM). DISCUSSION This trial will determine the effectiveness of an economic intervention that transfers the costs of feeding VLBWand VP infants from mothers to the NICU to address the disparity in the receipt of MOM feedings at NICU discharge by Black infants. The cost-effectiveness analysis will provide data that inform the adoption and scalability of this intervention. TRIAL REGISTRATION ClinicalTrials.gov: NCT04540575 , registered September 7, 2020.
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Affiliation(s)
- Tricia J Johnson
- Department of Health Systems Management, Rush University, 1700 West Van Buren Street, TOB Suite 126B, Chicago, USA.
| | - Paula P Meier
- Department of Pediatrics, Rush University Medical Center, Chicago, USA.,College of Nursing, Rush University, Chicago, USA
| | - Michael E Schoeny
- Department of Community, Systems and Mental Health Nursing, Rush University, Chicago, USA
| | - Amelia Bucek
- Department of Pediatrics, Rush University Medical Center, Chicago, USA
| | - Judy E Janes
- Department of Pediatrics, Rush University Medical Center, Chicago, USA
| | - Jesse J Kwiek
- Department of Microbiology, The Center for Retrovirus Research and the Infectious Disease Institute, The Ohio State University, Columbus, USA
| | - John A F Zupancic
- Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, USA.,Harvard Medical School, Boston, USA
| | - Sarah A Keim
- Center for Biobehavioral Health, The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, USA.,Department of Pediatrics, The Ohio State University College of Medicine, Columbus, USA.,Division of Epidemiology, The Ohio State University College of Public Health, Columbus, USA
| | - Aloka L Patel
- Department of Pediatrics, Rush University Medical Center, Chicago, USA
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Sankar MN, Weiner Y, Chopra N, Kan P, Williams Z, Lee HC. Barriers to optimal breast milk provision in the neonatal intensive care unit. J Perinatol 2022; 42:1076-1082. [PMID: 34815522 PMCID: PMC8610106 DOI: 10.1038/s41372-021-01275-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 10/19/2021] [Accepted: 11/10/2021] [Indexed: 11/13/2022]
Abstract
OBJECTIVE This study examines comprehensive patient and process factors that influence breast milk use in the NICU setting. STUDY DESIGN We examined the association of maternal, neonatal, and family factors and lactation support systems to identify gaps in breast milk use in a retrospective study of 865 infants born in 23-41 weeks gestation admitted to the NICU. RESULTS Breast milk at discharge for all infants was 89.3%, for extremely preterm 82.3%, moderately preterm 91.4%, late preterm 86.5%, and term 92.7%. Prematurity (OR 0.31 [0.17-0.56]), low birth weight, morbidities, Black maternal race (OR 0.20 [0.07-0.57]) and public insurance (OR 0.54 [0.34-0.85]) were associated with decreased breast milk use. Early initiation of feeds was associated with increased breast milk use. CONCLUSIONS There is a need to increase social as well as hospital support systems to address gaps in breast milk use in the NICU.
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Affiliation(s)
- Meera N. Sankar
- grid.168010.e0000000419368956Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA USA
| | - Ya’el Weiner
- grid.168010.e0000000419368956Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA USA ,grid.512564.1California Perinatal Quality Care Collaborative, Stanford, CA USA
| | - Neha Chopra
- grid.168010.e0000000419368956Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA USA ,grid.512564.1California Perinatal Quality Care Collaborative, Stanford, CA USA
| | - Peiyi Kan
- grid.168010.e0000000419368956Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA USA ,grid.512564.1California Perinatal Quality Care Collaborative, Stanford, CA USA
| | - Zakiyah Williams
- grid.414123.10000 0004 0450 875XLactation services, Lucile Packard Children’s Hospital, Stanford, CA USA
| | - Henry C. Lee
- grid.168010.e0000000419368956Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA USA ,grid.512564.1California Perinatal Quality Care Collaborative, Stanford, CA USA
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15
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Giving parents support: a randomized trial of peer support for parents after NICU discharge. J Perinatol 2022; 42:730-737. [PMID: 35260824 PMCID: PMC9184279 DOI: 10.1038/s41372-022-01341-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 01/01/2022] [Accepted: 02/03/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Peer support during inpatient hospitalization has been recommended for NICU parents and can improve maternal mental health. Less is known about the impact of peer support after NICU discharge on parental mental health and infant healthcare utilization. METHODS Three hundred families of infants approaching discharge from a Level IV NICU were randomized to receive a care notebook (control) or care notebook plus peer support for 12 months (intervention). Participants reported on measures of stress, depression, anxiety, self-efficacy, and infant healthcare utilization. Analysis compared outcomes between control and treatment groups. RESULTS Parental depression, anxiety, stress, and self-efficacy improved significantly for all participants, yet there were no differences between control and intervention groups. Infant ED visits, hospitalizations, immunization status, and developmental status at 12 months did not differ between groups. CONCLUSIONS Peer support after NICU discharge did not improve self-reported parental mental health measures or infant healthcare utilization. CLINICAL TRIAL REGISTRATION NCT02643472.
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16
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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: 76] [Impact Index Per Article: 25.3] [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.
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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
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17
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The relationship between prenatal attachment and postnatal adaptation, maternal anxiety and breast milk sodium level. COMPREHENSIVE PSYCHONEUROENDOCRINOLOGY 2021; 8:100085. [PMID: 35757660 PMCID: PMC9216695 DOI: 10.1016/j.cpnec.2021.100085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 08/31/2021] [Accepted: 09/02/2021] [Indexed: 11/21/2022] Open
Abstract
Objective To investigate the relationship between maternal-fetal attachment and breast milk sodium (BMS) levels. Methods This prospective case-control study was conducted at Baskent University. Third-trimester low-risk pregnancies were included in the study. After obtaining informed consent, the Prenatal Attachment Inventory (PAI), and the State-Trait Anxiety Inventory 1 (STAI 1) and STAI 2 were administered. After delivery, BMS values were measured at regular intervals. Results The mean age of the mothers and the mean gestational age were 29.6 ± 3.4 years and 38.4 ± 0.9 weeks, respectively. The mean STAI -1, STAI-2, and PAI scores were 38.2 ± 7.1, 38.8 ± 6.9, and 41.6 ± 10, respectively. When the study group was classified according to BMS levels, no differences were observed between the groups in terms of pregnancy STAI-1, pregnancy STAI-2, Muller PAI, and STAI-1 scores of the 5th, 15th, and 30th days. There was no correlation between the BMS levels on the 5th −15th days and pregnancy STAI-1, Pregnancy STAI-2, Muller PAI, and the STAI-1 scores of the 5th-10th-30th days. However, the BMS level on the 30th day had a positive significant correlation with the STAI-1 score on the 15th day (r = 0.473, p= .006). Additionally, the STAI-1 scores on the 30th day showed that there was a significant correlation with STAI-1 on the 5th day (r = 0.416, p= .015), STAI-1 on the 15th day (r = 0.497, p= .003), and breast milk sodium levels on the 30th day (r = 0.615, p< .001). Conclusion We found no relationship between PAI scores and BMS levels on the 5th-10th-30th day but STAI scores on the 15th day and 30th day had a positive correlation with BMS levels on the 30th day. STAI-1 and STAI-2 scores during pregnancy were positively correlated with STAI scores in the postnatal period. It is known that psychosocial factors in pregnancy and mother-infant attachment have many postpartum effects via neurohumoral mechanisms. There is no known data relationship between maternal-fetal bonding and breast milk sodium level. This is the first study to investigate the relationship between prenatal attachment and breast milk sodium values. Breast milk sodium levels seem to be more related to anxiety levels. There is no relationship between PAI scores in the last trimester and breast milk sodium in low-risk pregnant women.
