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Gyamfi A, Jefferson UT, O'Neill B, Lucas R, Spatz DL, Henderson WA. Breastfeeding Attitudes and Social Support Among Christian African Americans. Breastfeed Med 2024; 19:333-339. [PMID: 38546168 DOI: 10.1089/bfm.2023.0277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/12/2024]
Abstract
Purpose: To describe the breastfeeding attitudes and subjective norms of breastfeeding among African American Christians from the New England region. Study Design and Methods: A study was conducted using an online survey. Participants were recruited from four Christian churches in the New England region during the summer of 2021. Responses from direct questions about exclusive breastfeeding histories were tabulated. Open-ended question responses were analyzed using thematic analysis. Two results were merged to make the conclusions. Results: Participants (n = 101) aged 18-44 years (62.3%), college graduates (72.3%), and Catholics (71.4%) responded. Participants were willing to recommend six months of exclusive breastfeeding practice to relatives (89.9%) and friends/peers (87.9%) and support relatives (94.0%) and friends/peers (94.8%) to practice exclusive breastfeeding for 6 months. Breastfeeding attitude themes included beneficial and natural and receiving breastfeeding support. Subjective norms of breastfeeding themes included receiving support for breastfeeding; Christian leadership, teachings, and communal engagements; and gaps in Christian influence. Conclusion: The African American Christian community may be an emergent agent of breastfeeding social support for African American Christian women who chose to breastfeed. Health professionals should collaborate with African American Christian leadership to initiate programs to promote breastfeeding among African American Christian women in the United States.
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Affiliation(s)
- Adwoa Gyamfi
- School of Nursing, University of Connecticut, Storrs, Connecticut, USA
- School of Nursing and Midwifery, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | - Barbara O'Neill
- Urban Service Track/AHEC Scholars Nurses Climate Challenge Champion, University of Connecticut School of Nursing, Storrs, Connecticut, USA
| | - Ruth Lucas
- School of Nursing, University of Connecticut, Storrs, Connecticut, USA
| | - Diane L Spatz
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Wendy A Henderson
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Spatz DL. Human Milk and Medications: Nurses' Responsibility. MCN Am J Matern Child Nurs 2024; 49:174. [PMID: 38679829 DOI: 10.1097/nmc.0000000000001008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2024]
Affiliation(s)
- Diane L Spatz
- Diane L. Spatz is Professor of Perinatal Nursing & the Helen M. Shearer Professor of Nutrition, Family and Community Department, University of Pennsylvania School of Nursing, Nurse Scientist-Lactation, The Center for Pediatric Nursing Research and Evidence Based Practice, Children's Hospital of Philadelphia and an MCN Editorial Board Member. Dr. Spatz can be reached at
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Slater CN, Juntereal NA, Kral TVE, Spatz DL, Chao AM. Comparison of the Effect of Direct Breastfeeding, Expressed Human Milk, and Infant Formula Feeding on Infant Weight Trajectories: A Systematic Review. Breastfeed Med 2024; 19:235-247. [PMID: 38497755 DOI: 10.1089/bfm.2023.0149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
Background: Formula and breastfeeding are known factors associated with infant weight trajectories. Evidence exploring the effect of expressed human milk feeding on infant weight in the community setting has not been well synthesized. Objectives: This systematic review examined (1) weight changes among infants fed expressed human milk and (2) differences in weight change between infants fed expressed human milk and infants fed at the breast or infant formula via bottle. Methods: A comprehensive search of the literature was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The quality of each study was appraised using the Joanna Briggs Critical Appraisal Tools. Results: A total of six studies met the eligibility criteria and included a total of 5,152 infants. The within-subject analysis identified only 31 infants strictly or predominantly fed expressed human milk. The between-subject analysis comparing expressed human milk feeding to the available comparison groups (formula-fed or direct at the breastfed) revealed that higher weight gains were observed in the weight trajectories among infants in the bottle or formula-fed conditions in four of the six included studies. Conclusions: Findings from the few studies included in this review found a difference in the infant weight gain patterns among expressed human milk-fed infants when compared with their respective feeding groups (directly breastfed or formula-fed). Further research is needed to corroborate these findings and elucidate the clinical significance of the differences in weight gain patterns observed across infant feeding groups.
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Affiliation(s)
- Courtney N Slater
- University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
| | - Nina A Juntereal
- Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
| | - Tanja V E Kral
- Department of Biobehavioral Health Sciences, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Diane L Spatz
- Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
- Center for Pediatric Nursing Research & Evidence-Based Practice, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Ariana M Chao
- Department of Biobehavioral Health Sciences, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- Johns Hopkins University School of Nursing, Baltimore, Maryland, USA
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Acquaye SN, Spatz DL. Black Families Who Choose Long-Term Breastfeeding. MCN Am J Matern Child Nurs 2024; 49:15-21. [PMID: 37773086 DOI: 10.1097/nmc.0000000000000969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2023]
Abstract
PURPOSE Black families face disproportionate rates of poor health outcomes, including low rates of breastfeeding initiation and duration. Some Black mothers make the decision to breastfeed their child beyond infancy and report positive experiences. Understanding their backgrounds, motivations, and characteristics of their breastfeeding experiences may provide insight into what factors facilitate achievement of long-term breastfeeding for Black mothers. STUDY DESIGN AND METHODS Surveys were deployed through a variety of methods including social media and emails to organizations that work with breastfeeding families. Descriptive statistics were used to analyze survey data and the open-ended question was analyzed using a word cloud program. RESULTS Surveys were completed by 194 eligible mothers. Participants had a mean age of 31 years (range: 19-50). Mean breastfeeding duration of their currently breastfed and youngest child was 21 months (median: 19.5, range: 12-57). Primary reasons for breastfeeding beyond infancy included child wants to cuddle (28.9%) and child is tired (24.7%). Fifty-seven percent of participants reported that their child breastfed three to six times per day and 57.2% reported that their child woke up at least two times per night to feed. CLINICAL IMPLICATIONS Nurses are uniquely positioned to provide anticipatory guidance, resources, and support to breastfeeding parents. Just over half of the mothers in this study had not planned to breastfeed beyond 12 months at the start of their lactation journey. Nurses who work with breastfeeding families could be instrumental in providing resources, support, and tangible assistance for families who may consider breastfeeding beyond 1 year.
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Dario H, Spatz DL. An Integrative Review of Breastfeeding and Homelessness. Nurs Womens Health 2023; 27:416-426. [PMID: 37806318 DOI: 10.1016/j.nwh.2023.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 06/14/2023] [Accepted: 09/12/2023] [Indexed: 10/10/2023]
Abstract
OBJECTIVE To synthesize the current literature surrounding breastfeeding and homelessness, and to determine the impact of disparities in this population. DATA SOURCES An integrative search was conducted using Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines and using the search terms "breastfeeding" and "homelessness" throughout electronic databases PubMed, CINAHL, and Scopus. STUDY SELECTION Inclusion criteria were articles published in English from January 2007 to September 2022. Exclusion criteria were studies published more than 15 years ago, studies published in a language other than English, opinion articles, and irrelevance to breastfeeding and homelessness. The initial search yielded 100 results. After removing duplicates and articles because of irrelevance, the final number of articles for this synthesis was seven. DATA EXTRACTION Data were extracted from each article, critically appraised using Joanna Briggs Institute criteria, and summarized in a table of evidence. DATA SYNTHESIS Three common themes were identified: Decreased Breastfeeding Initiation Rates and Duration in the Homeless Population, Impact of Community and Clinical Support, and Breastfeeding Practices Influenced by Individual Factors. CONCLUSION Providers and nurses should refer patients to the Special Supplemental Nutrition Program for Women, Infants, and Children; use techniques to instill a parent's intent to breastfeed; provide early breastfeeding education; promote breastfeeding initiation within 1 hour of birth; and encourage peer support groups. Although current researchers provide insight into potential barriers and interventions, more research is needed to gain additional data on how to overcome identified barriers to breastfeeding.
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Lisanti AJ, Vittner DJ, Peterson J, Van Bergen AH, Miller TA, Gordon EE, Negrin KA, Desai H, Willette S, Jones MB, Caprarola SD, Jones AJ, Helman SM, Smith J, Anton CM, Bear LM, Malik L, Russell SK, Mieczkowski DJ, Hamilton BO, McCoy M, Feldman Y, Steltzer M, Savoca ML, Spatz DL, Butler SC. Developmental care pathway for hospitalised infants with CHD: on behalf of the Cardiac Newborn Neuroprotective Network, a Special Interest Group of the Cardiac Neurodevelopmental Outcome Collaborative. Cardiol Young 2023; 33:2521-2538. [PMID: 36994672 PMCID: PMC10544686 DOI: 10.1017/s1047951123000525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
Abstract
Infants and children born with CHD are at significant risk for neurodevelopmental delays and abnormalities. Individualised developmental care is widely recognised as best practice to support early neurodevelopment for medically fragile infants born premature or requiring surgical intervention after birth. However, wide variability in clinical practice is consistently demonstrated in units caring for infants with CHD. The Cardiac Newborn Neuroprotective Network, a Special Interest Group of the Cardiac Neurodevelopmental Outcome Collaborative, formed a working group of experts to create an evidence-based developmental care pathway to guide clinical practice in hospital settings caring for infants with CHD. The clinical pathway, "Developmental Care Pathway for Hospitalized Infants with Congenital Heart Disease," includes recommendations for standardised developmental assessment, parent mental health screening, and the implementation of a daily developmental care bundle, which incorporates individualised assessments and interventions tailored to meet the needs of this unique infant population and their families. Hospitals caring for infants with CHD are encouraged to adopt this developmental care pathway and track metrics and outcomes using a quality improvement framework.
