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Hilditch C, Rumbold AR, Keir A, Middleton P, Gomersall J. Effect of Neonatal Unit Interventions Designed to Increase Breastfeeding in Preterm Infants: An Overview of Systematic Reviews. Neonatology 2024:1-10. [PMID: 38513630 DOI: 10.1159/000536660] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 01/26/2024] [Indexed: 03/23/2024]
Abstract
INTRODUCTION This overview aims to systematically review evidence regarding effects of interventions undertaken in neonatal units to increase breastfeeding in preterm infants. METHODS We followed Cochrane methodology. Systematic reviews published to October 31, 2022, reporting meta-analysis of effects from original studies on breastfeeding rates in preterm infants of neonatal unit interventions designed to increase breastfeeding were included. RESULTS Avoidance of bottles during breastfeed establishment (comparator breastfeeds with bottle-feeds) demonstrated clear evidence of benefit for any breastfeeding at discharge and exclusive breastfeeding 3 months post-discharge, and possible evidence of benefit for exclusive breastfeeding at discharge, and any breastfeeding post-discharge. Kangaroo mother care (KMC) (comparator usual care) demonstrated clear evidence of benefit for any and exclusive breastfeeding at discharge and possible benefit for any breastfeeding post-discharge. Quality improvement (QI) bundle(s) to enable breastfeeds (comparator conventional care) showed possible evidence of benefit for any breastfeeding at discharge. Cup feeding (comparator other supplemental enteral feeding forms) demonstrated possible evidence of benefit for exclusive breastfeeding at discharge and any breastfeeding 3 months after. Early onset KMC (commenced <24 h post-birth), oral stimulation, and oropharyngeal colostrum administration, showed no evidence of benefit. No meta-analyses reported pooled effects for gestational age or birthweight subgroups. CONCLUSION There is ample evidence to support investment in KMC, avoidance of bottles during breastfeed establishment, cup feeding, and QI bundles targeted at better supporting breastfeeding in neonatal units to increase prevalence of breastfeeding in preterm infants and promote equal access to breastmilk. Stratifying effects by relevant subgroups is a research priority.
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Affiliation(s)
- Cathie Hilditch
- SAHMRI Women and Kids, and Medical Research Institute, Adelaide, South Australia, Australia
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
- Robinson Research Institute, Adelaide, South Australia, Australia
- Women's and Children's Health Network, Adelaide, South Australia, Australia
| | - Alice R Rumbold
- SAHMRI Women and Kids, and Medical Research Institute, Adelaide, South Australia, Australia
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Amy Keir
- SAHMRI Women and Kids, and Medical Research Institute, Adelaide, South Australia, Australia
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
- Robinson Research Institute, Adelaide, South Australia, Australia
- Women's and Children's Health Network, Adelaide, South Australia, Australia
| | - Philippa Middleton
- SAHMRI Women and Kids, and Medical Research Institute, Adelaide, South Australia, Australia
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
- Robinson Research Institute, Adelaide, South Australia, Australia
| | - Judith Gomersall
- School of Public Health, The University of Adelaide, Adelaide, South Australia, Australia
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Vesel L, Benotti E, Somji S, Bellad RM, Charantimath U, Dhaded SM, Goudar SS, Karadiguddi C, Mungarwadi G, Vernekar SS, Kisenge R, Manji K, Salim N, Samma A, Sudfeld CR, Hoffman IF, Mvalo T, Phiri M, Saidi F, Tseka J, Tsidya M, Caruso BA, Duggan CP, Israel-Ballard K, Lee AC, Mansen KL, Martin SL, North K, Young MF, Fishman E, Fleming K, Semrau KE, Spigel L, Tuller DE, Henrich N. Facilitators, barriers, and key influencers of breastfeeding among low birthweight infants: a qualitative study in India, Malawi, and Tanzania. Int Breastfeed J 2023; 18:59. [PMID: 37940987 PMCID: PMC10634072 DOI: 10.1186/s13006-023-00597-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Accepted: 11/02/2023] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND Low birthweight (LBW) infants are at increased risk of morbidity and mortality. Exclusive breastfeeding up to six months is recommended to help them thrive through infection prevention, growth improvements, and enhancements in neurodevelopment. However, limited data exist on the feeding experiences of LBW infants, their caregivers and key community influencers. The qualitative component of the Low Birthweight Infant Feeding Exploration (LIFE) study aimed to understand practices, facilitators, and barriers to optimal feeding options in the first six months for LBW infants in low-resource settings. METHODS This study was conducted in four sites in India, Malawi, and Tanzania from July 2019 to August 2020. We conducted 37 focus group discussions with mothers and family members of LBW infants and community leaders and 142 in-depth interviews with healthcare providers, government officials, and supply chain and donor human milk (DHM) experts. Data were analyzed using a framework approach. RESULTS All participants believed that mother's own milk was best for LBW infants. Direct breastfeeding was predominant and feeding expressed breast milk and infant formula were rare. DHM was a new concept for most. Adequate maternal nutrition, lactation support, and privacy in the facility aided breastfeeding and expression, but perceived insufficient milk, limited feeding counseling, and infant immaturity were common barriers. Most believed that DHM uptake could be enabled through community awareness by overcoming misconceptions, safety concerns, and perceived family resistance. CONCLUSION This study fills an evidence gap in LBW infant feeding practices and their facilitators and barriers in resource-limited settings. LBW infants face unique feeding challenges such as poor latching and tiring at the breast. Similarly, their mothers are faced with numerous difficulties, including attainment of adequate milk supply, breast pain and emotional stress. Lactation support and feeding counseling could address obstacles faced by mothers and infants by providing psychosocial, verbal and physical support to empower mothers with skills, knowledge and confidence and facilitate earlier, more and better breast milk feeding. Findings on DHM are critical to the future development of human milk banks and highlight the need to solicit partnership from stakeholders in the community and health system.
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Affiliation(s)
- Linda Vesel
- Ariadne Labs at Brigham and Women's Hospital, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Emily Benotti
- Ariadne Labs at Brigham and Women's Hospital, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Sarah Somji
- Department of Pediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Roopa M Bellad
- KLE Academy of Higher Education and Research's Jawaharlal Nehru Medical College, Belgaum, Karnataka, India
| | - Umesh Charantimath
- KLE Academy of Higher Education and Research's Jawaharlal Nehru Medical College, Belgaum, Karnataka, India
| | - Sangappa M Dhaded
- KLE Academy of Higher Education and Research's Jawaharlal Nehru Medical College, Belgaum, Karnataka, India
| | - Shivaprasad S Goudar
- KLE Academy of Higher Education and Research's Jawaharlal Nehru Medical College, Belgaum, Karnataka, India
| | - Chandrashekhar Karadiguddi
- KLE Academy of Higher Education and Research's Jawaharlal Nehru Medical College, Belgaum, Karnataka, India
| | - Geetanjali Mungarwadi
- KLE Academy of Higher Education and Research's Jawaharlal Nehru Medical College, Belgaum, Karnataka, India
| | - Sunil S Vernekar
- KLE Academy of Higher Education and Research's Jawaharlal Nehru Medical College, Belgaum, Karnataka, India
| | - Rodrick Kisenge
- Department of Pediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Karim Manji
- Department of Pediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Nahya Salim
- Department of Pediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Abraham Samma
- Department of Pediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Christopher R Sudfeld
- Departments of Global Health and Population and Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Irving F Hoffman
- Institute for Global Health and Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Tisungane Mvalo
- University of North Carolina Project Malawi, Lilongwe, Malawi
- Department of Pediatrics, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Melda Phiri
- University of North Carolina Project Malawi, Lilongwe, Malawi
| | - Friday Saidi
- University of North Carolina Project Malawi, Lilongwe, Malawi
- Department of Obstetrics and Gynecology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jennifer Tseka
- University of North Carolina Project Malawi, Lilongwe, Malawi
| | - Mercy Tsidya
- University of North Carolina Project Malawi, Lilongwe, Malawi
| | - Bethany A Caruso
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Christopher P Duggan
- Departments of Global Health and Population and Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Center for Nutrition, Boston Children's Hospital, Boston, MA, USA
| | - Kiersten Israel-Ballard
- Ariadne Labs at Brigham and Women's Hospital, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Anne Cc Lee
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Kimberly L Mansen
- Maternal, Newborn, Child Health and Nutrition Program, PATH, Seattle, WA, USA
| | - Stephanie L Martin
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Krysten North
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Melissa F Young
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Eliza Fishman
- Ariadne Labs at Brigham and Women's Hospital, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Katelyn Fleming
- Ariadne Labs at Brigham and Women's Hospital, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Katherine Ea Semrau
- Ariadne Labs at Brigham and Women's Hospital, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Lauren Spigel
- Ariadne Labs at Brigham and Women's Hospital, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Danielle E Tuller
- Ariadne Labs at Brigham and Women's Hospital, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Natalie Henrich
- Ariadne Labs at Brigham and Women's Hospital, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Izaddoost N, Amiri-Farahani L, Haghani S, Bordbar A, Shojaii A, Pezaro S. The effect of orally consumed Lactuca sativa syrup on human milk volume and weight gain in the preterm infant: a randomized controlled clinical trial. Sci Rep 2023; 13:18896. [PMID: 37919481 PMCID: PMC10622505 DOI: 10.1038/s41598-023-46441-0] [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] [Received: 07/01/2023] [Accepted: 11/01/2023] [Indexed: 11/04/2023] Open
Abstract
Human milk feeding can support premature infants to thrive. Yet those with premature infants can be challenged in human milk production. Considering this, and the use of potentially harmful human milk enhancers, the present study was conducted with the aim of determining the effect of orally consumed Lactuca sativa (L. sativa) syrup (lettuce extract) on human milk volume and subsequent weight gain in the preterm infant. Extracts from lettuce and other plants such as silymarin are already evidenced to be safe for use during lactation and have other therapeutic effects in humans. Yet this is the first study of its kind. This parallel randomized clinical trial included lactating participants with their preterm infants who were born at < 32 weeks' gestation and admitted to an intensive care unit. Convenience sampling was used to recruit participants. Eligible participants were allocated to groups randomly: intervention (n = 47), placebo (n = 46), and control (n = 47). The intervention group received one tablespoon of Lactuca sativa (L. sativa) syrup, and the placebo group received one tablespoon of placebo syrup 3 times a day for 1 week. Those in the control group did not receive any herbal or chemical milk-enhancing compounds. Routine care was provided to all three groups. Participants recorded their milk volume for 7 days in a daily information recorder form. Infant weight was measured prior to the intervention, and on the third, fifth and seventh days of the intervention period. There was a statistically significant difference observed in the adjusted mean volume of milk on the fourth and fifth days between the intervention, placebo, and control groups (P < 0.05). The adjusted mean milk volume of those in the intervention group on the first day was significantly higher than those in the control group and those in the placebo group. On the second day, the adjusted mean milk volume of those in the intervention group was higher than in those from the control group; and on the fourth day it was higher than in those from both the control and placebo groups; on the fifth day it was higher than in those in the placebo group; on the sixth day it was higher than in those in the control group and on the seventh day it was higher than in those in the control group (P < 0.05). There was no statistically significant difference in terms of the mean changes (with or without adjustment) in the weight of preterm infants between any of the groups. Lactuca sativa (L. sativa) syrup increases the volume of human milk production and no specific side effects have been reported in its use. Therefore, Lactuca sativa syrup can be recommended for use as one of the compounds that increase human milk volume.
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Affiliation(s)
- Niloufar Izaddoost
- Department of Reproductive Health and Midwifery, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Leila Amiri-Farahani
- Department of Reproductive Health and Midwifery, Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, 1996713883, Iran.
| | - Shima Haghani
- Department of Biostatistics, Nursing and Midwifery Care Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Arash Bordbar
- Shahid Akbarabadi Clinical Research Development Unit (ShACRDU), Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Asie Shojaii
- Research Institute for Islamic and Complementary Medicine, School of Persian Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Sally Pezaro
- The Research Centre for Healthcare and Communities, Coventry University, Coventry, UK
- The University of Notre Dame, Notre Dame, Australia
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Owolabi AJ, Samuel FO, Feskens EJM, Schaafsma A, Melse-Boonstra A. Significant variations in feeding practices and choice of guidelines for the management of late preterm infants among healthcare professionals in Nigeria. Acta Paediatr 2023; 112:2137-2148. [PMID: 37460198 DOI: 10.1111/apa.16906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 07/06/2023] [Accepted: 07/07/2023] [Indexed: 07/22/2023]
Abstract
AIM We aimed to gain insights into current nutritional management practices of late preterm infants (34-36 weeks gestational age) in Nigeria. METHODS Purposive sampling was employed to recruit 19 healthcare professionals (neonatologists, paediatricians, general practitioners and nurses) involved in the care and nutritional management of late preterm infants in Lagos and Ogun states, Nigeria. Data were collected using interviews, either individually or in small focus groups, between 15 August and 6 September 2022. Thematic analysis of interview transcripts was carried out to interpret the data. RESULTS Ten distinct themes emerged across the research questions and objectives. For growth monitoring, 11, 6, 1 and 1 of our participants preferred to use the 2006 WHO growth standards, Fenton preterm growth chart, Ballard score and Intergrowth-21, respectively. Regarding the growth velocity of late preterm infants, most healthcare professionals aimed for 15 g/kg BW/day or more during hospitalisation. Breastmilk was unanimously the primary feeding option for late preterm infants. Most healthcare professionals preferred to use international guidelines over local guidelines. CONCLUSION Our study shows that there is a wide divergence in the nutritional guidelines used in managing late preterm infants in Nigeria. Regarding growth monitoring, healthcare professionals tended to aim for a growth velocity higher than necessary for late preterm infants, which may be disadvantageous for their long-term health.
