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Kappel SS, Maastrup R, Iyore EO, Greisen G, Egeskov M, Lando A, Hansen BM. Time intervals between pumping did not affect breastmilk protein produced by mothers of preterm infants. Acta Paediatr 2024. [PMID: 38530084 DOI: 10.1111/apa.17219] [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: 10/10/2023] [Revised: 03/14/2024] [Accepted: 03/19/2024] [Indexed: 03/27/2024]
Abstract
AIM Few studies investigate factors that might influence the content of expressed breastmilk. This study aims to investigate the influence of the intervals between breastmilk pumping and the time of the day on protein and fat concentration in breastmilk. METHODS Mothers of very preterm infants in a neonatal ward who expressed more than 400 mL per day were included. Expressed breastmilk was obtained from each mother over 30 h who were pumping at strictly planned and varying intervals: 2, 3, 4 and 6 h. All samples were analysed using infrared transmission spectroscopy. RESULTS Ten mothers participated at a median of 22 days postpartum. A total of 176 milk samples were analysed, and the average protein and fat concentrations in g/100 mL were 1.1 ± 0.23 and 4.2 ± 1.3, respectively. The time intervals between breast pumping sessions did not impact protein content, but fat content decreased by longer intervals (p < 0.01). The time of the day for milk pumping did not influence the protein or fat content. CONCLUSION A single milk sample collected after any 2-6 h interval, at any time during the day, represents the protein content in the breastmilk, but not the fat content which decreased with longer intervals.
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Affiliation(s)
- Susanne S Kappel
- Department of Neonatology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Ragnhild Maastrup
- Department of Neonatology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Elisabeth O Iyore
- Department of Neonatology, Copenhagen University Hospital Herlev, Herlev, Denmark
| | - Gorm Greisen
- Department of Neonatology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Merete Egeskov
- Department of Clinical Metabolomics Core Facility, Clinical Biochemistry, Rigshospitalet, Copenhagen, Denmark
| | - Ane Lando
- Department of Neonatology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Bo M Hansen
- Department of Neonatology, Copenhagen University Hospital Hillerød, Hillerød, Denmark
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Brimdyr K, Stevens J, Svensson K, Blair A, Turner-Maffei C, Grady J, Bastarache L, Al Alfy A, Crenshaw JT, Giugliani ERJ, Ewald U, Haider R, Jonas W, Kagawa M, Lilliesköld S, Maastrup R, Sinclair R, Swift E, Takahashi Y, Cadwell K. Skin-to-skin contact after birth: developing a research and practice guideline. Acta Paediatr 2023. [PMID: 37166443 DOI: 10.1111/apa.16842] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 05/05/2023] [Accepted: 05/10/2023] [Indexed: 05/12/2023]
Abstract
AIM Skin-to-skin contact immediately after birth is recognized as an evidence-based best practice and an acknowledged contributor to improved short- and long-term health outcomes including decreased infant mortality. However, implementation and definition of skin-to-skin contact is inconsistent in both practice and research studies. This project utilized the World Health Organization guideline process to clarify best practice and improve the consistency of application. METHODS The rigorous guideline development process combines a systematic review with acumen and judgement of experts with a wide range of credentials and experience. RESULTS The developed guideline received "strong recommendation" from the Expert Panel. The result concluded that there was a high level of confidence in the evidence and that the practice is not resource intensive. Research gaps were identified and areas for continued work delineated. CONCLUSION The World Health Organization guideline development process reached the conclusion immediate, continuous, uninterrupted skin-to-skin contact should be the standard of care for all mothers and all babies (from 1000 grams with experienced staff if assistance is needed), after all modes of birth. Delaying non-essential routine care in favor of uninterrupted skin-to-skin contact after birth has been shown to be safe and allows for progression of newborns through their instinctive behaviors.
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Affiliation(s)
| | - Jeni Stevens
- New South Wales Health, Western Sydney University
| | | | | | | | | | | | | | | | | | - Uwe Ewald
- Department of Women´s and Children´s Health, Uppsala University
| | - Rukhsana Haider
- Training and Assistance for Health and Nutrition Foundation (TAHN)
| | | | - Mike Kagawa
- Makerere University College of Health Sciences
| | - Siri Lilliesköld
- Department of Women's and Children's Health Karolinska Institutet, Stockholm, Sweden
- Department of Neonatology, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | | | | | - Emma Swift
- University of Iceland, Reykjavik Birth Center
| | - Yuki Takahashi
- Nursing Sciences, Department of Integrated Health Sciences, Nagoya University Graduate School of Medicine
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Lubbe W, Springer L, Maastrup R, Haiek LN, Nyaloko M. Baseline status regarding compliance with neo-BFHI recommendations in South African neonatal wards: a cross-sectional survey. BMC Health Serv Res 2023; 23:420. [PMID: 37127608 PMCID: PMC10152633 DOI: 10.1186/s12913-023-09396-6] [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] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 04/12/2023] [Indexed: 05/03/2023] Open
Abstract
BACKGROUND In 2009, the World Health Organization and the United Nations Children's Fund issued a revised Baby-friendly Hospital Initiative (BFHI) package to encourage all healthcare facilities to promote the advice of exclusive breastfeeding. The scope of the BFHI was expanded to include neonatal units by the Nordic and Quebec Working Group. AIM To determine the level of compliance with the recommendations outlined in the "Baby-friendly Hospital Initiative for neonatal wards" (Neo-BFHI) in the South African neonatal wards. METHOD In this cross-sectional survey, the sample included neonatal wards (N = 33) from public and private hospital facilities. Using EasyTrial software, the Neo-BFHI self-assessment questionnaire was utilized to collect the data. The data was transferred to MS Excel (version 15.0.5127.1000) and analysed with the Statistical Package for Social Sciences version 24. RESULTS The South African median score for Neo-BFHI compliance was 77. Neonatal wards in public hospitals scored higher (85) than those in private hospitals (73). Neonatal wards in hospitals that were accredited Baby-friendly had higher compliance scores than those without accreditation. The country had the highest compliance scores (100, 90) on Guiding Principle 1 (respect towards mothers) and step 5 (breastfeeding support), respectively. However, it scored low (71, 58) on steps 4 (enhancing kangaroo mother care) and 7 (maternal infant "togetherness"), respectively. Level 1 and 2 care facilities scored significantly higher than level 3. CONCLUSION Although South Africa successfully implemented the Neo-BFHI recommendations, private hospitals had a smaller number of BFHI-accredited facilities and lower compliance than public hospitals. Strategies should be developed to strengthen and improve BFHI accreditation and compliance, particularly in private hospitals.