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Affiliation(s)
- Amy J. Lisanti
- Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, PA, USA, Research Institute, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Dorothy J. Vittner
- Egan School of Nursing and Health Studies, Fairfield University Fairfield, CT, USA, Connecticut Children’s, Hartford, CT, USA
| | | | - Andrew H. Van Bergen
- Advocate Children’s Heart Institute, Advocate Children’s Hospital, Oak Lawn, IL, USA
| | - Thomas A. Miller
- Department of Pediatrics, Maine Medical Center, Portland, ME, USA
| | - Erin E. Gordon
- DO, Inpatient Cardiac Neurodevelopment Program, Division of Critical Care Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Karli A Negrin
- Department of Therapeutic and Rehabilitative Services, Nemours Children Hospital, Wilmington, Delaware, USA
| | - Hema Desai
- Rehabilitation Services, CHOC Children’s Hospital, Orange, CA, USA
| | - Suzie Willette
- Department of Speech-Language Pathology, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA
| | - Melissa B Jones
- Cardiac Critical Care, Children’s National Hospital, Washington DC USA
| | - Sherrill D. Caprarola
- Heart Institute, Children’s Hospital Colorado, University of Colorado, Aurora, CO, USA
| | - Anna J. Jones
- Office of Advanced Practice Providers, UT Southwestern Medical Center, Dallas, TX, USA, Heart Center, Children’s Health, Dallas, TX, USA
| | - Stephanie M. Helman
- Department of Acute and Tertiary Care, University of Pittsburgh School of Nursing, Pittsburgh, PA, USA
| | - Jodi Smith
- Parent Representative, The Mended Hearts, Inc., Program Director, Richmond, VA, USA
| | - Corinne M. Anton
- Department of Psychology and Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas, USA, Department of Cardiology, Children’s Health, Dallas, Texas, USA
| | - Laurel M. Bear
- Department of Pediatrics, Medical College of Wisconsin, Children’s Wisconsin, Milwaukee, WI, USA
| | - Lauren Malik
- Department of Acute Care Therapy Services, Primary Children’s Hospital, Salt Lake City, UT, USA
| | - Sarah K. Russell
- Department of Therapeutic and Rehabilitative Services, Nemours Children Hospital, Wilmington, DE, USA
| | - Dana J. Mieczkowski
- Department of Therapeutic and Rehabilitative Services, Nemours Children Hospital, Wilmington, DE, USA
| | - Bridy O. Hamilton
- Department of Therapeutic and Rehabilitative Services, Nemours Children Hospital, Wilmington, Delaware, USA
| | - Meghan McCoy
- Pediatric and Congenital Heart Center, Duke University Hospital, Durham, NC, USA
| | - Yvette Feldman
- Nursing & Patient Care Center of Excellence, St. Luke’s Health System, Boise, ID, USA
| | - Michelle Steltzer
- Single Ventricle Center of Excellence, Ann & Robert H. Lurie Children’s Hospital, Chicago, IL, USA
| | - Melanie L Savoca
- Department of Clinical Nutrition, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Diane L. Spatz
- Department of Family & Community Health, University of Pennsylvania School of Nursing, The Center for Pediatric Nursing Research and Evidence Based Practice, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Samantha C. Butler
- Department of Psychiatry (Psychology), Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
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Affiliation(s)
- Diane L Spatz
- Diane L. Spatz is a Professor of Perinatal Nursing and the Helen M. Shearer Professor of Nutrition at the University of Pennsylvania School of Nursing sharing a joint appointment as a Nurse Scientist in Lactation at the Center for Pediatric Nursing Research and Evidence Based Practice at Children's Hospital of Philadelphia. Dr. Spatz can be reached at
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Dell LG, Spatz DL. Managing tandem breastfeeding during acute hospitalization: A case study. J Pediatr Nurs 2023; 73:e134-e137. [PMID: 37544856 DOI: 10.1016/j.pedn.2023.07.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 07/31/2023] [Accepted: 07/31/2023] [Indexed: 08/08/2023]
Abstract
This case study presents a mother who continued tandem breastfeeding throughout the acute admission of her critically ill newborn. Her younger child, the subject of this case report was admitted to our hospital with septic shock and progressing bullous scalp lesions. The infant had streptococcal toxic shock syndrome and necrotizing fasciitis of the scalp due to streptococcus pyogenes. The infant required immediate life-sustaining interventions, followed by weekly surgical procedures which meant the infant had brief periods of intravenous nutrition surrounding the time of anesthesia administration. During instances when the infant was unable to orally feed, such as while intubated for procedures, she was fed her mother's milk via nasogastric tube. At times that the infant was stable to orally feed, the mother directly breastfed the infant. Even when the infant was on strict bedrest, bedside nurses assisted the mother with infant positioning to breastfeed. In addition, when the infant was able to be held out of bed, the mother was able to resume breastfeeding both of her children simultaneously. Despite the critical nature of this child's illness, the mother was able to provide 100% human milk diet to her child during the 68-day hospital stay. With assistance and support of nursing staff the mother was ultimately able to resume breastfeeding both children simultaneously.
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Affiliation(s)
- Lisa G Dell
- Staff Nurse & Chair of Unit Based Human Milk Committee, Newborn/Infant Intensive Care Unit, Children's Hospital of Philadelphia, USA
| | - Diane L Spatz
- Professor of Perinatal Nursing & the Helen M. Shearer Profession of Nutrition, The University of Pennsylvania School of Nursing, Nurse Scientist-Lactation, The Center for Pediatric Nursing Research & Evidence Based Practice, Children's Hospital of Philadelphia, USA.
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Elgersma KM, Wolfson J, Fulkerson JA, Georgieff MK, Looman WS, Spatz DL, Shah KM, Uzark K, McKechnie AC. Predictors of Human Milk Feeding and Direct Breastfeeding for Infants with Single Ventricle Congenital Heart Disease: Machine Learning Analysis of the National Pediatric Cardiology Quality Improvement Collaborative Registry. J Pediatr 2023; 261:113562. [PMID: 37329981 PMCID: PMC10527750 DOI: 10.1016/j.jpeds.2023.113562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 06/07/2023] [Accepted: 06/12/2023] [Indexed: 06/19/2023]
Abstract
OBJECTIVE To identify factors that support or limit human milk (HM) feeding and direct breastfeeding (BF) for infants with single ventricle congenital heart disease at neonatal stage 1 palliation (S1P) discharge and at stage 2 palliation (S2P) (∼4-6 months old). STUDY DESIGN Analysis of the National Pediatric Cardiology Quality Improvement Collaborative (NPC-QIC) registry (2016-2021; 67 sites). Primary outcomes were any HM, exclusive HM, and any direct BF at S1P discharge and at S2P. The main analysis involved multiple phases of elastic net logistic regression on imputed data to identify important predictors. RESULTS For 1944 infants, the strongest predictor domain areas included preoperative feeding, demographics/social determinants of health, feeding route, clinical course, and site. Significant findings included: preoperative BF was associated with any HM at S1P discharge (OR = 2.02, 95% CI = 1.74-3.44) and any BF at S2P (OR = 2.29, 95% CI = 1.38-3.80); private/self-insurance was associated with any HM at S1P discharge (OR = 1.91, 95% CI = 1.58-2.47); and Black/African-American infants had lower odds of any HM at S1P discharge (OR = 0.54, 95% CI = 0.38-0.65) and at S2P (0.57, 0.30-0.86). Adjusted odds of HM/BF practices varied among NPC-QIC sites. CONCLUSIONS Preoperative feeding practices predict later HM and BF for infants with single ventricle congenital heart disease; therefore, family-centered interventions focused on HM/BF during the S1P preoperative time are needed. These interventions should include evidence-based strategies to address implicit bias and seek to minimize disparities related to social determinants of health. Future research is needed to identify supportive practices common to high-performing NPC-QIC sites.
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Affiliation(s)
| | - Julian Wolfson
- Division of Biostatistics, University of Minnesota School of Public Health, Minneapolis, MN
| | - Jayne A Fulkerson
- University of Minnesota School of Nursing, Minneapolis, MN; Division of Epidemiology, University of Minnesota School of Public Health, Minneapolis, MN
| | - Michael K Georgieff
- Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN; Division of Neonatology, M Health Fairview University of Minnesota Masonic Children's Hospital, Minneapolis, MN
| | - Wendy S Looman
- University of Minnesota School of Nursing, Minneapolis, MN
| | - Diane L Spatz
- University of Pennsylvania School of Nursing, Philadephia, PA; Children's Hospital of Philadelphia, Philadephia, PA
| | - Kavisha M Shah
- Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN; Division of Pediatric Cardiology, M Health Fairview University of Minnesota Masonic Children's Hospital, Minneapolis, MN
| | - Karen Uzark
- Division of Cardiac Surgery, University of Michigan Medical School, Ann Arbor, MI; C. S. Mott Children's Hospital, Ann Arbor, MI
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Elgersma KM, Wolfson J, Fulkerson JA, Georgieff MK, Looman WS, Spatz DL, Shah KM, Uzark K, McKechnie AC. Human Milk Feeding and Direct Breastfeeding Improve Outcomes for Infants With Single Ventricle Congenital Heart Disease: Propensity Score-Matched Analysis of the NPC-QIC Registry. J Am Heart Assoc 2023; 12:e030756. [PMID: 37642030 PMCID: PMC10547322 DOI: 10.1161/jaha.123.030756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 07/28/2023] [Indexed: 08/31/2023]
Abstract
Background Infants with single ventricle congenital heart disease undergo 3 staged surgeries/interventions, with risk for morbidity and mortality. We estimated the effect of human milk (HM) and direct breastfeeding on outcomes including necrotizing enterocolitis, infection-related complications, length of stay, and mortality. Methods and Results We analyzed the National Pediatric Cardiology Quality Improvement Collaborative (NPC-QIC) registry (2016-2021), examining HM/breastfeeding groups during stage 1 and stage 2 palliations. We calculated propensity scores for feeding exposures, then fitted Poisson and logistic regression models to compare outcomes between propensity-matched cohorts. Participants included 2491 infants (68 sites). Estimates for all outcomes were better in HM/breastfeeding groups. Infants fed exclusive HM before stage 1 palliation (S1P) had lower odds of preoperative necrotizing enterocolitis (odds ratio [OR], 0.37 [95% CI, 0.17-0.84]; P=0.017) and shorter S1P length of stay (rate ratio [RR], 0.87 [95% CI, 0.78-0.98]; P=0.027). During the S1P hospitalization, infants with high HM had lower odds of postoperative necrotizing enterocolitis (OR, 0.28 [95% CI, 0.15-0.50]; P<0.001) and sepsis (OR, 0.29 [95% CI, 0.13-0.65]; P=0.003), and shorter S1P length of stay (RR, 0.75 [95% CI, 0.66-0.86]; P<0.001). At stage 2 palliation, infants with any HM (RR, 0.82 [95% CI, 0.69-0.97]; P=0.018) and any breastfeeding (RR, 0.71 [95% CI, 0.57-0.89]; P=0.003) experienced shorter length of stay. Conclusions Infants with single ventricle congenital heart disease in high-HM and breastfeeding groups experienced multiple significantly better outcomes. Given our findings of improved health, strategies to increase the rates of HM/breastfeeding in these patients should be implemented. Future research should replicate these findings with granular feeding data and in broader congenital heart disease populations, and should examine mechanisms (eg, HM components, microbiome) by which HM/breastfeeding benefits these infants.
