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McCarty DB, Clary-Williams E, LeBLond KD, Liu T, Zbornik-Thompson T, Ulrich JN, Go MS. Interdisciplinary collaborative eye examinations to protect preterm infant neurodevelopment: a quality improvement project. Front Psychol 2024; 15:1354033. [PMID: 38770256 PMCID: PMC11102993 DOI: 10.3389/fpsyg.2024.1354033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 04/25/2024] [Indexed: 05/22/2024] Open
Abstract
Introduction Infants born <31 weeks gestational age with birth weight ≤ 1,500 grams receive routine eye examinations to screen for Retinopathy of Prematurity (ROP) while in the Neonatal Intensive Care Unit (NICU) to help prevent vision threatening complications; however, preterm infants' sensory systems are underdeveloped, and repeated exposure to painful stimuli is associated with worse developmental outcomes. Methods An interdisciplinary NICU team designed a collaborative eye exam model (CEEM) incorporating best practice recommendations for infant pain control during exams. Pain scores and vital signs were recorded before, during, and after exams. Two sets of mixed-effects regression models with a random intercept on infants were established to investigate relationships between the intervention, birth gestational age (BGA), postmenstrual age (PMA), and outcomes associated with painful stimuli. Survey feedback was elicited from NICU stakeholders about the CEEM. Results Thirty standard of care (SC) and 35 CEEM exams of 37 infants were included in final analysis. In infants of the same BGA, the number of desaturation events was significantly reduced in the CEEM group (p = 0.003) and became 1.53 times smaller with each additional week of BGA (p = 0.009). Probability of heart rate recovery within 15 min lowered significantly in the CEEM group (p = 0.04). In SC or CEEM or between infants of the same PMA, no differences were observed for bradycardia, heart rate range, chance of heart rate recovery, or pain scores. Increases in tachycardia (p < 0.001) events and desaturations p = 0.006 were discovered in the CEEM group. When considering interaction effects, the CEEM appeared to reduce the number of desaturations to a greater degree for infants at earliest BGAs with attenuation of this effect with greater BGA. Regarding PMA, bradycardia and tachycardia events were reduced for infants across PMAs in the CEEM, but the effect for tachycardia improves with age, while the effect for bradycardia diminishes with age. Stakeholders agreed that the infant's eye exam experience and the staff experience was "very much" improved by the CEEM. Discussion Despite variable findings in selected outcome measures, the CEEM was positively viewed by staff. Infants may benefit from the CEEM differently based on BGA and PMA.
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Affiliation(s)
- Dana B. McCarty
- Division of Physical Therapy, Department of Health Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Erika Clary-Williams
- Pediatric Rehabilitation Services, Monroe Carell Jr. Children’s Hospital at Vanderbilt, Nashville, TN, United States
| | - Kristen D. LeBLond
- Department of Physical Therapy and Occupational Therapy, Duke University Hospital, Durham, NC, United States
| | - Tianyi Liu
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Tika Zbornik-Thompson
- Department of Ophthalmology, University of North Carolina, Chapel Hill, NC, United States
| | - J. Niklas Ulrich
- Department of Ophthalmology, University of North Carolina, Chapel Hill, NC, United States
| | - Michelle S. Go
- Department of Ophthalmology, Duke University Medical Center, Durham, NC, United States
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Janwadkar A, Duran G, Irving TD, Shah D, Arevalo R, Sanchez M, Adjo J, Rubin D. Perception of pacifier use among caregivers of infants 0-1 years of age. J Investig Med 2023; 71:941-945. [PMID: 37530133 DOI: 10.1177/10815589231193952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/03/2023]
Abstract
American Academy of Pediatrics approves pacifier use for soothing and calming; it recommends delaying its use until breastfeeding is well established. Though pacifiers have protective effects against sudden infant death syndrome, prolonged use of a pacifier can lead to complications. American Academy of Family Physicians discourages the use by 6 months to 1 year of age. Pacifier use guidelines are not established primarily due to a paucity of information regarding initiation, termination, benefits, and harmful effects of pacifiers by parents. We aim to investigate pacifier use among caregivers of 0-1-year-old infants. It was a descriptive study of parents or caregivers of children 0-1 year of age who completed a questionnaire focused on pacifier use. Statistical analysis was calculated using SPSS version 23. One hundred thirty-three caregivers were interviewed. One hundred eighteen (88.7%) caregivers were mothers. Ninety-one (68.4%) of caregivers identified as Hispanic and 42 (30.1%) as African American. Caregivers reported that mean pacifier use was 16 months and 3.4 h/day. One hundred six (80%) reported the most common use of the pacifier alone was to calm the baby. For the weaning method, 37 (27.8%) stated that gradual decrease of pacifiers was useful whereas 33 (24.8%) stated that abrupt removal of pacifiers was effective. Seventy-two (54.1%) reported that their family and friends recommended pacifiers. Eleven (8.3%) caregivers reported that information about pacifiers was provided by medical and day-care providers. Pacifier use was not significantly related to the feeding method during the first 2 months of life. This study identifies impressions and common misconceptions of pacifier use which may assist in the development of comprehensive guidelines.