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Affiliation(s)
- Adedotun Joshua Owolabi
- Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, The Netherlands
| | - Folake O Samuel
- Department of Human Nutrition and Dietetics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Edith J M Feskens
- Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, The Netherlands
| | - Anne Schaafsma
- Expert Nutrition Team, FrieslandCampina, Stationsplein, Amersfoort, The Netherlands
| | - Alida Melse-Boonstra
- Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, The Netherlands
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Quan M, Li Z, Ward LP, Feng S, Jing Y, Wang L, Yuan J. A quality improvement project to increase breast milk feeding of hospitalized late preterm infants in China. Int Breastfeed J 2023; 18:45. [PMID: 37612777 PMCID: PMC10463707 DOI: 10.1186/s13006-023-00582-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 08/12/2023] [Indexed: 08/25/2023] Open
Abstract
BACKGROUND The breastfeeding rates of late preterm infants are lower than both term and extremely preterm infants. To explore the interventions of increasing full breast milk feeding rate of hospitalized late preterm infants on the 7th day after birth (D7) and evaluate the effect of these quality improvement (QI) interventions. METHODS The full breast milk feeding (amount of enteral breast milk reached 120ml/kg/d on D7) rate of hospitalized late preterm infants during May 2017 and November 2017 was set as the baseline before intervention, and the specific aim of promoting breast milk feeding was put forward. The Pareto Chart was used to analyze the factors that affect breast milk feeding process, as well as the discussion of multidisciplinary experts. Key drivers were constructed, including informational materials and education about breast milk feeding, consultations and support on optimal breast milk initiation, initiating breast milk expression within one hour after birth, accurate measurement and recording of expressed breast milk, stimulating continuous and effective lactation, proper breast pump selection in and out of hospital and sending and preserving of expressed milk to NICU. Control chart was used to monitor the monthly change of full breast milk feeding rate until the aim was achieved and sustained. RESULTS The baseline of full breast milk feeding rate of late preterm infants was 10%, and the aim of QI was to increase the rate to 60% within a two-year period. Control chart dynamically showed the full breast milk feeding rate increased to 80% with the implementation of the interventions, achieved and made the aim of QI sustained. CONCLUSION QI interventions including breast milk feeding education, early postpartum breast milk pumping, kangaroo care to stimulate breast milk secretion, and convenient way of transporting breast milk to NICU, could significantly improve the full breast milk feeding rate of hospitalized late preterm infants.
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Affiliation(s)
- Meiying Quan
- Pediatric department, State Key Laboratory of Complex Severe and Rare Disease, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, No.1 Shuaifuyuan, Wangfujing, Dongcheng District, Beijing, 100730, China
| | - Zhenghong Li
- Pediatric department, State Key Laboratory of Complex Severe and Rare Disease, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, No.1 Shuaifuyuan, Wangfujing, Dongcheng District, Beijing, 100730, China.
| | - Laura Placke Ward
- Division of Neonatology, NICU, Cincinnati Children's Hospital Medical Center, Ohio, United States
| | - Shuju Feng
- Pediatric department, State Key Laboratory of Complex Severe and Rare Disease, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, No.1 Shuaifuyuan, Wangfujing, Dongcheng District, Beijing, 100730, China
| | - Yalin Jing
- Pediatric department, State Key Laboratory of Complex Severe and Rare Disease, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, No.1 Shuaifuyuan, Wangfujing, Dongcheng District, Beijing, 100730, China
| | - Lin Wang
- Pediatric department, State Key Laboratory of Complex Severe and Rare Disease, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, No.1 Shuaifuyuan, Wangfujing, Dongcheng District, Beijing, 100730, China
| | - Jing Yuan
- Pediatric department, State Key Laboratory of Complex Severe and Rare Disease, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, No.1 Shuaifuyuan, Wangfujing, Dongcheng District, Beijing, 100730, China
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Vizzari G, Morniroli D, D’Auria A, Travella P, Bezze E, Sannino P, Rampini S, Marchisio P, Plevani L, Mosca F, Giannì ML. Feeding Difficulties in Late Preterm Infants and Their Impact on Maternal Mental Health and the Mother-Infant Relationship: A Literature Review. Nutrients 2023; 15:2180. [PMID: 37432319 PMCID: PMC10180855 DOI: 10.3390/nu15092180] [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] [Received: 03/07/2023] [Revised: 04/19/2023] [Accepted: 04/28/2023] [Indexed: 07/12/2023] Open
Abstract
Late preterm infants constitute the largest subset of premature infants and are more likely to experience feeding issues leading to delayed oral feeding independence and low breastfeeding rates. Considering the increased parental concern about their infants' nutrition and growth, we performed a literature review to provide an update on the feeding challenges faced by late preterm infants and the impact of these issues on maternal mental health and the mother-infant relationship. Based on our findings, late preterm infants have a high prevalence of feeding difficulties which need to be addressed by targeted support interventions to promote breastfeeding success and the establishment of a harmonious dyadic interaction between the mother and her infant, all of which contribute to the prevention of altered feeding behavior later in life. There is still a need for additional research to develop a standardized and shared strategy that can be proven to be effective. Should this be accomplished, it will be possible to offer appropriate support for mothers, encourage the oral skills and maturation of late preterm infants, and improve the relationship quality within the dyad.
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Affiliation(s)
- Giulia Vizzari
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, NICU, 20122 Milan, Italy; (G.V.); (L.P.); (F.M.)
| | - Daniela Morniroli
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy; (D.M.); (P.T.)
| | - Arianna D’Auria
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy; (D.M.); (P.T.)
| | - Paola Travella
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy; (D.M.); (P.T.)
| | - Elena Bezze
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Direzione Professioni Sanitarie, 20122 Milan, Italy; (E.B.); (P.S.); (S.R.)
| | - Patrizio Sannino
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Direzione Professioni Sanitarie, 20122 Milan, Italy; (E.B.); (P.S.); (S.R.)
| | - Serena Rampini
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Direzione Professioni Sanitarie, 20122 Milan, Italy; (E.B.); (P.S.); (S.R.)
| | - Paola Marchisio
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Pediatric Highly Intensive Care Unit, 20122 Milan, Italy;
- Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy
| | - Laura Plevani
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, NICU, 20122 Milan, Italy; (G.V.); (L.P.); (F.M.)
| | - Fabio Mosca
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, NICU, 20122 Milan, Italy; (G.V.); (L.P.); (F.M.)
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy; (D.M.); (P.T.)
| | - Maria Lorella Giannì
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, NICU, 20122 Milan, Italy; (G.V.); (L.P.); (F.M.)
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy; (D.M.); (P.T.)
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Ramezani S, Garkaz O, Khosravi A, Ghasemi Z, Paryab S, Bolbolhaghighi N. The Effect of Breast Massage Training on Self-Efficacy and Perceived Stress of Prim Parous Women: A Clinical Trial Study. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2023; 28:352-356. [PMID: 37575508 PMCID: PMC10412802 DOI: 10.4103/ijnmr.ijnmr_87_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 08/26/2020] [Accepted: 04/18/2022] [Indexed: 08/15/2023]
Abstract
Background Breastfeeding is a highly efficacious, health-promoting activity that prevents many disorders and diseases. Successful breastfeeding depends on various maternal physiological and psychological factors, among which breastfeeding self-efficacy is an adjustable framework. This study investigates the effect of breast massage training on self-efficacy and perceived stress in primiparous women. Materials and Methods This study is a clinical trial study on 132 eligible primiparous mothers referred to Bahar Hospital from August 15, 2019, to December 15, 2020. The women were randomly divided into intervention and control groups. The massage was performed in the intervention group before breastfeeding. The data were collected using a standard breastfeeding self-efficacy questionnaire and the Sheldon Perceived Standard Questionnaire. Data were entered into SPSS 18 and analyzed using descriptive statistics, Chi-square, and analysis of variance. Results The results of this study showed that the mean (SD) breastfeeding self-efficacy in the breast massage training group with direct midwife involvement was 61.63 (9.21), higher than the one in the control group 51.51 (11.62). In addition, perceived stress was 19.81 in the intervention group and 24.84 in the control group, which was also statistically significant. Conclusions Due to the increase in self-efficacy scores and decrease in stress scores after breast massage, this method can improve breastfeeding performance in women. Therefore, educational strategies should be developed in this area.
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Affiliation(s)
- Somayeh Ramezani
- M.Sc. of Counselling in Midwifery, Bahar Hospital, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Omid Garkaz
- Department of Epidemiology, School of Public Health, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Ahmad Khosravi
- Assistant Professor of Epidemiology, Center for Health-Related Social and Behavioral Sciences, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Zohra Ghasemi
- Bahar Hospital, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Sahar Paryab
- School of Nursing and Midwifery, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Nahid Bolbolhaghighi
- Assistant Professor of Midwifery, School of Nursing and Midwifery, Shahroud University of Medical Sciences, Shahroud, Iran
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Brødsgaard A, Andersen BL, Skaaning D, Petersen M. From Expressing Human Milk to Breastfeeding-An Essential Element in the Journey to Motherhood of Mothers of Prematurely Born Infants. Adv Neonatal Care 2022; 22:560-570. [PMID: 34923499 PMCID: PMC10519291 DOI: 10.1097/anc.0000000000000962] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Lactation and breastfeeding present an extraordinary challenge for mothers of prematurely born infants. PURPOSE To explore the significance of and the circumstances that affect lactation for mothers of premature infants. METHODS A qualitative exploratory study based on single, in-depth, semistructured interviews with 16 purposefully sampled mothers of premature infants admitted to the neonatal intensive care unit (NICU). Data were analyzed using content analysis. The study was reported according to Standards for Reporting Qualitative Research. FINDINGS The overall theme was "From expressing human milk to breastfeeding-an essential element in the journey to motherhood." The theme emerged from 3 categories: the birth preparation time has been interrupted; expressing human milk is essential for lactation; and the motherhood journey encompasses breastfeeding. The analysis also revealed that the categories were impacted by initiating, performing, and maintaining lactation and further influenced by inhibitors and promoters. IMPLICATIONS FOR PRACTICE The promoters for performing milk expression and breastfeeding should be stimulated and the inhibitors should be eliminated. The achievement of "zero separation" and mother-infant couplet care in the NICU would be beneficial. In order for mothers to maintain successful lactation, it is essential that they receive supportive around-the-clock access to health professionals with expertise in lactation and breastfeeding until exclusive breastfeeding is well established. IMPLICATIONS FOR RESEARCH The study highlights the need to investigate mother-infant as one entity rather than separately as mother and infant.
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Affiliation(s)
- Anne Brødsgaard
- Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital, Amager Hvidovre, Denmark (Drs Brødsgaard and Skaaning and Mss Andersen and Petersen); and Nursing and Health Care, Institute of Public Health, Aarhus University, Aarhus, Denmark (Dr Brødsgaard)
| | - Bente Lund Andersen
- Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital, Amager Hvidovre, Denmark (Drs Brødsgaard and Skaaning and Mss Andersen and Petersen); and Nursing and Health Care, Institute of Public Health, Aarhus University, Aarhus, Denmark (Dr Brødsgaard)
| | - Diana Skaaning
- Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital, Amager Hvidovre, Denmark (Drs Brødsgaard and Skaaning and Mss Andersen and Petersen); and Nursing and Health Care, Institute of Public Health, Aarhus University, Aarhus, Denmark (Dr Brødsgaard)
| | - Mette Petersen
- Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital, Amager Hvidovre, Denmark (Drs Brødsgaard and Skaaning and Mss Andersen and Petersen); and Nursing and Health Care, Institute of Public Health, Aarhus University, Aarhus, Denmark (Dr Brødsgaard)
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9
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Giraldo-Marín IC, Henao Murillo NA, Londoño Rodríguez MC, Aguirre Torres M, López Palacio GJ. Factors associated with the duration of breastfeeding in mothers of babies cared for in a kangaroo family program. INVESTIGACION Y EDUCACION EN ENFERMERIA 2022; 40:e08. [PMID: 36867781 PMCID: PMC10017126 DOI: 10.17533/udea.iee.v40n3e08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 10/08/2022] [Indexed: 06/18/2023]
Abstract
OBJECTIVES To determine the factors associated with the duration of breastfeeding in mothers of babies cared for in a kangaroo family program. METHODS Quantitative, observational study with a secondary source of a retrospective cohort of 707 babies with monitoring at admission, at 40 weeks, at three and at six months of corrected age in the kangaroo family program of a public hospital in the municipality of Rionegro (Antioquia, Colombia) from 2016 to 2019. RESULTS 49.6% of babies were born with low weight for gestational age and 51.5% were female. 58.3% of the mothers were unemployed and 86.2% of them lived with their partner. When entering the kangaroo family program, 94.2% of the babies received breastfeeding and at six months they were 44.7%. The variables that were associated with the duration of breastfeeding up to six months according to the explanatory model were: the mother's cohabitation with her partner (adjusted prevalence ratio - APR: 1.34) and receiving breastfeeding when entering the kangaroo family program (APR: 2.30). CONCLUSIONS The factors related to the duration of breastfeeding in mothers of babies cared for in the kangaroo family program were that the mother lived with her partner and that the mother was breastfeeding when she entered the program, therefore they received education and support from the interdisciplinary team, which could favor confidence and willingness towards breastfeeding.
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10
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Early infancy growth, body composition and type of feeding in late and moderate preterms. Pediatr Res 2022:10.1038/s41390-022-02317-z. [PMID: 36183005 PMCID: PMC9526212 DOI: 10.1038/s41390-022-02317-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 09/13/2022] [Accepted: 09/14/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Late and moderate preterm (LMPT) infants are at risk for adverse later life outcomes. We determined the association between feeding method at enrolment and growth and body composition of LMPT infants until 3 months corrected age (3mCA). METHODS Infants born between 32+0 and 36+6 weeks of gestation (n = 107) were enrolled up to 4 weeks corrected age and stratified according to feeding at enrolment. We performed anthropometric measurements at enrolment, term equivalent age (TEA) and 3mCA, including skinfold measurements and body composition using dual X-ray absorptiometry (DEXA). RESULTS Feeding method at enrolment was associated with fat mass (FM) (breast 554.9 g, mixed 716.8 g, formula 637.7 g, p = 0.048), lean body mass (LM) (2512 g, 2853 g, 2722 g, respectively, p = 0.009) and lean mass index (LMI) (10.6 kg/m2, 11.6 kg/m2,11.2 kg/m2 respectively, p = 0.008) at TEA, but not 3mCA. Breastfed infants demonstrated greater increase in LM (breast 1707 g, mixed 1536 g, formula 1384 g, p = 0.03) and LMI (1.23 kg/m2, 0.10 kg/m2, 0.52 kg/m2, respectively, p = 0.022) between TEA and 3mCA. CONCLUSIONS Breastfed LMPT infants have lower FM and greater LM increase and LMI increase up to 3mCA compared to formula or mixed-fed infants. These findings stress the importance of supporting breastfeeding in this population. IMPACT Infants born late and moderate preterm age who are exclusively breastfed soon after birth gain more lean mass up to 3 months corrected age compared to mixed- or formula-fed infants. Breastfed infants have lower lean and fat mass at term equivalent age compared to mixed- and formula-fed infants. This is the first study exploring this population's growth and body composition in detail at 3 months corrected age. Our results underline the importance of supporting mothers to initiate and continue breastfeeding at least until 3 months corrected age.
