Human-milk feeding after NICU discharge

A comparative study of mothers of infants hospitalized in an open ward neonatal intensive care unit and a combined pod and single-family room design

Background

The well-being of mothers of infants requiring Neonatal Intensive Care Unit (NICU) hospitalization may be affected by the architectural design of the unit. A few recent studies suggest there may be some drawbacks of single-family rooms (SFRs) for infants and their mothers, such as isolation of mothers and reduced exposure to auditory stimulation for infants.

Purpose

To compare NICU-stress, symptoms of depression, perceptions of nurse-parent support and family-centered care, sleep disturbances, breastfeeding self-efficacy and readiness for discharge in mothers of infants cared for in an open ward (OW) to those cared for in a unit that includes both pods and SFRs.

Methods

A pre-post quasi-experimental study was conducted in a Canadian level 3 unit before and after transitioning to a new unit of 6-bed pods and SFRs. OW data were collected in 2014 and pod/SFR data 1 year after the transition in 2017 to 2018. Mothers of infants hospitalized for at least 2 weeks completed questionnaires about stress, depressive symptoms, support, family-centered care, and sleep disturbances. In the week prior to discharge, they responded to breastfeeding self-efficacy and readiness for discharge questionnaires. They described their presence in the NICU at enrollment and again prior to discharge.

Results

Pod/SFR mothers reported significantly less NICU-stress compared to OW mothers. OW mothers had greater sights and sounds stress and felt more restricted in their parental role. Pod/SFR mothers reported greater respect from staff. Controlling for maternal education, pod/SFR mothers perceived their infant’s readiness for discharge to be greater than OW mothers. There were no significant differences between groups in depressive symptoms, nurse-parent support, sleep disturbances, and breastfeeding self-efficacy.

At enrollment and again in the weeks preceding discharge, pod/SFR mothers were present significantly more hours per week than OW mothers, controlling for maternal education.

Conclusions

Further study of small pods is indicated as these units may be less stressful for parents, and enhance family-centered care, as well as maternal presence, compared to OWs.

Expressing Human Milk in the NICU: Coping Mechanisms and Challenges Shape the Complex Experience of Closeness and Separation

BACKGROUND

Human milk has multiple benefits for human health; however, rates of infants receiving human milk at discharge in Canadian neonatal intensive care units (NICUs) are far below recommendations of the Baby Friendly Hospital Initiative supported by the Canadian Pediatric Association. Mothers of infants requiring NICU care usually need to express their milk, especially mothers of premature infants, since for some time their infant is unable to feed directly at the breast. Expressing human milk for an extended period can be challenging for mothers.

PURPOSE

To document maternal experiences expressing human milk for their infant in the NICU as a closeness or separation experience, and to discover what factors gave rise to these perceptions.

METHODS

In this descriptive qualitative cross-sectional study, 15 mothers whose infants were hospitalized in a level III NICU and who were expressing human milk audio recorded their thoughts and feelings with a smartphone application for 48 hours while they were expressing milk. A thematic content analysis was used to analyze data.

FINDINGS

Expressing human milk for their hospitalized infant was a difficult experience for all mothers, and most described both closeness and separation feelings while expressing milk. Their feelings fluctuated depending on their coping mechanisms, perceived challenges, as well as their location and environment. Mothers were all pursuing their goal of continued milk expression with various levels of motivation.

IMPLICATIONS FOR PRACTICE

NICUs should adopt a family-centered approach to care whereby mothers' care needs related to milk expression are addressed. Nurses can ask open-ended questions to explore how mothers are coping, and they can assist mothers to find effective coping strategies to minimize the challenges related to milk expression to promote mother-infant closeness.

IMPLICATIONS FOR RESEARCH

The impact of environment and location on mothers with hospitalized infants should be explored, as unit designs could be altered to foster closeness.

Breastfeeding Preterm Infants at a Neonatal Care Unit in Rural Tanzania

OBJECTIVE

To describe the breastfeeding experiences of mothers with preterm and low-birth-weight infants in a neonatal unit in Tanzania.

DESIGN

A qualitative research design.

SETTING

A neonatal unit at a referral hospital in rural Tanzania.

PARTICIPANTS

Convenience sample of 10 new mothers with preterm infants. Additionally, to triangulate the data, five nurses affiliated with the neonatal unit were interviewed.