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Affiliation(s)
| | | | | | - Dhaivat Shah
- Clinical Research, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Ronald Arevalo
- Pediatrics, St. Barnabas Hospital, Bronx, NY, USA
- CUNY School of Medicine, New York City, NY, USA
| | - Miguel Sanchez
- Pediatrics, St. Barnabas Hospital, Bronx, NY, USA
- CUNY School of Medicine, New York City, NY, USA
| | - Janine Adjo
- Pediatrics, St. Barnabas Hospital, Bronx, NY, USA
- CUNY School of Medicine, New York City, NY, USA
| | - David Rubin
- Pediatrics, St. Barnabas Hospital, Bronx, NY, USA
- CUNY School of Medicine, New York City, NY, USA
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[Evidence-based guideline for neonatal pain management in China (2023)]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2023; 25:109-127. [PMID: 36854686 PMCID: PMC9979385 DOI: 10.7499/j.issn.1008-8830.2210052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 12/06/2022] [Indexed: 03/02/2023]
Abstract
Pain disrupts neonatal vital signs and internal environment homeostasis and affects the recovery process, and recurrent pain stimulation is one of the important risk factors for neurodevelopmental disorders and some chronic diseases. In order to standardize pain management practice in neonatal wards in China and effectively prevent and reduce the adverse effects of pain on the physical and mental development of neonates, National Clinical Research Center for Child Health and Diseases (Children's Hospital of Chongqing Medical University) convened a multidisciplinary panel to formulate the evidence-based guideline for neonatal pain management in China (2023 edition) following the principles and methods for the guideline development issued by the World Health Organization. Based on the best evidence and expert consensus, this guideline gives 26 recommendations for nine clinical issues, i.e., the classification and definition of neonatal pain, common sources of pain, pain assessment principles, pain assessment methods, analgesic principle, non-pharmaceutical analgesic methods, pharmaceutical analgesic methods, parental participation in pain management, and recording methods for pain management, so as to provide medical staff with guidance and a decision-making basis for neonatal pain assessment and analgesia management.
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Correlation between Pacifier Use in Preterm Neonates and Breastfeeding in Infancy: A Systematic Review. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9101585. [PMID: 36291521 PMCID: PMC9600199 DOI: 10.3390/children9101585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 10/17/2022] [Accepted: 10/18/2022] [Indexed: 11/05/2022]
Abstract
Background: Breastfeeding is very important for the proper nutrition and growth of the child, as well as, the health of the mother. To start breastfeeding, the neonate must have extensive oral capacities for sucking functions but, premature neonates may not have the muscle strength needed to suck successfully. However, the non-nutritive sucking achieved by using a pacifier, has been identified by previous research as a factor associated with shorter duration and exclusivity of breastfeeding. This study aims to perform a systematic review to investigate the relationship between pacifier use in preterm neonates and breastfeeding in infancy. Methods: We included prospective studies, as well as randomized controlled studies that evaluated the association between pacifier use by preterm neonates and of breastfeeding in infancy. Ten research articles from PubMed/Medline, Google Scholar and Crossref were included in the review from a total of 1455 articles. The results differ depending on the type of study.Most prospective studies have shown a negative correlation between pacifier use and breastfeeding, while the randomized controlled studies found a positive correlation. Conclusions: Pacifier use in preterm infants helps transition from tube to oral feeding, breastfeeding, faster weight gain and earlier discharge from the NICU. However, the relationship between pacifiers and breastfeeding is more complicated, as it appears to be influenced by additional risk factors.