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Affiliation(s)
- Welma Lubbe
- NuMiQ Research Focus Area, North-West University South Africa, Potchefstroom, South Africa
| | - Lisa Springer
- NuMiQ Research Focus Area, North-West University South Africa, Potchefstroom, South Africa
| | - Ragnhild Maastrup
- Department of Neonatology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Laura N Haiek
- Ministère de la Santé et des Services sociaux, Direction générale de la santé publique, Quebec, Canada
- Department of Family Medicine, McGill University, Montreal, Quebec, Canada
- St. Mary's Hospital, St. Mary's Research Centre, Montreal, Quebec, Canada
| | - Madimetja Nyaloko
- NuMiQ Research Focus Area, North-West University South Africa, Potchefstroom, South Africa.
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Kappel SS, Maastrup R, Sangild PT, Jakobsen KT, Christensen VB, Aunsholt L. Nurses' and Physicians' Rationale Behind Clinical Performance and Interpretation of Routine Prefeed Gastric Aspiration in Preterm Infants: A Cross-sectional Study. J Perinat Neonatal Nurs 2023; 37:77-83. [PMID: 36548337 DOI: 10.1097/jpn.0000000000000618] [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] [Indexed: 02/01/2023]
Abstract
This study aims at understanding the rationale behind performing prefeed gastric aspirations in preterm infants, how nurses and physicians interpret the gastric aspiration and variations between them, and illuminating potential barriers for omitting routine prefeed aspiration. Nurses and physicians from all Danish neonatal intensive care units completed a questionnaire. Of 682 participants, the majority (94%) indicated that they routinely performed prefeed aspiration, primarily to check the feeding tube placement (nurses: 88%, physicians: 46%). Nurses feared necrotizing enterocolitis when observing a large gastric residual (GR) volume (31%) and green-stained GR (63%). Fewer nurses relative to physicians had "no worries" related to large volumes (15% vs 34%) or green-stained GR (14% vs 24%, both P < .01). More nurses than physicians intended to pause enteral feeding when observing green-stained GR (31% vs 16%, P < .01) and more nurses were concerned of completely omitting routine gastric aspirations (90% vs 46%, P < .05). The rationale behind the clinical use of GR volume and color as markers of necrotizing enterocolitis and feeding intolerance differs markedly between nurses and physicians in Denmark. If routine prefeed gastric aspiration should be omitted, special focus on information about early signs of necrotizing enterocolitis and methods to check tube placement is needed.
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Affiliation(s)
- Susanne Soendergaard Kappel
- Departments of Neonatology (MScN Kappel and Drs Maastrup, Sangild, and Aunsholt) and Pediatrics and Adolescent Medicine (Dr Christensen), Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark; Comparative Pediatrics and Nutrition, University of Copenhagen, Copenhagen, Denmark (MScN Kappel and Drs Sangild and Aunsholt); Department of Pediatrics, Odense University Hospital, Odense, Denmark (Dr Sangild); and The Think Tank DEA, Copenhagen, Denmark (Dr Jakobsen)
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Cabrera-Lafuente M, Alonso-Díaz C, Pumarega MTM, Díaz-Almirón M, Haiek LN, Maastrup R, Pallás-Alonso C. Breastfeeding practices in neonatal wards in Spain. Neo-BFHI international survey. An Pediatr (Barc) 2022; 96:300-308. [PMID: 35523686 DOI: 10.1016/j.anpede.2021.04.010] [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] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 04/15/2021] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION In 2017, a worldwide survey was conducted on compliance with the practices promoted by Neo-BFHI (Baby-friendly Hospital Initiative expansion to neonatal wards). OBJECTIVE To present the results of the Spanish wards that participated in the global survey and compare them with those obtained internationally. MATERIAL AND METHODS Cross-sectional study through a survey on compliance with the Neo-BFHI ("Three basic principles", "Ten steps adapted to neonatal wards" and "the compliance with the International Code of Marketing of Breast-milk Substitutes" and subsequent relevant World Health Assembly resolutions). Compliance was calculated as the mean in each indicator and a final mean score for each neonatal unit. For the partial and final scores for each country and at the international level, the median was used. All scores ranged between 0 and 100. RESULTS The response rate in Spain was 90%. The range of the national mean for neonatal wards were from 37 to 99, with no differences in the final score according to the level of care. The global score for Spain (72) is below the international median (77) and this also occurs in 8 of 14 items. The neonatal wards from BFHI designated hospitals, obtained a significantly higher mean global score, and in 9 of 14 items than the non-accredited ones. CONCLUSIONS Both international and national results indicate an improvement in breast feeding practices in neonatal units. The benefits of the BFHI accreditation of maternity reach neonatal wards. Spain has several key points below the international score.