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18
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Healthy Habits and Emotional Balance in Women during the Postpartum Period: Differences between Term and Preterm Delivery. CHILDREN-BASEL 2021; 8:children8100937. [PMID: 34682201 PMCID: PMC8534591 DOI: 10.3390/children8100937] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 10/14/2021] [Accepted: 10/16/2021] [Indexed: 01/03/2023]
Abstract
Breastfeeding could be considered as a vulnerable period, rising the risk to shift from optimism to pessimism. Preterm delivery is an event that increases postpartum maternal stress and depression, which can have a negative impact on breastfeeding and maternal–filial wellbeing. The adherence to healthy habits may have a positive influence on this vulnerable population. We aimed to analyze the impact of prematurity on maternal psychological aspects during postpartum and to study if adherence to the Healthy Food Pyramid influences psychological variables. Fifty-five breastfeeding women being attended in the Hospital Clínico San Carlos (Madrid, Spain) were recruited during the first day postpartum. The medical data were collected from the obstetrical records. The women answered an auto-administered questionnaire with several sections: sociodemographic characteristics, Perceived Stress Scale (PSS), and Life Orientation Test (LOT), at 14 days and 6 months postpartum, Adherence to the Healthy Food Pyramid Questionnaire (AP-Q) at 28 days postpartum and the Edinburgh Postpartum Depression Scale (EPDS) at 6 months postpartum. The PSS and LOT scores were not statistically different in mothers with preterm compared to term delivery either at 14 days or at 6 months postpartum. Longitudinally, the PSS did not show significant differences, but the LOT score was lower at 6 months compared to 14 days postpartum (p-Value = 0.046). A higher EPDS score was significantly found in mothers with preterm delivery (9.0 ± 4.7) than those with a term delivery (5.4 ± 4.2; p-value = 0.040). A significant and positive correlation was observed between the AP-Q score and LOT both at 14 days and 6 months postpartum. Conclusively, maternal optimism decreases during the postpartum period, women with preterm delivery being at risk of postpartum depression. Furthermore, there is a relationship between optimism and adherence to healthy habits. Healthcare professional counseling is essential during the entire breastfeeding period, particularly in vulnerable mothers with preterm delivery.
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19
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A Call to Action to Fight for Equity and End Necrotizing Enterocolitis Disparities. Adv Neonatal Care 2021; 21:333-335. [PMID: 34469364 DOI: 10.1097/anc.0000000000000940] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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20
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Piwoszkin LM, Corley M, Meganathan K, Narendran V, Nommsen-Rivers L, Ward LP. Predictors of the Provision of Mother's Milk Feedings in Newborns Admitted to the Neonatal Intensive Care Unit. Breastfeed Med 2021; 16:640-647. [PMID: 33835834 DOI: 10.1089/bfm.2020.0284] [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: 11/13/2022]
Abstract
Background: Breast milk reduces morbidity and mortality in infants admitted to neonatal intensive care unit (NICU). Objectives: We determined predictors of procuring mother's own milk (MOM) among NICU-admitted newborn-mother dyads: (1) initiation of any milk expression; (2) initiation of milk expression within 6 hours of birth; (3) MOM as the first enteral feeding; (4) colostrum for oral care within 36 hours of birth if not yet orally fed; and (5) provision of MOM at 21 days of life or discharge, whichever occurred first. Methods: We performed a retrospective chart review of NICU-admitted newborn-mother dyads at an urban medical center from June 1, 2018-May 31, 2019. We excluded infants not directly admitted to the NICU, those never enterally fed, multiple gestations if not the first to be discharged, and infants discharged to a nonbiological caregiver. We used chi-square analysis to examine unadjusted associations between independent variables and MOM outcomes and then used logistic regression to determine the adjusted odds ratio and 95% confidence interval (AOR [95% CI]) for predictors of MOM outcomes. Results: There were 341 mother-infant dyads who met inclusion criteria and 71% of these mothers initiated milk expression. Smoking, multiparity, gestational diabetes, and Hepatitis C lowered the odds for at least one MOM outcome; whereas mothers who delivered at 28-32 weeks versus ≥33 weeks, and infants with birthweight <1,500 g versus 1,500-2,500 g had higher odds for at least one MOM outcome. Conclusion: Maternal/infant dyad characteristics may predict some, but not all NICU breastfeeding outcomes. This suggests that hospital practices may influence these outcomes and can inform future interventions.
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Affiliation(s)
- Lisa Marie Piwoszkin
- Division of Neonatology and Pulmonary Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Megan Corley
- Department of Rehabilitation, Exercise, and Nutrition, University of Cincinnati College of Allied Health Sciences, Cincinnati, Ohio, USA
| | - Karthikeyan Meganathan
- Department of Analytical and Diagnostic Sciences, University of Cincinnati, Cincinnati, Ohio, USA
| | - Vivek Narendran
- Division of Neonatology and Pulmonary Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
| | - Laurie Nommsen-Rivers
- Department of Rehabilitation, Exercise, and Nutrition, University of Cincinnati College of Allied Health Sciences, Cincinnati, Ohio, USA
| | - Laura P Ward
- Division of Neonatology and Pulmonary Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
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21
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Parker LA, Krueger C, Sullivan S, Mueller M. Demographic, Social, and Personal Factors Associated With Lactation Cessation by 6 Weeks in Mothers of Very Low Birth Weight Infants. J Hum Lact 2021; 37:511-520. [PMID: 33030992 DOI: 10.1177/0890334420940239] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Although mother's own milk decreases prematurity-associated morbidities, mothers of infants born preterm and very low birth weight experience a significantly shorter lactation duration. Little is known regarding factors associated with lactation cessation during the hospitalization of a very low birth weight infant. RESEARCH AIM To determine demographic, social, and personal factors associated with lactation cessation by 6-weeks postpartum in mothers delivering very low birth weight infants. METHODS We used a retrospective, longitudinal, two-group comparison design using data from a randomized control study. Mothers of very low birth weight infants (N = 142) were enrolled from a labor and delivery unit associated with a Level 4 neonatal intensive care unit. Demographic, social, and health information was obtained from the medical records. Participants were surveyed regarding lactation goals, experience, and reason(s) for cessation. RESULTS Participants who did not continue lactating for more than 6 weeks were more likely to be unemployed (p = .019), Medicaid eligible (p = .009), less educated (p < .031), smoke (p = .002), provide less skin-to-skin care (p = .007), and to delay the decision to provide their milk to their infant (p = .007). After Bonferroni adjustment, only minutes of skin-to-skin care remained statistically significant. Insufficient maternal milk production was the most common reason for lactation cessation. CONCLUSION While the etiology of lactation cessation is often non-modifiable, strategies aimed at maintaining mother's own milk production, smoking cessation, increasing skin-to-skin care, and promoting an earlier decision to lactate, may prolong lactation duration in this vulnerable population.This RCT was registered (2012-00071) with ClinicalTrials.com on 6/28/2013.