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Affiliation(s)
| | - Julian Wolfson
- Division of BiostatisticsUniversity of Minnesota School of Public HealthMinneapolisMNUSA
| | - Jayne A. Fulkerson
- University of Minnesota School of NursingMinneapolisMNUSA
- Division of EpidemiologyUniversity of Minnesota School of Public HealthMinneapolisMNUSA
| | - Michael K. Georgieff
- Department of PediatricsUniversity of Minnesota Medical SchoolMinneapolisMNUSA
- M Health Fairview University of Minnesota Masonic Children’s HospitalMinneapolisMNUSA
| | | | - Diane L. Spatz
- University of Pennsylvania School of NursingPhiladelphiaPAUSA
- Children’s Hospital of PhiladelphiaPhiladelphiaPAUSA
| | - Kavisha M. Shah
- Department of PediatricsUniversity of Minnesota Medical SchoolMinneapolisMNUSA
- M Health Fairview University of Minnesota Masonic Children’s HospitalMinneapolisMNUSA
| | - Karen Uzark
- Division of Cardiac SurgeryUniversity of Michigan Medical SchoolAnn ArborMIUSA
- C. S. Mott Children’s HospitalAnn ArborMIUSA
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Spatz DL. Guidance for Breastfeeding and HIV. MCN Am J Matern Child Nurs 2023; 48:282. [PMID: 37574696 DOI: 10.1097/nmc.0000000000000943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2023]
Affiliation(s)
- Diane L Spatz
- Diane L. Spatz is a Professor of Perinatal Nursing and the Helen M. Shearer Professor of Nutrition at the University of Pennsylvania School of Nursing sharing a joint appointment as a Nurse Scientist in Lactation at the Center for Pediatric Nursing Research and Evidence Based Practice at Children's Hospital of Philadelphia. Dr. Spatz can be reached via email at
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Spatz DL. The PUMP Act Passes! MCN Am J Matern Child Nurs 2023; 48:226. [PMID: 37365707 DOI: 10.1097/nmc.0000000000000931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2023]
Affiliation(s)
- Diane L Spatz
- Diane L. Spatz is a Professor of Perinatal Nursing and the Helen M. Shearer Professor of Nutrition at the University of Pennsylvania School of Nursing sharing a joint appointment as a Nurse Scientist in Lactation at the Center for Pediatric Nursing Research and Evidence Based Practice at Children's Hospital of Philadelphia. Dr. Spatz can be reached via email at
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Spatz DL, Juntereal N. Re: "Education and Experiences of Antenatal Breast Milk Expression: A Systematic Review" by Sobik et al. Breastfeed Med 2023; 18:404. [PMID: 37155640 DOI: 10.1089/bfm.2023.0058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Affiliation(s)
- Diane L Spatz
- Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Center for Pediatric Nursing Research & Evidence-Based Practice, Children's Hospital of Philadelphia, Pennsylvania, USA
| | - Nina Juntereal
- Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Spatz DL. Human Milk to Protect from Respiratory Infections. MCN Am J Matern Child Nurs 2023; 48:170. [PMID: 37101332 DOI: 10.1097/nmc.0000000000000913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Affiliation(s)
- Diane L Spatz
- Diane L. Spatz is a Professor of Perinatal Nursing and the Helen M. Shearer Professor of Nutrition at the University of Pennsylvania School of Nursing sharing a joint appointment as a Nurse Scientist in Lactation at the Center for Pediatric Nursing Research and Evidence Based Practice at Children's Hospital of Philadelphia, Philadelphia, PA. Dr. Spatz can be reached via email at
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Elgersma KM, Wolfson J, Fulkerson JA, Georgieff MK, Looman WS, Spatz DL, Shah KM, Uzark K, McKechnie AC. Human milk feeding and direct breastfeeding improve outcomes for infants with single ventricle congenital heart disease: Propensity score matched analysis of the NPC-QIC registry. medRxiv 2023:2023.04.26.23289126. [PMID: 37162951 PMCID: PMC10168482 DOI: 10.1101/2023.04.26.23289126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Background Infants with single ventricle (SV) congenital heart disease (CHD) undergo three staged surgeries/interventions, with risk for morbidity and mortality. We estimated the effect of human milk (HM) and direct breastfeeding (BF) on outcomes including necrotizing enterocolitis (NEC), infection-related complications, length of stay (LOS), and mortality. Methods We analyzed the National Pediatric Cardiology Quality Improvement Collaborative registry (2016-2021), examining HM/BF groups during stage 1 (S1P) and stage 2 (S2P) palliations. We calculated propensity scores for feeding exposures, then fitted Poisson and logistic regression models to compare outcomes between propensity-matched cohorts. Results Participants included 2491 infants (68 sites). Estimates for all outcomes were better in HM/BF groups. Infants fed exclusive HM before S1P had lower odds of preoperative NEC (OR=0.37, 95% CI=0.17-0.84, p=0.017) and shorter S1P LOS (RR=0.87, 0.78-0.98, p=0.027). During the S1P hospitalization, infants with high HM had lower odds of postoperative NEC (OR=0.28, 0.15-0.50, p<0.001) and sepsis (0.29, 0.13-0.65, p=0.003), and shorter S1P LOS (RR=0.75, 0.66-0.86, p<0.001). At S2P, infants with any HM (0.82, 0.69-0.97, p=0.018) and any BF (0.71, 0.57-0.89, p=0.003) experienced shorter LOS. Conclusions Infants with SV CHD in high HM and BF groups experienced multiple significantly better outcomes. Given our findings of improved health, strategies to increase the rates of HM/BF in these patients should be implemented. Future research should replicate these findings with granular feeding data and in broader CHD populations, and should examine mechanisms (eg, HM components; microbiome) by which HM/BF benefits these infants. Clinical Perspective What is new?: This is the first large, multisite study examining the impact of human milk and breastfeeding on outcomes for infants with single ventricle congenital heart disease.All outcome estimates were better in high human milk and breastfeeding groups, with significantly lower odds of necrotizing enterocolitis, sepsis, and infection-related complications; and significantly shorter length of stay at both the neonatal stage 1 palliation and the subsequent stage 2 palliation.All estimates of all-cause mortality were substantially lower in human milk and breastfeeding groups, with clinically important estimates of 75%-100% lower odds of mortality in direct breastfeeding groups.What are the clinical implications?: There is a critical need for improved, condition-specific lactation support to address the low prevalence of human milk and breastfeeding for infants with single ventricle congenital heart disease.Increasing the dose and duration of human milk and direct breastfeeding has strong potential to substantially improve the health outcomes of these vulnerable infants.
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Affiliation(s)
| | - Julian Wolfson
- University of Minnesota School of Public Health, Division of Biostatistics
| | - Jayne A. Fulkerson
- University of Minnesota School of Nursing
- University of Minnesota School of Public Health, Division of Epidemiology
| | - Michael K. Georgieff
- University of Minnesota Medical School, Department of Pediatrics
- M Health Fairview University of Minnesota Masonic Children’s Hospital
| | | | - Diane L. Spatz
- University of Pennsylvania School of Nursing
- Children’s Hospital of Philadelphia
| | - Kavisha M. Shah
- University of Minnesota Medical School, Department of Pediatrics
- M Health Fairview University of Minnesota Masonic Children’s Hospital
| | - Karen Uzark
- University of Michigan Medical School, Division of Cardiac Surgery
- C. S. Mott Children's Hospital
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Elgersma KM, Spatz DL, Fulkerson JA, Wolfson J, Georgieff MK, Looman WS, Shah KM, Uzark K, McKechnie AC. Patterns of Breastfeeding and Human Milk Feeding in Infants with Single-Ventricle Congenital Heart Disease: A Population Study of the National Pediatric Cardiology Quality Improvement Collaborative Registry. Breastfeed Med 2023; 18:315-325. [PMID: 37071633 PMCID: PMC10124172 DOI: 10.1089/bfm.2023.0036] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
Abstract
Introduction: Infants with single-ventricle (SV) congenital heart disease (CHD) undergo staged surgical and/or catheter-based palliation and commonly experience feeding challenges and poor growth. Little is known about human milk (HM) feeding or direct breastfeeding (BF) in this population. Aim: To determine (1) HM and BF prevalence for infants with SV CHD, and (2) whether BF at neonatal stage 1 palliation (S1P) discharge is associated with any HM at stage 2 palliation (S2P; ∼4-6 months old). Materials and Methods: Analysis of the National Pediatric Cardiology Quality Improvement Collaborative registry (2016-2021) using (1) descriptive statistics for prevalence, and (2) logistic regression adjusted for multiple variables (e.g., prematurity, insurance, length of stay) to examine early BF/later HM feeding. Results: Participants included 2,491 infants from 68 sites. HM prevalence ranged from 49.3% any/41.5% exclusive before S1P to 37.1% any/7.0% exclusive at S2P. Direct BF ranged from 16.1% any/7.9% exclusive before S1P to 9.2% any/3.2% exclusive at S2P discharge. Prevalence varied among sites; for example, 0-100% any HM before S1P. Infants BF at S1P discharge had greater odds of any HM (odds ratio = 4.11, 95% confidence interval [CI] = 2.79-6.07, p < 0.001) and exclusive HM (1.85, 95% CI 1.03-3.30, p = 0.039) at S2P. Conclusions: The prevalence of HM and BF for infants with SV CHD was low and declined over time. Direct BF at S1P discharge was associated with increased odds of any HM at S2P. Wide variation suggests that site-specific practices impact feeding outcomes. HM and BF prevalence are suboptimal in this population, and identification of supportive institutional practices is needed.