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Wood NK, Odom-Maryon T, Smart DA. Factors Associated With Exclusive Direct Breastfeeding in the First 3 Months. Nurs Womens Health 2022; 26:299-307. [PMID: 35714762 DOI: 10.1016/j.nwh.2022.05.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 03/01/2022] [Accepted: 05/19/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To identify factors associated with exclusive direct breastfeeding in the first 3 months among mother and infant dyads living in the United States. DESIGN A secondary analysis of data collected using a cross-sectional online survey completed over a 4-month period in late 2019. PARTICIPANTS We recruited a convenience sample of 370 mothers with healthy full-term singleton infants between 1 and 12 weeks of age whose feeding methods consisted of direct breastfeeding at least once a day. Mothers had not returned to work/school at the time of the survey completion. MEASUREMENTS The questionnaire consisted of 34 questions about maternal and infant factors that influence decisions about infant feeding, professional support, and parental preferences. RESULTS Mothers who practiced feeding on demand (adjusted OR [aOR] = 35.76, 95% confidence interval [CI] [2.04, 500.00]) and mothers of infants 1 to 4 weeks of age (aOR = 2.74, 95% CI [1.54, 4.85]) were more likely to use exclusive direct breastfeeding. The odds of exclusive direct breastfeeding decreased with mothers who breastfed with a nipple shield while in the hospital/birth center/home (aOR = 0.13, 95% CI [0.05, 0.35]), used pacifiers (aOR = 0.31, 95% CI [0.21, 0.65]), or had perceptions of insufficient milk (aOR = 0.11, 95% CI [0.04, 0.26]). CONCLUSION Demand feeding and an infant's age of 1 to 4 weeks contributed to exclusive direct breastfeeding. Lower rates of exclusive direct breastfeeding were associated with the use of nipple shields immediately after birth, pacifier use, and perceptions of insufficient milk. Further investigation is warranted to fully differentiate exclusive direct breastfeeding from exclusive breastfeeding.
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Hockamp N, Sievers E, Hülk P, Rudolf H, Rudloff S, Lücke T, Kersting M. The role of breastfeeding promotion in German hospitals for exclusive breastfeeding duration. MATERNAL & CHILD NUTRITION 2022; 18:e13326. [PMID: 35080138 PMCID: PMC8932702 DOI: 10.1111/mcn.13326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 12/18/2021] [Accepted: 01/04/2022] [Indexed: 11/27/2022]
Abstract
Breastfeeding promotion and support in hospitals is expected to have a positive impact on maternal breastfeeding outcomes. The objective of this study is to examine the association between breastfeeding promotion in maternity hospitals in Germany and exclusive breastfeeding (EBF) rates during the first 4 months. Thus, a nationwide cross‐sectional web‐based survey of breastfeeding promotion was conducted in 103 hospitals. Mother–infant pairs (n = 962) were recruited at these hospitals for a prospective web‐based survey of breastfeeding status at five‐time points, that is, during a hospital stay, at discharge as well as after 0.5, 2, and 4 months. The hospital analysis was based on the “10 Steps to Successful Breastfeeding” of the World Health Organization and the United Nations Children's Fund, adapted for Germany. Their degree of implementation was stratified by a breastfeeding promotion index (BPI) as low (≤5 steps), medium (6–8 steps), and high (≥9 steps). The association between the BPI and the odds of EBF at each of the five‐time points was estimated by multivariable regression models, adjusting for various maternal factors. At all time points, the proportion of EBF among mothers from high BPI hospitals exceeded the proportion of those from medium or low BPI hospitals. A high BPI was associated with higher odds of EBF during the hospital stay and at discharge, while maternal factors for EBF such as breastfeeding experience and no early use of a pacifier persisted beyond. The high commitment of hospitals and tailored support of mothers is essential for EBF. A high breastfeeding promotion index (BPI) favours exclusive breastfeeding (EBF) in the hospital environment, while maternal factors persisted beyond. Even in a country with a high level of maternal and child care, breastfeeding promotion in hospitals plays a significant role in the successful start of breastfeeding. Maternal factors, primarily breastfeeding experience and no early use of a pacifier, were persistent and stronger predictors of EBF than the BPI. The steps that need to be improved most refer to breastfeeding information, early breastfeeding initiation, and alternative feeding methods. High hospital commitment complemented by tailored, individualised postdischarge support of mothers are critical components for sustained breastfeeding success.