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22
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Wiechers C, Bernhard W, Goelz R, Poets CF, Franz AR. Optimizing Early Neonatal Nutrition and Dietary Pattern in Premature Infants. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:7544. [PMID: 34300000 PMCID: PMC8304391 DOI: 10.3390/ijerph18147544] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 07/09/2021] [Accepted: 07/12/2021] [Indexed: 12/18/2022]
Abstract
Providing adequate amounts of all essential macro- and micronutrients to preterm infants during the period of extraordinarily rapid growth from 24 to 34 weeks' postmenstrual age to achieve growth as in utero is challenging yet important, since early growth restriction and suboptimal neonatal nutrition have been identified as risk factors for adverse long-term development. Along with now well-established early parenteral nutrition, this review emphasizes enteral nutrition, which should be started early and rapidly increased. To minimize the side effects of parenteral nutrition and improve outcomes, early full enteral nutrition based on expressed mothers' own milk is an important goal. Although neonatal nutrition has improved in recent decades, existing knowledge about, for example, the optimal composition and duration of parenteral nutrition, practical aspects of the transition to full enteral nutrition or the need for breast milk fortification is limited and intensively discussed. Therefore, further prospective studies on various aspects of preterm infant feeding are needed, especially with regard to the effects on long-term outcomes. This narrative review will summarize currently available and still missing evidence regarding optimal preterm infant nutrition, with emphasis on enteral nutrition and early postnatal growth, and deduce a practical approach.
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Affiliation(s)
- Cornelia Wiechers
- Department of Neonatology, University Children′s Hospital, Eberhard Karls University, Calwerstr. 7, 72076 Tübingen, Germany; (W.B.); (R.G.); (C.F.P.); (A.R.F.)
| | - Wolfgang Bernhard
- Department of Neonatology, University Children′s Hospital, Eberhard Karls University, Calwerstr. 7, 72076 Tübingen, Germany; (W.B.); (R.G.); (C.F.P.); (A.R.F.)
| | - Rangmar Goelz
- Department of Neonatology, University Children′s Hospital, Eberhard Karls University, Calwerstr. 7, 72076 Tübingen, Germany; (W.B.); (R.G.); (C.F.P.); (A.R.F.)
| | - Christian F. Poets
- Department of Neonatology, University Children′s Hospital, Eberhard Karls University, Calwerstr. 7, 72076 Tübingen, Germany; (W.B.); (R.G.); (C.F.P.); (A.R.F.)
| | - Axel R. Franz
- Department of Neonatology, University Children′s Hospital, Eberhard Karls University, Calwerstr. 7, 72076 Tübingen, Germany; (W.B.); (R.G.); (C.F.P.); (A.R.F.)
- Center for Pediatric Clinical Studies, University Children′s Hospital, Eberhard Karls University, 72076 Tübingen, Germany
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Abstract
Breast milk provides optimal nourishment for all infants and has special advantages in preterm infants. Breast milk is associated with lower rates of necrotizing enterocolitis and bronchopulmonary dysplasia and improved neurodevelopmental outcomes in the preterm population. Mothers in the NICU may experience multiple psychological, physical, and social/cultural barriers that impede successful breastfeeding. Professional lactation support is of crucial importance in this population. With the social distancing requirements of the pandemic, many clinicians have adopted novel methods of education and communication to ensure continued timely support for NICU mothers.
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Affiliation(s)
- Padma S Nandula
- Division of Neonatology, Department of Pediatrics, University of Florida College of Medicine, Jacksonville, FL
| | - Mark L Hudak
- Division of Neonatology, Department of Pediatrics, University of Florida College of Medicine, Jacksonville, FL
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Early exclusive breastfeeding cessation and postpartum depression: Assessing the mediating and moderating role of maternal stress and social support. PLoS One 2021; 16:e0251419. [PMID: 33999929 PMCID: PMC8128229 DOI: 10.1371/journal.pone.0251419] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 04/26/2021] [Indexed: 01/15/2023] Open
Abstract
Background Early termination of exclusive breastfeeding (EBF) and postpartum depression (PPD) are both recognized as global health problems. Recent literature reviews demonstrate a notable link between PPD and breastfeeding outcomes, however, the underlying mechanisms linking the two remain unclear. Objectives The aim of the study is to: 1) explore the comparative risk for PPD among new mothers who terminated EBF before the 6-month mark, compared to those who did not; and 2) test whether maternal stress and social support operate to mediate and/or moderate the relationship between EBF and PPD. Methods Between October 2015 and January 2016, a cross-sectional study was carried out among 426 new mothers of Bangladesh who were six months postpartum. Results Based on the multivariate logistic regression model, non-exclusively breastfeeding mothers were 7.58-fold more likely to experience PPD (95% CI [3.94, 14.59]) than exclusively breastfeeding mothers. Additionally, maternal stress and social support not only partially mediate the relationship between EBF and PPD but also substantially moderate this relationship. Specifically, the odds of PPD are significantly higher among mothers who had early EBF interruption in conjunction with increased stress levels and limited social support. Conclusions Current evidence suggests that concurrent screening for EBF difficulties and maternal stress are important red flags that might hint at complications even before mother’s screen positive for PPD. Support and care from family members can provide assistance in overcoming this issue.
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Abstract
BACKGROUND Mother's own milk (MOM) is well known to decrease prematurity-related morbidities, yet mothers delivering preterm infants often produce insufficient quantities of milk to provide these benefits. Although a critical need exists for research to support lactation success in this vulnerable population, development and investigation of interventions to increase available MOM for infant consumption requires consistent, valid, and reliable measures of lactation outcomes. OBJECTIVES The aim of this study was to compare and contrast methods of measuring lactation outcomes in mothers of preterm infants and evaluate their advantages and disadvantages. METHODS Measures of lactation outcomes were reviewed and synthesized. Insights on best practices and future research directions are provided. RESULTS Volume of MOM produced, lactation duration, and time to onset of secretory activation are important measures of lactation success. The most valid and reliable measure of milk production is likely weighing each vial of expressed milk combined with test weighing when infants breastfeed. Measures of lactation duration should include actual days mothers lactated rather than limiting to infant consumption of MOM as a proxy for duration and include not only whether mothers are lactating at infant discharge but whether they are also lactating at other health-relevant time points during hospitalization. Although time to onset of secretory activation is an important lactation outcome, information regarding valid and reliable indicators of onset in women delivering preterm infants is limited, and investigation of such indicators is a research priority. Variables that may affect lactation outcomes, including time to initiation of expression following delivery, duration of expression sessions, expression method, time spent in skin-to-skin care, maternal demographics and comorbidities, as well as maternal intent to lactate, must be considered when researchers investigate lactation outcomes in mothers of very low birth weight infants. DISCUSSION Consistent and valid measures of lactation outcomes are required to produce reliable results from which evidence-based practice recommendations can be developed in order to improve lactation success in this vulnerable population.
