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Chiao SS, Razzaq KK, Sheeran JS, Forkin KT, Spangler SN, Knio ZO, Kellams AL, Tiouririne M. Effect of enhanced recovery after surgery for elective cesarean deliveries on neonatal outcomes. J Perinatol 2022; 42:1283-1287. [PMID: 35013588 DOI: 10.1038/s41372-021-01309-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Received: 08/20/2021] [Revised: 12/14/2021] [Accepted: 12/23/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To evaluate the impact of initiation of an enhanced recovery after cesarean delivery (ERAC) protocol for elective cesarean delivery (CD) on neonatal outcomes. STUDY DESIGN We performed a retrospective analysis of elective CD at ≥39 weeks gestational age between September 2014 and August 2018 at a single institution before and after ERAC protocol implementation. Our primary outcome was composite neonatal complication rate and secondary outcome was rate of breastfeeding. We performed univariate analyses to detect differences in outcomes between the pre-ERAC and post-ERAC groups. RESULTS We included 362 neonates born via elective CD before (n = 135) and after (n = 227) ERAC implementation. The post-ERAC group experienced fewer composite neonatal complications (33.0% vs. 47.4%, p = 0.009) and greater breastfeeding rates (80.2% vs. 67.4%, p = 0.009) compared to the pre-ERAC group. CONCLUSION ERAC protocol implementation does not negatively impact neonates and may benefit both mother and baby.
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Affiliation(s)
- Sunny S Chiao
- Department of Anesthesiology, University of Virginia Health System, Charlottesville, VA, USA.
| | - Khadija K Razzaq
- University of Virginia School of Medicine, University of Virginia, Charlottesville, VA, USA
| | - Jessica S Sheeran
- Department of Anesthesiology, University of Virginia Health System, Charlottesville, VA, USA
| | - Katherine T Forkin
- Department of Anesthesiology, University of Virginia Health System, Charlottesville, VA, USA
| | - Sarah N Spangler
- Department of Anesthesiology, University of Virginia Health System, Charlottesville, VA, USA
| | - Ziyad O Knio
- Department of Anesthesiology, University of Virginia Health System, Charlottesville, VA, USA
| | - Ann L Kellams
- Department of Pediatrics, University of Virginia Health System, Charlottesville, VA, USA
| | - Mohamed Tiouririne
- Department of Anesthesiology, University of Virginia Health System, Charlottesville, VA, USA
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Safon CB, Heeren TC, Kerr SM, Clermont D, Corwin MJ, Colson ER, Moon RY, Kellams AL, Hauck FR, Parker MG. Disparities in Breastfeeding Among U.S. Black Mothers: Identification of Mechanisms. Breastfeed Med 2021; 16:140-149. [PMID: 33539248 PMCID: PMC7891211 DOI: 10.1089/bfm.2020.0310] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Objective: Disparities in U.S. breastfeeding rates persist among Black mothers according to birth country and between Black and White mothers, necessitating further investigation of modifiable mediating factors to inform interventions. This study seeks to examine the extent that social, maternal, infant factors and Theory of Planned Behavior (TPB) domains (attitudes, perceived control, and subjective norms) mediate the association of maternal race/birth country and breastfeeding continuation. Methods: A national cohort of 2,050 mothers self-identifying as U.S.-born non-Hispanic Black (n = 689), foreign-born non-Hispanic Black (n = 139), and U.S.-born non-Hispanic White (n = 1,222) was analyzed. Using logistic regression, associations of race/birth country and any/exclusive breastfeeding at 2-6 months were examined. Structural equation modeling was used to determine whether social, maternal, and infant factors and TPB domains mediate these relationships. Results: 40.0% of U.S.-born Black, 82.2% of foreign-born Black, and 57.3% of U.S.-born White mothers reported any breastfeeding at 2-6 months. Compared with U.S.-born Black mothers, odds of any breastfeeding were sevenfold higher among foreign-born Black mothers (odds ratio [OR] = 7.04 95% confidence interval [CI] = 4.80-10.31), which was explained partly by social/maternal/infant factors and TPB domains. Compared with U.S.-born White mothers, any breastfeeding was lower (OR = 0.54, 95% CI = 0.40-0.73) among U.S.-born Black mothers and higher (OR = 3.81, 95% CI = 2.48-5.87) among foreign-born Black mothers; these differences were also mediated by the aforementioned factors. Conclusions: Among Black mothers in the United States, breastfeeding continuation varied substantially by birth country. Promotion of interventions targeting positive attitudes, perceived control, and subjective norms may reduce disparities among Black and between Black and White mothers.