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Affiliation(s)
- Nele Hockamp
- Research Department of Child Nutrition, University Hospital of Pediatrics and Adolescent Medicine, St. Josef‐Hospital Ruhr‐University Bochum Bochum Germany
| | | | - Philipp Hülk
- Research Department of Child Nutrition, University Hospital of Pediatrics and Adolescent Medicine, St. Josef‐Hospital Ruhr‐University Bochum Bochum Germany
| | - Henrik Rudolf
- Department of Medical Informatics, Biometry and Epidemiology Ruhr‐University Bochum Bochum Germany
| | - Silvia Rudloff
- Institute of Nutritional Sciences and Department of Pediatrics Justus‐Liebig University Giessen Giessen Germany
| | - Thomas Lücke
- Research Department of Child Nutrition, University Hospital of Pediatrics and Adolescent Medicine, St. Josef‐Hospital Ruhr‐University Bochum Bochum Germany
| | - Mathilde Kersting
- Research Department of Child Nutrition, University Hospital of Pediatrics and Adolescent Medicine, St. Josef‐Hospital Ruhr‐University Bochum Bochum Germany
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Balaminut T, Semenic S, Haiek LN, Rossetto EG, Leite AM, Fonseca LMM, Christoffel MM, Scochi CGS. Baby-Friendly Hospital Initiative for Neonatal Wards: impact on breastfeeding practices among preterm infants. Rev Bras Enferm 2021; 74:e20200909. [PMID: 34190823 DOI: 10.1590/0034-7167-2020-0909] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 11/01/2020] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE to assess breastfeeding support practices for preterm infants at two Baby-Friendly hospitals in southeastern Brazil, comparing the effect of implementing the guidelines for Baby-Friendly Hospital Initiative for Neonatal wards. METHODS a quasi-experimental study, pre- and post-intervention with control. Implementation of this initiative in the intervention hospital using Knowledge Translation. Data collection on compliance with the adapted Ten Steps, Three Guiding Principles and the Code before and after the intervention was carried out via interviews with mothers of preterm babies and professionals, unit observation and documentary analysis in the intervention and control hospitals. Intra-intergroup comparison was performed. RESULTS increases in global compliance with the Three Principles, Ten Steps, the Code, partial compliance with each Principle and in most Steps was greater in the intervention hospital. Conclusion: this initiative improved practices related to breastfeeding in the intervention hospital, demonstrating the potential to improve care and breastfeeding in neonatal wards.