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Abstract
Mother's own milk (MOM) feeding is a cost-effective strategy to reduce risks of comorbidities associated with prematurity and improve long-term health of infants hospitalized in the Neonatal Intensive Care Unit (NICU). Significant racial and socioeconomic disparities exist in MOM provision in the NICU, highlighting the importance of developing strategies to reduce these disparities. Mothers of infants in the NICU experience many health concerns which may negatively impact lactation physiology. Objective measures of lactation physiology are limited but may assist in identifying mothers at particular risk. Several strategies to assist mothers of hospitalized infants are essential, including maternal education, qualified lactation professionals, early and frequent milk expression with a hospital-grade double electric breast pump, and providing support for transitioning to direct breastfeeding prior to discharge from the NICU.
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Association between Maternal Postpartum Depression, Stress, Optimism, and Breastfeeding Pattern in the First Six Months. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17197153. [PMID: 33007816 PMCID: PMC7579508 DOI: 10.3390/ijerph17197153] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 09/23/2020] [Accepted: 09/28/2020] [Indexed: 11/17/2022]
Abstract
Early breastfeeding cessation is a major public health problem. Several factors can affect breastfeeding pattern, and psychological aspects have been poorly explored. We hypothesize that psychological factors and breastfeeding pattern have a relationship. We have assessed in mothers during the first six months of lactation if breastfeeding pattern is associated with maternal stress, postpartum depression, and dispositional optimism, and if these psychological factors play a role on breastfeeding adherence. In total, 711 women participated, answering online the following questionnaires: sociodemographic, perceived stress scale, Edinburgh postpartum depression scale, life orientation test, and breastfeeding adherence score. Women were categorized according to infant feeding practices as exclusive breastfeeding (EBF) or mixed breastfeeding (MBF). The EBF group had a lower score of perceived stress compared to those giving MBF (first month: EBF = 1.5 [1.1; 1.9], MBF = 1.8 [1.5; 2.0]; p-Value = 0.030; third month: EBF = 1.6 [1.2; 2.0], MBF = 1.8 [1.5; 2.4]; p-Value = 0.038) and also had a lower score of postpartum depression (third month: EBF = 8.0 [6.0; 11.0], MBF = 11.0 [9.0; 15.0]; p-Value = 0.001). The breastfeeding adherence score showed a positive correlation with maternal perceived stress (first month: ρ = 0.27; p-Value = 0.018), and postpartum depression (third month: ρ = 0.30; p-Value < 0.001), and a negative correlation with maternal dispositional optimism (second month: ρ = −0.20; p-Value = 0.028). MBF was positively associated with breastfeeding adherence score (odd ratio (OR) = 1.4 [1.2–1.6]; p-Value < 0.001) and with postpartum depression (OR = 1.1 [1.0; 1.1]; p-Value = 0.020). In the third month of breastfeeding, women with MBF exhibited higher perceive stress and postpartum depression compared to those with EBF and no difference in dispositional optimism. The maternal psychological aspects are associated with breastfeeding pattern. Evaluation of maternal psychological concerns and providing support to lactating mothers may help improving breastfeeding adherence.
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Palnizky Soffer G, Siri M, Mangel L, Mandel D, Lubetzky R. Impact of Maternal Anxiety on Human Milk Macronutrients Content: A Prospective Observational Study. Breastfeed Med 2020; 15:572-575. [PMID: 32598169 DOI: 10.1089/bfm.2020.0034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Objective: The impact of maternal anxiety on the macronutrients content of human milk (HM) is unknown. We hypothesized that maternal stress generated by her infant's hospitalization will affect the mother's breast milk's macronutrients content. Materials and Methods: HM samples (2-3 mL) were collected from 21 mothers whose infants were hospitalized for 2-3 days between August 2016 and November 2017 due to neonatal fever. Samples were provided at three time points: first day of admission, second day of admission, and 1 week after discharge. The maternal anxiety level was measured by the State-Trait Anxiety Inventory (STAI). Milk analyses for macronutrients were performed by infrared transmission spectroscopy. Results: Fat and energy contents of HM on day 7 were significantly higher compared with the day of admission (p = 0.019 and p = 0.022, respectively), whereas they were similar to values on day 2. The maternal anxiety level (STAI) at the time of infant admission was significantly higher than at 1 week after discharge (p < 0.001). There was no significant correlation between the changes in fat content and changes in the STAI score between admission and 1 week after discharge. Conclusion: Short infant hospitalization is associated with a significant rise in maternal stress; however, macronutrients content of HM remained unaffected.
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Affiliation(s)
- Gili Palnizky Soffer
- Department of Pediatrics, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Maayan Siri
- Department of Pediatrics, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Laurence Mangel
- Department of Neonatology, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dror Mandel
- Department of Neonatology, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ronit Lubetzky
- Department of Pediatrics, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Abstract
Although risk for necrotizing enterocolitis (NEC) is often presented from the perspective of a premature infant's vulnerability to nonmodifiable risk factors, in this paper we describe the evidence and present recommendations to manage modifiable risks that are amenable to clinical actions. Using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria, we present recommendations in the context of their supporting evidence in a way that balances risks (e.g. potential harm, cost) and benefits. Across the prenatal, intrapartum, early and late clinical course, strategies to limit NEC risk in premature infants are presented. Our goal is to summarize modifiable NEC risk factors, grade the evidence to offer quality improvement (QI) targets for healthcare teams and offer a patient-family advocate's perspective on how to engage parents to recognize and reduce NEC risk.
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Louis-Jacques AF, Stuebe AM. Enabling Breastfeeding to Support Lifelong Health for Mother and Child. Obstet Gynecol Clin North Am 2020; 47:363-381. [PMID: 32762923 DOI: 10.1016/j.ogc.2020.04.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The health benefits of breastfeeding are well documented, and more than 80% of US women initiate breastfeeding; however, mothers in the United States face substantial challenges in meeting their personal breastfeeding goals, with approximately 60% weaning earlier than they had intended. In addition, there are significant racial/ethnic inequities in infant-feeding behaviors, and these inequities are a major public health concern. Enabling women to meet their breastfeeding goals is a public health priority. Infant feeding should be addressed as a modifiable health behavior, rather than a lifestyle choice.
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Affiliation(s)
- Adetola F Louis-Jacques
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of South Florida Morsani College of Medicine, 2 Tampa General Circle, 6th Floor, Tampa, FL 33606, USA.
| | - Alison M Stuebe
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC, USA; Department of Maternal and Child Health, Carolina Global Breastfeeding Institute, Gillings School of Global Public Health, 3010 Old Clinic Building, CB #7516, Chapel Hill, NC 27599, USA
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Desorcy-Scherer K, Bendixen MM, Parker LA. Determinants of the Very Low-Birth-Weight Infant's Intestinal Microbiome: A Systematic Review. J Perinat Neonatal Nurs 2020; 34:257-275. [PMID: 32697547 PMCID: PMC7464589 DOI: 10.1097/jpn.0000000000000506] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The intestinal microbiome is the genetic material from microorganisms residing in the intestinal tract. Very low-birth-weight infants (VLBW; birth weight ≤1500 g) are a physiologically compromised population undergoing a unique period of initial intestinal microbiome establishment. Evidence supports a connection between the intestinal microbiome and gastrointestinal illness that disproportionately affects VLBW infants. Necrotizing enterocolitis, an inflammatory and often necrotic condition of the intestine, and late-onset sepsis, a bloodstream infection occurring after 3 days of life, are thought to be associated with delayed or abnormal intestinal microbiome development. Here, we review the determinants, or factors, that influence the VLBW infant's intestinal microbiome and discuss clinical implications. PubMed, Web of Science, EMBASE, and CINAHL were systematically searched for publications addressing factors with the potential to affect the intestinal microbiome of VLBW infants. Results indicate that infant's age and weight, mode of delivery, antibiotic exposure, medication use, feeding regime, environment, and perinatal-/infant-associated factors may be important determinants of the microbiome in this vulnerable population. Clinicians have opportunities to support positive development of the VLBW infant's intestinal microbiome through antibiotic stewardship, support of human milk feeding, and hygienic care practices.