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11
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Jonsdottir RB, Flacking R, Jonsdottir H. Breastfeeding initiation, duration, and experiences of mothers of late preterm twins: a mixed-methods study. Int Breastfeed J 2022; 17:68. [PMID: 36076279 PMCID: PMC9461222 DOI: 10.1186/s13006-022-00507-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 08/25/2022] [Indexed: 11/17/2022] Open
Abstract
Background Twins and late preterm (LPT) infants are at an increased risk of being breastfed to a lesser extent than term singletons. This study aimed to describe the initiation and duration of any and exclusive breastfeeding at the breast for mothers of LPT twins and term twins during the first 4 months and to explore the breastfeeding experiences of mothers of LPT twins. Methods A sequential two-sample quantitative–qualitative explanatory mixed-methods design was used. The quantitative data were derived from a longitudinal cohort study in which 22 mothers of LPT twins and 41 mothers of term twins answered questionnaires at one and four months after birth (2015–2017). The qualitative data were obtained from semi-structured interviews with 14 mothers of LPT twins (2020–2021), based on results from the quantitative study and literature. Analysis included descriptive statistics of quantitative data and deductive content analysis of the qualitative data, followed by condensation and synthesis. Results All mothers of LPT twins (100%) and most mothers of term twins (96%) initiated breastfeeding. There was no difference in any breastfeeding during the first week at home (98% versus 95%) and at 1 month (88% versus 85%). However, at 4 months, the difference was significant (44% versus 75%). The qualitative data highlighted that mothers of LPT twins experienced breastfeeding as complex and strenuous. Key factors influencing mothers’ experiences and decisions were their infants’ immature breastfeeding behaviors requiring them to express breast milk alongside breastfeeding, the burden of following task-oriented feeding regimes, and the lack of guidance from healthcare professionals. As a result, mothers started to question the worth of their breastfeeding efforts, leading to changes in breastfeeding management with diverse results. Support from fathers and grandparents positively influenced sustained breastfeeding. Conclusions Mothers of LPT twins want to breastfeed, but they face many challenges in breastfeeding during the first month, leading to more LPT twins’ mothers than term twins’ mothers ceasing breastfeeding during the following months. To promote and safeguard breastfeeding in this vulnerable group, care must be differentiated from routine term infant services, and healthcare professionals need to receive proper education and training. Supplementary Information The online version contains supplementary material available at 10.1186/s13006-022-00507-3.
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Affiliation(s)
- Rakel B Jonsdottir
- Neonatal Intensive Care Unit, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland. .,Faculty of Nursing, School of Health Sciences, University of Iceland, Reykjavik, Iceland.
| | - Renée Flacking
- School of Health and Welfare, Dalarna University, Falun, Sweden
| | - Helga Jonsdottir
- Faculty of Nursing, School of Health Sciences, University of Iceland, Reykjavik, Iceland
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12
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Souza RCD, Wolkers PCB, Pereira LA, Romão RS, Medeiros ES, Ferreira DMDLM, Rinaldi AEM, Azevedo VMGDO. The possible mediating relationship promoted by the self-efficacy of breastfeeding associated with the Kangaroo Method on indicators of exclusive breastfeeding. J Pediatr (Rio J) 2022; 98:540-544. [PMID: 35257670 PMCID: PMC9510796 DOI: 10.1016/j.jped.2021.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 12/07/2021] [Accepted: 12/14/2021] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE Assess the mediating role of breastfeeding self-efficacy in the association between the Kangaroo Neonatal Intermediate Care Unit and exclusive breastfeeding. METHOD Cross-sectional study nested in a cohort, carried out in the Neonatal Unit of a Brazilian university hospital between September 2018 and March 2020. The sample consisted of 114 newborns weighing ≤1800 g and their mothers who were divided into those who participated in the first and second stages of the Kangaroo Method and those who only passed through the first stage, categorized as the Conventional group. To assess the self-efficacy of breastfeeding, the Breastfeeding Self Efficacy Scale - Short-Form was used. The Mann-Whitney test was used to compare the breastfeeding self-efficacy score between the groups, and Fisher's exact test to compare rates of exclusive breastfeeding. The adjusted structural equation model was used to check for the mediating effect of breastfeeding self-efficacy. The significance level adopted was 5%. RESULTS The kangaroo group had a higher rate of exclusive breastfeeding at hospital discharge (p = 0.000). There was a positive association between having remained in the kangaroo (p = 0.003) and the breastfeeding self-efficacy score (p = 0.025) with the rate of exclusive breastfeeding at hospital discharge. Breastfeeding self-efficacy did not act as a mediator. CONCLUSION The self-efficacy of breastfeeding and the stay of the low birth weight newborn baby in the kangaroo unit acted positively and independently in exclusive breastfeeding, and the self-efficacy of breastfeeding did not act as a mediator in this association.
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Affiliation(s)
- Rayany Cristina de Souza
- Pós-graduação em Ciências da Saúde/FAMED, Universidade Federal de Uberlândia, Uberlândia, MG, Brazil
| | | | | | - Rejane Sousa Romão
- Pós-graduação em Ciências da Saúde/FAMED, Universidade Federal de Uberlândia, Uberlândia, MG, Brazil
| | - Eliziane Santos Medeiros
- Pós-graduação em Ciências da Saúde/FAMED, Universidade Federal de Uberlândia, Uberlândia, MG, Brazil
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13
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Keir A, Rumbold A, Collins CT, McPhee AJ, Varghese J, Morris S, Sullivan TR, Leemaqz S, Middleton P, Makrides M, Best KP. Breastfeeding outcomes in late preterm infants: A multi-centre prospective cohort study. PLoS One 2022; 17:e0272583. [PMID: 35969612 PMCID: PMC9377594 DOI: 10.1371/journal.pone.0272583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 07/21/2022] [Indexed: 11/19/2022] Open
Abstract
Objectives To describe (1) infant feeding practices during initial hospitalisation and up to 6 months corrected age (CA) in infants born late preterm with mothers intending to breastfeed, (2) the impact of early feeding practices on hospital length of stay and (3) maternal and infant factors associated with duration of breastfeeding. Methods We conducted a prospective cohort study of infants born at 34+0 to 36+6 weeks gestational age during 2018–2020. Families were followed up until the infant reached 6 months of age (corrected for prematurity). Feeding practices during the birth hospitalisation, length of initial hospital stay, and the prevalence of exclusive or any breastfeeding at 6 weeks, 3 months, and 6 months CA were examined. Associations between maternal and infant characteristics and breastfeeding at 6 weeks, 3 months and 6 months CA were assessed using multivariable logistic regression models. Results 270 infants were enrolled, of these, 30% were multiple births. Overall, 78% of infants received only breastmilk as their first feed, and 83% received formula during the hospitalisation. Seventy-four per cent of infants were exclusively breastfed at discharge, 41% at 6 weeks CA, 35% at 3 months CA, and 29% at 6 months CA. The corresponding combined exclusive and partial breastfeeding rates (any breastfeeding) were 72%, 64%, and 53% of babies at 6 weeks CA, 3 months CA, and 6 months CA, respectively. The mean duration of hospitalisation was 2.9 days longer (95% confidence interval (CI) 0.31, 5.43 days) in infants who received any formula compared with those receiving only breastmilk (adjusted for GA, maternal age, multiple birth, site, and neonatal intensive care unit admission). In multivariable models, receipt of formula as the first milk feed was associated with a reduction in exclusive breastfeeding at 6 weeks CA (odds ratio = 0.22; 95% CI 0.09 to 0.53) and intention to breastfeed >6 months with an increase (odds ratio = 4.98; 95% CI 2.39 to 10.40). Intention to breastfeed >6 months remained an important predictor of exclusive breastfeeding at 3 and 6 months CA. Conclusions Our study demonstrates that long-term exclusive breastfeeding rates were low in a cohort of women intending to provide breastmilk to their late preterm infants, with approximately half providing any breastmilk at 6 months CA. Formula as the first milk feed and intention to breastfeed >6 months were significant predictors of breastfeeding duration. Improving breastfeeding outcomes may require strategies to support early lactation and a better understanding of the ongoing support needs of this population.
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Affiliation(s)
- Amy Keir
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, South Australia
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia
- Department of Neonatal Medicine, Women’s and Children’s Hospital, North Adelaide, South Australia
- Robinson Research Institute, The University of Adelaide, Adelaide, South Australia
- * E-mail:
| | - Alice Rumbold
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, South Australia
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia
- Robinson Research Institute, The University of Adelaide, Adelaide, South Australia
| | - Carmel T. Collins
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, South Australia
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia
| | - Andrew J. McPhee
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, South Australia
| | - Jojy Varghese
- Lyell McEwin Hospital, Elizabeth Vale, South Australia
| | - Scott Morris
- Department of Neonatology, Flinders Medical Centre, Bedford Park, South Australia, Australia
| | - Thomas R. Sullivan
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, South Australia
- School of Public Health, The University of Adelaide, Adelaide, South Australia
| | - Shalem Leemaqz
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, South Australia
| | - Philippa Middleton
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, South Australia
| | - Maria Makrides
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, South Australia
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia
| | - Karen P. Best
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, South Australia
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia
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Zubaidah Z, Rustina Y, Nurhaeni N, Hastono SP. Experience of Mother on Caring of Children with Low Birth Weight in an Urban Setting, Indonesia: A Descriptive Phenomenological Study. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2021.8260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Low birth weight is a major public health issue; it causes higher mortality rate among neonatal. Therefore, it is essential for caregivers to know how to save the baby’s life with evidence-based practices at home. The previous studies found that low birth weight mothers had poor awareness caring their babies at home care adequately.
AIM: The objective of the study was to explore experience of mothers on caring for children with low birth weight from an urban setting in a low-middle-income country.
METHODS: This was a descriptive phenomenological approach. This study was conducted in a rural setting in the Semarang region of Indonesia. Ten mothers whose babies with low birth weight had been discharged from the perinatology care unit in a secondary level hospital and resided in Semarang were interviewed in their homes using a semi-structured interview guide. Data were audiotaped, transcribed verbatim, and analyzed inductively by content analysis.
RESULTS: Twenty mothers aged 20–37 years were interviewed. Most of the babies were moderate to late preterm, and the gestational age at delivery ranged between 33 and 38 weeks gestation, and the birth weights of the babies ranged between 1.4 and 2 kg. Five major themes emerged, which included the psychological response of mothers, sharing information related to the care procedure, breastfeeding, social support, and health-seeking behavior.
CONCLUSIONS: The findings indicate that home management of low birth weight babies poses multiple needs and is associated with poor quality of care. Hence, extensive education and identification of other social support systems are needed to augment facility-based care for mothers and their babies.
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15
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Pollard DL. Relationship Between the Rates of Breast Milk Production of Preterm Mothers in the First Week Post-Delivery and Continuation of Breastfeeding Through Discharge. CLINICAL LACTATION 2022. [DOI: 10.1891/cl.2021-0021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BackgroundMothers of preterm infants born between 26- and 35-weeks’ gestation often report challenges with maintaining a pumping schedule and experience perceptions of low milk supply, both of which may contribute to early termination of breastfeeding within the first few weeks.PurposeThe purpose of this study was to assess the relationship between the amount of expressed milk volumes in the first 2 weeks after delivery and infant’s continuing to receive mother’s milk at hospital discharge. These results were part of a larger study that examined multiple maternal variables that may impact the amount of milk volumes and continuation of breastfeeding in the preterm infant admitted to the NICU.MethodsMothers of infants (N = 37) in the NICU were recruited for this correlational, longitudinal study. Data was collected at 24–48 hours post-delivery, at 2 weeks, at 4 weeks from mothers participating in the study and from infant chart reviews.Results/OutcomesMothers who reported higher expressed milk volumes at 3 days post-delivery had consistently higher volumes of expressed breast milk and a higher percentage of continued breastfeeding at hospital discharge. There was no statistically significant relationship between breastfeeding self-efficacy scores, socio-demographic variables, or pumping frequency and the percentage of infants receiving breast milk at hospital discharge. Overall, 76.4% of the infants enrolled in the study were receiving 100% of their intake with fortified mother’s milk at hospital discharge.Discussion/Implications for PracticeThe use of a breast pump log in the first 2 weeks to monitor milk volumes may assist in predicting mothers who are at risk of lower milk supply and early discontinuation of breastfeeding.
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Wang L, He J. Exclusive breastfeeding of full-term infants during the first 6 months after discharge from a neonatal unit in China: A cross-sectional study. Jpn J Nurs Sci 2021; 19:e12466. [PMID: 34931439 DOI: 10.1111/jjns.12466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 11/22/2021] [Accepted: 11/26/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To elucidate breastfeeding patterns, the reasons for stopping exclusive breastfeeding, and the sociodemographic characteristics associated with exclusive breastfeeding of full-term infants during the 6 months after discharge from a neonatal unit in China. METHODS This cross-sectional study included mothers of full-term infants who were discharged from the 40-bed neonatal unit (level IIA) of a tertiary hospital in Hunan province, China between August 2019 and September 2020. Information on breastfeeding patterns was collected through telephone interviews with the mothers 6 months after their infants had been discharged from the neonatal unit. Binary logistic regression was used to determine the factors associated with exclusive breastfeeding. RESULTS This study included 489 mother-infant dyads. At 6 months after discharge, 51.5% of mothers were exclusively breastfeeding, 29.0% of mothers were partially breastfeeding, and 19.4% of mothers were not breastfeeding. The most common reason for stopping breastfeeding was "poor milk supply" (81.2%). Factors associated with exclusive breastfeeding included multiparity, exclusive breastfeeding before the hospitalization, providing breast milk to the hospitalized infant, and a high level of maternal education. CONCLUSIONS In the Chinese culture, mothers who experienced multiparity and higher-level education were more likely to breastfeed their infants to 6 months after discharge from the neonatal unit. In addition, infants who were exclusively breastfed before and during hospitalization were also more likely to be exclusively breastfed after discharge. The results will help inform future research aimed at identifying interventions to reduce early breastfeeding cessation.