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Affiliation(s)
| | - Diane L. Spatz
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Center for Pediatric Nursing Research and Evidence Based Practice, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Jayne A. Fulkerson
- School of Nursing, University of Minnesota, Minneapolis, Minnesota, USA
- Divisions of Epidemiology and School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Julian Wolfson
- Divisions of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Michael K. Georgieff
- Department of Pediatrics, University of Minnesota Medical School, Minneapolis, Minnesota, USA
- Department of Pediatric Cardiology, M Health Fairview University of Minnesota Masonic Children's Hospital, Minneapolis, Minnesota, USA
| | - Wendy S. Looman
- School of Nursing, University of Minnesota, Minneapolis, Minnesota, USA
| | - Kavisha M. Shah
- Department of Pediatrics, University of Minnesota Medical School, Minneapolis, Minnesota, USA
- Department of Pediatric Cardiology, M Health Fairview University of Minnesota Masonic Children's Hospital, Minneapolis, Minnesota, USA
| | - Karen Uzark
- Division of Cardiac Surgery, University of Michigan Medical School, Ann Arbor, Michigan, USA
- Department of Cardiac Surgery and Pediatrics (Cardiology), C. S. Mott Children's Hospital, Ann Arbor, Michigan, USA
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Acquaye SN, Spatz DL. Lactation Experiences of Black Mothers Who Breastfed a Child Beyond Age One. Breastfeed Med 2023; 18:326-333. [PMID: 36971582 DOI: 10.1089/bfm.2022.0284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
Abstract
Background: Although it is recommended that breastfeeding continues for at least 2 years, less than 30% of Black/African American children are still breastfed by their first birthday. This indicates the need to better understand the factors that affect continued and long-term (after 12 months of life) breastfeeding. The goal of this research was to hear from Black mothers who had long-term breastfeeding experiences to understand the barriers and facilitators of setting and reaching long-term breastfeeding goals. Materials and Methods: Participants were recruited through a variety of organizations serving breastfeeding mothers. Qualitative interviews were conducted through a secure, online meeting platform. Interviews were transcribed and analyzed using Qualitative Content Analysis. Participant demographics were collected and analyzed using descriptive statistics. Results: A total of 18 interviews were completed and six themes were identified: initiating breastfeeding, deciding to continue beyond 12 months, pressure to stop breastfeeding, support to continue breastfeeding, need for effective education and information about breastfeeding, and overall struggles. Discussion: This research provides insight for developing interventions to support optimal breastfeeding duration for Black families. Population-specific interventions must always be guided by the voices and experiences of members of that population. This research adds to existing knowledge by providing recommendations for health care providers and breastfeeding advocates based on experiences shared directly from Black breastfeeding mothers.
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Affiliation(s)
- Stephanie N Acquaye
- School of Nursing, Department of Family and Community Health, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Diane L Spatz
- School of Nursing, Department of Family and Community Health, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Center for Pediatric Nursing Research and Evidence-Based Practice, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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18
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Gyamfi A, Spatz DL, Jefferson UT, Lucas R, O'Neill B, Henderson WA. Breastfeeding Social Support Among African American Women in the United States: A Meta-Ethnography. Adv Neonatal Care 2023; 23:72-80. [PMID: 35939758 PMCID: PMC9891275 DOI: 10.1097/anc.0000000000001021] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND In the United States, there are racial disparities in 6 months of exclusive breastfeeding. Only, 25.8% of American infants were breastfed for the first 180 days of life, with African American infants least (19.8%) exclusively breastfed in 2018. PURPOSE The meta-ethnography explored the breastfeeding support for African American women in the United States. DATA SOURCES The online databases of American Psychological Association, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, PubMed, and Scopus were searched with key words, and the search was not limited by the year of publication. STUDY SELECTION The inclusion criteria for the study selection entailed all qualitative studies conducted on breastfeeding support among self-identified African American women in the United States, written in English language, peer reviewed, or dissertation. The initial search produced 905 articles of which 8 met the eligibility criteria. DATA EXTRACTION Data extraction and analysis were guided by Noblit and Hare's (1988) meta-ethnography approach. The analysis process was completed by a team of researchers, inclusive of breastfeeding experts. RESULTS Five overarching themes emerged including trustworthy information; early postpartum support by key influencers; maternal culture; tangible resources, and Black mothers' empowerment. IMPLICATIONS FOR PRACTICE AND RESEARCH Social support is a major determinant for the initiation and continuation of breastfeeding among African American women in the United States. Future longitudinal studies are warranted to explore the social support of breastfeeding among African American women in the United States.
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Affiliation(s)
- Adwoa Gyamfi
- Correspondence: Adwoa Gyamfi, PhD, MPH, BSc, RN, University of Connecticut, School of Nursing, 231 Glenbrook Rd Unit 4026, Storrs, CT 06269 ()
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19
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Spatz DL. Lactation Accommodations in the Workplace. MCN Am J Matern Child Nurs 2023; 48:50. [PMID: 36469896 DOI: 10.1097/nmc.0000000000000883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Diane L Spatz
- Dr. Diane L. Spatz is a Professor of Perinatal Nursing and the Helen M. Shearer Professor of Nutrition at the University of Pennsylvania School of Nursing and a Nurse Scientist in the Center for Pediatric Nursing Research and Evidence Based Practice and Children's Hospital of Philadelphia. Dr. Spatz can be reached via email at
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20
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Conover N, Vanderpool J, Ginsberg J, Kawan M, Spatz DL. Establishing a Breastfeeding Consortium for Clinicians in Pediatric Outpatient Care. MCN Am J Matern Child Nurs 2023; 48:24-29. [PMID: 36136072 DOI: 10.1097/nmc.0000000000000877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Creating a supportive environment for breastfeeding mothers in the primary care setting has been shown to improve breastfeeding rates and duration. An important aspect of establishing a breastfeeding-friendly practice is to engage and educate health care providers. To increase consistency of breastfeeding care and interventions across a large primary care network, we established an Ambulatory Breastfeeding Consortium (ABC) focused on information sharing and discussion centered on care of breastfeeding and lactating families. The COVID-19 pandemic further highlighted the need to share up-to-date education and guidance, and the importance of the role of primary care providers in breastfeeding support. The ABC has been effective in engaging primary care nurses and other clinicians and disseminating information while encouraging discussion on the importance of providing informed care to breastfeeding families. Although more breastfeeding-specific education is recommended for clinicians, the ABC serves as a model for primary care clinicians to improve their knowledge and provide support for families through education, shared experience, and awareness across many pediatric primary care network sites.
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21
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Davis JA, Glasser M, Spatz DL, Scott P, Demirci JR. First Feed Type Is Associated With Birth/Lactating Parent's Own Milk Use During NICU Stay Among Infants Who Require Surgery. Adv Neonatal Care 2022; 22:578-588. [PMID: 35421040 PMCID: PMC9556699 DOI: 10.1097/anc.0000000000000981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Early exclusive birth/lactating parent's own milk (B/LPOM) feeds have been associated with longer duration of B/LPOM use for infant feedings in healthy term and hospitalized preterm infants. This relationship has not been explored in infants undergoing neonatal surgery (surgical infants). PURPOSE To evaluate the relationship between early exclusive B/LPOM feeds and cumulative B/LPOM patterns during surgical infants' neonatal intensive care unit (NICU) hospitalization. METHODS A secondary cross-sectional analysis was performed using the electronic health record data of surgical infants admitted to a level IV NICU between January 2014 and March 2015. Multiple linear regression and Fisher's exact test were used to examine the associations between first NICU feed type and total percentage of diet composed of B/LPOM during NICU stay and continuation of any or exclusive B/LPOM feedings at NICU discharge, respectively. RESULTS The analysis included 59 infants who required surgery for gastrointestinal, cardiac, or multisystem defects or pregnancy-related complications. Receipt of B/LPOM as the first NICU feed was associated with higher percentage of B/LPOM feeds ( P < .001) throughout NICU stay, as well as continuation of any or exclusive B/LPOM feedings at NICU discharge ( P = .03). IMPLICATIONS FOR PRACTICE Early exclusive B/LPOM feeds may be an important predictor for continuation of any B/LPOM use throughout the NICU stay and at NICU discharge. Continued efforts to identify and address gaps in prenatal and postpartum lactation support for parents of surgical infants are needed. IMPLICATIONS FOR RESEARCH Powered studies are needed to corroborate these findings and to explore the potential impact of other factors on duration and exclusivity of B/LPOM use. VIDEO ABSTRACT AVAILABLE AT https://journals.lww.com/advancesinneonatalcare/Pages/videogallery.aspx .