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Villamor-Martínez E, Pierro M, Cavallaro G, Mosca F, Villamor E. Mother's Own Milk and Bronchopulmonary Dysplasia: A Systematic Review and Meta-Analysis. Front Pediatr 2019; 7:224. [PMID: 31275904 PMCID: PMC6593284 DOI: 10.3389/fped.2019.00224] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 05/20/2019] [Indexed: 12/24/2022] Open
Abstract
Background: Bronchopulmonary dysplasia (BPD) is the most common complication of very preterm birth and can lead to lifelong health consequences. Optimal nutrition is a cornerstone in the prevention and treatment of BPD. In very preterm infants, mother's own milk (MOM) feeding is associated with lower risks of necrotizing enterocolitis, retinopathy of prematurity, and sepsis. Although several studies have shown that MOM may protect against BPD, a systematic analysis of the evidence has not been performed to date. Methods: A comprehensive literature search was conducted using PubMed/MEDLINE and EMBASE, from their inception to 1 December 2017. Longitudinal studies comparing the incidence of BPD in preterm infants fed with exclusive MOM, MOM supplemented with preterm formula (PF), and/or exclusively fed with PF were selected. A random-effects model was used to calculate the Mantel Haenszel risk ratio (RR) and 95% confidence interval (CI). Results: Fifteen studies met the inclusion criteria (4,984 infants, 1,416 BPD cases). Use of exclusive MOM feedings was associated with a significant reduction in the risk of BPD (RR 0.74, 95% CI 0.57-0.96, 5 studies). In contrast, meta-analysis could not demonstrate a significant effect on BPD risk when infants fed with more than 50% MOM were compared with infants fed with <50% MOM (RR 0.98, 95% CI 0.77-1.23, 10 studies) or when infants fed with MOM supplemented with PF were compared with infants fed with exclusive PF (RR 1.00, 95% CI 0.78-1.27, 6 studies). Meta-regression showed that differences in gestational age were a significant confounder of the effect of MOM. Conclusion: To our knowledge, this is the first systematic review and meta-analysis that specifically evaluates the role of MOM on BPD. Our data indicate that MOM may reduce the incidence of BPD when used as an exclusive diet, but this result needs to be interpreted with caution. We did not find the same difference in analyses with other dosages of MOM. Further studies adequately powered to detect changes in BPD rates and that adjust for confounders are needed to confirm the beneficial effects of MOM on BPD.
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Affiliation(s)
- Eduardo Villamor-Martínez
- Department of Pediatrics, School for Oncology and Developmental Biology (GROW), Maastricht University Medical Center (MUMC+), Maastricht, Netherlands
| | - Maria Pierro
- UOC TIN e Neonatologia, Dipartimento Salute Mamma e Bambino, Fondazione Poliambulanza, Brescia, Italy
| | - Giacomo Cavallaro
- Neonatal Intensive Care Unit, Department of Clinical Sciences and Community Health, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Fabio Mosca
- Neonatal Intensive Care Unit, Department of Clinical Sciences and Community Health, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Eduardo Villamor
- Department of Pediatrics, School for Oncology and Developmental Biology (GROW), Maastricht University Medical Center (MUMC+), Maastricht, Netherlands
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Mediators of racial and ethnic disparity in mother's own milk feeding in very low birth weight infants. Pediatr Res 2019; 85:662-670. [PMID: 30679795 PMCID: PMC6435382 DOI: 10.1038/s41390-019-0290-2] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 12/20/2018] [Accepted: 12/24/2018] [Indexed: 01/11/2023]
Abstract
BACKGROUND Despite high initiation rates for mother's own milk (MOM) provision, MOM feeding at discharge from the neonatal intensive care unit (NICU) drops precipitously and reveals a racial/ethnic disparity. This study sought to identify factors that (1) predict MOM feeding at NICU discharge, and (2) mediate racial/ethnic disparity in MOM feeding at discharge. METHODS Secondary analysis of prospective cohort study of 415 mothers and their very low birth weight infants. Variables were grouped into five categories (demographics, neighborhood structural, social, maternal health, and MOM pumping). Significant predictors from each category were entered into a multivariable logistic regression model. RESULTS Although 97.6% of infants received MOM feedings, black infants were significantly less likely to receive MOM feeding at discharge. Positive predictors were daily pumping frequency, reaching pumped MOM volume ≥500 mL/day by 14 days, and maternal age. Negative predictors were low socioeconomic status (SES) and perceived breastfeeding support from the infant's maternal grandmother. Low SES, maternal age, and daily pumping frequency mediated the racial/ethnic differences. CONCLUSIONS Multiple potentially modifiable factors predict MOM feeding at NICU discharge. Importantly, low SES, pumping frequency, and maternal age were identified as the mediators of racial and ethnic disparity. Strategies to mitigate the effects of modifiable factors should be developed and evaluated in future research.
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Gephart SM, Newnam KM. Closing the Gap Between Recommended and Actual Human Milk Use for Fragile Infants: What Will It Take to Overcome Disparities? Clin Perinatol 2019; 46:39-50. [PMID: 30771818 DOI: 10.1016/j.clp.2018.09.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
This article describes the components of human milk and their value to reduce risk for necrotizing enterocolitis, disparities in access to human milk, potential relationships to care practices within the neonatal intensive care unit, and ways to overcome the disparity.
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Affiliation(s)
- Sheila M Gephart
- Community and Health Systems Science Division, College of Nursing, The University of Arizona, PO Box 210203, Tucson, AZ 85721, USA.
| | - Katherine M Newnam
- College of Nursing, The University of Tennessee Knoxville, 1200 Volunteer Boulevard #361, Knoxville, TN 37996, USA
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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.
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Affiliation(s)
- Ilana Levene
- Neonatal Unit, John Radcliffe Hospital, Oxford, UK
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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.