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Affiliation(s)
| | - Sonia Semenic
- McGill University, Ingram School of Nursing. Montreal, Quebec, Canada
| | - Laura N Haiek
- McGill University, Department of Family Medicine. Montreal, Quebec, Canada
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Enhancing breastfeeding establishment in preterm infants: A randomized clinical trial of two non-nutritive sucking approaches. Early Hum Dev 2021; 156:105347. [PMID: 33714801 DOI: 10.1016/j.earlhumdev.2021.105347] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 02/26/2021] [Accepted: 03/02/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Preterm infants and their mothers face many barriers to the establishment of exclusive breastfeeding in the neonatal intensive care unit. OBJECTIVE The objective of this study was to assess and compare the effect of maternally administered non-nutritive sucking (NNS) on an emptied breast versus a pacifier on exclusive breastfeeding establishment at hospital discharge. STUDY DESIGN A block randomized study design was performed. TRIAL REGISTRATION NUMBER NCT03434743. METHODS A total of 33 preterm infants born less than or equal to 34 weeks gestation participated in the study. The NNS on an emptied breast or pacifier interventions were administered by mothers, once a day for 15 min. Outcomes included: exclusive breastfeeding acquisition, described as infants who received greater than or equal to 50% of direct breastfeeds at hospital discharge; time to achieve independent oral feeding, defined as the number of days to transition from complete tube feeds to full oral feeds (full breast, partial breast/bottle, or full bottle); length of hospitalization, described as the number of days from admission to hospital discharge. RESULTS A significantly greater number of infants in the NNS emptied breast group acquired exclusive breastfeeds at hospital discharge as compared with those in the NNS pacifier group (63% vs. 24%, p = 0.037). There was no difference between groups in time to achieve independent oral feeds (14.4 ± 8.0 vs. 14.4 ± 6.4 days, p = 0.683) and length of hospital stay (48.7 ± 33.7 vs. 53.1 ± 30.6 days, p = 0.595). CONCLUSION Provision of NNS on an emptied breast is a safe and low-cost infant and mother targeted intervention which can increase exclusive breastfeeding rates and its well-recognized advantages in a highly vulnerable population.
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Herrera S, Pierrat V, Kaminski M, Benhammou V, Bonnet AL, Ancel PY, Germa A. Factors associated with non-nutritive sucking habits at 2 years of age among very preterm children: EPIPAGE-2 cohort study. Paediatr Perinat Epidemiol 2021; 35:217-226. [PMID: 33016411 DOI: 10.1111/ppe.12725] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 08/30/2020] [Accepted: 08/23/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND The association between prolonged non-nutritive sucking habits (NNSHs, ie, sucking pacifiers or fingers) and maxillofacial growth anomalies in the general population has been widely described. Because maturation of sucking abilities is not fully achieved in very preterm infants (<32 weeks' gestation), neonatal services worldwide rely on the use of pacifiers to promote the development of adequate sucking reflexes, possibly prolonging NNSHs during infancy. OBJECTIVE We aimed to describe the frequency and to identify factors associated with NNSHs at age 2 years in very preterm children. METHODS The study was based on data from EPIPAGE-2, a French national prospective cohort study of preterm births during 2011 that included 2593 children born between 24 and 31 weeks' gestation. The primary outcome was NNSHs at 2 years. Multivariable log-linear regression models with generalized estimation equations were used to study the association between the characteristics studied and NNSHs. Multiple imputations were used to take into account missing data. RESULTS The frequency of NNSHs was 69% in the overall sample but higher among girls (adjusted risk ratio [RR] 1.12, 95% confidence interval [CI] 1.05, 1.17), children born from multiple pregnancies (eg, twins/triplets) (RR 1.07, 95% CI 1.00, 1.11), children who were fed by nasogastric tube (RR 1.07, 95% CI 1.01, 1.13), or those who benefitted from developmental care programmes (RR 1.10, 95% CI 1.02, 1.19). The NNSHs frequency was lower if mothers were not born in France (RR 0.70, 95% CI 0.64, 0.77), children had 2 or more older siblings (RR 0.88, 95% CI 0.82, 0.96), or children were breast-fed at discharge (RR 0.90, 95% CI 0.85, 0.95). CONCLUSIONS NNSHs at 2 years seemed associated with cultural background, development care programmes, and breast feeding. Whether NNSHs at 2 years among very preterm children are associated with future maxillofacial growth anomalies deserves further attention.