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Affiliation(s)
- Jessica A Davis
- University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania (Ms Davis and Drs Glasser, Scott, and Demirci); and University of Pennsylvania School of Nursing, Philadelphia, and The Children's Hospital of Philadelphia (CHOP), Philadelphia, and Children's Hospital of Philadelphia's Mothers' Milk Bank, Philadelphia, Pennsylvania (Dr Spatz)
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22
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Kawan M, Gregory EF, Spatz DL. Improving breastfeeding care & support in a large, urban, pediatric primary care practice. J Pediatr Nurs 2022; 70:e3-e8. [PMID: 36424329 DOI: 10.1016/j.pedn.2022.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 10/06/2022] [Accepted: 10/14/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND SPECIFIC AIMS Human milk/breastfeeding is the gold standard for infant nutrition. Interventions in pediatric primary care could improve breastfeeding exclusivity and duration. Our specific aims were two-fold: 1) Accurately measure breastfeeding indicators and 2) Implement AAP Breastfeeding-Friendly Pediatric Office Practice Recommendations. MATERIALS AND METHODS In 2018, a single, urban, large primary care pediatric practice initiated a Quality Improvement project to improve breastfeeding outcomes. Stakeholders met to discuss metrics of interest, develop documentation templates, review data capture, and plan interventions to support breastfeeding. Practice based interventions to improve measurement included: piloting documentation templates, incorporation of default templates office-wide, and developing tracking tools for both use of templates and breastfeeding outcomes. Interventions to support breastfeeding occurred simultaneously and included workflow redesign to increase nurse-provided breastfeeding education, partnering with community-based lactation consultants for outpatient support, staff education, and National Breastfeeding Month activities. RESULTS Since initiation of the data analytic tool, breastfeeding data has been analyzed from over 30,000 visits (86% Medicaid-insured, 82% Black race). Currently, 80% of providers use default templates that allow standardized data capture. At first newborn visit, 74% of infants were breastfed. At six months, 36% of infants were breastfed; 23% exclusively. Standardized documentation of infant feeding status improved and has remained consistent. Breastfeeding duration did not significantly improve despite practice interventions. CONCLUSIONS Pediatric primary care measurement tools are feasible and critical to understand breastfeeding continuation. Increased resources and interventions to support breastfeeding in Primary Care are necessary to improve outcomes.
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Affiliation(s)
- Meg Kawan
- Children's Hospital of Philadelphia, United States of America
| | - Emily F Gregory
- Children's Hospital of Philadelphia, United States of America
| | - Diane L Spatz
- Children's Hospital of Philadelphia, United States of America; University of Pennsylvania School of Nursing, United States of America.
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Abstract
PURPOSE To assess the effects of acupressure on lactation. METHODS A literature search was conducted via Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase, and PubMed using keyword search terms acupuncture, Tuina and breastfeeding, human lactation or human milk and excluded auricular. Inclusion criteria were articles in English with no restriction on publication date. We included acupuncture as well as acupressure to ensure that relevant articles were not missed. RESULTS After duplicates were removed, our initial search yielded 217 articles. Using the PRISMA checklist (Liberati et al., 2009), six articles met inclusion criteria (five research studies, one case study). Preliminary evidence suggests acupressure offers a promising and inexpensive method of enhancing secretory activation following cesarean and vaginal term and late preterm births, specifically when performed at acupoints CV 17, ST 18, and SI 1. CLINICAL IMPLICATIONS Human milk is the optimal source of infant nutrition. Concern of low milk supply is most often cited as the cause for early supplementation with formula as well as early cessation of breastfeeding. Acupressure may be helpful in improving milk supply in early postpartum, but more research on acupressure and lactation is warranted.
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24
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Spatz DL. Treatment of Low Milk Supply. MCN Am J Matern Child Nurs 2022; 47:361. [PMID: 36227078 DOI: 10.1097/nmc.0000000000000867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Diane L Spatz
- Dr. Diane L. Spatz is a Professor of Perinatal Nursing and the Helen M. Shearer Professor of Nutrition at the University of Pennsylvania School of Nursing and a Nurse Scientist in the Center for Pediatric Nursing Research and Evidence Based Practice and Children's Hospital of Philadelphia. Dr. Spatz can be reached via email at
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Affiliation(s)
- Diane L Spatz
- Dr. Spatz is a Professor of Perinatal Nursing & the Helen M. Shearer Professor of Nutrition at the University of Pennsylvania. She holds a joint appointment with the Center for Pediatric Nursing Research & Evidence Based Practice at Children's Hospital of Philadelphia where she is a nurse scientist in lactation. Dr. Spatz can be reached via email at
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26
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Froh EB, Spatz DL. Lactation Outcomes After Participation in a Tailored Prenatal Nutrition Consultation Among Women With Infants With Congenital Anomalies. J Obstet Gynecol Neonatal Nurs 2022; 51:590-598. [PMID: 35988697 DOI: 10.1016/j.jogn.2022.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 07/19/2022] [Accepted: 07/25/2022] [Indexed: 10/15/2022] Open
Abstract
OBJECTIVE To describe lactation outcomes among of a cohort of mother-infant dyads in which the women had an individualized prenatal nutrition consultation intervention. DESIGN Descriptive cohort study. SETTING A free-standing children's hospital with a center for fetal diagnosis and treatment and a specialized maternity unit. PARTICIPANTS A total of 160 women who had prenatal nutrition consultations in 2014 to 2017 and gave birth to infants with known congenital anomalies and required intensive care after birth. METHODS We surveyed women regarding their lactation outcomes after the Breastfeeding Report Card metrics of the Centers for Disease Control and Prevention and obtained permission to abstract demographic and clinical information from the setting's electronic health record. We analyzed data with standard descriptive statistics. RESULTS Among the cohort, 86.9% (n = 139) of participants intended to provide human milk or combination feeding in the prenatal period. A total of 128 (92.1%) infants were first exposed to human milk enterally. At the time of discharge, 92.1% (n = 128) of the infants received human milk. The breastfeeding outcomes of the cohort significantly surpassed national data: initiation (98.1% vs. 84.1% national), breastfeeding at 3 months (89.4%), exclusive breastfeeding at 3 months (60% vs. 46.9% national), breastfeeding at 6 months (76.9% vs. 58.3% national), exclusive breastfeeding at 6 months (45% vs. 25.6% national), breastfeeding at 12 months (50.6% vs. 35.3% national), and breastfeeding beyond 12 months (34.4%). CONCLUSIONS Lactation outcomes among women who had prenatal nutrition consultations far surpassed national data, and this intervention has implications for family-centered prenatal care, informed decision making, and improved breastfeeding outcomes in the hospital setting and postdischarge.
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Paraszczuk AM, Candelaria LM, Hylton-McGuire K, Spatz DL. The Voice of Mothers Who Continue to Express Milk After Their Infant's Death for Donation to a Milk Bank. Breastfeed Med 2022; 17:660-665. [PMID: 35549706 DOI: 10.1089/bfm.2021.0326] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background: The second stage of lactation with copious milk production occurs after birth regardless of the infant's survival. Previous research indicates that milk donation following a perinatal loss may help some bereaved mothers come to terms with their loss. The purpose of this study was to explore the experience of women choosing to continue to express milk after a perinatal loss specifically for donation to a nonprofit milk bank governed by the Human Milk Banking Association of North America (HMBANA). Materials and Methods: Participants were recruited through HMBANA's milk bank directors' listserv, their bereavement committee, and through their website. Participants were eligible if they donated to an HMBANA milk bank and specifically continued to pump milk for the purpose of milk donation following a perinatal loss. Qualitative interviews were conducted with each participant using a secured web-based platform. Data collection and analysis occurred concurrently using qualitative content analysis until there was acknowledged informational redundancy. Participants' demographic and lactation data were collected and analyzed using descriptive statistics. Results: Over 10 months, 21 participants were interviewed. Donating after perinatal loss has been described as a positive, valuable, and nurturing experience. Diminished grieving, enhanced connection to the infant, establishment of legacy, and creation of a positive from a negative are highlighted in several themes that illuminate the phenomena of bereaved donation. Discussion: The findings of this research are consistent with published literature, but in this study, two subgroups were formed. This enabled the researchers to compare the experience of those with previous breastfeeding experience and those without, which adds to the knowledge about the phenomenon. It provides information for health care professionals (HCPs) to understand the experience of bereaved milk donors and serves as a call to action for HCPs to develop best practices and incorporate lactation management in enhanced, individualized bereavement care for these women.
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Affiliation(s)
- Ann Marie Paraszczuk
- Barbara H. Hagan School of Nursing, Molloy College, Rockville Centre, New York, USA
| | - Laura M Candelaria
- Barbara H. Hagan School of Nursing, Molloy College, Rockville Centre, New York, USA
| | | | - Diane L Spatz
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Center for Nursing Research & Evidence-Based Practice, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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Affiliation(s)
- Diane L Spatz
- University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA.,The Center for Pediatric Nursing Research and Evidence Based Practice, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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29
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Elgersma KM, McKechnie AC, Schorr EN, Shah KM, Trebilcock AL, Ramel SE, Ambrose MB, Swanson NM, Sommerness SA, Spatz DL. The Impact of Human Milk on Outcomes for Infants with Congenital Heart Disease: A Systematic Review. Breastfeed Med 2022; 17:393-411. [PMID: 35167760 DOI: 10.1089/bfm.2021.0334] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Background: Infants with congenital heart disease (CHD) are at risk for feeding-related morbidity and mortality, with growth failure and oral feeding problems associated with poor outcomes. The benefits of human milk (HM) for preterm infants have been well documented, but evidence on HM for infants with CHD has recently begun to emerge. Objectives: Our primary aim was to examine the impact of HM feeding on outcomes for infants with CHD. Methods: Following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines, a search was conducted using MEDLINE, CINAHL, and Cochrane Database of Systematic Reviews. The quality of each study was assessed using the Joanna Briggs Critical Appraisal Tools. A total of 16 studies were included. Results: There was evidence that an exclusive HM diet reduces the risk of necrotizing enterocolitis (NEC) for infants with CHD. Evidence with a higher risk for bias indicated that a well-managed HM diet may be associated with improved growth, shorter length of stay, and improved postoperative feeding and nutritional outcomes. Chylothorax outcomes were similar between modified HM and medium-chain triglyceride formula. The studies had significant limitations related to power, lack of control for covariates, and inconsistent delineation of feeding groups. Conclusions: Based on the reduced risk for NEC and given the conclusive benefits in other vulnerable populations, we recommend that clinicians and institutions prioritize programs to support HM feeding for infants with CHD. Large high-quality studies are needed to validate these results. Future work should clarify best practices in managing an HM diet to support optimal growth and development for these infants.