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Affiliation(s)
- Cara B Safon
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Timothy C Heeren
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Stephen M Kerr
- Slone Epidemiology Center, Boston University, Boston, Massachusetts, USA
| | - Daphney Clermont
- Slone Epidemiology Center, Boston University, Boston, Massachusetts, USA.,Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.,Cardinal Glennon Children's Hospital, St. Louis University, St. Louis City County, Missouri, USA
| | - Michael J Corwin
- Slone Epidemiology Center, Boston University, Boston, Massachusetts, USA.,Department of Pediatrics, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Eve R Colson
- Department of Pediatrics, Washington University, St. Louis, Missouri, USA
| | - Rachel Y Moon
- Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Ann L Kellams
- Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Fern R Hauck
- Department of Family Medicine, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Margaret G Parker
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
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Luu LA, Flowers RH, Kellams AL, Zeichner S, Preston DC, Zlotoff BJ, Wisniewski JA. Apple cider vinegar soaks [0.5%] as a treatment for atopic dermatitis do not improve skin barrier integrity. Pediatr Dermatol 2019; 36:634-639. [PMID: 31328306 DOI: 10.1111/pde.13888] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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: 11/26/2022]
Abstract
BACKGROUND/OBJECTIVES Atopic dermatitis (AD) is a common chronic inflammatory skin condition associated with high transepidermal water loss, high skin pH, and Staphylococcus aureus skin colonization. The treatment of AD with bath additives remains highly debated. Recent evidence suggests that dilute apple cider vinegar (ACV) may improve skin barrier integrity in AD, but its safety and efficacy are not well studied. This pilot split-arm study analyzed the effect of dilute apple cider vinegar soaks on skin barrier integrity in patients with atopic dermatitis as measured by skin transepidermal water loss and skin pH. METHODS A total of 22 subjects (11 AD and 11 healthy controls) were enrolled. Subjects soaked both of their forearms for 14 days, with one arm in dilute ACV (0.5% acetic acid) and the other in water 10 minutes daily. Transepidermal water loss and pH were measured pre- and post-treatment. RESULTS In both groups, transepidermal water loss increased and pH decreased at 0 minutes post-ACV treatment, but these effects were not sustained at 60 minutes. In total, 72.7% (16/22) of subjects reported mild side effects from ACV with improvement after discontinuing the soaks. CONCLUSIONS Dilute ACV soaks have no significant effect on skin barrier integrity but caused skin irritation in a majority of subjects. Study limitations include analysis of a single brand, dilution, and application of ACV. Future studies are needed to explore whether lower concentrations of ACV soaks or other applications such as a leave-on acidic ointment could improve skin barrier integrity in a safe, nonirritating way.