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Affiliation(s)
- Li Wang
- Nursing Department, Shenzhen University General Hospital, Shen Zhen, China
| | - Junli He
- Department of Pediatrics, Shenzhen University General Hospital, Shen Zhen, China
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17
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Zhang B, Yue J, Duan Z, Zhao Y, Williams S, Huang L, Zhang X, Wu W, Zhang L, Liu J, Zhao G. Maternal experience of intermittent kangaroo mother care for late preterm infants: a mixed-methods study in four postnatal wards in China. BMJ Open 2021; 11:e050221. [PMID: 34493519 PMCID: PMC8424842 DOI: 10.1136/bmjopen-2021-050221] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE To describe how mothers of late preterm infants experienced the provision of intermittent kangaroo mother care (KMC) in four postnatal wards in different hospitals in China, under a pilot KMC project. DESIGN A concurrent mixed-methods approach incorporating quantitative maternal questionnaires and qualitative semistructured interviews. SETTING Four postnatal wards in level-III hospitals based in different provinces of Southeast and Northwest China. PARTICIPANTS All 752 mothers who provided intermittent KMC to their late preterm newborns in the four participating postnatal wards consented to participate in the study (quantitative component), as well as six nurses, two obstetricians and two mothers from two of the participating postnatal wards (qualitative component). OUTCOME MEASURES Maternal KMC experiences during a hospital stay, patients' perceptions of KMC initiation, processes, benefits and challenges. RESULTS Most mothers had not heard of KMC before being introduced to it in the postnatal ward. On average, mothers and newborns stayed in postnatal wards for 3.6 days; during their stay, mothers provided an average of 3.5 KMC sessions, which is an average of 1.1 sessions a day. Each KMC session lasted an average of 68 min, though there was much variation in the length of a session. Common reasons given for discontinuing a KMC session included restroom use, infant crying and perceived time limitations. Some mothers would have preferred to provide KMC for longer periods of time and nurses encouraged this. Most mothers experienced no difficulty providing KMC, received support from family and medical staff and intended to continue with KMC postdischarge. CONCLUSION In order to improve the maternal experience of KMC, it is recommended that raising awareness of KMC should be included in antenatal care and after birth. Longer periods of KMC provision should be encouraged, greater privacy should be provided for mothers providing KMC in postnatal wards and family members should be encouraged to support KMC.
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Affiliation(s)
- Bo Zhang
- Peking University First Hospital, Beijing, China
| | - Jieya Yue
- Peking University First Hospital, Beijing, China
| | - Zhiying Duan
- Peking University First Hospital, Beijing, China
| | - Yingxi Zhao
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | | | - Limin Huang
- Hunan Provincial Maternal and Child Health Hospital, Hunan, China
| | - Xiaoqin Zhang
- Northwest Women & Children Hospital Department of Obstetrics, Shaanxi, China
| | - Wenli Wu
- Linyi Maternity and Child Health Hospital, Shandong, China
| | | | - Jun Liu
- Peking University First Hospital, Beijing, China
| | - Gengli Zhao
- Peking University First Hospital, Beijing, China
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Obaid M, Igawa T, Maxwell A, Murray YL, Rahman A, Aboudi D, Olivo K, Roeder T, Valdes-Greene R, Brumberg H, Alpan G, Parvez B. "Liquid Gold" Lactation Bundle and Breastfeeding Rates in Racially Diverse Mothers of Extremely Low-Birth-Weight Infants. Breastfeed Med 2021; 16:463-470. [PMID: 34042464 DOI: 10.1089/bfm.2020.0322] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background: In 2015, we implemented a comprehensive lactation bundle named Liquid Gold. Lactation bundles in the neonatal intensive care unit have not been well studied. Materials and Methods: This is an ongoing quality improvement breastfeeding project of racially diverse mothers and infants of extremely low birth weight (≤1,000 g). Four epochs were assessed; baseline (B; January 2012-July 2013), transition (T; human milk [HM]-derived fortifier; August 2013-December 2014), Liquid Gold (LG; full bundle, including staff education, colostrum oral care, kangaroo care, antenatal and postpartum counseling, provision of pasteurized donor HM, and breast pumps; January 2015-February 2016), and current (C; ongoing impact, Spanish-speaking lactation consultant, and HM cream; March 2016-April 2019). Results: Four hundred twenty-three mother-infant dyads were assessed. The rate of exclusive mother's own milk at discharge increased significantly in LG compared with previous epochs and was sustained over time. During LG, African American (AA) mothers had a significant surge of breastfeeding initiation (30% in B and 41% in T versus 78% in LG), but this was not sustained in C. AA mothers also experienced a significant decline in the use of exclusive formula feeding in the C epoch (68% in LG versus 46% in C). Hispanic and White mothers sustained their breastfeeding rates over time. Conclusions: Our Liquid Gold lactation bundle led to a significant increase in the provision of HM in the NICU and at discharge in the most vulnerable infants. AA mothers experienced the highest surge in breastfeeding initiation and greatest reduction in formula use. Breastfeeding goals and support need to be tailored to each mother with specific consideration for racial/ethnic background for optimal success.
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Affiliation(s)
- Maria Obaid
- Division of Newborn Medicine, Westchester Medical Center, Maria Fareri Children's Hospital, Valhalla, New York, USA
| | - Teryn Igawa
- New York Medical College School of Medicine, Valhalla, New York, USA
| | - Abigael Maxwell
- Division of Newborn Medicine, Westchester Medical Center, Maria Fareri Children's Hospital, Valhalla, New York, USA
| | - Yuanyi L Murray
- Division of Newborn Medicine, Westchester Medical Center, Maria Fareri Children's Hospital, Valhalla, New York, USA.,Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Amanda Rahman
- Division of Newborn Medicine, Westchester Medical Center, Maria Fareri Children's Hospital, Valhalla, New York, USA.,Department of Neonatal-Perinatal Medicine, Staten Island University Hospital, Staten Island, New York, USA
| | - David Aboudi
- Division of Newborn Medicine, Westchester Medical Center, Maria Fareri Children's Hospital, Valhalla, New York, USA.,NYC DOHMH New York, New York, USA
| | - Karina Olivo
- Division of Newborn Medicine, Westchester Medical Center, Maria Fareri Children's Hospital, Valhalla, New York, USA
| | - Tina Roeder
- Division of Newborn Medicine, Westchester Medical Center, Maria Fareri Children's Hospital, Valhalla, New York, USA
| | - Rhonda Valdes-Greene
- Division of Newborn Medicine, Westchester Medical Center, Maria Fareri Children's Hospital, Valhalla, New York, USA
| | - Heather Brumberg
- Division of Newborn Medicine, Westchester Medical Center, Maria Fareri Children's Hospital, Valhalla, New York, USA
| | - Gad Alpan
- Division of Newborn Medicine, Westchester Medical Center, Maria Fareri Children's Hospital, Valhalla, New York, USA
| | - Boriana Parvez
- Division of Newborn Medicine, Westchester Medical Center, Maria Fareri Children's Hospital, Valhalla, New York, USA
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Carpay NC, Kakaroukas A, D Embleton N, van Elburg RM. Barriers and Facilitators to Breastfeeding in Moderate and Late Preterm Infants: A Systematic Review. Breastfeed Med 2021; 16:370-384. [PMID: 33733865 DOI: 10.1089/bfm.2020.0379] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Rationale: Most of the preterm infants are born between 32 and 36 weeks of gestation (moderate to late preterm infants [MLPIs]). This comes with significant short- and long-term risks. Breastfeeding reduces many of these risks, but breastfeeding rates in MLPIs are lower than those in full-term infants. We performed a systematic review of studies identifying factors associated with successful breastfeeding in MLPIs and interventions to improve breastfeeding. Methods: Systematic search performed using PubMed April 24, 2020. In total, 11 articles describing barriers to breastfeeding in MLPIs and 6 articles about interventions to improve breastfeeding were included. Interventions were categorized according to different outcomes: breastfeeding initiation, continuation for 5 days to 6 weeks, and continuation ≥3 months. Because of heterogeneity in study characteristics, no meta-analysis was performed. Results: Breastfeeding rates were lower in those with lower socioeconomic status and single-parent households. Providing parents with more information and direct health care support significantly improved breastfeeding initiation. Cup feeding instead of bottle feeding had inconsistent effects on breastfeeding initiation and continuation. Continuous skin-to-skin contact did not affect breastfeeding initiation or continuation. Discussion: Risk groups for lower breastfeeding rates of MLPIs include mothers with lower socioeconomic status and single mothers. Interventions that may improve breastfeeding include cup feeding and providing parents with more information and health care support. Key limitations of included studies are lack of adequate adjustment for confounders and lack of blinding. However, this is the first systematic review identifying both risk groups and interventions to improve breastfeeding in MLPIs.
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Affiliation(s)
- Nora C Carpay
- Emma Children's Hospital, Amsterdam University Medical Centers, location AMC, The Netherlands
| | - Andreas Kakaroukas
- Newcastle Neonatal Service, Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Nicholas D Embleton
- Newcastle Neonatal Service, Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Ruurd M van Elburg
- Emma Children's Hospital, Amsterdam University Medical Centers, location AMC, The Netherlands
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20
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Woldetensay YK, Belachew T, Ghosh S, Kantelhardt EJ, Biesalski HK, Scherbaum V. The effect of maternal depressive symptoms on infant feeding practices in rural Ethiopia: community based birth cohort study. Int Breastfeed J 2021; 16:27. [PMID: 33743775 PMCID: PMC7980325 DOI: 10.1186/s13006-021-00375-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 03/12/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Maternal depression and other psychosocial factors have been shown to have adverse consequences on infant feeding practices. This study explored the longitudinal relationship of maternal depressive symptoms and other selected psychosocial factors with infant feeding practices (IFPs) in rural Ethiopia using summary IFP index. METHODS This study uses existing data from the ENGINE birth cohort study, conducted from March 2014 to March 2016 in three districts in the southwest of Ethiopia. A total of 4680 pregnant women were recruited and data were collected once during pregnancy (twice for those in the first trimester), at birth, and then every 3 months until the child was 12 months old. A standardized questionnaire was used to collect data on IFPs, maternal depressive symptoms, household food insecurity, intimate partner violence (IPV), maternal social support, active social participation, and other sociodemographic variables. A composite measure of IFP index was computed using 14 WHO recommended infant and young child feeding (IYCF) practice indicators. High IFP index indicated best practice. Prenatal and postnatal maternal depressive symptoms were assessed using the patient health questionnaire (PHQ-9). Linear multilevel mixed effects model was fitted to assess longitudinal relationship of IFPs with maternal depression and other psychosocial factors. RESULTS Reports of higher postnatal depressive symptoms (ß = - 1.03, P = 0.001) and IPV (ß = - 0.21, P = 0.001) were associated with lower scores on the IFP index. Whereas, reports of better maternal social support (ß = 0.11, P = 0.002) and active social participation (ß = 0.55, P < 0.001) were associated with higher scores on the IFP index. Contrary to expectations, moderate household food insecurity (ß = 0.84, P = 0.003), severe household food insecurity (ß = 1.03, P = 0.01) and infant morbidity episodes (ß = 0.63, P = 0.013) were associated with higher scores on the IFP index. CONCLUSIONS Overall, a multitude of factors are related to IFPs and hence coordinated, multi-sectoral and multi-stakeholder interventions including maternal depressive symptoms screening and management are needed to improve infant feeding practices.
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Affiliation(s)
- Yitbarek Kidane Woldetensay
- Institute of Nutrition Science (140a), University of Hohenheim, Stuttgart, Germany
- Food Security Center, University of Hohenheim, Stuttgart, Germany
| | - Tefera Belachew
- Department of Population and Family Health, College of Health Sciences, Jimma University, Jimma, Ethiopia
| | - Shibani Ghosh
- Tufts University, Friedman School of Nutrition Science and Policy, Boston, USA
| | - Eva Johanna Kantelhardt
- Department of Gynecology, Faculty of Medicine, Martin-Luther University, Halle, Germany
- Institute of Medical Epidemiology, Biostatistics, and Informatics, Faculty of Medicine, Martin-Luther University, Halle, Germany
| | - Hans Konrad Biesalski
- Institute of Nutrition Science (140a), University of Hohenheim, Stuttgart, Germany
- Food Security Center, University of Hohenheim, Stuttgart, Germany
| | - Veronika Scherbaum
- Institute of Nutrition Science (140a), University of Hohenheim, Stuttgart, Germany
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21
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Kang JH, Son H, Byun SY, Han G. [Effect of Direct Breastfeeding Program for Premature Infants in Neonatal Intensive Care Unit]. J Korean Acad Nurs 2021; 51:119-132. [PMID: 33706336 DOI: 10.4040/jkan.20240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 01/17/2021] [Accepted: 01/20/2021] [Indexed: 11/09/2022]
Abstract
PURPOSE This study aimed to identify the effects of a direct breastfeeding program for premature infants in neonatal intensive care units (NICUs). METHODS This quasi-experimental study was conducted during August 2016 to April 2017. Sixty mothers of premature infants were assigned to the experimental (n = 31) or control groups (n = 29). The program was comprised of breastfeeding education and direct breastfeeding support. The experimental and control groups were provided with education and counseling on breastfeeding at the time of admission and discharge. In the experimental group, the mothers initiated oral feeding with direct breastfeeding and engaged in breastfeeding at least seven times during the NICU stay. The collected data were analyzed by the χ²-test and repeated measures ANOVA using an SPSS program. RESULTS The experimental group showed a higher direct breastfeeding practice rate (χ² = 19.29, p < .001), breastfeeding continuation rate (χ² = 3.76, p < .001), and self-efficacy (F = 25.37, p < .001) than the control group except for maternal attachment. CONCLUSION The direct breastfeeding program in the NICU has significant effects on the practice and continuation rate of breastfeeding and breastfeeding self-efficacy. Therefore, this program can be applied in the NICU settings where direct breastfeeding is limited.