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Affiliation(s)
| | - Véronique Pierrat
- Université de Paris, CRESS, INSERM, INRA, Paris, France.,Department of Neonatal Medicine, Jeanne de Flandre Hospital, CHU Lille, Lille, France
| | | | | | - Anne-Laure Bonnet
- Université de Paris, EA2496, Montrouge, France.,Department of Odontology, AP-HP, Charles Foix Hospital, Paris, France
| | - Pierre-Yves Ancel
- Université de Paris, CRESS, INSERM, INRA, Paris, France.,Clinical Research Unit, Centre for Clinical Investigation P1419, Cochin Broca Hôtel-Dieu Hospital, Paris, France
| | - Alice Germa
- Université de Paris, CRESS, INSERM, INRA, Paris, France.,Department of Odontology, AP-HP, Charles Foix Hospital, Paris, France
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Kivlighan KT, Murray-Krezan C, Schwartz T, Shuster G, Cox K. Improved breastfeeding duration with Baby Friendly Hospital Initiative implementation in a diverse and underserved population. Birth 2020; 47:135-143. [PMID: 31788842 DOI: 10.1111/birt.12468] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 10/27/2019] [Accepted: 10/28/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Few studies have evaluated the impact of Baby Friendly Hospital Initiative (BFHI) implementation on underserved populations in the United States. We undertook this study in New Mexico, a large southwestern state with a diverse population and limited health care access. METHODS A quasi-experimental, retrospective cohort design was used to compare short-term breastfeeding duration between a pre-BFHI and a post-BFHI cohort. Among the post-BFHI cohort, logistic regression models were fitted to predict short-term breastfeeding duration from both individual and cumulative exposure to inpatient maternity care practices (Steps 4 to 9). RESULTS Implementation of the BFHI and cumulative exposure to the Ten Steps increased short-term duration of any breastfeeding and exclusive breastfeeding at 2-6 weeks postpartum. Exposure to all six of the inpatient Ten Steps increased the odds of any breastfeeding by 34 times and exclusive breastfeeding by 24 times. Exposure to Step 9 ("Give no pacifiers or artificial nipples") uniquely increased the likelihood of any breastfeeding at 2-6 weeks postpartum by 5.7 times, whereas Step 6 ("Give infants no food or drink other than breastmilk") increased the rate of exclusive breastfeeding by 4.4 times at 2-6 weeks postpartum. CONCLUSION These findings demonstrate that the Baby Friendly Hospital Initiative can have a positive impact on breastfeeding among underserved populations.
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Affiliation(s)
- Katie T Kivlighan
- Department of Obstetrics and Gynecology, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Cristina Murray-Krezan
- Division of Epidemiology, Biostatistics, and Preventive Medicine, Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Thais Schwartz
- Institute for Social Research, University of New Mexico, Albuquerque, NM, USA
| | - Geoff Shuster
- College of Nursing, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Kim Cox
- College of Nursing, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
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Hermanson Å, Åstrand LL. The effects of early pacifier use on breastfeeding: A randomised controlled trial. Women Birth 2019; 33:e473-e482. [PMID: 31704126 DOI: 10.1016/j.wombi.2019.10.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 10/03/2019] [Accepted: 10/03/2019] [Indexed: 01/15/2023]
Abstract
BACKGROUND The majority of observational studies have found associations between pacifier use and shorter breastfeeding duration. Results from four randomised controlled trials did not reveal any difference in breastfeeding outcomes. The relationship between early pacifier use and breastfeeding outcomes remains unclear. AIM To investigate whether a recommendation of early pacifier use affects the proportion of breastfeeding at six months compared to a recommendation to avoid pacifier use during the first two weeks. METHODS An open, randomised controlled trial with parallel group design; 239 primiparous mothers and their term infants were randomly assigned to an intervention group or a control group. The primary outcome was the proportion of breastfeeding at six months. Secondary outcomes were the proportions of breastfeeding and breastfeeding problems at two and four months. To investigate factors which may influence breastfeeding, a multivariate logistic regressions analysis was performed. FINDINGS A total of 209 participants (87.5%) completed the study. There were no significant differences between the groups with respect to breastfeeding at six months. No negative association for breastfeeding between early versus late introduction of pacifier was found. Factors significantly associated with cessation of breastfeeding at six months were: use of nipple shield, intention to breastfeed, severe breastfeeding problems at two weeks, pacifier use at two months and lower educational level. CONCLUSION Early versus late recommendation of pacifier introduction did not affect the proportion of breastfeeding at six months. However, the compliance to the randomised group was insufficient. No negative association was found in the observational analysis.