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Affiliation(s)
- Lydia A Luu
- Department of Dermatology, University of Virginia, Charlottesville, Virginia
| | - Richard H Flowers
- Department of Dermatology, University of Virginia, Charlottesville, Virginia
| | - Ann L Kellams
- Division of General Pediatrics, Department of Pediatrics, University of Virginia, Charlottesville, Virginia
| | - Steven Zeichner
- Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Virginia, Charlottesville, Virginia
| | - DeVon C Preston
- Division of Allergy and Immunology, Department of Pediatrics and Internal Medicine, University of Virginia, Charlottesville, Virginia
| | - Barrett J Zlotoff
- Department of Dermatology, University of Virginia, Charlottesville, Virginia
| | - Julia A Wisniewski
- Division of Allergy and Immunology, Department of Pediatrics and Internal Medicine, University of Virginia, Charlottesville, Virginia
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Colson ER, Schaeffer P, Hauck FR, Provini L, McClain M, Corwin MJ, Drake EE, Kellams AL, Geller NL, Tanabe K, Moon RY. Facilitators and Barriers to Implementation of Safe Infant Sleep Recommendations in the Hospital Setting. J Obstet Gynecol Neonatal Nurs 2019; 48:332-340. [PMID: 30974076 PMCID: PMC8824483 DOI: 10.1016/j.jogn.2019.02.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2019] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To identify facilitators and barriers to the implementation of safe sleep recommendations from the American Academy of Pediatrics from the perspective of hospital staff as part of a needs assessment that was used to design a successful quality improvement intervention to change clinical practice. DESIGN Qualitative design. SETTING Multiple sites of three hospitals in the northeastern and southern United States. PARTICIPANTS We used purposeful sampling to identify 46 participants who cared for infants on inpatient hospital units (nurses and other staff members). METHODS A qualitative researcher used grounded theory to moderate the focus groups. We constructed the initial interview guide and then changed it as needed to capture more information about new ideas as they arose. Researchers from diverse backgrounds participated in the analysis and used the constant comparative method to select important concepts and to develop codes and subsequent themes. We continued to collect data until saturation was reached. RESULTS We identified themes and subthemes, and the taxonomy fit into the Grol and Wensing framework for change in clinical practice. The six primary themes included The Innovation Itself, The Individual Health Care Professional, The Patient, The Social Context, The Organizational Context, and The Economic and Political Context. CONCLUSION Participants described facilitators and barriers to the implementation of the American Academy of Pediatrics recommendations for safe infant sleep. Identification of these themes informed our quality improvement intervention to promote safe infant sleep. Findings can be used by others when faced with the need for similar change.
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Abstract
Background: Most women in the United States do not meet their breastfeeding goals, and low-income women breastfeed at lower rates than the general population. While risk factors for early cessation have been documented, specific reasons for discontinuing among this population are less understood. We examined reasons for cessation among low-income mothers to inform the development of targeted strategies to address breastfeeding disparities. Materials and Methods: We performed a secondary data analysis using prospective data collected during a randomized intervention trial of Special Supplemental Nutrition Program for Women, Infants, and Children (WIC)-eligible women interviewed in the third trimester and at 1, 3, and 6 months postpartum. We included the 221 women who initiated breastfeeding and stopped by 6 months. Women's reasons for discontinuing breastfeeding were grouped by thematic category and compared by time of breastfeeding cessation. Results: The most common reasons reported overall for breastfeeding cessation were concerns about breast milk supply and latch difficulty. Some reasons differed significantly by time of cessation. Latch difficulty was reported most often by women who breastfed for 1 month or less; supply concerns increased with increasing breastfeeding duration. Returning to work/school was uncommonly reported for those who stopped by 1 month, but more frequently reported in those with later cessation. Conclusions: We found that low-income women reported similar reasons for early breastfeeding cessation as have been reported for other populations of women. These results underscore the need for appropriately timed, culturally sensitive interventions to reduce disparities in duration of breastfeeding, specifically to address latch difficulty in the first few weeks and supply concerns as infants grow.