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Affiliation(s)
- Ji Hyun Kang
- Department of Nursing, Pusan National University Hospital, Busan, Korea
| | - Hyunmi Son
- College of Nursing, Pusan National University, Yangsan, Korea.
| | - Shin Yun Byun
- Department of Pediatrics, Pusan National University School of Medicine, Yangsan, Korea
| | - Gyumin Han
- College of Nursing, Pusan National University, Yangsan, Korea
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22
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Ongun H, Demir M. Family-centered lactation counseling and breastfeeding in preterm infants upon neonatal intensive care discharge. J Clin Neonatol 2021. [DOI: 10.4103/jcn.jcn_167_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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23
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Cordero L, Stenger MR, Landon MB, Nankervis CA. Breastfeeding initiation among women with preeclampsia with and without severe features. J Neonatal Perinatal Med 2020; 14:419-426. [PMID: 33337389 DOI: 10.3233/npm-200508] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Timely delivery and magnesium sulfate (MgSO4) are mainstay in the treatment of preeclampsia with severe features (PWSF). Premature delivery, severity of illness and mother-infant separation may increase the risk for breastfeeding (BF) initiation failure. OBJECTIVE To compare BF initiation among women with late-onset PWSF treated with MgSO4 to women with late-onset preeclampsia without severe features (WOSF) who did not receive MgSO4. METHODS Retrospective study of 158 women with PWSF and 104 with WOSF who delivered at ≥34 weeks. Intention to BF, formula feed (FF) or partially BF was declared prenatally. At discharge, exclusive BF included direct BF or direct BF with expressed breast milk (EBM). RESULTS PWSF and WOSF groups were similar in age, race, and obstetric history. PWSF and WSOF differed in primiparity (65 & 51%), late preterm births (73 vs 15%), admission to NICU (44 &17%) and mother (5 & 4d) and infant (6 & 3d) hospital stay. Both groups were similar in intention to BF (80 & 84%), to FF (16 & 13%) and to partially BF (5 & 5%). At discharge, exclusive BF (37 & 39%), partial BF (33 & 31%) and FF (30 & 30%) were similar. Exclusive BF in the PWSF group was 43% direct BF, 28% direct BF and EBM and 29% EBM alone whereas in the WOSF group exclusive BF was 93% direct BF and 7% direct BF and EBM. CONCLUSION BF initiation rates for women with PWSF and WOSF were similar. EBM alone or with direct BF enabled infants in the PWSF group to exclusively BF at discharge.
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Affiliation(s)
- L Cordero
- Department of Pediatrics, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - M R Stenger
- Department of Pediatrics, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - M B Landon
- Department of Obstetrics and Gynecology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - C A Nankervis
- Department of Pediatrics, The Ohio State University Wexner Medical Center, Columbus, OH, USA
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24
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韩 露, 徐 小, 童 笑, 张 欣, 刘 捷, 杨 立, 刘 慧, 闫 菊, 宋 志, 梅 亚, 米 荣, 秦 选, 刘 玉, 齐 宇, 张 巍, 曾 慧, 崔 红, 龙 卉, 郭 果, 陈 旭, 杨 召, 孙 芳, 付 晓, 王 长, 李 正. [Effect of breastfeeding on the development of infection-related diseases during hospitalization in late preterm infants in 25 hospitals in Beijing, China]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2020; 22:1245-1250. [PMID: 33327992 PMCID: PMC7735928 DOI: 10.7499/j.issn.1008-8830.2007065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 11/04/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To investigate the incidence rate of infectious diseases during hospitalization in late preterm infants in Beijing, China, as well as the risk factors for infectious diseases and the effect of breastfeeding on the development of infectious diseases. METHODS Related data were collected from the late preterm infants who were hospitalized in the neonatal wards of 25 hospitals in Beijing, China, from October 23, 2015 to October 30, 2017. According to the feeding pattern, they were divided into a breastfeeding group and a formula feeding group. The two groups were compared in terms of general status and incidence rate of infectious diseases. A multivariate logistic regression analysis was used to investigate the risk factors for infectious diseases. RESULTS A total of 1 576 late preterm infants were enrolled, with 153 infants in the breastfeeding group and 1 423 in the formula feeding group. Of all infants, 484 (30.71%) experienced infectious diseases. The breastfeeding group had a significantly lower incidence rate of infectious diseases than the formula feeding group (22.88% vs 31.55%, P=0.033). The multivariate logistic regression analysis showed that breastfeeding was an independent protective factor against infectious diseases (OR=0.534, P=0.004), while male sex, premature rupture of membranes, gestational diabetes mellitus, and asphyxia were risk factors for infectious diseases (OR=1.328, 5.386, 1.535, and 2.353 respectively, P < 0.05). CONCLUSIONS Breastfeeding can significantly reduce the incidence of infectious diseases and is a protective factor against infectious diseases in late preterm infants. Breastfeeding should therefore be actively promoted for late preterm infants during hospitalization.
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Affiliation(s)
- 露艳 韩
- 清华大学第一附属医院儿科, 北京 100016Department of Pediatrics, First Hospital of Tsinghua University, Beijing 100016, China
| | - 小静 徐
- 清华大学第一附属医院儿科, 北京 100016Department of Pediatrics, First Hospital of Tsinghua University, Beijing 100016, China
| | | | | | | | | | | | | | | | - 亚波 梅
- 中国人民解放军总医院第七医学中心儿科, 北京 100710
| | - 荣 米
- 首都儿科研究所附属儿童医院儿科, 北京 100191
| | - 选光 秦
- 首都医科大学附属北京朝阳医院儿科, 北京 100043
| | - 玉环 刘
- 首都医科大学附属北京地坛医院儿科, 北京 100015
| | - 宇洁 齐
- 首都医科大学附属北京儿童医院儿科, 北京 100045
| | - 巍 张
- 首都医科大学附属北京妇产医院儿科, 北京 100026
| | - 慧慧 曾
- 首都医科大学附属北京妇产医院儿科, 北京 100026
| | - 红 崔
- 首都医科大学附属北京友谊医院儿科, 北京 100050
| | - 卉 龙
- . 中国人民解放军总医院第一医学中心儿科, 北京 100853
| | - 果 郭
- 中国人民解放军总医院第五医学中心, 北京 100039
| | - 旭琳 陈
- 中国人民解放军总医院第三医学中心, 北京 100101
| | - 召意 杨
- 中国人民解放军总医院第六医学中心儿科, 北京 100048
| | | | | | - 长燕 王
- 中国医学科学院北京协和医学院北京协和医院儿科, 北京 100730
| | - 正红 李
- 中国医学科学院北京协和医学院北京协和医院儿科, 北京 100730
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Giraldo Montoya DI, López Herrera FE, Quirós Jaramillo AM, Agudelo Gómez A, Sierra Cano SM, Agudelo Restrepo D. Breastfeeding abandonment causes and success factors in relactation. AQUICHAN 2020. [DOI: 10.5294/aqui.2020.20.3.6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Objective: To identify the causes of breastfeeding abandonment and the success factors associated with relactation in mothers with children attended in a specialised health institution.
Methodology: Descriptive transversal design through non-probabilistic convenience sampling, with 100 mothers and their children. A structured survey was used and central tendency measurements and frequencies were analysed. The study was approved by the Ethics committee of the School of Health Sciences at the University Pontificia Bolivariana.
Results: The average age was 26.8 years; 73 % had a low socioeconomic level; 59 % were cohabitating; 46 % were housewives; 32 % had a high school degree; 57 % were first-time mothers; 74 % had a high obstetric risk; and 59 % had children by caesarean section. Causes of breastfeeding abandonment were newborn hospitalization (79 %) and low birth weight (52 %). Health professionals suggested substitutes for hypogalactia in 18 % of the mothers. Incorrect maternal posture: 66.1 and 61 % with no previous experience. Relactation success factors were: chronological age under one month (48 %); effective newborn breast sucking (89 %); good newborn breast grasping (71 %). During the non-breastfeeding period, 72 % received mixed milk, 82 % did not breastfeed between 8 and 30 days, 98 % of the mothers were willing to relactate, 91 % considered the support of their families and health professionals as good.
Conclusion: Children hospitalization was the main cause of breastfeeding abandonment and the main success factors for relactation were effective breast sucking, mothers’ readiness and support.
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Nakamura K, Matsumoto N, Nakamura M, Takeuchi A, Kageyama M, Yorifuji T. Exclusively Breastfeeding Modifies the Adverse Association of Late Preterm Birth and Gastrointestinal Infection: A Nationwide Birth Cohort Study. Breastfeed Med 2020; 15:509-515. [PMID: 32543213 DOI: 10.1089/bfm.2020.0064] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Introduction: Late preterm infants (LPIs) are at greater risk for short- and long-term morbidity compared with term infants. However, little is known about whether breastfeeding can reduce the adverse effect of late preterm (LP) birth on various diseases. Therefore, we examined the association of LP birth with the risk of hospitalizations from 6 to 18 months of age, then explored the possible modification of this effect by breastfeeding. Materials and Methods: Data were extracted from a nationwide population-based longitudinal survey in Japan. We restricted our analysis to term and LPIs with information on hospitalization (n = 31,578). Multivariate adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were estimated to evaluate the association between LP birth and hospitalization using term birth as the reference. We then examined whether breastfeeding status modified the potential adverse effects of LP birth on each health outcome. Results: LPIs were more likely to be hospitalized for all-cause (aOR, 1.58; 95% CI, 1.35-1.86), respiratory (aOR, 1.52; 95% CI, 1.21-1.92) and gastrointestinal infections (aOR, 1.73; 95% CI, 1.14-2.62) than term infants. While LPIs had a higher risk of hospitalization for all-cause and respiratory infection regardless of breastfeeding status, we did not observe an increased risk of hospitalization for gastrointestinal infection among the exclusively breastfed LPIs, in contrast with increased risk among the non-exclusively breastfed LPIs. Conclusions: We found that LPIs had a higher risk of all-cause and cause-specific hospitalization compared with term infants. Moreover, exclusive breastfeeding probably reduced the adverse effect of LP birth on gastrointestinal infection.
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Affiliation(s)
- Kazue Nakamura
- Department of Epidemiology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan.,Division of Neonatology, Okayama Medical Center, National Hospital Organization, Okayama, Japan
| | - Naomi Matsumoto
- Department of Epidemiology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Makoto Nakamura
- Division of Neonatology, Okayama Medical Center, National Hospital Organization, Okayama, Japan
| | - Akihito Takeuchi
- Division of Neonatology, Okayama Medical Center, National Hospital Organization, Okayama, Japan
| | - Misao Kageyama
- Division of Neonatology, Okayama Medical Center, National Hospital Organization, Okayama, Japan
| | - Takashi Yorifuji
- Department of Epidemiology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
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Influence of NICU Nurse Education on Intention to Support Lactation Using Tailored Techniques: A Pilot Study. Adv Neonatal Care 2020; 20:314-323. [PMID: 31990695 DOI: 10.1097/anc.0000000000000702] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Preterm infants' outcomes improve when fed their mothers' milk. Low percentages of neonatal intensive care unit (NICU) nurses support mothers facing barriers to establishing and sustaining adequate milk supplies. Nurses' motivations and attitudes are instrumental, but understudied, factors in their intention to promote maternal lactation. PURPOSE Using the Theory of Reasoned Action, this study explored (1) NICU nurses' attitudes, social pressures, feelings of preparedness, perceptions of comfort, and intention to support lactation; and (2) magnitude of relationships among these concepts before and after undertaking an educational module. METHODS A descriptive pre-/postintervention design included a sample of 24 NICU nurses who completed a module, including general lactation and hands-on expressing information. The Nursing Support for Breastfeeding Questionnaire was administered before and after completing the module. RESULTS Attitudes, social norms, perception of preparedness, and intention were moderate to high before and after completion of the module. Perception of comfort was moderate. When comparing pre- and postintervention, effect sizes for intention and perception of comfort were moderate. Magnitude of the relationship between attitudes and intention was strong before intervention and moderate after intervention. Subjective norms demonstrated stronger relationships with attitudes and intention after intervention. Preparedness and comfort had stronger relationships with attitudes than with intention both before and after intervention. IMPLICATIONS FOR PRACTICE Nurses' attitudes, perception of preparedness, and comfort are modifiable considerations in developing strategies to support evidence-based lactation techniques. IMPLICATIONS FOR RESEARCH Additional studies are needed with fully powered and stronger designs to validate findings to guide interventions for nurse support for NICU mothers to optimize lactation.
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Zhang B, Duan Z, Zhao Y, Williams S, Wall S, Huang L, Zhang X, Wu W, Yue J, Zhang L, Liu J, Zhao G. Intermittent kangaroo mother care and the practice of breastfeeding late preterm infants: results from four hospitals in different provinces of China. Int Breastfeed J 2020; 15:64. [PMID: 32680538 PMCID: PMC7367356 DOI: 10.1186/s13006-020-00309-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 07/09/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND China has an extremely low exclusive breastfeeding rate. Kangaroo mother care (KMC) has been shown to increase the exclusive breastfeeding rate among infants born extremely or very preterm. However, there is limited evidence surrounding intermittent KMC and exclusive breastfeeding in late preterm infants. In our study we investigated the association between the provision of intermittent KMC and breastfeeding practice for late preterm infants in four hospitals in different provinces of China. METHODS Intermittent KMC was recommended to the mothers of all preterm infants admitted to the postnatal wards of participating hospitals between March 2018 and March 2019. Those who agreed to practice KMC were enrolled in the "KMC group", those who did not were enrolled in the "No KMC group". Basic maternal socio-demographic information was collected, feeding practice; outcome and method, were recorded daily whilst in hospital. A follow-up survey of feeding practice was conducted 42 days after discharge. Calculations for feeding practice were performed separately for both groups. Logistics regression was used to analyze the association between KMC and feeding outcome and method, adjusting for socio-demographic covariates. RESULTS Among the 844 mothers participating in the study, 627 (74.3%) chose to perform KMC. More of the mothers who provided KMC were exclusively breast milk feeding their infants in the 24 h before hospital discharge (54.6%) and at follow-up (57.3%), compared to mothers who did not provide KMC (34.6% at discharge and 33.2% at follow-up,). Mothers in the KMC group were more likely to be breastfeeding (method) than mothers in the No KMC group (65.3% vs. 52.1% at discharge, and 83.1% vs. 67.3% at follow up). Logistic regression indicated that compared with the No KMC group, mothers who provided KMC were twice as likely to be exclusively breast milk feeding their infants at discharge (OR = 2.15 (95% CI 1.53, 3.02)), use breastfeeding method at discharge as opposed to other means such as bottle or cup feeding (OR = 1.61 (95% CI 1.15, 2.25)), be exclusive breast milk feeding at follow-up (OR = 2.55 (95% CI 1.81, 3.61)), and use breastfeeding method at follow-up (OR = 2.09 (95% CI 1.44, 3.02)). CONCLUSIONS Intermittent KMC was associated with a nearly doubled increase in exclusive breast milk feeding (outcome) and breastfeeding (method) at both discharge and 42 days after discharge for late preterm infants. This is especially important in China where exclusive breastfeeding rates are low, intermittent KMC provides a feasible means to increase the likelihood of these vulnerable infants receiving the benefits of exclusive breastmilk.