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Affiliation(s)
| | - Clara Alonso-Díaz
- Servicio de Neonatología, Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | | | - Laura N Haiek
- Ministère de la santé et des Services sociaux, Direction générale de la santé publique, Quebec, Canada; McGill University, Department of Family Medicine, Montreal, Quebec, Canada
| | - Ragnhild Maastrup
- Department of Neonatology, Copenhagen University Hospital Rigshospitalet, University Hospital Rigshospitalet, Department of Neonatology, Blegdamsvej, Denmark
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Maastrup R, Hannula L, Hansen MN, Ezeonodo A, Haiek LN. The Baby-friendly Hospital Initiative for neonatal wards. A mini review. Acta Paediatr 2022; 111:750-755. [PMID: 34932843 DOI: 10.1111/apa.16230] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [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: 08/23/2021] [Revised: 12/01/2021] [Accepted: 12/20/2021] [Indexed: 11/30/2022]
Abstract
The Baby-friendly Hospital Initiative for Neonatal Wards (Neo-BFHI) is an expansion of the WHO/UNICEF Ten Steps to Successful Breastfeeding to address the needs of infants and families in all levels of neonatal care. The Neo-BFHI includes Three Guiding Principles as basic tenets, Ten Steps to protect, promote and support breastfeeding closely following the original Baby-friendly Hospital Initiative, and adherence to the International Code of Marketing of Breast-milk Substitutes. In 2020, the WHO/UNICEF published recommendations for breastfeeding small, sick and preterm newborns that aligns with the Neo-BFHI. Conclusion: This mini review provides a brief description of the content in the Neo-BFHI.
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Affiliation(s)
- Ragnhild Maastrup
- Knowledge Centre for Breastfeeding Infants with Special Needs Department of Neonatology, Rigshospitalet Copenhagen University Hospital Copenhagen Denmark
- Research Unit Women's and Children's Health Juliane Marie Centre Rigshospitalet Copenhagen University Hospital Copenhagen Denmark
| | - Leena Hannula
- School of Health Care Metropolia University of Applied Sciences Metropolia Finland
| | - Mette Ness Hansen
- Norwegian National Advisory Unit on Breastfeeding Division of Gynaecology and Obstetrics Rikshospitalet Oslo University Hospital Oslo Norway
| | - Aino Ezeonodo
- School of Health Care Metropolia University of Applied Sciences Metropolia Finland
| | - Laura N. Haiek
- Ministère de la Santé et des Services sociaux Québec QC Canada
- McGill University Department of Family Medicine and St. Mary's Research Centre Montréal QC Canada
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Abstract
BACKGROUND The expansion of the Baby-Friendly Hospital Initiative to neonatal wards, known as the Neo-BFHI, provides recommendations to support breastfeeding, as outlined in the Three Guiding Principles, the expanded Ten Steps, and the International Code for Marketing of Breast-Milk Substitutes. In 2017, Russia participated in an international survey about compliance with the Neo-BFHI. RESEARCH AIM To assess breastfeeding support policies and practices in Russian neonatal wards at the country and federal district level in accordance with the Neo-BFHI recommendations. METHODS This study was a prospective cross-sectional survey. We used the Neo-BFHI Self-Assessment questionnaire to collect data from neonatal wards that had all levels of care. A total of N = 60 Russian neonatal wards in hospitals that have ever been designated Baby-Friendly or planned to do so participated in the survey. RESULTS Compliance scores at the federal district and country level ranging from 0-100 were used to summarize results. The median country overall score was 90 (IQR = 83 - 93). Respect for mothers, continuity of care, having a breastfeeding policy, and rooming-in had the highest median scores. Family-centered care, antenatal informing, skin-to-skin contact, and human milk use had the lowest median scores. Neonatal wards in the hospitals that were ever designated as Baby-Friendly had significantly higher scores than those that were never designated. Most respondents (n = 48, 80%) expressed a desire to obtain Neo-BFHI designation in their neonatal wards. CONCLUSION Neo-BFHI recommendations can be successfully implemented in Russian neonatal wards at hospitals designated Baby-Friendly or planning to be designated.
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Affiliation(s)
- Liubov V Abolyan
- 68477 Sechenov First Moscow State Medical University, Department for Health Care and Public Health, Moscow, Russia
| | - Laura N Haiek
- 6777 Ministère de la Santé et des Services Sociaux, Direction Générale de la Santé Publique, Quebec, Canada.,McGill University, Department of Family Medicine, Montreal, Quebec, Canada
| | - Irina M Pastbina
- 531302 Ministry of Health of the Arkhangelsk Region, Department of Mother and Child Care, Arkhangelsk, Russia
| | - Ragnhild Maastrup
- 53146 Copenhagen University Hospital Rigshospitalet, Department of Neonatology, Copenhagen, Denmark
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Cabrera-Lafuente M, Alonso-Díaz C, Moral Pumarega MT, Díaz-Almirón M, Haiek LN, Maastrup R, Pallás-Alonso C. [Breastfeeding practices in neonatal wards in Spain. Neo-BFHI international survey]. An Pediatr (Barc) 2021; 96:S1695-4033(21)00178-8. [PMID: 34045162 DOI: 10.1016/j.anpedi.2021.04.010] [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] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 04/09/2021] [Accepted: 04/15/2021] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION In 2017, a worldwide survey was conducted on compliance with the practices promoted by Neo-BFHI (Baby-friendly Hospital Initiative expansion to neonatal wards). OBJECTIVE Present the results of the Spanish wards that participated in the global survey and compare them with those obtained internationally. MATERIAL AND METHODS Cross-sectional study through a survey on compliance with the Neo-BFHI ("Three basic principles", "Ten steps adapted to neonatal wards" and "the compliance with the International Code of Marketing of Breast-milk Substitutes" and subsequent relevant World Health Assembly resolutions). Compliance was calculated as the mean in each indicator and a final mean score for each neonatal unit. For the partial and final scores for each country and at the international level, the median was used. All score ranged between 0 and 100. RESULTS The response rate in Spain was 90%. The range of the national mean for neonatal wards were from 37 to 99, with no differences in the final score according to the level of care. The global score for Spain (72) is below the international median (77) and this also occurs in 8 of 14 items. The neonatal wards from BFHI designated hospitals, obtained a significantly higher mean global score, and in 9 of 14 items than the non-accredited ones. CONCLUSIONS Both international and national results indicate an improvement in breastfeeding practices in neonatal units. The benefits of the BFHI accreditation of maternity reach neonatal wards. Spain has several key points below the international score.