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Affiliation(s)
- Paige P Hornsby
- 1 Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia
| | - Kelly K Gurka
- 2 Department of Epidemiology, University of Florida, Gainesville, Florida
| | - Mark R Conaway
- 1 Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia
| | - Ann L Kellams
- 3 Department of Pediatrics, University of Virginia, Charlottesville, Virginia
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Abstract
Background: Many women initiate breastfeeding but do not meet their duration goals, and low-income women initiate and continue breastfeeding at lower rates than their counterparts. One-on-one counseling is associated with increased breastfeeding but requires significant resources. In contrast, video education, which requires fewer resources and is effective in other health care settings, such as vaccine uptake, has gone untested for prolonging breastfeeding duration among low-income women. Objective: To determine whether use of an educational breastfeeding video shown individually to low-income pregnant women in the prenatal clinic would prolong duration of any and exclusive breastfeeding. Methods: A multicenter, randomized, controlled trial was conducted in four prenatal clinics. Low-income pregnant women were randomized to view the intervention (breastfeeding education) or control (prenatal nutrition) video in the third trimester and interviewed by telephone at 1, 3, and 6 months postpartum about infant feeding practices. Kaplan-Meier survival curves with log-rank tests and Cox proportional hazards regression were utilized to compare groups. Results: Of the 816 eligible women approached, 64% participated: 263 assigned to the intervention, and 259 assigned to the control. Six-month data were obtained for 211 (80%) and 220 (85%) women, respectively. Rate of breastfeeding cessation did not differ by group (hazard ratios; HR = 1.00, 95% confidence interval [CI]: 0.81-1.24 and HR = 0.93, 95% CI: 0.76-1.14, for any and exclusive breastfeeding, respectively). Conclusion: A single viewing of a breastfeeding education video shown in the prenatal clinic did not impact breastfeeding duration or exclusivity among low-income women in this study. Although not sufficient alone, educational videos may be useful as one component of a comprehensive program to promote breastfeeding.
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Affiliation(s)
- Ann L Kellams
- Department of Pediatrics, University of Virginia, Charlottesville, Virginia
| | - Kelly K Gurka
- Department of Epidemiology, University of Florida, Gainesville, Florida
| | - Paige P Hornsby
- Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia
| | - Emily Drake
- School of Nursing, University of Virginia, Charlottesville, Virginia
| | - Mark R Conaway
- Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia
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Kellams AL, Harrel C, Omage S, Gregory C, Rosen-Carole C, Noble L. Response to Ward et al. re: "ABM Clinical Protocol #3: Supplementary Feedings in the Healthy Term Breastfed Neonate, Revised 2017". Breastfeed Med 2017; 12:575-576. [PMID: 29058449 DOI: 10.1089/bfm.2017.29062.ajk] [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: 11/13/2022]
Affiliation(s)
- Ann L Kellams
- 1 Department of Pediatrics, University of Virginia , Charlottesville, Virginia
| | - Cadey Harrel
- 2 Department of Family & Community Medicine, University of Arizona College of Medicine and Family Medicine Residency , Tucson, Arizona
| | - Stephanie Omage
- 3 Discipline of General Practice, The University of Queensland , Brisbane, Australia
| | - Carrie Gregory
- 4 Department of Pediatrics, University of Rochester , Rochester, New York.,5 Department of OBGYN, University of Rochester , Rochester, New York
| | - Casey Rosen-Carole
- 4 Department of Pediatrics, University of Rochester , Rochester, New York.,5 Department of OBGYN, University of Rochester , Rochester, New York
| | - Lawrence Noble
- 6 Icahn School of Medicine at Mount Sinai/Elmhurst Hospital , New York, New York