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Affiliation(s)
| | | | - Erica N Schorr
- University of Minnesota School of Nursing, Minneapolis, Minnesota, USA
| | - Kavisha M Shah
- University of Minnesota School of Nursing, Minneapolis, Minnesota, USA.,Department of Pediatrics, M Health Fairview University of Minnesota Masonic Children's Hospital, Minneapolis, Minnesota, USA
| | - Anna L Trebilcock
- University of Minnesota School of Nursing, Minneapolis, Minnesota, USA
| | - Sara E Ramel
- University of Minnesota School of Nursing, Minneapolis, Minnesota, USA.,Department of Pediatrics, M Health Fairview University of Minnesota Masonic Children's Hospital, Minneapolis, Minnesota, USA
| | - Matthew B Ambrose
- University of Minnesota School of Nursing, Minneapolis, Minnesota, USA.,Department of Pediatrics, M Health Fairview University of Minnesota Masonic Children's Hospital, Minneapolis, Minnesota, USA
| | - Nellie Munn Swanson
- University of Minnesota School of Nursing, Minneapolis, Minnesota, USA.,Department of Nursing, Children's Minnesota, Minneapolis, Minnesota, USA
| | | | - Diane L Spatz
- Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA.,Center for Nursing Research & Evidence Based Practice, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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30
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Spatz DL. Benefits of Mother-Baby Skin-to-Skin Contact. MCN Am J Matern Child Nurs 2022; 47:170. [PMID: 35475929 DOI: 10.1097/nmc.0000000000000818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Diane L Spatz
- Diane Spatz is a Professor of Perinatal Nursing & the Helen M. Shearer Professor of Nutrition at the University of Pennsylvania. She holds a joint appointment with the Center for Pediatric Nursing Research and Evidence-Based Practice at Children's Hospital of Philadelphia where she is a nurse scientist in lactation. Dr. Spatz can be reached via email at
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Spatz DL. 2020 mPINC Scores: Opportunities for Improvement. MCN Am J Matern Child Nurs 2022; 47:109. [PMID: 35202015 DOI: 10.1097/nmc.0000000000000797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Diane L Spatz
- Dr. Spatz is a Professor of Perinatal Nursing & the Helen M. Shearer Professor of Nutrition at the University of Pennsylvania. She holds a joint appointment with the Center for Pediatric Nursing Research & Evidence Based Practice at Children's Hospital of Philadelphia where she is a nurse scientist in lactation. Dr. Spatz can be reached via email at
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Abstract
Breastfeeding and pumping to express human milk are restricted practices for incarcerated women, and their infants are at high risk for not receiving human milk. Clinical practice guidelines are not applied to perinatal women who are incarcerated, and the rates of breastfeeding and the potential to do so in correctional facilities are extrapolated from small studies. The purpose of this analysis is to summarize current national trends in breastfeeding and lactation policy and the extent to which lactation in correctional facilities is addressed, identify ongoing lactation support programs and strategies in correctional facilities as potential areas for further study, and offer a context-specific, adaptable, and evidence-based approach to breastfeeding and lactation support using the Spatz 10-step model. This analysis calls for strategic updates to research and policy and offers recommendations in collaboration with existing programs to increase access to breastfeeding and lactation services for incarcerated women.
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Affiliation(s)
- Liliana Schmitt
- University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
| | - Diane L Spatz
- University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA.,The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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van Goudoever JB, Spatz DL, Hoban R, Dumitriu D, Gyamfi-Bannerman C, Berns M, McKechnie L, Davanzo R. Updating Clinical Practices to Promote and Protect Human Milk and Breastfeeding in a COVID-19 Era. Front Pediatr 2022; 10:867540. [PMID: 35558372 PMCID: PMC9086708 DOI: 10.3389/fped.2022.867540] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 03/30/2022] [Indexed: 12/23/2022] Open
Abstract
The COVID-19 pandemic has impacted breastfeeding and lactation globally, with clinical practices implemented early in the pandemic being mostly anti-breastfeeding, e.g., separation of mothers from their infants, and not evidence based. As the pandemic has progressed, evidence has emerged reconfirming the value of human milk and the importance of protecting and supporting breastfeeding, especially the initiation of lactation. However, it is clear that COVID-19 has changed the clinical care paradigm around breastfeeding and lactation support and, as such, it is imperative that practices adapt and evolve to maintain the emphasis on lactation support. We participated in a round table conference aiming to rescue and develop protocols and practices that support breastfeeding during the COVID-19 pandemic. One key area to target will be to maximize the use of the antenatal period. The early identification of lactation risk factors together with the development of person-centered methods to deliver breastfeeding information and education to parents-to-be will be critical. In addition, the establishment of a hospital culture that values breastfeeding and prioritizes the use of human milk will be integral for the motivation of health care professionals. That culture will also support active management of the initiation of lactation and the development of a 'back-up plan' toolkit to support the mother experiencing lactation difficulties. Post-discharge support will also be crucial with the development of both in-person and virtual lactation support programs, in particular for the immediate post-discharge period to benefit mothers who experience an early discharge process. These measures will allow for a new, adapted framework of practice that acknowledges the current COVID-19 paradigm and maintains the emphasis on the need to protect and support breastfeeding and the use of human milk.
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Affiliation(s)
| | - Diane L Spatz
- University of Pennsylvania School of Nursing & Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Rebecca Hoban
- The Hospital for Sick Children (SickKids), University of Toronto, Toronto, ON, Canada
| | - Dani Dumitriu
- Columbia University Irving Medical Center, New York, NY, United States
| | | | - Monika Berns
- Charité - Universitätsmedizin, Klink für Neonatologie, Berlin, Germany
| | - Liz McKechnie
- Leeds Centre for Newborn Care, Leeds Teaching Hospitals, Leeds, United Kingdom
| | - Riccardo Davanzo
- Institute for Maternal and Child Health Institute, IRCCS "Burlo Garofolo", Trieste, Italy
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Wild KT, Bartholomew D, Edwards TM, Froh E, Spatz DL, Huber M, Hedrick HL, Nawab US. Achieving adequate growth in infants with congenital diaphragmatic hernia prior to discharge. J Pediatr Surg 2021; 56:2200-2206. [PMID: 33888352 DOI: 10.1016/j.jpedsurg.2021.03.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 03/08/2021] [Accepted: 03/19/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND/PURPOSE To evaluate the enteral feeding requirements, including caloric provisions, of infants with CDH in relation to growth patterns. METHODS A retrospective observational study was conducted on infants with CDH between August 2012 and March 2017. Electronic medical records were reviewed to extract detailed infant feeding data and anthropometric measurements at monthly intervals until discharge. Statistical methods of analysis included generalized linear models, Pearson correlation coefficient, Analysis of variance (ANOVA), Kruskal-Wallis, Wilcoxon rank sum, and Fisher's Exact tests. RESULTS Among 149 infants with CDH, 45% (n = 67) met criteria for malnutrition at discharge. Maternal human milk (HM) was initiated in 95% of infants (n = 142) and continued in 79% of infants (n = 118) at discharge. Overall, 50% received fortification of feeds, including 60% (n = 89) of formula fed infants compared to only 21% (n = 31) of HM fed infants (p<0.001). Infants fed formula had lower weight-for-length z-scores at discharge compared to those fed HM. CONCLUSIONS Infants receiving HM demonstrated improved growth compared to formula fed infants. However, higher calorie feeding regimens need to be initiated earlier to improve growth velocity. Prompt recognition of malnutrition and growth failure with aggressive supplementation may improve the overall growth of infants with CDH and has the potential to improve long term neurodevelopmental outcomes.
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Affiliation(s)
- K Taylor Wild
- Division of Neonatology, The Children's Hospital of Philadelphia, Perelman School of Medicine at University of Pennsylvania, 3401 Civic Center Boulevard, Philadelphia, PA 19104, United States; Division of Human Genetics, The Children's Hospital of Philadelphia, Perelman School of Medicine at University of Pennsylvania, Philadelphia, PA, United States.
| | - Dana Bartholomew
- Division of Pediatric General, Thoracic, and Fetal Surgery, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
| | - Taryn M Edwards
- Division of Pediatric General, Thoracic, and Fetal Surgery, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
| | - Elizabeth Froh
- Department of Nursing and Clinical Care Services, Children's Hospital of Philadelphia, Philadelphia, PA, United States; School of Nursing, University of Pennsylvania, Philadelphia, PA, United States
| | - Diane L Spatz
- Department of Nursing and Clinical Care Services, Children's Hospital of Philadelphia, Philadelphia, PA, United States; School of Nursing, University of Pennsylvania, Philadelphia, PA, United States
| | - Matthew Huber
- Division of Neonatology, The Children's Hospital of Philadelphia, Perelman School of Medicine at University of Pennsylvania, 3401 Civic Center Boulevard, Philadelphia, PA 19104, United States
| | - Holly L Hedrick
- Division of Pediatric General, Thoracic, and Fetal Surgery, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
| | - Ursula S Nawab
- Division of Neonatology, The Children's Hospital of Philadelphia, Perelman School of Medicine at University of Pennsylvania, 3401 Civic Center Boulevard, Philadelphia, PA 19104, United States
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Spatz DL. Proactive Planning for Breastfeeding Assistance and Support Post Birth. MCN Am J Matern Child Nurs 2021; 46:362. [PMID: 34653036 DOI: 10.1097/nmc.0000000000000773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Diane L Spatz
- Diane L. Spatz is a Professor of Perinatal Nursing & the Helen M. Shearer Professor of Nutrition at the University of Pennsylvania. She holds a joint appointment with the Center for Nursing Research & Evidence Based Practice at Children's Hospital of Philadelphia where she is a nurse scientist in lactation. Dr. Spatz can be reached via email at
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Spatz DL, Conover NM. Case Report: Managing Growth Failure While Maintaining Exclusive Breastfeeding. J Pediatr Nurs 2021; 61:47-50. [PMID: 33744622 DOI: 10.1016/j.pedn.2021.03.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 03/09/2021] [Accepted: 03/12/2021] [Indexed: 10/21/2022]
Abstract
This case study presents a mother who was able to maintain exclusive breastfeeding after having an infant who experienced growth failure between the two- and four-month pediatric primary care visits. This mother was exclusively breastfeeding her child and the infant was noted to "fall off the growth curve" at the four-month infant pediatric visit. At this point the mother was advised to formula feed her infant. The mother did not want to give formula and sought out assistance from the first author who connected the mother with an advance practice nurse at the pediatric site. By working with a nurse practitioner to develop an individualized feeding plan, the mother's breastfeeding relationship was able to be maintained and the infant gained weight. Despite receiving initial recommendations to formula feed her child, we were able to work beyond those recommendations by providing evidence based breastfeeding interventions and support. A breastfeeding assessment is an important factor in each wellness visit.