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Racial and Ethnic Disparities in the Use of Mother's Milk Feeding for Very Low Birth Weight Infants in Massachusetts. J Pediatr 2019; 204:134-141.e1. [PMID: 30274926 DOI: 10.1016/j.jpeds.2018.08.036] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 08/01/2018] [Accepted: 08/16/2018] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To examine the extent to which maternal race/ethnicity is associated with mother's milk use among hospitalized very low birth weight (VLBW) infants and maternal receipt of hospital breastfeeding support practices (human milk prenatal education, first milk expression <6 hours after delivery, lactation consultation <24 hours, any skin-to-skin care <1 month). STUDY DESIGN We studied 1318 mother-VLBW infant pairs in 9 Massachusetts level 3 neonatal intensive care units (NICUs) between January 2015 and November 2017. We estimated associations of maternal race/ethnicity with any and exclusive mother's milk on day 7, on day 28, and at discharge/transfer and hospital practices. We estimated HRs comparing the probability of continued milk use over the hospitalization by race/ethnicity and tested mediation by hospital practices, adjusting for birth weight and gestational age and including hospital and plurality as random effects. RESULTS Mothers were 48% non-Hispanic white, 21% non-Hispanic black, and 20% Hispanic. Initiation of mother's milk was similar across groups, but infants of Hispanic mothers (hazard ratio [HR], 2.71; 95% CI, 2.05-3.59) and non-Hispanic black mothers (HR, 1.55; 95% CI, 1.17-2.07) stopped receiving milk earlier in the hospitalization compared with infants of non-Hispanic white mothers. Hispanic mothers had lower odds of providing skin-to-skin care at <1 month (OR, 0.61; 95% CI, 0.43-0.87) compared with non-Hispanic whites. CONCLUSIONS Hispanic and non-Hispanic black mothers were less likely than non-Hispanic white mothers to continue providing milk for their VLBW infants throughout the NICU stay.
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Optimizing Support for Breastfeeding as Part of Obstetric Practice. Fam Med 2018. [DOI: 10.30841/2307-5112.6.2018.169480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Parker MG, Lopera AM, Kalluri NS, Kistin CJ. "I Felt Like I Was a Part of Trying to Keep My Baby Alive": Perspectives of Hispanic and Non-Hispanic Black Mothers in Providing Milk for Their Very Preterm Infants. Breastfeed Med 2018; 13:657-665. [PMID: 30299981 DOI: 10.1089/bfm.2018.0104] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Background: Compared with non-Hispanic white, Hispanic and non-Hispanic black mothers of very preterm infants are less likely to provide mother's milk at the point of hospital discharge; the perspectives of these mothers are poorly understood. Objectives: To examine the perceived barriers and facilitators of providing milk for very preterm infants during the hospitalization among Hispanic and non-Hispanic black mothers. Materials and Methods: We conducted 23 in-depth, semistructured interviews of English and Spanish-speaking Hispanic and non-Hispanic black mothers that initiated milk production for their very preterm infants, ≤1,750 g at birth. Following thematic saturation, results were validated through expert triangulation and member checking. Results: Twelve mothers were Hispanic, where three were English speaking and nine were Spanish speaking. Eleven mothers were non-Hispanic black and English speaking. We found themes pertaining to general experiences: (1) Breastfeeding intent impacts mothers' success in providing milk throughout the hospitalization; (2) Pumping milk for a hospitalized infant is repetitive, exhausting, and does not elicit the same emotional connection as breastfeeding; (3) Hospital providers are an important source of support, when sufficient time is spent to address ongoing issues; (4) Providing milk creates a unique sense of purpose when mothers otherwise feel a lack of control; and we found themes pertaining to the experiences of Hispanic and non-Hispanic black mothers: (1) Breastfeeding as a cultural norm influences mothers' intent to initiate and continue breastfeeding; (2) Hospital staff are viewed as more supportive when interactions and treatment are perceived as racially/ethnically unbiased and (3) when communication occurs in the primary language; and (4) Mother-infant separation creates logistical challenges that negatively impact ongoing milk production. Conclusions: While providing milk for a hospitalized very preterm infant is exhausting, and logistically challenging, Hispanic and non-Hispanic black mothers are inspired to do so because of their intent to breastfeed, support from hospital providers, and feelings of purpose.
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Affiliation(s)
- Margaret G Parker
- Department of Pediatrics, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts
| | - Adriana M Lopera
- Department of Pediatrics, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts
| | - Nikita S Kalluri
- Department of Pediatrics, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts
| | - Caroline J Kistin
- Department of Pediatrics, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts
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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
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Moudi Z, Molashahi B, Ansari H, Imani M. The effect of a care program and social support on anxiety level in mothers of late preterm infants in Sistan and Baluchestan, Iran. Women Health 2018; 59:569-578. [PMID: 30422094 DOI: 10.1080/03630242.2018.1508540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Late and moderate preterm (LAMP) neonates are at risk of developing severe complications that can lead to anxiety in mothers. The aim of this study was to determine the effectiveness of a care program on the anxiety level of mothers with LAMP babies and to determine the effectiveness of the care program on the level of anxiety of new mothers in the presence of social support. This quasi-experimental study was conducted on 80 mothers whose late preterm infants were admitted to neonatal intensive care unit at Ali-ibn Abi Talib Hospital, Zahedan. Data were gathered between July 10 and October 13, 2016. The intervention group received the care program. Anxiety and social support were evaluated using the State-Trait Anxiety Inventory and Multidimensional Scale of Perceived Social Support (MSPSS), respectively. After receiving the intervention, the mean MSPSS was higher for the mothers in the intervention group (p = .0025). Additionally, they experienced less state anxiety 72 hours after discharge and 1 month after delivery (p < .0025). Regression analysis showed that mothers with higher social support were 39 percent more likely to be in the "no to moderate STAI" (<51) group. Perceived social support can mediate the effect of care programs on diminishing anxiety.
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Affiliation(s)
- Zahra Moudi
- a Pregnancy Health Research Center , Zahedan University of Medical Sciences , Zahedan , Iran.,b Dept of Midwifery , School of Nursing &Midwifery , Zahedan , Iran
| | - Batoul Molashahi
- a Pregnancy Health Research Center , Zahedan University of Medical Sciences , Zahedan , Iran
| | - Hossein Ansari
- d Dept of Epidemiology & Biostatistics, School of Health , Zahedan University of Medical Sciences , Zahedan , Iran
| | - Mahmoud Imani
- c Dept of Pediatrics , Zahedan University of Medical Science , Zahedan , Iran
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Gharib S, Fletcher M, Tucker R, Vohr B, Lechner BE. Effect of Dedicated Lactation Support Services on Breastfeeding Outcomes in Extremely-Low-Birth-Weight Neonates. J Hum Lact 2018; 34:728-736. [PMID: 29161535 DOI: 10.1177/0890334417741304] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Breastfeeding is associated with major benefits for high-risk infants born prematurely, yet this population faces significant challenges to breastfeeding. Lactation services provide successful interventions, yet the impact of lactation services on breastfeeding outcomes in preterm infants is understudied. Research aim: The provision of full-time lactation support in the neonatal intensive care unit (NICU) will improve quantitative breastfeeding measures in premature infants. METHODS A longitudinal retrospective nonexperimental design was used. Data were collected from medical records of breastfeeding outcomes in patients 30 weeks' gestational age and under admitted to a level IV regional NICU over three epochs of varying levels of lactation services, from none to full time. Demographic, medical, and breastfeeding data were collected. Data analysis was performed using standard statistical tests and hierarchical regression analysis. RESULTS A significant increase in the number of lactation consults was observed across epochs, and the number of infants who received human milk via feeding at the breast, as the first oral feeding, increased across epochs. After controlling for covariates, the odds of infants receiving any human milk compared with exclusive formula feeding increased across epochs. CONCLUSION The provision of full-time dedicated NICU lactation support is associated with an increase in breastfeeding outcome measures for high-risk preterm infants.