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Affiliation(s)
- Åsa Hermanson
- Department of Obstetrics, and Gynaecology, University Hospital, Linköping, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden.
| | - Lotta Lindh Åstrand
- Department of Obstetrics, and Gynaecology, Linköping University, Linköping, Sweden; Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
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Do a Few Weeks Matter? Late Preterm Infants and Breastfeeding Issues. Nutrients 2019; 11:nu11020312. [PMID: 30717261 PMCID: PMC6413139 DOI: 10.3390/nu11020312] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 01/27/2019] [Accepted: 01/29/2019] [Indexed: 12/17/2022] Open
Abstract
The late preterm infant population is increasing globally. Many studies show that late preterm infants are at risk of experiencing challenges common to premature babies, with breastfeeding issues being one of the most common. In this study, we investigated factors and variables that could interfere with breastfeeding initiation and duration in this population. We conducted a prospective observational study, in which we administered questionnaires on breastfeeding variables and habits to mothers of late preterm infants who were delivered in the well-baby nursery of our hospital and followed up for three months after delivery. We enrolled 149 mothers and 189 neonates, including 40 pairs of twins. Our findings showed that late preterm infants had a low rate of breastfeeding initiation and early breastfeeding discontinuation at 15, 40 and 90 days of life. The mothers with higher educational levels and previous positive breastfeeding experience had a longer breastfeeding duration. The negative factors for breastfeeding were the following: Advanced maternal age, Italian ethnicity, the feeling of reduced milk supply and having twins. This study underlines the importance of considering these variables in the promotion and protection of breastfeeding in this vulnerable population, thus offering mothers tailored support.
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Buccini G, Pérez-Escamilla R, D’Aquino Benicio MH, Justo Giugliani ER, Isoyama Venancio S. Exclusive breastfeeding changes in Brazil attributable to pacifier use. PLoS One 2018; 13:e0208261. [PMID: 30566449 PMCID: PMC6300199 DOI: 10.1371/journal.pone.0208261] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Accepted: 11/13/2018] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Identifying key interventions to increase exclusive breastfeeding duration has been a challenge. Pacifier use has been associated with exclusive breastfeeding discontinuation in Brazil. However, the proportion of the improvement in exclusive breastfeeding duration attributable to pacifier use remains unknown. RESEARCH AIM Quantify the proportion of increases in exclusive breastfeeding prevalence that can be attributed to reduced pacifier use over time. METHODS Secondary data analyses of two nationally representative cross-sectional surveys conducted in States' capitals in 1999 and in 2008 (N = 42,395 Brazilian infants under 6 months of age). We estimated the fraction of exclusive breastfeeding prevalence improvements that could be attributed to pacifier use based on multilevel regression analysis. RESULTS From 1999 to 2008, there was an increase of 15.2 percentage points in exclusive breastfeeding prevalence and a decrease of approximately 17 percentage points in the prevalence of pacifier use among infants under 6 months. Reduction in pacifier use explained an increase in 5.5 percentage points' exclusive breastfeeding rates. If pacifier use were to decrease from 41.6% (prevalence in 2008) to 14% (as found in New Zealand), there would be an expected additional increase in exclusive breastfeeding of approximately 12 percentage points. CONCLUSIONS About one-third of the improvements in EBF prevalence observed in Brazil over a decade can be attributed to the corresponding decline in pacifier use.