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Affiliation(s)
| | - Clara Alonso-Díaz
- Servicio de Neonatología, Hospital Universitario 12 de Octubre, Madrid, España
| | | | - Mariana Díaz-Almirón
- Sección de Bioestadística, IdiPAZ, Hospital Universitario La Paz, Madrid, España
| | - Laura N Haiek
- Ministère de la Santé et des Services sociaux, Direction générale de la santé publique, Quebec, Canadá; McGill University, Department of Family Medicine, Montreal, Quebec, Canada
| | - Ragnhild Maastrup
- Department of Neonatology, Copenhagen University Hospital Rigshospitalet, University Hospital Rigshospitalet, Department of Neonatology, Blegdamsvej, Dinamarca
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Maastrup R, Rom AL, Walloee S, Sandfeld HB, Kronborg H. Improved exclusive breastfeeding rates in preterm infants after a neonatal nurse training program focusing on six breastfeeding-supportive clinical practices. PLoS One 2021; 16:e0245273. [PMID: 33534831 PMCID: PMC7857627 DOI: 10.1371/journal.pone.0245273] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 12/27/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Early breast milk expression, prolonged skin-to-skin contact, rooming-in, use of test-weighing and minimizing use of pacifiers are positively associated with exclusive breastfeeding of preterm infants, whereas use of nipple shields is negatively associated. AIM To test whether a training program for neonatal nurses with a focus on these six breastfeeding-supportive clinical practices affects the rate of preterm infants exclusively breastfed at discharge to home, the postmenstrual age at establishment of exclusive breastfeeding, and maternal self-reported use of the practice in the neonatal intensive care unit, the. METHODS A quasi-experimental multi-centre intervention study from 2016-2019 including a control group of 420 preterm mother-infant dyads, an intervention with a training program for neonatal nurses and implementation of weekly breastfeeding meetings for neonatal nurses, and an intervention group of 494 preterm mother-infant dyads. RESULTS Significantly more preterm infants in the intervention group were exclusively breastfed at discharge to home (66.6%) than in the control group (58.1%) p = 0.008. There was no significant difference in postmenstrual age at establishment of exclusive breastfeeding between control and intervention group (37.5 vs.37.8 weeks, p = 0.073). Compared to the control group the number of infants continuing daily skin-to-skin contact after incubator care increased (83.2% vs. 88.3%, p = 0.035), infants using a nipple shield decreased (61.8% vs. 54.2%, p = 0.029), and the number of mothers initiating breast milk expression before six hours post-partum increased (32.6% vs. 42.4%, p = 0.007). There was a significant correlation between percentage of neonatal nurses participating in the breastfeeding training program and changes in exclusive breastfeeding rates (Pearson Correlation 0.638, p = 0.047). CONCLUSION Exclusive breastfeeding rates in preterm infants and maternal self-reported use of breastfeeding-supportive practices increased by training neonatal nurses in the six clinical practices. It is important to include all nurses in the breastfeeding training program to ensure positive effect on exclusive breastfeeding rates.
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Affiliation(s)
- Ragnhild Maastrup
- Department of Neonatology, Knowledge Centre for Breastfeeding Infants with Special Needs, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,Research Unit Women's and Children's Health, Juliane Marie Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Ane L Rom
- Research Unit Women's and Children's Health, Juliane Marie Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Sisse Walloee
- Dept of Clinical Research, OPEN-Patient data Explorative Network, University of Southern Denmark, Odense, Denmark
| | | | - Hanne Kronborg
- Department of Public Health, Section for Nursing, Aarhus University, Aarhus, Denmark
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Maastrup R, Walloee S, Kronborg H. Nipple shield use in preterm infants: Prevalence, motives for use and association with exclusive breastfeeding-Results from a national cohort study. PLoS One 2019; 14:e0222811. [PMID: 31539900 PMCID: PMC6754237 DOI: 10.1371/journal.pone.0222811] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 09/07/2019] [Indexed: 12/18/2022] Open
Abstract
Background and aim Prevalence and motives for nipple shield use are not well studied in preterm infants and recommendations of nipple shield use in preterm infants are inconsistent. The aim of this study was to determine the prevalence of nipple shield use, explore the motives for nipple shield use and elucidate the association with exclusive breastfeeding in preterm infants. Methods The study was part of a prospective survey of a Danish national cohort of preterm infants based on questionnaires answered by the 1221 mothers of 1488 preterm infants with gestational age of 24–36 weeks. Data on nipple shield use was available for 1407 infants. Results Nipple shields were used by 54% of the mother-infant dyads for many different motives and was more often related to breastfeeding problems associated with the infant than with the mother. The most common motive for nipple shield use was “infant slipped the nipple” (52%). The lower the gestational age, the more frequently nipple shields were used for motives related to the infant. For those using a nipple shield, only the motive “infant fell asleep at the breast” was associated with a higher risk of not breastfeeding exclusively at discharge (OR 1.90 (95% CI 1.15; 3.13), p = 0.012), and “breast too engorged” with a lower risk of not breastfeeding exclusively (OR 0.32 (0.16; 0.63), p = 0.001), but overall nipple shield use was associated with failure of exclusive breastfeeding. Conclusion The present study does not give justifiable motives for nipple shield use, except for “breast too engorged”. Nipple shields should not be recommended for infants falling asleep at the breast, instead, staff and mothers should be patient, allowing the dyad time skin-to-skin. The results indicate that the use of a nipple shield does not promote exclusive breastfeeding in preterm infants.