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Moon RY, Hauck FR, Colson ER, Kellams AL, Geller NL, Heeren T, Kerr SM, Drake EE, Tanabe K, McClain M, Corwin MJ. The Effect of Nursing Quality Improvement and Mobile Health Interventions on Infant Sleep Practices: A Randomized Clinical Trial. JAMA 2017; 318:351-359. [PMID: 28742913 PMCID: PMC5593130 DOI: 10.1001/jama.2017.8982] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Inadequate adherence to recommendations known to reduce the risk of sudden unexpected infant death has contributed to a slowing in the decline of these deaths. OBJECTIVE To assess the effectiveness of 2 interventions separately and combined to promote infant safe sleep practices compared with control interventions. DESIGN, SETTING, AND PARTICIPANTS Four-group cluster randomized clinical trial of mothers of healthy term newborns who were recruited between March 2015 and May 2016 at 16 US hospitals with more than 100 births annually. Data collection ended in October 2016. INTERVENTIONS All participants were beneficiaries of a nursing quality improvement campaign in infant safe sleep practices (intervention) or breastfeeding (control), and then received a 60-day mobile health program, in which mothers received frequent emails or text messages containing short videos with educational content about infant safe sleep practices (intervention) or breastfeeding (control) and queries about infant care practices. MAIN OUTCOMES AND MEASURES The primary outcome was maternal self-reported adherence to 4 infant safe sleep practices of sleep position (supine), sleep location (room sharing without bed sharing), soft bedding use (none), and pacifier use (any); data were collected by maternal survey when the infant was aged 60 to 240 days. RESULTS Of the 1600 mothers who were randomized to 1 of 4 groups (400 per group), 1263 completed the survey (78.9%). The mean (SD) maternal age was 28.1 years (5.8 years) and 32.8% of respondents were non-Hispanic white, 32.3% Hispanic, 27.2% non-Hispanic black, and 7.7% other race/ethnicity. The mean (SD) infant age was 11.2 weeks (4.4 weeks) and 51.2% were female. In the adjusted analyses, mothers receiving the safe sleep mobile health intervention had higher prevalence of placing their infants supine compared with mothers receiving the control mobile health intervention (89.1% vs 80.2%, respectively; adjusted risk difference, 8.9% [95% CI, 5.3%-11.7%]), room sharing without bed sharing (82.8% vs 70.4%; adjusted risk difference, 12.4% [95% CI, 9.3%-15.1%]), no soft bedding use (79.4% vs 67.6%; adjusted risk difference, 11.8% [95% CI, 8.1%-15.2%]), and any pacifier use (68.5% vs 59.8%; adjusted risk difference, 8.7% [95% CI, 3.9%-13.1%]). The independent effect of the nursing quality improvement intervention was not significant for all outcomes. Interactions between the 2 interventions were only significant for the supine sleep position. CONCLUSIONS AND RELEVANCE Among mothers of healthy term newborns, a mobile health intervention, but not a nursing quality improvement intervention, improved adherence to infant safe sleep practices compared with control interventions. Whether widespread implementation is feasible or if it reduces sudden and unexpected infant death rates remains to be studied. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01713868.
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Affiliation(s)
- Rachel Y Moon
- Department of Pediatrics, School of Medicine, University of Virginia, Charlottesville
| | - Fern R Hauck
- Department of Family Medicine, School of Medicine, University of Virginia, Charlottesville
| | - Eve R Colson
- Department of Pediatrics, Yale University, New Haven, Connecticut
| | - Ann L Kellams
- Department of Pediatrics, School of Medicine, University of Virginia, Charlottesville
| | - Nicole L Geller
- Slone Epidemiology Center, Boston University, Boston, Massachusetts
| | - Timothy Heeren
- Department of Biostatistics, School of Public Health, Boston University, Boston, Massachusetts
| | - Stephen M Kerr
- Slone Epidemiology Center, Boston University, Boston, Massachusetts
| | - Emily E Drake
- Department of Family, Community, and Mental Health Systems, School of Nursing, University of Virginia, Charlottesville
| | - Kawai Tanabe
- Department of Family Medicine, School of Medicine, University of Virginia, Charlottesville
| | - Mary McClain
- Slone Epidemiology Center, Boston University, Boston, Massachusetts
| | - Michael J Corwin
- Slone Epidemiology Center, Boston University, Boston, Massachusetts