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Affiliation(s)
- Bo Zhang
- Peking University First Hospital, 1 Xi'anmen St, Xicheng, Beijing, China
| | - Zhiying Duan
- Peking University First Hospital, 1 Xi'anmen St, Xicheng, Beijing, China
| | - Yingxi Zhao
- University of Oxford Nuffield Department of Medicine, Oxford, UK
| | | | - Stephen Wall
- Save the Children Saving Newborn Lives, Washington, DC, USA
| | - Limin Huang
- Hunan Provincial Maternal and Child Health Hospital, Changsha, Hunan, China
| | - Xiaoqin Zhang
- Northwest Women & Children Hospital Department of Obstetrics, Xi'an, Shaanxi, China
| | - Wenli Wu
- Linyi Maternity and Child Health Hospital, Linyi, Shandong, China
| | - Jieya Yue
- Peking University First Hospital, 1 Xi'anmen St, Xicheng, Beijing, China
| | | | - Jun Liu
- Peking University First Hospital, 1 Xi'anmen St, Xicheng, Beijing, China.
| | - Gengli Zhao
- Peking University First Hospital, 1 Xi'anmen St, Xicheng, Beijing, China.
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Pemo K, Phillips D, Hutchinson AM. Midwives’ perceptions of barriers to exclusive breastfeeding in Bhutan: A qualitative study. Women Birth 2020; 33:e377-e384. [DOI: 10.1016/j.wombi.2019.07.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 07/07/2019] [Accepted: 07/08/2019] [Indexed: 02/04/2023]
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30
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Asadi G, Aslani A, Nayebinia AS, Fathnezhad-Kazemi A. Explaining breastfeeding experiences and assessing factors affecting breastfeeding self-efficacy in mothers of premature infants: a mixed method study protocol. Reprod Health 2020; 17:42. [PMID: 32183866 PMCID: PMC7079430 DOI: 10.1186/s12978-020-0895-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 03/09/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Breastfeeding has a great effect on health promotion and disease prevention in premature infants. However, various factors affect the success of breastfeeding process in mothers. The present study aims to: a) explain breastfeeding experiences; b) assess the factors affecting breastfeeding self-efficacy; and c) present a guideline for promoting breastfeeding in mothers of premature infants. METHODS This mixed-methods study with a sequential explanatory design consisted of three phases. The first phase is qualitative study to explore the breastfeeding experiences in mothers of premature infants. In this phase, the subjects will be selected through purposive sampling; moreover, in-depth individual interviewing will be used for data collection. Finally, the conventional content analysis approach will be employed for data analysis. The second phase is quantitative and will be used a cross-sectional approach to assess the association of the social determinants of health with breastfeeding self-efficacy in mothers of premature infants. In this phase, the multistage cluster sampling method will be used to select 360 subjects who will be visited healthcare centers in Tabriz, Iran. The third phase focused on developing strategies to increase the ability of mothers to breastfeed their premature infants, using the qualitative and quantitative results of previous phases, a review of the related literature, and the nominal group technique will be performed among experts. DISCUSSION The present research is the first study that investigated the experiences of breastfeeding and factors influencing breastfeeding self-efficacy in mothers of premature infants. For the purposes of the study, the mixed methods approach will be used which aimed to develop strategies for the improvement of healthcare services in this regard. It is worth noting that there is no strategic guideline in Iran's healthcare system for the improvement of breastfeeding, especially regarding mothers of premature infants. Therefore, it is hoped that the strategy proposed in the current study can lead to improvements in this regard. ETHICAL CODE IR.TBZMED.REC.1398.100.
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Affiliation(s)
- Gholamreza Asadi
- Department of Pediatric, Tabriz Branch, Islamic Azad University, Tabriz, Iran
| | - Armin Aslani
- Student Research Committee, Islamic Azad University, Tabriz branch, Tabriz, Iran
| | - Anvar-Sadat Nayebinia
- Department of Midwifery, College of Nursing & Midwifery, Clinical Cares and Health Promotion Research Center, Karaj Branch, Islamic Azad University, Karaj, Iran
| | - Azita Fathnezhad-Kazemi
- Reproductive Health, Department of Midwifery, Tabriz Branch, Islamic Azad University, Tabriz, Iran.
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Moreira TB, Silva LRD, Silva MDB, Silva LJD, Mourão PP, Moreira APA. Vivência materna no contexto da amamentação do recém-nascido hospitalizado e submetido à intervenção cirúrgica. ESCOLA ANNA NERY 2020. [DOI: 10.1590/2177-9465-ean-2019-0281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
RESUMO Objetivo Descrever a vivência materna no contexto da amamentação do filho recém-nascido, hospitalizado em Unidade de Terapia Intensiva Neonatal (UTIN) e submetido à intervenção cirúrgica. Método Pesquisa de abordagem qualitativa, descritiva e exploratória, realizada em um Instituto Federal do Rio de Janeiro, através de entrevistas audiogravadas com oito mulheres que vivenciaram a amamentação de filhos hospitalizados, para o tratamento dos dados foi utilizado a análise de conteúdo modalidade temática. Resultados Por meio da análise de conteúdo modalidade temática foram elaboradas três categorias: Enfrentando dificuldades na amamentação diante da hospitalização e cirurgia do filho; construindo vínculo com o filho diante de condições limitantes do colo e do peito; necessitando de apoio para amamentar o filho submetido à cirurgia. Conclusões e Implicações para a prática O vínculo materno deve ser sempre estimulado em todos os cenários de cuidado neonatal, principalmente em situações de maior vulnerabilidade que podem interferir dificultando o processo de amamentação como a hospitalização para realização de procedimento cirúrgico. Diálogo e processos conjuntos entre os setores de apoio as lactantes e recém-nascidos fortalecem a segurança materna, tornando evidente a importância da troca de experiências entre as equipes para construção do acolhimento, incentivo e apoio a essa nutriz e seu filho.
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Lomotey AY, Bam V, Diji AK, Asante E, Asante HB, Osei J. Experiences of mothers with preterm babies at a Mother and Baby Unit of a tertiary hospital: A descriptive phenomenological study. Nurs Open 2020; 7:150-159. [PMID: 31871698 PMCID: PMC6917974 DOI: 10.1002/nop2.373] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 08/10/2019] [Accepted: 08/22/2019] [Indexed: 11/08/2022] Open
Abstract
Aim To describe the lived experiences of mothers with preterm babies at a Mother and Baby Unit (MBU) of a tertiary hospital. Design A descriptive phenomenological approach. Method Ten mothers were purposively sampled during the month of May, 2017 to describe their experiences of having preterm babies. Recorded in-depth individual interviews were transcribed verbatim; codes were generated and inductively organised into themes. Results Four themes were actively generated: 'Emotional experiences of mothers', 'Mother-baby interaction', 'Perception on care and support' and 'Challenges within Mother and Baby Unit environment'. Mothers were anxious about the premature delivery and were afraid of possible infant's death. They cherished interactions with their babies during kangaroo mother care and breastfeeding. Mothers applauded the nurses for their professional competence. They expressed concerns about inadequate accommodation, high cost of care, the frequency and duration of mother-baby interactions.
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Affiliation(s)
| | - Victoria Bam
- Department of NursingP. M. B., U. P. O.KNUST‐KumasiGhana
| | | | - Ernest Asante
- Department of NursingP. M. B., U. P. O.KNUST‐KumasiGhana
| | | | - Joyce Osei
- Department of NursingP. M. B., U. P. O.KNUST‐KumasiGhana
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Yang Y, Brandon D, Lu H, Cong X. Breastfeeding experiences and perspectives on support among Chinese mothers separated from their hospitalized preterm infants: a qualitative study. Int Breastfeed J 2019; 14:45. [PMID: 31695726 PMCID: PMC6824106 DOI: 10.1186/s13006-019-0242-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 10/14/2019] [Indexed: 12/19/2022] Open
Abstract
Background Chinese mothers of preterm infants often face obstacles to breastfeeding and commonly experience prolonged maternal-infant separation when their high-risk infants are hospitalized in a Neonatal Intensive Care Unit (NICU). This separation hinders mother-infant attachment and the establishment of breastfeeding. Currently, little is known about Chinese mothers’ experiences breastfeeding their preterm infants, or their support needs. The aim of this study was to develop an understanding of mothers’ experiences breastfeeding a hospitalized preterm infant and the support needed to establish a milk supply during the period separation from their infants. Methods A qualitative descriptive study was conducted in Beijing in 2017. A total of 11 Chinese mothers were individually interviewed while separated from their infants. The interviews were audio-recorded and transcribed verbatim. A thematic analysis involving a seven-step protocol identified key themes. Results Mothers of preterm infants reported physically and mentally challenging breastfeeding experiences during the period they were separated from their babies. They viewed expressing breast milk as integral to their maternal role, even though some found expressing breastmilk exhausting. With little professional support available, the mothers depended upon nonprofessionals to establish breastfeeding. Conclusions The study identified the difficulties mothers experienced establishing a milk supply while separated from their preterm infants, and the importance of access to health professional support.
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Affiliation(s)
- Yuanyuan Yang
- 1Peking University School of Nursing, 38 Xueyuan Road, Haidian District, Beijing, 100191 China
| | - Debra Brandon
- 2Duke University School of Nursing, 307 Trent Drive, Durham, NC 27710 USA
| | - Hong Lu
- 1Peking University School of Nursing, 38 Xueyuan Road, Haidian District, Beijing, 100191 China
| | - Xiaomei Cong
- 3University of Connecticut School of Nursing, 231 Glenbrook Road, Storrs, CT 06269-4026 USA
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Feasibility of Standardized Human Milk Collection in Neonatal Care Units. Sci Rep 2019; 9:14343. [PMID: 31586132 PMCID: PMC6778269 DOI: 10.1038/s41598-019-50560-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 09/11/2019] [Indexed: 01/21/2023] Open
Abstract
Research in human lactation is a growing field. However, difficulties in studying human milk originate from the dynamicity of its composition. Using standardized collection protocols is mandatory to minimize variation and warrant comparability of findings across different studies. Yet, information on the feasibility of collecting human milk with standardized procedures, especially in neonatal units, are lacking. The present study aims to report on the feasibility and difficulties to collect human milk according to a standardized protocol, during early lactation from women who gave birth to preterm infants. Human milk was collected from 129 mothers of moderate- to late-preterm infants according to two variations of a standard protocol which differed for number of collection time-points. Collection rates and adherence to the sampling protocol were evaluated together with reason for missed collection. Collection of ≥1 sample was successful for 80% of the mothers. However adherence to the standard protocol was overall low (36% and 27%). Collection rates were different between the two protocol variations (73% against 92%, p ≤ 0.001). Amongst the reason for missed collection, low milk supply was the most recurrent (40%). Our findings show that while collecting human milk in neonatal units is achievable, obtaining standard and comparable samples results challenging.
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Duran S, Kaynak S, Karadaş A. The relationship between breastfeeding attitudes and perceived stress levels of Turkish mothers. Scand J Caring Sci 2019; 34:456-463. [PMID: 31487080 DOI: 10.1111/scs.12749] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 08/09/2019] [Indexed: 11/30/2022]
Abstract
AIMS In the present study, it was aimed to investigate the relationships between breastfeeding attitude and perceived stress levels of Turkish mothers. METHODS In this descriptive study, the Personal Information Form prepared by the researchers, Perceived Stress Scale (PSS) and Iowa Infant Feeding Attitude Scale (IIFAS) were used to collect the study data. The present study included 788 mothers having 0-6 month-old infants. The data obtained were with the independent t-test, one-way ANOVA and Pearson correlation analyses. FINDINGS The mean scores of the participants obtained from the PSS and IIFAS were 25.60 ± 7.3 and 61 ± 6.6, respectively. At the end of the correlation analysis, it was observed that breastfeeding attitude decreased as the perceived stress level increased in mothers. CONCLUSIONS The results of the research indicated that as the perceived stress levels of mothers in the postpartum period increased, their breastfeeding attitudes decreased. It is suggested that nurses should support women by providing education and counselling during pregnancy and postpartum period.
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Affiliation(s)
- Songül Duran
- Elderly Care Program, Demokrasi University Vocational School of Health Services, İzmir, Turkey
| | - Serap Kaynak
- Department of Nursing, Balıkesir University Faculty of Health, Balıkesir, Turkey
| | - Ayşe Karadaş
- Department of Nursing, Balıkesir University School of Health, Balıkesir, Turkey
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Mitha A, Piedvache A, Khoshnood B, Fresson J, Glorieux I, Roué JM, Blondel B, Durox M, Burguet A, Ancel PY, Kaminski M, Pierrat V. The impact of neonatal unit policies on breast milk feeding at discharge of moderate preterm infants: The EPIPAGE-2 cohort study. MATERNAL AND CHILD NUTRITION 2019; 15:e12875. [PMID: 31310706 DOI: 10.1111/mcn.12875] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 06/26/2019] [Accepted: 07/09/2019] [Indexed: 01/30/2023]
Abstract
Facilitating factors and barriers to breast milk feeding (BMF) for preterm infants have been mainly studied in very preterm populations, but little is known about moderate preterm infants. We aimed to analyze hospital unit characteristics and BMF policies associated with BMF at discharge for infants born at 32 to 34 weeks' gestation. EPIPAGE-2, a French national cohort of preterm births, included 883 infants born at 32 to 34 weeks' gestation. We investigated kangaroo care in the first 24 hr, early involvement of parents in feeding support, volume of the unit, BMF information given to mothers hospitalized for threatened preterm delivery, protocols for BMF, presence of a professional trained in human lactation, unit training in neurodevelopmental care, and regional BMF initiation rates in the general population. Multilevel logistic regression analysis was used to investigate associations between unit policies and BMF at discharge, adjusted for individual characteristics and estimating odds ratios (ORs) and 95% confidence intervals (CIs). Overall, 59% (490/828) of infants received BMF at discharge (27% to 87% between units). Rates of BMF at discharge were higher with kangaroo care (adjusted OR 2.03 [95% CI 1.01, 4.10]), early involvement of parents in feeding support (1.94 [1.23, 3.04]), unit training in a neurodevelopmental care programme (2.57 [1.18, 5.60]), and in regions with a high level of BMF initiation in the general population (1.85 [1.05, 3.28]). Creating synergies by interventions at the unit and population level may reduce the variability in BMF rates at discharge for moderate preterm infants.