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Affiliation(s)
- Ragnhild Maastrup
- Knowledge Centre for Breastfeeding Infants with Special Needs, Department of Neonatology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Research Unit Women’s and Children’s Health, Juliane Marie Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- * E-mail:
| | - Sisse Walloee
- Research Unit Women’s and Children’s Health, Juliane Marie Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Obstetrics and Gynecology, Slagelse Hospital, Slagelse, Denmark
| | - Hanne Kronborg
- Department of Public Health, Section for Nursing, Aarhus University, Aarhus, Denmark
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Holm KG, Clemensen J, Brødsgaard A, Smith AC, Maastrup R, Zachariassen G. Growth and breastfeeding of preterm infants receiving neonatal tele-homecare compared to hospital-based care. J Neonatal Perinatal Med 2019; 12:277-284. [PMID: 30856122 DOI: 10.3233/npm-18143] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVE Neonatal tele-homecare implies that parents of clinically stable preterm infants can manage tube feeding and establishment of oral feeding in the home. Support is provided from the neonatal intensive care unit (NICU) through a telehealth service. The aim of this study was to compare growth and breastfeeding rates amongst infants being managed in the NICU (conventional care) and by neonatal tele-homecare. METHODS A total of 96 preterm infants with tube feeding requirements participated in the observational study of neonatal tele-homecare. Retrospective data in 278 preterm infants receiving standard care in the same neonatal intensive care unit prior to implementation of neonatal tele-homecare were used for comparison. Rates of breastfeeding and growth were monitored during neonatal tele-homecare. Infant weights were converted to standard deviation weight-for-age z-scores based on a reference. RESULTS There was no significant difference in rates of exclusive breastfeeding between the neonatal tele-homecare infants and the controls. Among the very preterm singleton infants more neonatal tele-homecare infants were exclusively breastfed at discharge compared to the controls (p = 0.04). There was no significant difference in median weight for age z-scores at discharge. CONCLUSION This study demonstrates that neonatal tele-homecare may be an appropriate model of care for the management of preterm infants outside of the hospital environment; with the added benefit of higher rates of breastfeeding at time of discharge for very preterm infants.
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Affiliation(s)
- Kristina Garne Holm
- Hans Christian Andersen Hospital for Children and Adolescents,, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
- OPEN, Odense Patient Explorative Network, Odense University Hospital, Odense, Denmark
| | - Jane Clemensen
- Hans Christian Andersen Hospital for Children and Adolescents,, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
- Center for Innovative Medical Technology, Odense University Hospital, Odense, Denmark
| | - Anne Brødsgaard
- Department of Pediatrics, Amager Hvidovre Hospital, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Public Health, Department of Science in Nursing, Aarhus University, Aarhus, Denmark
| | - Anthony C Smith
- Center for Online Health, University of Queensland, Brisbane, Australia
| | - Ragnhild Maastrup
- Department of Neonatology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Gitte Zachariassen
- Hans Christian Andersen Hospital for Children and Adolescents,, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
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Maastrup R, Haiek LN. Compliance with the "Baby-friendly Hospital Initiative for Neonatal Wards" in 36 countries. Matern Child Nutr 2018; 15:e12690. [PMID: 30198645 PMCID: PMC6586157 DOI: 10.1111/mcn.12690] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 08/23/2018] [Accepted: 08/31/2018] [Indexed: 12/02/2022]
Abstract
In 2012, the Baby‐friendly Hospital Initiative for Neonatal Wards (Neo‐BFHI) began providing recommendations to improve breastfeeding support for preterm and ill infants. This cross‐sectional survey aimed to measure compliance on a global level with the Neo‐BFHI's expanded Ten Steps to successful breastfeeding and three Guiding Principles in neonatal wards. In 2017, the Neo‐BFHI Self‐Assessment questionnaire was used in 15 languages to collect data from neonatal wards of all levels of care. Answers were summarized into compliance scores ranging from 0 to 100 at the ward, country, and international levels. A total of 917 neonatal wards from 36 low‐, middle‐, and high‐income countries from all continents participated. The median international overall score was 77, and median country overall scores ranged from 52 to 91. Guiding Principle 1 (respect for mothers), Step 5 (breastfeeding initiation and support), and Step 6 (human milk use) had the highest scores, 100, 88, and 88, respectively. Step 3 (antenatal information) and Step 7 (rooming‐in) had the lowest scores, 63 and 67, respectively. High‐income countries had significantly higher scores for Guiding Principles 2 (family‐centered care), Step 4 (skin‐to‐skin contact), and Step 5. Neonatal wards in hospitals ever‐designated Baby‐friendly had significantly higher scores than those never designated. Sixty percent of managers stated they would like to obtain Neo‐BFHI designation. Currently, Neo‐BFHI recommendations are partly implemented in many countries. The high number of participating wards indicates international readiness to expand Baby‐friendly standards to neonatal settings. Hospitals and governments should increase their efforts to better support breastfeeding in neonatal wards.
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Affiliation(s)
- Ragnhild Maastrup
- Department of Neonatology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Laura N Haiek
- Ministère de la Santé et des Services sociaux, Direction générale de la santé publique, Quebec, Quebec, Canada.,McGill University, Department of Family Medicine, Montreal, Quebec, Canada.,St. Mary's Hospital, St. Mary's Research Centre, Montreal, Quebec, Canada
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Maastrup R, Weis J, Engsig AB, Johannsen KL, Zoffmann V. ‘Now she has become my daughter’: parents’ early experiences of skin-to-skin contact with extremely preterm infants. Scand J Caring Sci 2017; 32:545-553. [DOI: 10.1111/scs.12478] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 04/23/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Ragnhild Maastrup
- Department of Neonatology and The Research Unit for Women's and Children's Health; The Juliane Marie Centre; Copenhagen University Hospital; Rigshospitalet; Copenhagen Denmark
| | - Janne Weis
- Department of Neonatology and The Research Unit for Women's and Children's Health; The Juliane Marie Centre; Copenhagen University Hospital; Rigshospitalet; Copenhagen Denmark
| | - Anne B. Engsig
- Public Health; University of Copenhagen; Copenhagen Denmark
| | | | - Vibeke Zoffmann
- The Research Unit for Women's and Children's Health; The Juliane Marie Centre; Copenhagen University Hospital; Rigshospitalet; Copenhagen Denmark
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Kronborg H, Foverskov E, Nilsson I, Maastrup R. Why do mothers use nipple shields and how does this influence duration of exclusive breastfeeding? Matern Child Nutr 2016; 13. [PMID: 26799605 DOI: 10.1111/mcn.12251] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Revised: 10/13/2015] [Accepted: 11/03/2015] [Indexed: 11/28/2022]
Abstract
The present study addressed the contentious discussions about the benefits and risks of nipple shield use. The objective was to explore self-reported reasons for using a nipple shield and examine associations pertaining to the mother, the infant and duration of breastfeeding. Data were collected from 4815 Danish mothers (68%) who filled out a self-administered questionnaire with open and closed question. Data were analyzed by content and statistical descriptive and multivariable analysis. Results showed that 22% of the mothers used nipple shields in the beginning and 7% used it the entire breastfeeding period. Primiparae used nipple shields more often than multiparae, and early breastfeeding problems as well as background factors like lower age, education and higher body mass index were associated with a higher likelihood of using nipple shields. Characteristics of infants associated with introducing nipple shields were lower- gestational age and birthweight. The use of nipple shields was furthermore found to be associated with a threefold increased risk of earlier cessation of exclusive breastfeeding: among primiparae odds ratio = 3.80 (confidence interval 2.61-5.53); among multiparae odds ratio = 3.33 (confidence interval 1.88-5.93). Mothers' own descriptions underlined how various early breastfeeding problems led to the use of nipple shields. Some mothers were helped through a difficult period; others described the use creating a kind of dependence. The results highlight how nipple shields may help breastfeeding mothers in the early period but is not necessarily a supportive solution to the inexperienced mother who needs extra support in the early process of learning to breastfeed.