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Affiliation(s)
- Sharareh Gharib
- 1 Women & Infants Hospital of Rhode Island, Providence, RI, USA
| | - Molly Fletcher
- 1 Women & Infants Hospital of Rhode Island, Providence, RI, USA
| | - Richard Tucker
- 1 Women & Infants Hospital of Rhode Island, Providence, RI, USA
| | - Betty Vohr
- 1 Women & Infants Hospital of Rhode Island, Providence, RI, USA
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Romaine A, Clark RH, Davis BR, Hendershot K, Kite V, Laughon M, Updike I, Miranda ML, Meier PP, Patel AL, Smith PB, Cotten CM, Benjamin DK, Greenberg RG. Predictors of Prolonged Breast Milk Provision to Very Low Birth Weight Infants. J Pediatr 2018; 202:23-30.e1. [PMID: 30170862 PMCID: PMC6203611 DOI: 10.1016/j.jpeds.2018.07.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 05/16/2018] [Accepted: 07/02/2018] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To identify factors associated with prolonged maternal breast milk (BM) provision in very low birth weight (VLBW) infants. STUDY DESIGN This was a cohort study of VLBW infants who initially received maternal BM and were born at one of 197 neonatal intensive care units managed by the Pediatrix Medical Group from 2010 to 2012. We used multivariable logistic regression to identify demographic, clinical, and maternal factors associated with provision of maternal BM on day of life (DOL) 30 and at discharge. RESULTS Median gestational age for all infants was 28 weeks (25th, 75th percentiles: 26, 30), and median maternal age was 28 years (23, 33). Of 8806 infants, 6261 (71%) received maternal BM on DOL 30, and 4003 of 8097 (49%) received maternal BM at discharge to home. Predictors of maternal BM provision at DOL 30 included increased maternal age, white maternal race, absence of history of necrotizing enterocolitis or late-onset sepsis, higher household income, lower education level, lack of donor BM exposure, and lower gestational age. CONCLUSIONS Our results suggest that maternal-infant demographic and clinical factors and household neighborhood socioeconomic characteristics were associated with provision of maternal BM at 30 postnatal days to VLBW infants. Identification of these factors allows providers to anticipate mothers' needs and develop tailored interventions designed to improve rates of prolonged maternal BM provision and infant outcomes.
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Affiliation(s)
- Andrew Romaine
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | | | - Briana R Davis
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - Kaitlin Hendershot
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - Vance Kite
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - Madeleine Laughon
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - Isaac Updike
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | | | - Paula P Meier
- Department of Pediatrics, Rush University Medical Center, Chicago, IL
| | - Aloka L Patel
- Department of Pediatrics, Rush University Medical Center, Chicago, IL
| | - P Brian Smith
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC; Department of Pediatrics, Duke University School of Medicine, Durham, NC
| | - C Michael Cotten
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC; Department of Pediatrics, Duke University School of Medicine, Durham, NC
| | - Daniel K Benjamin
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC; Department of Pediatrics, Duke University School of Medicine, Durham, NC
| | - Rachel G Greenberg
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC; Department of Pediatrics, Duke University School of Medicine, Durham, NC.
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ACOG Committee Opinion No. 756: Optimizing Support for Breastfeeding as Part of Obstetric Practice. Obstet Gynecol 2018; 132:e187-e196. [DOI: 10.1097/aog.0000000000002890] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Impact of Quality Improvement Program on Expressed Breastmilk Usage in Very Low Birth Weight Infants. Indian Pediatr 2018. [DOI: 10.1007/s13312-018-1371-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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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.
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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.
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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
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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.
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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
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Whitford HM, Wallis SK, Dowswell T, West HM, Renfrew MJ. Breastfeeding education and support for women with twins or higher order multiples. Cochrane Database Syst Rev 2017; 2:CD012003. [PMID: 28244065 PMCID: PMC6464508 DOI: 10.1002/14651858.cd012003.pub2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND There are rising rates of multiple births worldwide with associated higher rates of complications and more hospital care, often due to prematurity. While there is strong evidence about the risks of not breastfeeding, rates of breastfeeding in women who have given birth to more than one infant are lower than with singleton births. Breastfeeding more than one infant can be more challenging because of difficulties associated with the birth or prematurity. The extra demands on the mother of frequent suckling, coordinating the needs of more than one infant or admission to the neonatal intensive care unit can lead to delayed initiation or early cessation. Additional options such as breast milk expression, the use of donor milk or different methods of supplementary feeding may be considered. Support and education about breastfeeding has been found to improve the duration of any breastfeeding for healthy term infants and their mothers, however evidence is lacking about interventions that are effective to support women with twins or higher order multiples. OBJECTIVES To assess effectiveness of breastfeeding education and support for women with twins or higher order multiples. SEARCH METHODS We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 June 2016), ClinicalTrials.gov (30 June 2016), the WHO International Clinical Trials Registry Platform (ICTRP) (1 July 2016), the excluded studies list from the equivalent Cochrane review of singletons, and reference lists of retrieved studies. SELECTION CRITERIA Randomised or quasi-randomised trials comparing extra education or support for women with twins or higher order multiples were included. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy. We planned to assess the quality of evidence using the GRADE approach, but were unable to analyse any data. MAIN RESULTS We found 10 trials (23 reports) of education and support for breastfeeding that included women with twins or higher order multiples. The quality of evidence was mixed, and the risk of bias was mostly high or unclear. It is difficult to blind women or staff to group allocation for this intervention, so in all studies there was high risk of performance and high or unclear risk of detection bias. Trials recruited 5787 women (this included 512 women interviewed as part of a cluster randomised trial); of these, data were available from two studies for 42 women with twins or higher order multiples. None of the interventions were specifically designed for women with more than one infant, and the outcomes for multiples were not reported separately for each infant. Due to the scarcity of evidence and the format in which data were reported, a narrative description of the data is presented, no analyses are presented in this review, and we were unable to GRADE the evidence.The two trials with data for women with multiple births compared home nurse visits versus usual care (15 women), and telephone peer counselling versus usual care (27 women). The number of women who initiated breastfeeding was reported (all 15 women in one study, 25 out of 27 women in one study). Stopping any breastfeeding before four to six weeks postpartum, stopping exclusive breastfeeding before four to six weeks postpartum, stopping any breastfeeding before six months postpartum andstopping exclusive breastfeeding before six months postpartum were not explicitly reported, and there were insufficient data to draw any meaningful conclusions from survival data. Stopping breast milk expression before four to six weeks postpartum, andstopping breast milk expression before six months postpartum were not reported. Measures ofmaternal satisfaction were reported in one study of 15 women, but there were insufficient data to draw any conclusions; no other secondary outcomes were reported for women with multiple births in either study. No adverse events were reported. AUTHORS' CONCLUSIONS We found no evidence from randomised controlled trials about the effectiveness of breastfeeding education and support for women with twins or higher order multiples, or the most effective way to provide education and support . There was no evidence about the best way to deliver the intervention, the timing of care, or the best person to deliver the care. There is a need for well-designed, adequately powered studies of interventions designed for women with twins or higher order multiples to find out what types of education and support are effective in helping these mothers to breastfeed their babies.