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Affiliation(s)
- Ayoub Mitha
- French National Institute of Health and Medical Research Unit 1153, Obstetrical, Perinatal, and Pediatric Epidemiology Team, Centre of Research in Epidemiology and Statistics Sorbonne Paris Cité, Paris Descartes University, Paris, France.,Department of Neonatal Medicine, CHU Lille, Jeanne de Flandre Hospital, Lille, France
| | - Aurélie Piedvache
- French National Institute of Health and Medical Research Unit 1153, Obstetrical, Perinatal, and Pediatric Epidemiology Team, Centre of Research in Epidemiology and Statistics Sorbonne Paris Cité, Paris Descartes University, Paris, France
| | - Babak Khoshnood
- French National Institute of Health and Medical Research Unit 1153, Obstetrical, Perinatal, and Pediatric Epidemiology Team, Centre of Research in Epidemiology and Statistics Sorbonne Paris Cité, Paris Descartes University, Paris, France
| | - Jeanne Fresson
- French National Institute of Health and Medical Research Unit 1153, Obstetrical, Perinatal, and Pediatric Epidemiology Team, Centre of Research in Epidemiology and Statistics Sorbonne Paris Cité, Paris Descartes University, Paris, France.,Department of Clinical Epidemiology and Biostatistics, CHRU Nancy, Nancy, France
| | - Isabelle Glorieux
- Department of Neonatology, Toulouse University Hospital, Toulouse, France
| | - Jean-Michel Roué
- Department of Neonatal Pediatrics and Intensive Care, Brest University Hospital, Brest, France
| | - Béatrice Blondel
- French National Institute of Health and Medical Research Unit 1153, Obstetrical, Perinatal, and Pediatric Epidemiology Team, Centre of Research in Epidemiology and Statistics Sorbonne Paris Cité, Paris Descartes University, Paris, France
| | - Mélanie Durox
- French National Institute of Health and Medical Research Unit 1153, Obstetrical, Perinatal, and Pediatric Epidemiology Team, Centre of Research in Epidemiology and Statistics Sorbonne Paris Cité, Paris Descartes University, Paris, France
| | - Antoine Burguet
- Department of Neonatal Pediatrics, Dijon University Hospital, Dijon, France
| | - Pierre-Yves Ancel
- French National Institute of Health and Medical Research Unit 1153, Obstetrical, Perinatal, and Pediatric Epidemiology Team, Centre of Research in Epidemiology and Statistics Sorbonne Paris Cité, Paris Descartes University, Paris, France.,Clinical Research Unit, Center for Clinical Investigation P1419, Cochin Broca Hôtel-Dieu Hospital, Paris, France
| | - Monique Kaminski
- French National Institute of Health and Medical Research Unit 1153, Obstetrical, Perinatal, and Pediatric Epidemiology Team, Centre of Research in Epidemiology and Statistics Sorbonne Paris Cité, Paris Descartes University, Paris, France
| | - Véronique Pierrat
- French National Institute of Health and Medical Research Unit 1153, Obstetrical, Perinatal, and Pediatric Epidemiology Team, Centre of Research in Epidemiology and Statistics Sorbonne Paris Cité, Paris Descartes University, Paris, France.,Department of Neonatal Medicine, CHU Lille, Jeanne de Flandre Hospital, Lille, France
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Hilditch C, Howes A, Dempster N, Keir A. What evidence-based strategies have been shown to improve breastfeeding rates in preterm infants? J Paediatr Child Health 2019; 55:907-914. [PMID: 31228328 DOI: 10.1111/jpc.14551] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Revised: 05/07/2019] [Accepted: 05/31/2019] [Indexed: 12/01/2022]
Abstract
Breast milk is the preferred form of nutrition for all infants and has been shown to reduce morbidity and improve health outcomes in preterm infants. However, mothers of preterm infants face many challenges initiating and sustaining breastfeeding within the neonatal unit. This scoping review examines evidence-based practices which aim to improve breastfeeding rates in preterm infants at the time of hospital discharge. A literature review identified 17 articles which are included in this review. Supporting evidence was found for the implementation of kangaroo mother care and/or skin-to-skin care, peer counsellors, provision of oropharyngeal colostrum in early infancy and use of donor human milk banks. However, overall it is apparent that high quality research including systematic review and data synthesis in the form of meta-analysis is required in this area to reach sound conclusions regarding recommendations of different interventions. This scoping review provides an important foundation for further research into this area.
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Affiliation(s)
- Cathie Hilditch
- Healthy Mothers, Babies and Children Theme, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia.,Adelaide Medical School and Robinson Research Institute, University of Adelaide, Adelaide, South Australia, Australia.,Department of Neonatal Medicine, Women's and Children's Hospital Network, Adelaide, South Australia, Australia
| | - Alexander Howes
- Department of Neonatal Medicine, Women's and Children's Hospital Network, Adelaide, South Australia, Australia
| | - Natalie Dempster
- Department of Neonatal Medicine, Women's and Children's Hospital Network, Adelaide, South Australia, Australia
| | - Amy Keir
- Healthy Mothers, Babies and Children Theme, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia.,Adelaide Medical School and Robinson Research Institute, University of Adelaide, Adelaide, South Australia, Australia.,Department of Neonatal Medicine, Women's and Children's Hospital Network, Adelaide, South Australia, Australia
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Feeding the Late and Moderately Preterm Infant: A Position Paper of the European Society for Paediatric Gastroenterology, Hepatology and Nutrition Committee on Nutrition. J Pediatr Gastroenterol Nutr 2019; 69:259-270. [PMID: 31095091 DOI: 10.1097/mpg.0000000000002397] [Citation(s) in RCA: 79] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Nutritional guidelines and requirements for late or moderately preterm (LMPT) infants are notably absent, although they represent the largest population of preterm infants. The European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) Committee on Nutrition (CoN) performed a review of the literature with the aim to provide guidance on how to feed infants born LMPT, and identify gaps in the literature and research priorities.Only limited data from controlled trials are available. Late preterm infants have unique, often unrecognized, vulnerabilities that predispose them to high rates of nutritionally related morbidity and hospital readmissions. They frequently have feeding difficulties that delay hospital discharge, and poorer rates of breastfeeding initiation and duration compared with term infants. This review also identified that moderately preterm infants frequently exhibit postnatal growth restriction.The ESPGHAN CoN strongly endorses breast milk as the preferred method of feeding LMPT infants and also emphasizes that mothers of LMPT infants should receive qualified, extended lactation support, and frequent follow-up. Individualized feeding plans should be promoted. Hospital discharge should be delayed until LMPT infants have a safe discharge plan that takes into account local situation and resources.In the LMPT population, the need for active nutritional support increases with lower gestational ages. There may be a role for enhanced nutritional support including the use of human milk fortifier, enriched formula, parenteral nutrition, and/or additional supplements, depending on factors, such as gestational age, birth weight, and significant comorbidities. Further research is needed to assess the benefits (improved nutrient intakes) versus risks (interruption of breast-feeding) of providing nutrient-enrichment to the LMPT infant.
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Evans L, Hilditch C, Keir A. Are there interventions that improve breastfeeding and the use of breast milk in late preterm infants? J Paediatr Child Health 2019; 55:477-480. [PMID: 30957329 DOI: 10.1111/jpc.14404] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 01/15/2019] [Accepted: 01/17/2019] [Indexed: 11/28/2022]
Abstract
To answer the clinical question 'Among late preterm infants are there any interventions that improve the rates of breastfeeding and the use of breast milk compared with current practice?'. MEDLINE via Ovid, Embase via Ovid, the Maternity and Infant Care Database and the Cochrane Library were searched for relevant articles. Articles were excluded if they did not discuss specific interventions to improve breastfeeding, for example, if they only commented on factors such as age, race and education. Articles were also excluded if they were not specific to the late preterm infant population. A total of 516 articles were found and screened by title and abstract independently by two reviewers. The full text of 17 articles was independently reviewed. The reference lists of these full-text articles were screened, and 14 abstracts were subsequently reviewed. The final analysis included three studies. There is limited high-quality research evidence for interventions to improve breastfeeding in late preterm infants. In the absence of robust academic research, clinical practice should be guided by clinical expertise and involve a multidisciplinary team, including qualified lactation consultants. While it seems reasonable for hospitals to support interventions that improve breastfeeding in term infants, managing late preterm infants as healthy term infants without additional specialist support may result in high breastfeeding failure rates among late preterm infants.
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Affiliation(s)
- Louise Evans
- Department of Neonatal Medicine, Women's and Children's Hospital Network, Adelaide, South Australia, Australia
| | - Cathie Hilditch
- Department of Neonatal Medicine, Women's and Children's Hospital Network, Adelaide, South Australia, Australia.,Healthy Mothers, Babies and Children Theme, South Australian Health, Medical Research Institute, Adelaide, South Australia, Australia.,Adelaide Medical School and the Robinson Research Institute, University of Adelaide, Adelaide, South Australia, Australia
| | - Amy Keir
- Department of Neonatal Medicine, Women's and Children's Hospital Network, Adelaide, South Australia, Australia.,Healthy Mothers, Babies and Children Theme, South Australian Health, Medical Research Institute, Adelaide, South Australia, Australia.,Adelaide Medical School and the Robinson Research Institute, University of Adelaide, Adelaide, South Australia, Australia
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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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Giannì ML, Bezze E, Colombo L, Rossetti C, Pesenti N, Roggero P, Sannino P, Muscolo S, Plevani L, Mosca F. Complementary Feeding Practices in a Cohort of Italian Late Preterm Infants. Nutrients 2018; 10:nu10121861. [PMID: 30513799 PMCID: PMC6316424 DOI: 10.3390/nu10121861] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 11/22/2018] [Accepted: 11/24/2018] [Indexed: 12/30/2022] Open
Abstract
Limited data are available on complementary feeding in preterm infants, who show increased nutritional needs and are at risk of altered postnatal growth. The aim of this study was to investigate the timing and content of complementary feeding in a cohort of late preterm infants. We conducted a prospective, observational study, including mothers who had given birth to infants admitted to level I or II of care with a gestational age between 34 and 36 weeks. Mothers were contacted at 3, 6 and 12 months after delivery by phone calls and were asked about their infant’s mode of feeding and the timing and schedule of the introduction of different solid foods types. A total of 49 mothers and 57 infants completed the study. The mean postnatal age of the introduction of complementary foods was 5.7 ± 0.7 months. Low energy and/or low protein-dense foods were first introduced in most infants. Fruit as the first type of complementary food in the infant’s diet was associated with a 1.6-month advance in initiating complementary feeding. The present findings provide further insight into complementary feeding practices in late preterm infants and underline the need for specific recommendations addressing this vulnerable population.
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Affiliation(s)
- Maria L Giannì
- Neonatal Intensive Care Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, via Commenda 12, 20122 Milan, Italy.
- Department of Clinical Sciences and Community Health, University of Milan, Via San Barnaba 8, 20122 Milan, Italy.
| | - Elena Bezze
- Neonatal Intensive Care Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, via Commenda 12, 20122 Milan, Italy.
| | - Lorenzo Colombo
- Neonatal Intensive Care Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, via Commenda 12, 20122 Milan, Italy.
| | - Camilla Rossetti
- Neonatal Intensive Care Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, via Commenda 12, 20122 Milan, Italy.
| | - Nicola Pesenti
- Neonatal Intensive Care Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, via Commenda 12, 20122 Milan, Italy.
| | - Paola Roggero
- Neonatal Intensive Care Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, via Commenda 12, 20122 Milan, Italy.
- Department of Clinical Sciences and Community Health, University of Milan, Via San Barnaba 8, 20122 Milan, Italy.
| | - Patrizio Sannino
- S.I.T.R.A. Basic Education Sector, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 28, 20122 Milan, Italy.
| | - Salvatore Muscolo
- Neonatal Intensive Care Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, via Commenda 12, 20122 Milan, Italy.
| | - Laura Plevani
- Neonatal Intensive Care Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, via Commenda 12, 20122 Milan, Italy.
| | - Fabio Mosca
- Neonatal Intensive Care Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, via Commenda 12, 20122 Milan, Italy.
- Department of Clinical Sciences and Community Health, University of Milan, Via San Barnaba 8, 20122 Milan, Italy.
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Mosca F, Roggero P, Garbarino F, Morniroli D, Bracco B, Morlacchi L, Mallardi D, Gianni ML, Consonni D. Determinants of breastfeeding discontinuation in an Italian cohort of mother-infant dyads in the first six months of life: a randomized controlled trial. Ital J Pediatr 2018; 44:134. [PMID: 30400806 PMCID: PMC6219192 DOI: 10.1186/s13052-018-0572-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 10/16/2018] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Among breastfeeding determinants, the marketing of breast milk substitutes might contribute to suboptimal breastfeeding rates. The aim of this study was to investigate the effect of receiving information on breast milk substitutes on breastfeeding rates. METHODS We conducted a randomized, single-blind, controlled trial from 2012 to 2014 in a northern Italian maternity ward. We enrolled 802 Caucasian mothers who gave birth to healthy, full-term singletons with a birth weight > 2500 g and who were exclusively breastfeeding from delivery to discharge. Mothers who gave birth to infants with congenital diseases, chromosomal abnormalities, perinatal infections and/or cardio-respiratory instability and/or mothers being affected by endocrine and/or metabolic and/or gastrointestinal and/or renal diseases were excluded. Mothers were randomized to either receive (group A, n = 405) or not (group B, n = 397) written information on a breast milk substitute at discharge. Breastfeeding was promoted and supported in all mother-infant pairs equally. The mode of feeding for up to 6 months after delivery was determined by phone interview. To detect a 10% difference between groups in the discontinuation rate of exclusive breastfeeding at three months of age at 5% significance and 80% power, a total of 356 mother-infant pairs per group were needed. RESULTS The exclusive breastfeeding prevalence was 91% and 92% at 7 days, 79% and 70% at 1 month, 75% and 66% at 2 months, 72% and 62% at 3 months, and 3% and 2% at 6 months in groups A and B, respectively. The relative risk (95% confidence interval) of exclusive breastfeeding (group A vs B) at 7 days and at 1, 2, 3 and 6 months was as follows: 0.99 (0.95-1.03), 1.12 (1.03-1.21), 1.13 (1.03-1.24), 1.15 (1.04-1.27), and 1.49 (0.62-3.61). Nutritional, lifestyle and lactational factors were the primary contributing determinants to early breastfeeding discontinuation. CONCLUSIONS The present findings indicate that receiving written information on breast milk substitutes at hospital discharge, provided that breastfeeding support and education are offered, does not negatively affect breastfeeding rates. TRIAL REGISTRATION NCT03208114. Registered 5 July 2017.