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Affiliation(s)
- Hanne Kronborg
- Department of Public Health, Section for Nursing, Aarhus University, Aarhus C, Denmark
| | - Else Foverskov
- Department of Public Health, Section for Nursing, Aarhus University, Aarhus C, Denmark.,Department of Public Health, Section of Social Medicin, University of Copenhagen, Copenhagen, Denmark
| | - Ingrid Nilsson
- Department of Public Health, Section for Nursing, Aarhus University, Aarhus C, Denmark.,Danish Committee for Health Education, Copenhagen, Denmark
| | - Ragnhild Maastrup
- Knowledge Centre for Breastfeeding Infants with Special Needs at Department of Neonatology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
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Maastrup R, Hansen BM, Kronborg H, Bojesen SN, Hallum K, Frandsen A, Kyhnaeb A, Svarer I, Hallström I. Breastfeeding progression in preterm infants is influenced by factors in infants, mothers and clinical practice: the results of a national cohort study with high breastfeeding initiation rates. PLoS One 2014; 9:e108208. [PMID: 25251690 PMCID: PMC4177123 DOI: 10.1371/journal.pone.0108208] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Accepted: 08/20/2014] [Indexed: 11/19/2022] Open
Abstract
Background and Aim Many preterm infants are not capable of exclusive breastfeeding from birth. To guide mothers in breastfeeding, it is important to know when preterm infants can initiate breastfeeding and progress. The aim was to analyse postmenstrual age (PMA) at breastfeeding milestones in different preterm gestational age (GA) groups, to describe rates of breastfeeding duration at pre-defined times, as well as analyse factors associated with PMA at the establishment of exclusive breastfeeding. Methods The study was part of a prospective survey of a national Danish cohort of preterm infants based on questionnaires and structured telephone interviews, including 1,221 mothers and their 1,488 preterm infants with GA of 24–36 weeks. Results Of the preterm infants, 99% initiated breastfeeding and 68% were discharged exclusively breastfed. Breastfeeding milestones were generally reached at different PMAs for different GA groups, but preterm infants were able to initiate breastfeeding at early times, with some delay in infants less than GA 32 weeks. Very preterm infants had lowest mean PMA (35.5 weeks) at first complete breastfeed, and moderate preterm infants had lowest mean PMA at the establishment of exclusive breastfeeding (36.4 weeks). Admitting mothers to the NICU together with the infant and minimising the use of a pacifier during breastfeeding transition were associated with 1.6 (95% CI 0.4–2.8) and 1.2 days (95% CI 0.1–2.3) earlier establishment of exclusive breastfeeding respectively. Infants that were small for gestational age were associated with 5.6 days (95% CI 4.1–7.0) later establishment of exclusive breastfeeding. Conclusion Breastfeeding competence is not developed at a fixed PMA, but is influenced by multiple factors in infants, mothers and clinical practice. Admitting mothers together with their infants to the NICU and minimising the use of pacifiers may contribute to earlier establishment of exclusive breastfeeding.
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Affiliation(s)
- Ragnhild Maastrup
- Knowledge Centre for Breastfeeding Infants with Special Needs at Department of Neonatology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
- Danish National Panel of Experts on Breastfeeding Infants with Special Needs, Copenhagen, Denmark
- * E-mail:
| | - Bo Moelholm Hansen
- Department of Neonatology, Copenhagen University Hospital Herlev, Herlev, Denmark
| | - Hanne Kronborg
- Department of Public Health, Section of Nursing, University of Aarhus, Aarhus, Denmark
| | - Susanne Norby Bojesen
- Danish National Panel of Experts on Breastfeeding Infants with Special Needs, Copenhagen, Denmark
- Department of Neonatology, Copenhagen University Hospital Herlev, Herlev, Denmark
| | - Karin Hallum
- Danish National Panel of Experts on Breastfeeding Infants with Special Needs, Copenhagen, Denmark
- Department of Neonatology, Viborg Regional Hospital, Viborg, Denmark
| | - Annemi Frandsen
- Danish National Panel of Experts on Breastfeeding Infants with Special Needs, Copenhagen, Denmark
- Paediatric Department, Holbaek University Hospital, Holbaek, Denmark
| | - Anne Kyhnaeb
- Danish National Panel of Experts on Breastfeeding Infants with Special Needs, Copenhagen, Denmark
- Department of Neonatology, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Inge Svarer
- Danish National Panel of Experts on Breastfeeding Infants with Special Needs, Copenhagen, Denmark
- Department of Neonatology, Odense University Hospital, Odense, Denmark
| | - Inger Hallström
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
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Maastrup R, Hansen BM, Kronborg H, Bojesen SN, Hallum K, Frandsen A, Kyhnaeb A, Svarer I, Hallström I. Factors associated with exclusive breastfeeding of preterm infants. Results from a prospective national cohort study. PLoS One 2014; 9:e89077. [PMID: 24586513 PMCID: PMC3929624 DOI: 10.1371/journal.pone.0089077] [Citation(s) in RCA: 87] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Accepted: 01/15/2014] [Indexed: 12/02/2022] Open
Abstract