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Affiliation(s)
- Heather M Whitford
- University of DundeeMother and Infant Research Unit, School of Nursing and Health Sciences, Dundee Centre for Health and Related Research11 Airlie PlaceDundeeScotlandUKDD1 4HJ
| | - Selina K Wallis
- Liverpool School of Tropical MedicineCapacity Research UnitLiverpoolUK
| | - Therese Dowswell
- The University of LiverpoolCochrane Pregnancy and Childbirth Group, Department of Women's and Children's HealthFirst Floor, Liverpool Women's NHS Foundation TrustCrown StreetLiverpoolUKL8 7SS
| | - Helen M West
- The University of LiverpoolInstitute of Psychology, Health and SocietyLiverpoolUK
| | - Mary J Renfrew
- University of DundeeMother and Infant Research Unit, School of Nursing and Health Sciences, Dundee Centre for Health and Related Research11 Airlie PlaceDundeeScotlandUKDD1 4HJ
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McFadden A, Gavine A, Renfrew MJ, Wade A, Buchanan P, Taylor JL, Veitch E, Rennie AM, Crowther SA, Neiman S, MacGillivray S. Support for healthy breastfeeding mothers with healthy term babies. Cochrane Database Syst Rev 2017; 2:CD001141. [PMID: 28244064 PMCID: PMC6464485 DOI: 10.1002/14651858.cd001141.pub5] [Citation(s) in RCA: 233] [Impact Index Per Article: 33.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND There is extensive evidence of important health risks for infants and mothers related to not breastfeeding. In 2003, the World Health Organization recommended that infants be breastfed exclusively until six months of age, with breastfeeding continuing as an important part of the infant's diet until at least two years of age. However, current breastfeeding rates in many countries do not reflect this recommendation. OBJECTIVES To describe forms of breastfeeding support which have been evaluated in controlled studies, the timing of the interventions and the settings in which they have been used.To examine the effectiveness of different modes of offering similar supportive interventions (for example, whether the support offered was proactive or reactive, face-to-face or over the telephone), and whether interventions containing both antenatal and postnatal elements were more effective than those taking place in the postnatal period alone.To examine the effectiveness of different care providers and (where information was available) training.To explore the interaction between background breastfeeding rates and effectiveness of support. SEARCH METHODS We searched Cochrane Pregnancy and Childbirth's Trials Register (29 February 2016) and reference lists of retrieved studies. SELECTION CRITERIA Randomised or quasi-randomised controlled trials comparing extra support for healthy breastfeeding mothers of healthy term babies with usual maternity care. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy. The quality of the evidence was assessed using the GRADE approach. MAIN RESULTS This updated review includes 100 trials involving more than 83,246 mother-infant pairs of which 73 studies contribute data (58 individually-randomised trials and 15 cluster-randomised trials). We considered that the overall risk of bias of trials included in the review was mixed. Of the 31 new studies included in this update, 21 provided data for one or more of the primary outcomes. The total number of mother-infant pairs in the 73 studies that contributed data to this review is 74,656 (this total was 56,451 in the previous version of this review). The 73 studies were conducted in 29 countries. Results of the analyses continue to confirm that all forms of extra support analyzed together showed a decrease in cessation of 'any breastfeeding', which includes partial and exclusive breastfeeding (average risk ratio (RR) for stopping any breastfeeding before six months 0.91, 95% confidence interval (CI) 0.88 to 0.95; moderate-quality evidence, 51 studies) and for stopping breastfeeding before four to six weeks (average RR 0.87, 95% CI 0.80 to 0.95; moderate-quality evidence, 33 studies). All forms of extra support together also showed a decrease in cessation of exclusive breastfeeding at six months (average RR 0.88, 95% CI 0.85 to 0.92; moderate-quality evidence, 46 studies) and at four to six weeks (average RR 0.79, 95% CI 0.71 to 0.89; moderate quality, 32 studies). We downgraded evidence to moderate-quality due to very high heterogeneity.We investigated substantial heterogeneity for all four outcomes with subgroup analyses for the following covariates: who delivered care, type of support, timing of support, background breastfeeding rate and number of postnatal contacts. Covariates were not able to explain heterogeneity in general. Though the interaction tests were significant for some analyses, we advise caution in the interpretation of results for subgroups due to the heterogeneity. Extra support by both lay and professionals had a positive impact on breastfeeding outcomes. Several factors may have also improved results for women practising exclusive breastfeeding, such as interventions delivered with a face-to-face component, high background initiation rates of breastfeeding, lay support, and a specific schedule of four to eight contacts. However, because within-group heterogeneity remained high for all of these analyses, we advise caution when making specific conclusions based on subgroup results. We noted no evidence for subgroup differences for the any breastfeeding outcomes. AUTHORS' CONCLUSIONS When breastfeeding support is offered to women, the duration and exclusivity of breastfeeding is increased. Characteristics of effective support include: that it is offered as standard by trained personnel during antenatal or postnatal care, that it includes ongoing scheduled visits so that women can predict when support will be available, and that it is tailored to the setting and the needs of the population group. Support is likely to be more effective in settings with high initiation rates. Support may be offered either by professional or lay/peer supporters, or a combination of both. Strategies that rely mainly on face-to-face support are more likely to succeed with women practising exclusive breastfeeding.
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Affiliation(s)
- Alison McFadden
- University of DundeeMother and Infant Research Unit, School of Nursing and Health Sciences, Dundee Centre for Health and Related Research11 Airlie PlaceDundeeTaysideUKDD1 4HJ
| | - Anna Gavine
- University of Dundeeevidence Synthesis Training and Research Group (eSTAR), School of Nursing and Health Sciences, Dundee Centre for Health and Related Research11 Airlie PlaceDundeeUKDD1 4HJ
| | - Mary J Renfrew
- University of DundeeMother and Infant Research Unit, School of Nursing and Health Sciences, Dundee Centre for Health and Related Research11 Airlie PlaceDundeeTaysideUKDD1 4HJ
| | - Angela Wade
- Institute of Child HealthCentre for Paediatric Epidemiology and Biostatistics30 Guilford StLondonUKWC1N 1 EH
| | | | | | - Emma Veitch
- Breastfeeding NetworkPaisleyRenfrewshireUKPA2 8YB
| | - Anne Marie Rennie
- NHS Grampian, Aberdeen Maternity HospitalCornhill RoadAberdeenUKAB25 2ZL
| | - Susan A Crowther
- Robert Gordon UniversityFaculty of Health and Social Care, School of Nursing and MidwiferyGarthdee RoadAberdeenUKAB10 7AQ
| | - Sara Neiman
- Breastfeeding NetworkPaisleyRenfrewshireUKPA2 8YB
| | - Stephen MacGillivray
- University of Dundeeevidence Synthesis Training and Research Group (eSTAR), School of Nursing and Health Sciences, Dundee Centre for Health and Related Research11 Airlie PlaceDundeeUKDD1 4HJ
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