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Affiliation(s)
- Diane L Spatz
- University of Pennsylvania School of Nursing, Children's Hospital of Philadelphia, United States of America.
| | - Nicole M Conover
- Primary Care Network, Children's Hospital of Philadelphia, United States of America
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Louis-Jacques AF, Vereen S, Hernandez I, Običan SG, Deubel TF, Miller EM, Spatz DL, Wilson RE. Impact of Doula-Led Lactation Education on Breastfeeding Outcomes in Low-Income, Minoritized Mothers. J Perinat Educ 2021; 30:203-212. [PMID: 34908819 DOI: 10.1891/j-pe-d-20-00022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Prenatal education may improve breastfeeding outcomes among low-income women. Our objective was to assess breastfeeding intentions and knowledge among women participating in doula-facilitated prenatal education classes from August 2016 to October 2017. Breastfeeding knowledge and infant feeding intentions were assessed before and after the classes. Breastfeeding rates were assessed at birth, 2-4 weeks postpartum, and 6-8 weeks postpartum. Paired t-tests tests were conducted. A total of 121 racially diverse, low-income women were enrolled. Intentions to breastfeed increased pre- to post-intervention (p = 0.007). Breastfeeding knowledge scores increased pre- to post-intervention (p <.001); specifically, among women who were exclusively breastfeeding or breastfeeding while supplementing with formula at birth (p < .001 and p = 0.046, respectively). Doula-facilitated breastfeeding education may help improve breastfeeding outcomes for low-income women.
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Spatz DL. Improving Lactation Education and Support in Primary Care. MCN Am J Matern Child Nurs 2021; 46:301. [PMID: 34398832 DOI: 10.1097/nmc.0000000000000752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Diane L Spatz
- Dr. Diane L. Spatz is a Professor of Perinatal Nursing & the Helen M. Shearer Professor of Nutrition at the University of Pennsylvania. She holds a joint appointment with the Children's Hospital of Philadelphia (CHOP) where she is a nurse scientist in lactation with the Center for Nursing Research & Evidence Based Practice. Dr. Spatz can be reached via email at
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Juntereal NA, Spatz DL. Mothers' Experiences with Antenatal Milk Expression. MCN Am J Matern Child Nurs 2021; 46:277-283. [PMID: 34398829 DOI: 10.1097/nmc.0000000000000749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Antenatal milk expression is a milk expression intervention beginning at either 36 or 37 weeks of gestation for the purpose of potential colostrum collection and storage prior to birth for postnatal infant feeding. Research on antenatal milk expression is limited and originates outside the United States. METHODS Women who used antenatal milk expression were interviewed about their experiences. A conventional, inductive approach to qualitative content analysis was used to analyze participants' responses. RESULTS Three women participated in interviews. They reported learning and performing antenatal milk expression for various postpartum needs including avoidance of formula, milk available for potential infant hypoglycemia, and to support human milk feeding during surrogate mother-infant separation. These mothers obtained education and information on antenatal milk expression primarily on their own. CLINICAL IMPLICATIONS Greater awareness and understanding of antenatal milk expression is needed in the professional community caring for childbearing women. Perinatal nurses need to be aware of all breastfeeding practices including antenatal milk expression. Knowledge of the practice and advocacy for more research on antenatal milk expression will improve lactation support and ensure expectant mothers reach their personal breastfeeding goals.
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Juntereal NA, Spatz DL. Integrative Review of Antenatal Milk Expression and Mother-Infant Outcomes During the First 2 Weeks After Birth. J Obstet Gynecol Neonatal Nurs 2021; 50:659-668. [PMID: 34403651 DOI: 10.1016/j.jogn.2021.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2021] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE To explore the practice of antenatal milk expression (AME) and related outcomes for mother-infant dyads during the first 2 weeks after birth. DATA SOURCES We searched the electronic databases MEDLINE, Embase, CINAHL, Emcare, Maternity & Infant Care Database, Scopus, and Web of Science for relevant literature. We also conducted backward reference searches on relevant publications and nondatabase searches after review of the full texts. STUDY SELECTION Articles were eligible for inclusion if they reported primary studies focused on AME, included samples of mother-infant dyads, and were published in English. We did not impose time or design limitations given the sparse availability of literature on AME. We identified 766 articles. After the removal of duplicates, we screened 588 articles, and of these, we included 15 articles in our review. DATA EXTRACTION We used the Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA) guidelines to guide data extraction and reporting. We evaluated the quality of evidence using the Melnyk and Fineout-Overholt rating system and the Joanna Briggs Institute critical appraisal tools. DATA SYNTHESIS We synthesized data from the included articles into four themes: Breastfeeding Self-Efficacy, Milk Supply, Infant Well-Being, and Infant Feeding Methods. CONCLUSION AME may support breastfeeding by improving breastfeeding self-efficacy and milk supply and by decreasing early formula use. Synthesized literature on AME shows the safety of the practice and that infants of women who practice AME have a greater likelihood of breastfeeding exclusivity during the short term.
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Affiliation(s)
- Diane L Spatz
- Dr. Diane L. Spatz is a Professor of Perinatal Nursing & the Helen M. Shearer Professor of Nutrition at the University of Pennsylvania. She holds a joint appointment with the Children's Hospital of Philadelphia (CHOP) where she is a nurse scientist for the lactation program & founder of CHOP's Mothers' Milk Bank. Dr. Spatz can be reached via email at
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Abstract
As nurses, we must continue to promote and protect the use of human milk and breastfeeding during and after the COVID-19 pandemic. We should continue access to online and virtual breastfeeding help but expand opportunities for in-person technical breastfeeding assistance in pediatric offices and in the community. Our breastfeeding expert, Dr. Spatz, offers suggestions for promoting breastfeeding during the pandemic and beyond.
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Affiliation(s)
- Diane L Spatz
- Dr. Diane L. Spatz is a Professor of Perinatal Nursing & the Helen M. Shearer Professor of Nutrition at the University of Pennsylvania. She holds a joint appointment with the Children's Hospital of Philadelphia (CHOP) where she is a nurse scientist for the lactation program & founder of CHOP's Mothers' Milk Bank. Dr. Spatz can be reached via email at
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Abstract
Many professional organizations and agencies have advocated for pregnant women and breastfeeding women to be offered the COVID-19 vaccine. Our breastfeeding expert, Dr. Spatz, reviews their recommendations and ways nurses can advocate for this population to receive the vaccine.
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Affiliation(s)
- Diane L Spatz
- Dr. Diane L. Spatz is a Professor of Perinatal Nursing & the Helen M. Shearer Professor of Nutrition at the University of Pennsylvania. She holds a joint appointment with the Children's Hospital of Philadelphia (CHOP) where she is a nurse scientist for the lactation program & founder of CHOP's Mothers' Milk Bank. Dr. Spatz can be reached via email at
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Abstract
Although the rate of breastfeeding initiation in the United States has continued to rise since 1972, African American mothers continue to experience a significant disparity in initiation. The aim of this study was to explore the perceptions of the facilitators and barriers of breastfeeding initiation among African American mothers from the perspective of subject matter experts (SMEs). This study was part of a larger study that also involved focus group methodology with African American women. The purpose of this article is to describe the opinions, knowledge, and perceptions of SMEs who work with African American mothers. A semistructured interview guide was used to interview 7 SMEs at which point no new themes emerged from the data. SMEs highlighted the significance of modifiable factors in breastfeeding initiation decisions and validated many perceptions of African American mothers. SMEs identified many critical issues foundational to community perspective and shaping future success in raising breastfeeding initiation rates. To increase breastfeeding initiation rates among African American mothers, strategies beyond the individual level are necessary. SMEs recognize the importance of addressing fundamental issues related to historical perspectives, normalization, education, and disparities in breastfeeding as critical.
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Affiliation(s)
- Tyonne D Hinson
- Nursing Patient Services, Boston Children's Hospital, Massachusetts (Dr Hinson); The Duke Clinical Research Institute and the Department Population Health Sciences, Duke University, Durham, North Carolina (Dr Skinner) University of Pennsylvania School of Nursing, The Children's Hospital of Philadelphia (CHOP), and CHOP's Mothers' Milk Bank, Philadelphia, Pennsylvania (Dr Spatz)
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Affiliation(s)
- Diane L Spatz
- Dr. Diane L. Spatz is a Professor of Perinatal Nursing & the Helen M. Shearer Professor of Nutrition at the University of Pennsylvania. Dr. Spatz holds a joint appointment with the Children's Hospital of Philadelphia (CHOP) where she is a nurse scientist for the lactation program & founder of CHOP's Mothers' Milk Bank. Dr. Spatz can be reached via email at
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Affiliation(s)
- Diane L Spatz
- Dr. Diane L. Spatz is a Professor of Perinatal Nursing & the Helen M. Shearer Professor of Nutrition at the University of Pennsylvania. She holds a joint appointment with the Children's Hospital of Philadelphia (CHOP) where she is a nurse scientist for the lactation program & founder of CHOP's Mothers' Milk Bank. Dr. Spatz can be reached via email at
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Abstract
Introduction: Cesarean birth is reported to be risk factor for the delayed onset of maternal lactation. The purpose of this study was to describe the timing of lactation initiation, subsequent feeding/milk expression patterns, and daily milk volumes among women who had a cesarean birth of an infant with a known congenital anomaly during the 3-day postpartum hospital stay. Materials and Methods: Retrospective descriptive cohort study. The electronic medical records of dyads, between 2014 and 2017 at the study setting, were abstracted for demographic and clinical data. Milk expression and milk volume data were abstracted from maternal lactation logs. Data were analyzed using descriptive statistics. Results: Among the cohort (n = 468 dyads), the mean time from infant delivery by cesarean to lactation initiation was 257.5 minutes. The cohort was divided into three groups by the timing of lactation initiation: EARLY (≤60 minutes; n = 112), MID (>60 minutes to ≤360 minutes; n = 309), and LATE (>360 minutes; n = 47). Statistically significant differences are seen between groups for the daily means: number of feeds/pumps and maternal milk volumes (irrespective of the presence of lactation risk factors). Discussion: This is the first study to explore the relationship of lactation initiation among women postcesarean birth whose infants have a known congenital anomaly. The time between the infant's birth and the first feed/milk expression, and the patterns of feeding/milk expression during the postpartum hospital stay, are key drivers for maternal milk supply.