Background and Aim Evidence-based knowledge of how to guide the mothers of preterm infants in breastfeeding establishment is contradictive or sparse. The aim was to investigate the associations between pre-specified clinical practices for facilitating breastfeeding, and exclusive breastfeeding at discharge as well as adequate duration thereof. Methods A prospective survey based on questionnaires was conducted with a Danish national cohort, comprised of 1,221 mothers and their 1,488 preterm infants with a gestational age of 24–36 weeks. Adjusted for covariates, the pre-specified clinical practices were analysed by multiple logistic regression analyses. Results At discharge 68% of the preterm infants were exclusively breastfed and 17% partially. Test-weighing the infant, and minimizing the use of a pacifier, showed a protective effect to exclusive breastfeeding at discharge (OR 0.6 (95% CI 0.4–0.8) and 0.4 (95% CI 0.3–0.6), respectively). The use of nipple shields (OR 2.3 (95% CI 1.6–3.2)) and the initiation of breast milk expression later than 48 hours postpartum (OR 4.9 (95% CI 1.9–12.6)) were associated with failure of exclusive breastfeeding at discharge. The clinical practices associated with an inadequate breastfeeding duration were the initiation of breast milk expression at 12–24 hours (OR 1.6 (95% CI 1.0–2.4)) and 24–48 hours (OR 1.8 (95% CI 1.0–3.1)) vs. before six hours postpartum, and the use of nipple shields (OR 1.4 (95% CI 1.1–1.9)). Conclusion Early initiation of breast milk pumping before 12 hours postpartum may increase breastfeeding rates, and it seems that the use of nipple shields should be restricted. The use of test-weighing and minimizing the use of a pacifier may promote the establishment of exclusive breastfeeding, but more research is needed regarding adequate support to the mother when test-weighing is ceased, as more of these mothers ceased exclusive breastfeeding at an early stage after discharge.
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Affiliation(s)
- Ragnhild Maastrup
- Knowledge Centre for Breastfeeding Infants with Special Needs at Department of Neonatology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
- Danish National Panel of Experts on Breastfeeding Infants with Special Needs
- * E-mail:
| | - Bo Moelholm Hansen
- Department of Neonatology, Copenhagen University Hospital Herlev, Herlev, Denmark
| | - Hanne Kronborg
- Department of Public Health, Section of Nursing, University of Aarhus, Aarhus, Denmark
| | - Susanne Norby Bojesen
- Danish National Panel of Experts on Breastfeeding Infants with Special Needs
- Department of Neonatology, Copenhagen University Hospital Herlev, Herlev, Denmark
| | - Karin Hallum
- Danish National Panel of Experts on Breastfeeding Infants with Special Needs
- Department of Neonatology, Viborg Regional Hospital, Viborg, Denmark
| | - Annemi Frandsen
- Danish National Panel of Experts on Breastfeeding Infants with Special Needs
- Paediatric Department, Holbaek University Hospital, Holbaek, Denmark
| | - Anne Kyhnaeb
- Danish National Panel of Experts on Breastfeeding Infants with Special Needs
- Department of Neonatology, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Inge Svarer
- Danish National Panel of Experts on Breastfeeding Infants with Special Needs
- Department of Neonatology, Odense University Hospital, Odense, Denmark
| | - Inger Hallström
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
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Nyqvist KH, Häggkvist AP, Hansen MN, Ezeonodo A, Hannula L, Maastrup R, Haiek LN. What is the purpose of the baby-friendly hospital initiative for neonatal wards? Commentary to a letter by Adik Levin in Birth, 40:2, June 2013. Birth 2013; 40:315-6. [PMID: 24344714 DOI: 10.1111/birt.12066] [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] [Accepted: 09/23/2013] [Indexed: 12/01/2022]
Affiliation(s)
- Kerstin H Nyqvist
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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Nyqvist KH, Häggkvist AP, Hansen MN, Kylberg E, Frandsen AL, Maastrup R, Ezeonodo A, Hannula L, Haiek LN. Expansion of the baby-friendly hospital initiative ten steps to successful breastfeeding into neonatal intensive care: expert group recommendations. J Hum Lact 2013; 29:300-9. [PMID: 23727630 DOI: 10.1177/0890334413489775] [Citation(s) in RCA: 133] [Impact Index Per Article: 12.1] [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: 11/15/2022]
Abstract
In the World Health Organization/United Nations Children's Fund document Baby-Friendly Hospital Initiative: Revised, Updated and Expanded for Integrated Care, neonatal care is mentioned as 1 area that would benefit from expansion of the original Ten Steps to Successful Breastfeeding. The different situations faced by preterm and sick infants and their mothers, compared to healthy infants and their mothers, necessitate a specific breastfeeding policy for neonatal intensive care and require that health care professionals have knowledge and skills in lactation and breastfeeding support, including provision of antenatal information, that are specific to neonatal care. Facilitation of early, continuous, and prolonged skin-to-skin contact (kangaroo mother care), early initiation of breastfeeding, and mothers' access to breastfeeding support during the infants' whole hospital stay are important. Mother's own milk or donor milk (when available) is the optimal nutrition. Efforts should be made to minimize parent-infant separation and facilitate parents' unrestricted presence with their infants. The initiation and continuation of breastfeeding should be guided only by infant competence and stability, using a semi-demand feeding regimen during the transition to exclusive breastfeeding. Pacifiers are appropriate during tube-feeding, for pain relief, and for calming infants. Nipple shields can be used for facilitating establishment of breastfeeding, but only after qualified support and attempts at the breast. Alternatives to bottles should be used until breastfeeding is well established. The discharge program should include adequate preparation of parents, information about access to lactation and breastfeeding support, both professional and peer support, and a plan for continued follow-up.
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Affiliation(s)
- Kerstin H Nyqvist
- Department of Women's and Children's Health, University Children's Hospital, Uppsala, Sweden.
