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Prial J, El-Shibiny H, El-Dib M, Benjamin J, Erdei C, Dodrill P, Szakmar E, Bell KA. Growth trajectories and need for oral feeding support among infants with neonatal encephalopathy treated with therapeutic hypothermia. J Perinatol 2024:10.1038/s41372-024-01983-7. [PMID: 38702507 DOI: 10.1038/s41372-024-01983-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 04/16/2024] [Accepted: 04/18/2024] [Indexed: 05/06/2024]
Abstract
OBJECTIVE Identify feeding supports required among infants with neonatal encephalopathy and determine growth trajectories to 3 years. STUDY DESIGN Single-center retrospective cohort study of 120 infants undergoing therapeutic hypothermia. Logistic regression and stratified analyses identified whether clinical factors, EEG-determined encephalopathy severity, and MRI-based brain injury predict feeding supports (nasogastric tube, oral feeding compensations) and growth. RESULTS 50.8% of infants required feeding supports in the hospital, decreasing to 14% at discharge. Moderate-to-severe encephalopathy and basal ganglia injury predicted feeding support needs. Yet, 35% of mildly encephalopathic infants required gavage tubes. Growth trajectories approximated expected growth of healthy infants. CONCLUSION Infants with neonatal encephalopathy-even if mild-frequently experience feeding difficulties during initial hospitalization. With support, most achieve full oral feeds by discharge and adequate early childhood growth. Clinical factors may help identify infants requiring feeding support, but do not detect all at-risk infants, supporting routine screening of this high-risk population.
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Affiliation(s)
- Jennifer Prial
- Division of Newborn Medicine, Department of Pediatrics, Brigham and Women's Hospital, Boston, MA, USA
| | - Hoda El-Shibiny
- Division of Newborn Medicine, Department of Pediatrics, Brigham and Women's Hospital, Boston, MA, USA
| | - Mohamed El-Dib
- Division of Newborn Medicine, Department of Pediatrics, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Jennifer Benjamin
- Division of Newborn Medicine, Department of Pediatrics, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Carmina Erdei
- Division of Newborn Medicine, Department of Pediatrics, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Pamela Dodrill
- Division of Newborn Medicine, Department of Pediatrics, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Eniko Szakmar
- Division of Newborn Medicine, Department of Pediatrics, Brigham and Women's Hospital, Boston, MA, USA
- Division of Neonatology, Pediatric Center, Semmelweis University, Budapest, Hungary
| | - Katherine A Bell
- Division of Newborn Medicine, Department of Pediatrics, Brigham and Women's Hospital, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
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Lugonja N, Marinković V, Pucarević M, Miletić S, Stojić N, Crnković D, Vrvić M. Human Milk-The Biofluid That Nourishes Infants from the First Day of Life. Foods 2024; 13:1298. [PMID: 38731669 PMCID: PMC11083309 DOI: 10.3390/foods13091298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 03/13/2024] [Accepted: 04/18/2024] [Indexed: 05/13/2024] Open
Abstract
Human milk is a biofluid with a unique composition among mammalian milks. Besides this milk's major components, its bioactive compounds, like hormones, immune factors, and oligosaccharides, are unique and important for infant growth and development. The best form of nutrition for term and preterm infants is the mother's own milk. However, in the absence of the mother's own milk, donor milk should be made available. Milk banks support neonatal intensive care units by providing preterm infants with human milk that generally has reasonable nutritive value for this sensitive population. However, neither mother's own milk nor donor milk has sufficient energy content for the growth of preterm babies, so adequate human milk supplementation is crucial for their progress. Due to the different characteristics of human breast milk, as well as ubiquitous environmental pollutants, such as microplastics, new methods are required for monitoring the quality and characteristics of human milk, which will lay a solid foundation for the further development and progress of human milk research.
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Affiliation(s)
- Nikoleta Lugonja
- Institute of Chemistry, Technology and Metallurgy, National Institute of the Republic of Serbia, University of Belgrade, Njegoševa 12, 11000 Belgrade, Serbia;
| | - Vesna Marinković
- Institute of Neonatology, Kralja Milutina 50, 11000 Belgrade, Serbia;
| | - Mira Pucarević
- Faculty of Environmental Protection, Educons University, Vojvode Putnika 87, 21208 Sremska Kamenica, Serbia; (M.P.); (N.S.); (M.V.)
| | - Srdjan Miletić
- Institute of Chemistry, Technology and Metallurgy, National Institute of the Republic of Serbia, University of Belgrade, Njegoševa 12, 11000 Belgrade, Serbia;
| | - Nataša Stojić
- Faculty of Environmental Protection, Educons University, Vojvode Putnika 87, 21208 Sremska Kamenica, Serbia; (M.P.); (N.S.); (M.V.)
| | - Dragan Crnković
- City Public Health Institute of Belgrade, Blvd. Despot Stefana 54a, 11108 Belgrade, Serbia;
| | - Miroslav Vrvić
- Faculty of Environmental Protection, Educons University, Vojvode Putnika 87, 21208 Sremska Kamenica, Serbia; (M.P.); (N.S.); (M.V.)