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Affiliation(s)
- Elizabeth B Froh
- Department of Nursing & Clinical Care Services, Center for Pediatric Nursing Research and Evidence-Based Practice, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Rachel Lee
- Children's Hospital of Philadelphia, Volunteer Research, Philadelphia, Pennsylvania, USA
| | - Diane L Spatz
- Department of Nursing & Clinical Care Services, Center for Pediatric Nursing Research and Evidence-Based Practice, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Spatz DL, Davanzo R, Müller JA, Powell R, Rigourd V, Yates A, Geddes DT, van Goudoever JB, Bode L. Promoting and Protecting Human Milk and Breastfeeding in a COVID-19 World. Front Pediatr 2021; 8:633700. [PMID: 33614547 PMCID: PMC7888272 DOI: 10.3389/fped.2020.633700] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 12/31/2020] [Indexed: 12/18/2022] Open
Abstract
The global COVID-19 pandemic has put enormous stress on healthcare systems and hospital staffing. However, through all this, families will continue to become pregnant, give birth, and breastfeed. Unfortunately, care of the childbearing family has been de-prioritized during the pandemic. Additionally, many healthcare practices during the pandemic have not been positive for the childbearing family or breastfeeding. Despite recommendations from the World Health Organization to promote early, direct breastfeeding and skin to skin contact, these and other recommendations are not being followed in the clinical setting. For example, some mothers have been forced to go through labor and birth alone in some institutions whilst some hospitals have limited or no parental visitation to infants in the NICU. Furthermore, hospitals are discharging mothers and their newborns early, limiting the amount of time that families receive expert lactation care, education, and technical assistance. In addition, some hospitals have furloughed staff or transferred them to COVID-19 wards, further negatively impacting direct care for families and their newborns. We are concerned that these massive changes in the care of childbearing families will be permanently adopted. Instead, we must use the pandemic to underscore the importance of human milk and breastfeeding as lifesaving medical interventions. We challenge healthcare professionals to change the current prenatal and post-birth practice paradigms to protect lactation physiology and to ensure that all families in need receive equal access to evidence-based lactation education, care and technical assistance.
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Affiliation(s)
- Diane L. Spatz
- University of Pennsylvania School of Nursing, Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Riccardo Davanzo
- Institute for Maternal and Child Health Institute, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Burlo Garofolo, Trieste, Italy
| | - Janis A. Müller
- Department of Virology, Institute of Molecular Virology, Ulm University Medical Center, Ulm, Germany
| | - Rebecca Powell
- Division of Infectious Diseases, Department of Medicine, Mount Sinai Hospital, New York, NY, United States
| | - Virginie Rigourd
- Regional Human Milk Bank (Ile de France), Hôpital Necker Enfants Malade, Paris, France
| | - Ann Yates
- International Confederation of Midwives, The Hague, Netherlands
| | - Donna T. Geddes
- School of Molecular Sciences, The University of Western Australia, Crawley, WA, Australia
| | - Johannes B. van Goudoever
- Emma Children's Hospital, Amsterdam University Medical Centers (Amsterdam UMC), Amsterdam, Netherlands
| | - Lars Bode
- Department of Pediatrics and Larsson-Rosenquist Foundation Mother-Milk-Infant Center of Research Excellence (MOMI CORE), University of California, San Diego, La Jolla, CA, United States
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Sinkiewicz-Darol E, Bernatowicz-Łojko U, Łubiech K, Adamczyk I, Twarużek M, Baranowska B, Skowron K, Spatz DL. Tandem Breastfeeding: A Descriptive Analysis of the Nutritional Value of Milk When Feeding a Younger and Older Child. Nutrients 2021; 13:277. [PMID: 33478010 PMCID: PMC7835967 DOI: 10.3390/nu13010277] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 01/17/2021] [Accepted: 01/18/2021] [Indexed: 11/16/2022] Open
Abstract
Breastfeeding is a gold standard of feeding of newborns and infants. Tandem breastfeeding (TBF) is feeding two children of different ages at the same time. The knowledge about the composition of human milk in prolonged lactation is still scarce. Milk from tandem breastfeeding women and after weaning was examined. Milk samples were collected from 13 TBF mothers. A 24-h milk collection was done. Analyses of fat, protein, carbohydrate and energy content were performed using MIRIS. Sociodemographic characteristics of TBF mothers was done. Higher fat content, energy value and total protein concentration was found in TBFM milk during tandem breastfeeding, than in milk after weaning the older child. The carbohydrate content remained stable. The composition of breastmilk, in terms of macronutrients, changes after weaning, taking into account the nutritional requirements of the younger child. The milk of nursing mothers in tandem did not show diurnal variability in individual components. These findings suggest an adaptive role of human milk to nutrient requirements of newborn and older children. The results may support the promotion of long breastfeeding, including tandem breastfeeding.
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Affiliation(s)
- Elena Sinkiewicz-Darol
- Human Milk Bank, Ludwik Rydygier’ Provincial Polyclinical Hospital in Torun, 87-100 Toruń, Poland; (U.B.-Ł.); (I.A.)
| | - Urszula Bernatowicz-Łojko
- Human Milk Bank, Ludwik Rydygier’ Provincial Polyclinical Hospital in Torun, 87-100 Toruń, Poland; (U.B.-Ł.); (I.A.)
- Centre of Postgraduate Medical Education, Departament of Midwifery, 01-813 Warsaw, Poland;
| | - Katarzyna Łubiech
- Department of Physiology and Toxicology, Faculty of Biological Sciences, Kazimierz Wielki University, Chodkiewicza 30 St., 85-064 Bydgoszcz, Poland; (K.Ł.); (M.T.)
| | - Iwona Adamczyk
- Human Milk Bank, Ludwik Rydygier’ Provincial Polyclinical Hospital in Torun, 87-100 Toruń, Poland; (U.B.-Ł.); (I.A.)
- Department of Physiology and Toxicology, Faculty of Biological Sciences, Kazimierz Wielki University, Chodkiewicza 30 St., 85-064 Bydgoszcz, Poland; (K.Ł.); (M.T.)
| | - Magdalena Twarużek
- Department of Physiology and Toxicology, Faculty of Biological Sciences, Kazimierz Wielki University, Chodkiewicza 30 St., 85-064 Bydgoszcz, Poland; (K.Ł.); (M.T.)
| | - Barbara Baranowska
- Centre of Postgraduate Medical Education, Departament of Midwifery, 01-813 Warsaw, Poland;
| | - Krzysztof Skowron
- Department of Microbiology, Nicolaus Copernicus University in Toruń, Ludwik Rydygier Collegium Medicum, 85-067 Bydgoszcz, Poland;
| | - Diane L. Spatz
- University of Pennsylvania School of Nursing, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA;
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Froh EB, Flood EL, Lavenberg JG, Lebet R, Lisanti AJ, Spatz DL, McCabe MA. Evidence in Hand: Optimizing the Unique Skill Set of a Hospital-Based Center for Nursing Research and Evidence-Based Practice. J Pediatr Nurs 2021; 56:60-63. [PMID: 33186864 PMCID: PMC7655024 DOI: 10.1016/j.pedn.2020.09.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 09/15/2020] [Accepted: 09/15/2020] [Indexed: 11/28/2022]
Abstract
This paper describes how, as the COVID-19 pandemic emerged, one hospital-based center for nursing research and evidence-based practice capitalized on its unique skill mix to quickly pivot to provide hospital administrators and staff with timely, relevant evidence regarding the care of patients and families, as well as the protection of direct care providers and all support staff. The products produced by this center, both proactive and in direct response, contributed to clinical operations decision-making and thus, tangibly impacted practice. The positive outcomes described speak not only to the clinical environment, but also to the presence and specialized contributions of a multiprofessional center for nursing research and evidence-based practice in such a way that was not possible prior to COVID-19.
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Affiliation(s)
- Elizabeth B Froh
- Children's Hospital of Philadelphia, Department of Nursing & Clinical Care Services, PA 19104, United States of America; University of Pennsylvania, School of Nursing. PA 19104, United States of America.
| | - Eloise L Flood
- Children's Hospital of Philadelphia, Department of Nursing & Clinical Care Services, PA 19104, United States of America
| | - Julia G Lavenberg
- Children's Hospital of Philadelphia, Department of Nursing & Clinical Care Services, PA 19104, United States of America
| | - Ruth Lebet
- Children's Hospital of Philadelphia, Department of Nursing & Clinical Care Services, PA 19104, United States of America; University of Pennsylvania, School of Nursing. PA 19104, United States of America
| | - Amy Jo Lisanti
- Children's Hospital of Philadelphia, Department of Nursing & Clinical Care Services, PA 19104, United States of America
| | - Diane L Spatz
- University of Pennsylvania, School of Nursing. PA 19104, United States of America; Children's Hospital of Philadelphia, Department of Nursing & Clinical Care Services, PA 19104, United States of America
| | - Margaret A McCabe
- Children's Hospital of Philadelphia, Department of Nursing & Clinical Care Services, PA 19104, United States of America; University of Pennsylvania, School of Nursing. PA 19104, United States of America
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