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Affiliation(s)
- Gabriela Buccini
- Departament of Nutrition, Universidade de São Paulo, São Paulo, São Paulo, Brazil
- Departament of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut, United States of America
| | - Rafael Pérez-Escamilla
- Departament of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut, United States of America
| | | | | | - Sonia Isoyama Venancio
- Departament of Nutrition, Universidade de São Paulo, São Paulo, São Paulo, Brazil
- Department of Director, Instituto de Saúde, São Paulo, São Paulo, Brazil
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Baker E, Masso S, McLeod S, Wren Y. Pacifiers, Thumb Sucking, Breastfeeding, and Bottle Use: Oral Sucking Habits of Children with and without Phonological Impairment. Folia Phoniatr Logop 2018; 70:165-173. [DOI: 10.1159/000492469] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 07/25/2018] [Indexed: 11/19/2022] Open
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Pawlukowska W, Rychert M, Urbanowicz E, Romanowska H, Rotter I, Giżewska M. Therapeutic effect of a cleft lip teat on infants with respiratory and feeding disorders: Two case reports. Medicine (Baltimore) 2018; 97:e11467. [PMID: 30075512 PMCID: PMC6081053 DOI: 10.1097/md.0000000000011467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 06/18/2018] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Existing research into the effects of teat application has mainly focused on its negative and positive influence on the development of the oral cavity. Our work demonstrates that apart from changing the setting of the articulatory organs, the teat can also affect the quality of breathing, eating and sleeping. PATIENTS CONCERNS We described the cases of 2 children: a 19-month-old girl and a 2.5-month-old boy, who had breathing disorders due to withdrawal of the tongue and impaired food intake. INTERVENTION The babies were bottled fed with a special teat for cleft lip patients to observe the influence of the teat on the setting of the articulatory organs and breathing. DIAGNOSIS We suspected that the specific construction of the teat-the wide outer part and the short internal part-would affect children's reflexes and articulatory organs so as to force the frontal position of the tongue, which was meant to facilitate breathing and eating. OUTCOMES It was found that feeding with the cleft lip teat stimulates the gyro-linguistic muscle, which results in the proper position of the tongue and consequently better breathing and improved quality of sleep. LESSONS A specialist bottle teat designed for babies with cleft lips can constitute an effective tool in the therapy of nonspecific respiratory disorders resulting from improper position of the tongue and other articulatory organs.
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Affiliation(s)
- Wioletta Pawlukowska
- Department of Medical Rehabilitation and Clinical Physiotherapy, Clinic of Neurology PUM
| | - Monika Rychert
- Clinic of Pediatrics, Endocrinology, Diabetology, Metabolic Diseases and Cardiology of the Developmental Age PUM, u. Unii Lubelskiej
| | - Ewa Urbanowicz
- Clinic of Pediatrics, Endocrinology, Diabetology, Metabolic Diseases and Cardiology of the Developmental Age PUM, u. Unii Lubelskiej
| | - Hanna Romanowska
- Clinic of Pediatrics, Endocrinology, Diabetology, Metabolic Diseases and Cardiology of the Developmental Age PUM, u. Unii Lubelskiej
| | - Iwona Rotter
- Department of Medical Rehabilitation and Clinical Physiotherapy, ul. Żołnierska, Szczecin, Poland
| | - Maria Giżewska
- Clinic of Pediatrics, Endocrinology, Diabetology, Metabolic Diseases and Cardiology of the Developmental Age PUM, u. Unii Lubelskiej
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16
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The Baby Friendly Hospital Initiative and the ten steps for successful breastfeeding. a critical review of the literature. J Perinatol 2018; 38:623-632. [PMID: 29416115 DOI: 10.1038/s41372-018-0068-0] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 01/01/2018] [Accepted: 01/18/2018] [Indexed: 11/08/2022]
Abstract
There is no doubt regarding the multiple benefits of breastfeeding for infants and society in general. Therefore, the World Health Organization (WHO) in a conjoint effort with United Nations International Children's Emergency Fund (UNICEF) developed the "Ten Steps to Successful Breastfeeding" in 1992, which became the backbone of the Baby Friendly Hospital Initiative (BFHI). Following this development, many hospitals and countries intensified their position towards creating a "breastfeeding oriented" practice. Over the past two decades, the interest increased in the BFHI and the Ten Steps. However, alongside the implementation of the initiative, extensive research continues to evaluate the benefits and dangers of the suggested practices. Hence, it is our intention to make a critical evaluation of the current BFHI and the Ten Steps recommendations in consideration of the importance of providing an evidence-based breastfeeding supported environment for our mothers and infants.
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