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Affiliation(s)
- Fabio Mosca
- NICU Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, via Commenda 12, Milano, Italy
- Department of Clinical Sciences and Community Health, University of Milan, via San Barnaba 8, 20122 Milan, Italy
| | - Paola Roggero
- NICU Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, via Commenda 12, Milano, Italy
- Department of Clinical Sciences and Community Health, University of Milan, via San Barnaba 8, 20122 Milan, Italy
| | - Francesca Garbarino
- NICU Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, via Commenda 12, Milano, Italy
- Department of Clinical Sciences and Community Health, University of Milan, via San Barnaba 8, 20122 Milan, Italy
| | - Daniela Morniroli
- NICU Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, via Commenda 12, Milano, Italy
- Department of Clinical Sciences and Community Health, University of Milan, via San Barnaba 8, 20122 Milan, Italy
| | - Beatrice Bracco
- NICU Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, via Commenda 12, Milano, Italy
| | - Laura Morlacchi
- NICU Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, via Commenda 12, Milano, Italy
| | - Domenica Mallardi
- NICU Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, via Commenda 12, Milano, Italy
| | - Maria Lorella Gianni
- NICU Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, via Commenda 12, Milano, Italy
- Department of Clinical Sciences and Community Health, University of Milan, via San Barnaba 8, 20122 Milan, Italy
| | - Dario Consonni
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico Epidemiology Unit, via San Barnaba 8, 20122 Milan, Italy
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Kandeel WA, Rabah TM, Zeid DA, El-Din EMS, Metwally AM, Shaalan A, El Etreby LA, Shaaban SY. Determinants of Exclusive Breastfeeding in a Sample of Egyptian Infants. Open Access Maced J Med Sci 2018; 6:1818-1823. [PMID: 30455755 PMCID: PMC6236050 DOI: 10.3889/oamjms.2018.359] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Revised: 09/04/2018] [Accepted: 09/09/2018] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Breastfeeding is an optimum, healthy, and economical mode of feeding an infant. However, many preventable obstacles hinder exclusive breastfeeding in the first six months of life. AIM We aimed to assess the social-, maternal- and infant-related factors disturbing exclusive breastfeeding in the first six months of life. METHODS It is a retrospective study included 827 dyads of mothers and infants older than 6 months (411 exclusively breastfed, 311 artificially-fed and 105 mixed feds). Mothers were interviewed to obtain sociodemographic information, maternal medical history and perinatal history and a detailed history of infant feeding. RSULTS Many factors were found to support the decision for artificial feeding rather than exclusive breastfeeding, including maternal age < 25 years (OR = 2.252), child birth order > 3rd (OR = 2.436), being a primi-para (OR = 1.878), single marital status (OR = 2.762), preterm infant (OR = 3.287) and complicated labor (OR = 1.841). Factors in favor of mixed feeding included cesarean section (OR = 2.004) and admission to the Neonatal Intensive Care Unit (OR = 1.925). CONCLUSIONS Although it isn't a community-based study and its results can't be generalised, plans to improve health and development of children are preferable to include the following: health education and awareness programs about the importance of exclusive breastfeeding should be directed for young and first-time mothers. Improved antenatal care to reduce perinatal and neonatal problems; and training, monitoring, and supervising community health care workers to recognise labour complications and provide support and knowledge to lactating mothers.
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Affiliation(s)
- Wafaa A. Kandeel
- Biological Anthropology Department, Medical Research Division, National Research Centre, Giza, Egypt
| | - Thanaa M. Rabah
- Department of Community Medicine Research, Medical Research Division, National Research Centre, Giza, Egypt
| | - Dina Abu Zeid
- Child Health Department, Medical Research Division, National Research Centre, Giza, Egypt
| | | | - Ammal M. Metwally
- Department of Community Medicine Research, Medical Research Division, National Research Centre, Giza, Egypt
| | - Ashraf Shaalan
- Biological Anthropology Department, Medical Research Division, National Research Centre, Giza, Egypt
| | - Lobna A. El Etreby
- Department of Community Medicine Research, Medical Research Division, National Research Centre, Giza, Egypt
| | - Sanaa Y. Shaaban
- Department of Pediatrics, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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Fucile S, Milutinov M, Timmons K, Dow K. Oral Sensorimotor Intervention Enhances Breastfeeding Establishment in Preterm Infants. Breastfeed Med 2018; 13:473-478. [PMID: 30113209 DOI: 10.1089/bfm.2018.0014] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To assess the efficacy of an oral sensorimotor intervention on breastfeeding establishment and maintenance in preterm infants. STUDY DESIGN Thirty-one preterm infants born ≤34 weeks gestation were randomized into an experimental or control group. The experimental group received a 15-minute program consisting of stroking the peri-oral structures for the first 5 minutes, tongue exercises for the next 5 minutes, followed by non-nutritive sucking for the final 5 minutes. The control group received a sham intervention for the same duration. The interventions were administered once daily for 10 days. The outcomes included: time to attainment of full oral feeding, breastfeeding acquisition (i.e., ≥50% of direct breastfeeding at hospital discharge), breastfeeding skill assessment using the Preterm Infant Breastfeeding Behavior Scale (PIBBS), length of hospitalization, and breastfeeding maintenance at 3 and 6 months posthospitalization. RESULTS Full oral feeding was attained earlier in the experimental group compared with the control (10.7 ± 2.1 vs. 19.3 ± 3.6 days, p < 0.01). This was associated with a greater number of infants in the intervention group acquiring breastfeeding at hospital discharge compared with the controls (n = 11 vs. 5, p = 0.049). There was no statistical difference in PIBBS score, length of hospitalization, and breastfeeding rates at 3 and 6 months posthospitalization between the two groups (all tests, p > 0.32). CONCLUSIONS An oral sensorimotor intervention accelerated the achievement of full oral feeding and enhanced direct breastfeeding rates at hospital discharge only. Provision of an oral sensorimotor intervention is a safe and low-cost intervention that may increase breastfeeding rates in a highly vulnerable population.
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Affiliation(s)
- Sandra Fucile
- Department of Pediatrics, Queen's University , Kingston, Ontario, Canada
| | - Miona Milutinov
- Department of Pediatrics, Queen's University , Kingston, Ontario, Canada
| | - Kevyn Timmons
- Department of Pediatrics, Queen's University , Kingston, Ontario, Canada
| | - Kimberly Dow
- Department of Pediatrics, Queen's University , Kingston, Ontario, Canada
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Yang Y, Li R, Wang J, Huang Q, Lu H. Knowledge of healthcare providers regarding breastfeeding preterm infants in mainland China. BMC Pediatr 2018; 18:251. [PMID: 30064391 PMCID: PMC6069978 DOI: 10.1186/s12887-018-1223-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 07/17/2018] [Indexed: 11/23/2022] Open
Abstract
Background Support from healthcare professionals has been identified as an important variable affecting successful breastfeeding in preterm infants. This study aimed to explore the knowledge of healthcare providers regarding breastfeeding preterm infants in mainland China. Methods An online cross-sectional survey of healthcare providers from 9 tertiary level neonatal intensive care units across 4 districts in mainland China was conducted from May–November, 2017. A total of 187 healthcare providers responded to the survey. Data included demographic information and current and desired knowledge about breastfeeding preterm infants. Breastfeeding knowledge was evaluated using a researcher-developed questionnaire with six domains based on breastfeeding preterm infant guidelines. Results The average percent of correctly answered questions was 53.73%. The domain with the highest mean percent was ‘indications and methods of breastfeeding’ (64.41%). The lowest scoring domain was ‘characteristics of premature human milk’ (38.83%). Knowledge score was related to the following factors: age, profession, professional title, education background and offspring amount by univariate analysis (p < 0.05). Multiple linear regression analysis found that healthcare provider breastfeeding knowledge was associated with profession (physician or nurse), professional title, sex and total offspring. In terms of training needs, 86.7% of healthcare providers reported insufficient knowledge about breastfeeding in the preterm infant population; 82.2% wanted more knowledge about indications and contraindications related to breastfeeding premature infant; and 71.7% considered expert lectures as the most effective way of acquiring additional breastfeeding knowledge. Conclusion The knowledge about breastfeeding in the preterm infant population among NICU healthcare professionals in mainland China was limited. More targeted training is needed to improve NICU healthcare provider knowledge regarding breastfeeding preterm infants.
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Affiliation(s)
- Yuanyuan Yang
- Peking University School of Nursing, #38 Xueyuan Road, Haidian District, Beijing, 100191, China
| | - Rui Li
- Peking University Third Hospital, Beijing, China
| | - Jing Wang
- Peking University Third Hospital, Beijing, China
| | - Qingying Huang
- Peking University School of Nursing, #38 Xueyuan Road, Haidian District, Beijing, 100191, China
| | - Hong Lu
- Peking University School of Nursing, #38 Xueyuan Road, Haidian District, Beijing, 100191, China.
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Mannel R, Peck JD. Outcomes Associated With Type of Milk Supplementation Among Late Preterm Infants. J Obstet Gynecol Neonatal Nurs 2018; 47:571-582. [PMID: 29287170 PMCID: PMC6021223 DOI: 10.1016/j.jogn.2017.11.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2017] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To assess whether type of milk supplementation provided to breastfeeding late preterm infants was associated with hospital length of stay (LOS) or breastfeeding status at discharge. DESIGN Retrospective chart review. SETTING Tertiary care teaching hospital in the southern United States. PARTICIPANTS Late preterm infants 35 0/7 to 36 6/7 weeks gestational age (N = 183) admitted to the mother-baby unit between November 1, 2014, and October 31, 2016. METHODS The exposure of interest was type of milk supplementation, for example, expressed human milk, pasteurized donor human milk, and formula. Outcomes measured were LOS and breastfeeding status at discharge. Generalized Poisson regression models were used to compare LOS by type of milk supplementation. Modified Poisson regression models were used to estimate risk ratios and 95% confidence intervals for associations with breastfeeding status at discharge. RESULTS The LOS for breastfed infants supplemented with expressed human milk and/or pasteurized donor human milk did not differ significantly from exclusively breastfed infants who received no supplement. Exclusively formula-fed infants had longer LOS of 3.2 days compared with 2.6 days for exclusively breastfed infants (p = .001). Breastfed infants who received any formula supplementation were 16% less likely to continue breastfeeding until day of discharge compared with breastfed infants who received human milk supplementation (risk ratio = .84, 95% confidence interval [.77, .92]). CONCLUSION The high prevalence of supplementation among breastfeeding late preterm infants underscores the potential effect of type of milk supplementation on LOS and breastfeeding outcomes. Our findings suggest that human milk supplementation discourages transition to formula feeding before hospital discharge without increasing LOS.
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Scime NV, Burke SM. Environmental Scan of Breastfeeding Resources in Canadian NICUs. J Obstet Gynecol Neonatal Nurs 2018; 47:202-213. [PMID: 29425679 DOI: 10.1016/j.jogn.2017.12.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2017] [Indexed: 01/26/2023] Open
Abstract
We conducted an environmental scan using a mixed methods approach to determine the types and frequencies of breastfeeding resources available to mothers of infants in Canadian NICUs. Through interviews with key informants from 29 Level 3 NICUs, we identified six categories of resources: breastfeeding-friendly layout, breastfeeding support personnel, breastfeeding education for mothers, breast pump-related resources, coordination of postdischarge breastfeeding support, and breastfeeding-related policies. Findings from this national study indicate that a wide range of breastfeeding resources were reportedly available in Canadian Level 3 NICUs. NICU professionals are encouraged to connect with other units across Canada to facilitate the exchange of breastfeeding resources and best practices.
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Bennett CF, Galloway C, Grassley JS. Education for WIC Peer Counselors About Breastfeeding the Late Preterm Infant. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2018; 50:198-202.e1. [PMID: 28818488 DOI: 10.1016/j.jneb.2017.05.364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 05/22/2017] [Accepted: 05/25/2017] [Indexed: 06/07/2023]
Abstract
Mothers of late preterm infants need ongoing support because they often find establishing breastfeeding (BF) to be complex and difficult. Special Supplemental Nutrition Program for Women, Infants and Children peer counselors provide BF information and emotional support to new mothers in many communities. However, their current training does not include education about BF for the late preterm infant. The purpose of this report is to present important information about BF and the late preterm infant that can enhance peer counselors' ability to offer appropriate support. The effect of this education on outcomes such as BF rates, maternal self-efficacy, infant hospital readmissions, and peer counselors' self-efficacy needs to be investigated.
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Affiliation(s)
- Cindi Faith Bennett
- Neonatal Intensive Care Unit, St Luke's Health System, Boise, ID; Neonatal Intensive Care Unit, St Luke's Children's Hospital, Boise, ID.
| | - Cynthia Galloway
- Special Supplemental Nutrition Program for Women, Infants, and Children Division of Preventive Health Services, Central District Health Department, Boise, ID
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Pike M, Kritzinger A, Krüger E. Breastfeeding Characteristics of Late-Preterm Infants in a Kangaroo Mother Care Unit. Breastfeed Med 2017; 12:637-644. [PMID: 28930483 DOI: 10.1089/bfm.2017.0055] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To describe the breastfeeding characteristics of late-preterm infants (LPIs) in a kangaroo mother care (KMC) unit. MATERIALS AND METHODS In a 20-bed KMC unit, the breastfeeding of 73 purposively-selected LPIs' (mean gestational age: 34.8 weeks) was observed once-off, using the Preterm Infant Breastfeeding Behavior Scale. Participants' mean age was 9.5 days, mean number of days in the unit was 3.1 days, and mean number of days breastfeeding was 7.5 on observation. RESULTS Only 13.7% of participants were directly breastfeeding without supplementary naso- or orogastric feeding/cup-feeding and 86.3% received supplementary cup-feeding of expressed breast milk. Most participants did not exhibit obvious rooting (83.5%) and although most latched-on (97.3%), those who did, latched shallowly (93%). The mean longest sucking burst was 18.8 (standard deviation: 10.5) and approximately half the participants swallowed repeatedly (53.4%). The mean breastfeeding session duration was 17.8 minutes, but most participants breastfed for less than 10 minutes (76.7%). No statistically significant differences in breastfeeding characteristics were detected between participants of different chronological ages. A general trend toward more mature behaviors in participants' breastfeeding for more days was present for many breastfeeding characteristics. More infants exhibited the most mature behavior for each breastfeeding characteristic when the environment was quiet, rather than noisy and disturbing, except for depth of latching (quiet: 0%, disturbance: 15.2%). CONCLUSION LPIs in this sample presented with subtle breastfeeding difficulties, highlighting their need for breastfeeding support. Further research is required to examine the effect of KMC on breastfeeding in LPIs.
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Affiliation(s)
- Melissa Pike
- Department of Speech-Language Pathology and Audiology, University of Pretoria , Pretoria, South Africa
| | - Alta Kritzinger
- Department of Speech-Language Pathology and Audiology, University of Pretoria , Pretoria, South Africa
| | - Esedra Krüger
- Department of Speech-Language Pathology and Audiology, University of Pretoria , Pretoria, South Africa
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