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Smith LA, Geller NL, Kellams AL, Colson ER, Rybin DV, Heeren T, Corwin MJ. Infant Sleep Location and Breastfeeding Practices in the United States, 2011-2014. Acad Pediatr 2016; 16:540-9. [PMID: 26851615 PMCID: PMC6202582 DOI: 10.1016/j.acap.2016.01.021] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [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: 09/20/2015] [Revised: 01/23/2016] [Accepted: 01/29/2016] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To describe the prevalence of breastfeeding and sleep location practices among US mothers and the factors associated with these behaviors, including advice received regarding these practices. METHODS A nationally representative sample of 3218 mothers who spoke English or Spanish were enrolled at a sample of 32 US birth hospitals between January 2011 and March 2014. RESULTS Exclusive breastfeeding was reported by 30.5% of mothers, while an additional 29.5% reported partial breastfeeding. The majority of mothers, 65.5%, reported usually room sharing without bed sharing, while 20.7% reported bed sharing. Compared to mothers who room shared without bed sharing, mothers who bed shared were more likely to report exclusive breastfeeding (adjusted odds ratio 2.46, 95% confidence interval 1.76, 3.45) or partial breastfeeding (adjusted odds ratio 1.75, 95% confidence interval 1.33, 2.31). The majority of mothers reported usually room sharing without bed sharing regardless of feeding practices, including 58.2% of exclusively breastfeeding mothers and 70.0% of nonbreastfeeding mothers. Receiving advice regarding sleep location or breastfeeding increased adherence to recommendations in a dose response manner (the adjusted odds of room sharing without bed sharing and exclusive breastfeeding increased as the relevant advice score increased); however, receiving advice regarding sleep location did not affect feeding practices. CONCLUSIONS Many mothers have not adopted the recommended infant sleep location or feeding practices. Receiving advice from multiple sources appears to promote adherence in a dose response manner. Many women are able to both breastfeed and room share without bed sharing, and advice to adhere to both of these recommendations did not decrease breastfeeding rates.
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Affiliation(s)
| | - Nicole L Geller
- Slone Epidemiology Center at Boston University, Boston, Mass
| | - Ann L Kellams
- Well Newborn and Breastfeeding Medicine Services, University of Virginia, Charlottesville, Va
| | - Eve R Colson
- Department of Pediatrics, Yale University, Yale School of Medicine, New Haven, Conn
| | - Denis V Rybin
- Data Coordinating Center, Boston University School of Public Health, Boston, Mass
| | - Timothy Heeren
- Department of Biostatistics, Boston University School of Public Health, Boston, Mass
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Kellams AL, Gurka KK, Hornsby PP, Drake E, Riffon M, Gellerson D, Gulati G, Coleman V. The Impact of a Prenatal Education Video on Rates of Breastfeeding Initiation and Exclusivity during the Newborn Hospital Stay in a Low-income Population. J Hum Lact 2016; 32:152-9. [PMID: 26289058 DOI: 10.1177/0890334415599402] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [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: 03/25/2015] [Accepted: 07/11/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Guidelines recommend prenatal education to improve breastfeeding rates; however, effective educational interventions targeted at low-income, minority populations are needed as they remain less likely to breastfeed. OBJECTIVE To determine whether a low-cost prenatal education video improves hospital rates of breastfeeding initiation and exclusivity in a low-income population. METHODS A total of 522 low-income women were randomized during a prenatal care visit occurring in the third trimester to view an educational video on either breastfeeding or prenatal nutrition and exercise. Using multivariable analyses, breastfeeding initiation rates and exclusivity during the hospital stay were compared. RESULTS Exposure to the intervention did not affect breastfeeding initiation rates or duration during the hospital stay. The lack of an effect on breastfeeding initiation persisted even after controlling for partner, parent, or other living at home and infant complications (adjusted odds ratio [OR] = 1.05, 95% CI, 0.70-1.56). In addition, breastfeeding exclusivity rates during the hospital stay did not differ between the groups (P = .87). CONCLUSION This study suggests that an educational breastfeeding video alone is ineffective in improving the hospital breastfeeding practices of low-income women. Increasing breastfeeding rates in this at-risk population likely requires a multipronged effort begun early in pregnancy or preconception.