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Olsson E, Andersen RD, Axelin A, Jonsdottir RB, Maastrup R, Eriksson M. Skin-to-skin care in neonatal intensive care units in the Nordic countries: a survey of attitudes and practices. Acta Paediatr 2012; 101:1140-6. [PMID: 22849363 DOI: 10.1111/j.1651-2227.2012.02802.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [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] [Indexed: 11/29/2022]
Abstract
AIM To investigate the application of skin-to-skin care (SSC) in the Nordic countries, the existence of guidelines for SSC and the attitudes of neonatal staff towards SSC. METHODS One questionnaire was distributed at unit level and one at staff level in all Nordic neonatal intensive care units (n = 109). RESULTS The unit questionnaire was answered by 95 (87%) units and the staff questionnaire by 1446 staff members (72%). All units offered SSC to various degrees, but guidelines only existed at 47% of them. Units in Denmark, Norway and Sweden seemed to use SSC earlier, longer and in more medically complicated situations than units in Finland and Iceland. Seventy-seven per cent of the units had private rooms where parents and infants could stay together, still the physical environment of the units limited the use of SSC. Medical risks were considered the main barrier for further implementation of SSC, while general development and early interaction were the most frequently mentioned benefits. CONCLUSION Skin-to-skin care is implemented in all Nordic neonatal units, but offered to various degrees, to various populations and to varying extents. Danish, Norwegian and Swedish units are offering SSC more extensively than units in Finland and Iceland.
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Affiliation(s)
- Emma Olsson
- Department of Paediatrics, Örebro University Hospital, Sweden.
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Nyqvist KH, Häggkvist AP, Hansen MN, Kylberg E, Frandsen AL, Maastrup R, Ezeonodo A, Hannula L, Koskinen K, Haiek LN. Expansion of the ten steps to successful breastfeeding into neonatal intensive care: expert group recommendations for three guiding principles. J Hum Lact 2012; 28:289-96. [PMID: 22674967 DOI: 10.1177/0890334412441862] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The World Health Organization/United Nations Children's Fund Baby-Friendly Hospital Initiative: Revised, Updated, and Expanded for Integrated Care (2009) identifies the need for expanding the guidelines originally developed for maternity units to include neonatal intensive care. For this purpose, an expert group from the Nordic countries and Quebec, Canada, prepared a draft proposal, which was discussed at an international workshop in Uppsala, Sweden, in September 2011. The expert group suggests the addition of 3 "Guiding Principles" to the Ten Steps to support this vulnerable population of mothers and infants: 1. The staff attitude to the mother must focus on the individual mother and her situation. 2. The facility must provide family-centered care, supported by the environment. 3. The health care system must ensure continuity of care, that is, continuity of pre-, peri-, and postnatal care and post-discharge care. The goal of the expert group is to create a final document, the Baby Friendly Hospital Initiative for Neonatal Units, including standards and criteria for each of the 3 Guiding Principles, Ten Steps, and the Code; to develop tools for self-appraisal and monitoring compliance with the guidelines; and for external assessment to decide whether neonatal intensive/intermediate care units meet the conditions required to be designated as Baby-Friendly. The documents will be finalized after consultation with the World Health Organization/United Nations Children's Fund, and the goal is to offer these documents to international health care, professional, and other nongovernmental organizations involved in lactation and breastfeeding support for mothers of infants who require special neonatal care.
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Abstract
BACKGROUND The incidence of breastfeeding of preterm infants is affected by the support provided at the hospital and in the neonatal intensive care unit (NICU). However, policies and guidelines promoting breastfeeding vary both nationally and internationally. OBJECTIVES The aim of this survey was to describe breastfeeding support in Danish NICUs, where approximately 98% of mothers initiate lactation. METHODS A national survey of all 19 Danish NICUs was conducted in 2009. Four NICUs were at designated Baby-Friendly hospitals, and 5 had a lactation consultant. In all NICUs, it was possible for some parents to stay overnight; 2 units had short restrictions on parents' presence. Five NICUs had integrated postpartum care for mothers. Breastfeeding policies, written guidelines, and systematic breastfeeding training for the staff were common in most NICUs. Seventeen NICUs recommended starting breast milk expression within 6 hours after birth, and mothers were encouraged to double pump. Most NICUs aimed to initiate skin-to-skin contact the first time the parents were in the NICU, and daily skin-to-skin contact was estimated to last for 2-4 hours in 63% and 4-8 hours in 37% of the units. The use of bottle-feeding was restricted. CONCLUSIONS The Danish NICUs described the support of breastfeeding as a high priority, which was reflected in the recommended policies for breast milk pumping, skin-to-skin contact, and the parents' presence in the NICU, as well as in the restricted use of bottle-feeding. However, support varied between units, and not all units supported optimal breastfeeding.
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Affiliation(s)
- Ragnhild Maastrup
- Knowledge Centre for Breastfeeding Infants with Special Needs, Department of Neonatology, Rigshospitalet, Copenhagen, Denmark.
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Abstract
AIM To determine if clinically stable extremely preterm infants can maintain their temperature during skin-to-skin contact and to screen for other negative effects. METHODS Continuous measurement of 22 stable infants' physical parameters 2 h before, during, and 2 h after skin-to-skin-contact. Mean gestational age at birth was 25 weeks and 4 days, mean post-natal age was 8 days, postmenstrual age was 26 weeks and 6 days, and mean actual weight 702 g. Mean duration of skin-to-skin-contact was 98 min. 16 infants were skin-to-skin with the mother, five with the father and one with an older sister. RESULTS There were no significant differences in mean skin temperature, heart rate, respiration rate, or oxygen saturation before, during, and after skin-to-skin contact. While staying within normal range, the mean skin temperature increased 0.1 degrees C during skin-to-skin contact with the mother and decreased 0.3 degrees C during skin-to-skin contact with the father (p = 0.011) (without post-hoc correction). CONCLUSION Clinically stable, extremely preterm infants can keep adequate skin temperature and adequate physical stability during skin-to-skin contact with their parents.
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