METHODS

A semistructured interview guide was used for data collection. All interviews were audiotaped and transcribed verbatim. Data were analyzed with inductive qualitative content analysis.

RESULTS

One main category, The mother has to adapt to the new situation to make breastfeeding natural, and three generic categories, The challenges of breastfeeding a premature infant, Enhancing the feeding situation, and The need for support, were used to describe breastfeeding challenges. Challenges consisted of the perception that the infant was different than healthy infants and the infant's and mother's health problems and needs. To improve the feeding situation, mothers learned how to feed their infants using timing strategies. Confidence and security were achieved with support from family and friends, the other mothers, and the health care staff.

CONCLUSION

Mothers perceived breastfeeding as natural but needed support to overcome the challenges of breastfeeding preterm infants. Through support and education they were empowered, adapted to their new situations, and felt confident with breastfeeding.

Transition From Hospital to Home in Parents of Preterm Infants: A Literature Review

Transition from hospital to home is a complex and multidimensional phenomenon for parents of prematurely born infants (<37 weeks of gestation). The absence of a clear conceptualization of this particular transition coupled with the challenges parents have when they return home and higher costs of healthcare service usage postdischarge dictates the need for a better understanding of this phenomenon. A literature review was undertaken using Whittemore and Knafl's theoretical framework for integrative review as a guide. A systematic search of the electronic databases (PsycINFO, PubMed, Medline, Cumulative Index of Nursing and Allied Health Literature, EMBASE, Cochrane Database for Systematic Reviews, and EBSCO) was performed. Fifty selected reports of research conducted on parents of preterm infants during 1980-2014 are included in this article. Five themes emerged from the review-disruption of parental role development, distorted development of parent-infant relationships, psychological consequences of a preterm birth and infant hospitalization, learning caregiving and parenting, and need for social and professional supports-which appear to reflect parental challenges during transition from hospital to home after discharge. Several inconsistencies in results of the studies dictate the need for further research in this vulnerable population; the better conceptualization and measurement of transitional challenges are warranted.

Mothers' experiences of infants discharge in Iranian NICU culture: a qualitative study

PURPOSE

This study examined mothers' experiences of the preparation of their infants for discharge in the Iranian neonatal intensive care unit (NICU) culture.

SUBJECTS AND SETTING

Participants included 16 mothers who had preterm infants who were hospitalized in Iranian NICUs.

DESIGN

A qualitative study was used to describe mothers' experiences of infant discharge from the NICU.

METHODS

Data collection was done by interviewing mothers who were in NICUs of Iranian University Hospitals. The qualitative data analysis package was used for coding and categorizing.

RESULTS

Four themes were identified: learning from multiple sources, conditional discharge, enabled mother, and continued nightmares.

CONCLUSION

This study highlighted several issues regarding mothers' experiences of infants' discharge plan. Nurses should be aware of these themes to support the mothers during preparation of their infants for discharge from NICUs.

Psychometric testing of the modified breastfeeding self-efficacy scale (short form) among mothers of ill or preterm infants

OBJECTIVE

To psychometrically assess the modified Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF) among mothers of ill or preterm infants.

DESIGN

Methodological study.

SETTING

Three neonatal intensive care units (NICUs) located in two hospitals in a central Canadian city.

PARTICIPANTS

One hundred forty-four (144) breastfeeding mothers of ill or preterm infants.

METHODS

Mothers completed the BSES-SF modified for mothers of ill or preterm infants, the Hill and Humenick (H&H) Lactation Scale, and demographic questions.

RESULTS

The Cronbach's alpha coefficient for internal consistency for the BSES-SF revised for mothers of ill or preterm infants was 0.88. Construct validity was assessed using comparison of contrasted groups (mothers who continued to breastfeed and those who discontinued) and correlation with the construct of maternal perceptions of insufficient milk supply. Support for predictive validity was demonstrated through significant mean differences between mothers who were breastfeeding (M = 83.44, SD = 8.23) and those who discontinued breastfeeding and breast pumping (M = 75.51, SD = 10.08) at 6-weeks post-infant hospital discharge.

CONCLUSION

Demographic response patterns suggest that the modified BSES-SF is a unique tool to identify breastfeeding mothers of ill or preterm infants at risk of prematurely discontinuing. This study provides evidence that the modified BSES-SF may be a valid and reliable measure of breastfeeding self-efficacy among a sample of mothers of ill or preterm infants.