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Affiliation(s)
- Ann L Kellams
- Department of Pediatrics, University of Virginia, Charlottesville, VA, USA
| | - Kelly K Gurka
- Department of Epidemiology, West Virginia University, Morgantown, WV, USA
| | - Paige P Hornsby
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA
| | - Emily Drake
- School of Nursing, University of Virginia, Charlottesville, VA, USA
| | - Mark Riffon
- Department of Biostatistics, West Virginia University, Morgantown, WV, USA
| | | | - Gauri Gulati
- Department of Pediatrics, Virginia Commonwealth University, Richmond, VA, USA
| | - Valerie Coleman
- Institute of Women's Health, Virginia Commonwealth University, Richmond, VA, USA
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Gurka KK, Hornsby PP, Drake E, Mulvihill EM, Kinsey EN, Yitayew MS, Lauer C, Corriveau S, Coleman V, Gulati G, Kellams AL. Exploring intended infant feeding decisions among low-income women. Breastfeed Med 2014; 9:377-84. [PMID: 25006693 DOI: 10.1089/bfm.2014.0013] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [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: 11/12/2022]
Abstract
BACKGROUND Low-income women have the lowest rates of breastfeeding in the United States. Greater understanding of factors that predict intention to feed artificial breastmilk substitute is needed to inform the design and timing of interventions to promote breastfeeding among vulnerable women. This study aimed to identify demographic and reproductive characteristics and other factors associated with intent to feed artificial breastmilk substitute among low-income women. MATERIALS AND METHODS Data from 520 low-income women interviewed at 24-41 weeks of gestation during enrollment in a prenatal breastfeeding education intervention study were analyzed. Participant characteristics, reasons for feeding decision, and sources and types of information received were compared among women intending to feed only artificial breastmilk substitute and other women. RESULTS Most participants (95%) had already chosen an infant feeding method at the time of interview. There were no differences in plans to return to work by feeding plan. Women reporting intention to feed only artificial breastmilk substitute were less likely to report receiving information about the benefits of breastfeeding, how to breastfeed, and pumps and were more likely to cite personal preference and convenience as reasons for their decision. Women were more likely to intend to feed artificial breastmilk substitute if they had a previous live birth or had not breastfed a child, including the most recent. CONCLUSIONS These findings suggest breastfeeding promotion should target women early and include sensitive, effective ways to promote breastfeeding among women who have not previously successfully breastfed. Breastfeeding history should be elicited, and plans to pump should be supported prenatally.
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Affiliation(s)
- Kelly K Gurka
- 1 Department of Epidemiology, West Virginia University , Morgantown, West Virginia
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Abstract
OBJECTIVE The purpose of this study was to determine whether implementing a program based on a clinical protocol affects breastfeeding rates within a pediatric primary care setting. Increasing breastfeeding rates is an important public health initiative identified by multiple agencies. METHODS The Academy of Breastfeeding Medicine (ABM) clinical protocol ("The Breastfeeding-Friendly Physician's Office, Part 1: Optimizing Care for Infants and Children") was used as a template for the provision of breastfeeding services within a pediatric primary care clinic. There were 757 mother-infant pairs included in the study. A retrospective before-and-after study design was used. Data collection points included the hospital stay, the newborn visit, and the 2-, 4-, and 6-month health maintenance visits. The 2 groups were compared to estimate the protocol's effectiveness as a method of increasing breastfeeding rates. RESULTS The results of this evaluation were positive for exclusive breastfeeding, with group comparisons showing a statistically significant increase in exclusive breastfeeding rates at all 5 time points. CONCLUSIONS Our diverse patient population within a pediatric practice had increased initiation rates and exclusive breastfeeding rates after implementation of the ABM's breastfeeding-friendly protocol. Families who receive care in a pediatric primary care setting that has implemented the ABM clinical protocol may have increased rates of exclusive breastfeeding.
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