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3
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Kappel SS, Maastrup R, Iyore EO, Greisen G, Egeskov M, Lando A, Hansen BM. Time intervals between pumping did not affect breastmilk protein produced by mothers of preterm infants. Acta Paediatr 2024. [PMID: 38530084 DOI: 10.1111/apa.17219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 03/14/2024] [Accepted: 03/19/2024] [Indexed: 03/27/2024]
Abstract
AIM Few studies investigate factors that might influence the content of expressed breastmilk. This study aims to investigate the influence of the intervals between breastmilk pumping and the time of the day on protein and fat concentration in breastmilk. METHODS Mothers of very preterm infants in a neonatal ward who expressed more than 400 mL per day were included. Expressed breastmilk was obtained from each mother over 30 h who were pumping at strictly planned and varying intervals: 2, 3, 4 and 6 h. All samples were analysed using infrared transmission spectroscopy. RESULTS Ten mothers participated at a median of 22 days postpartum. A total of 176 milk samples were analysed, and the average protein and fat concentrations in g/100 mL were 1.1 ± 0.23 and 4.2 ± 1.3, respectively. The time intervals between breast pumping sessions did not impact protein content, but fat content decreased by longer intervals (p < 0.01). The time of the day for milk pumping did not influence the protein or fat content. CONCLUSION A single milk sample collected after any 2-6 h interval, at any time during the day, represents the protein content in the breastmilk, but not the fat content which decreased with longer intervals.
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Affiliation(s)
- Susanne S Kappel
- Department of Neonatology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Ragnhild Maastrup
- Department of Neonatology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Elisabeth O Iyore
- Department of Neonatology, Copenhagen University Hospital Herlev, Herlev, Denmark
| | - Gorm Greisen
- Department of Neonatology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Merete Egeskov
- Department of Clinical Metabolomics Core Facility, Clinical Biochemistry, Rigshospitalet, Copenhagen, Denmark
| | - Ane Lando
- Department of Neonatology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Bo M Hansen
- Department of Neonatology, Copenhagen University Hospital Hillerød, Hillerød, Denmark
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Quitadamo PA, Zambianco F, Palumbo G, Wagner X, Gentile MA, Mondelli A. Monitoring the Use of Human Milk, the Ideal Food for Very Low-Birth-Weight Infants-A Narrative Review. Foods 2024; 13:649. [PMID: 38472762 DOI: 10.3390/foods13050649] [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: 06/09/2023] [Revised: 09/02/2023] [Accepted: 09/04/2023] [Indexed: 03/14/2024] Open
Abstract
Aware of the utmost importance of feeding premature babies-especially those of lower weight-with human milk, as well as the need to monitor this important element of neonatal care, we focused on four aspects in this review. First of all, we reviewed the beneficial effects of feeding premature infants with breast milk in the short and long term. Secondly, we performed a quantitative evaluation of the rates of breastfeeding and feeding with human milk in Very-Low-Birth-Weight infants (VLBWs) during hospitalization in the Neonatal Intensive Care Unit (NICU) and at discharge. Our aim was to take a snapshot of the current status of human milk-feeding care and track its trends over time. Then we analyzed, on the one hand, factors that have been proven to facilitate the use of maternal milk and, on the other hand, the risk factors of not feeding with breast milk. We also considered the spread of human milk banking so as to assess the availability of donated milk for the most vulnerable category of premature babies. Finally, we proposed a protocol designed as a tool for the systematic monitoring of actions that could be planned and implemented in NICUs in order to achieve the goal of feeding even more VLBWs with human milk.
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Affiliation(s)
- Pasqua Anna Quitadamo
- Neonatal Intensive Care Unit, Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, FG, Italy
- Human Milk Bank, Casa Sollievo Della Sofferenza, 71013 San Giovanni Rotondo, FG, Italy
| | - Federica Zambianco
- San Raffaele Faculty of Medicine, University of San Raffaele Vita-Salute, 20132 Milan, MI, Italy
| | - Giuseppina Palumbo
- Neonatal Intensive Care Unit, Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, FG, Italy
- Human Milk Bank, Casa Sollievo Della Sofferenza, 71013 San Giovanni Rotondo, FG, Italy
| | - Xavier Wagner
- Neonatal Intensive Care Unit, Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, FG, Italy
- Université Paris Cité, 79279 Paris, France
| | - Maria Assunta Gentile
- Neonatal Intensive Care Unit, Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, FG, Italy
- Human Milk Bank, Casa Sollievo Della Sofferenza, 71013 San Giovanni Rotondo, FG, Italy
| | - Antonio Mondelli
- Neonatal Intensive Care Unit, Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, FG, Italy
- Human Milk Bank, Casa Sollievo Della Sofferenza, 71013 San Giovanni Rotondo, FG, Italy
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Skaaning D, Brødsgaard A, Kronborg H, Kyhnæb A, Pryds O, Carlsen E. Maternal Reasons for Early Termination of Exclusive Breastfeeding in Premature Infants: A Prospective Study. J Perinat Neonatal Nurs 2024; 38:88-97. [PMID: 37115952 DOI: 10.1097/jpn.0000000000000693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
PURPOSE Maternal concerns for health and growth in prematurely born infants affect the breastfeeding duration. METHOD This prospective observational study evaluated whether maternal concerns regarding insufficient milk supply were supported by inadequate nutrients in human milk or low infant growth. The study followed mothers of 211 premature born infants for 6 months after delivery. RESULTS Of the 211 infants, 156 were not exclusively breastfed for the recommended 6 months after delivery. For 79 of these 156 infants, termination was due to maternal concerns regarding insufficient milk supply. There was no difference in human milk nutrients or infant growth when comparing infants who were exclusively breastfed with those who were not. CONCLUSION Maternal concern regarding insufficient milk supply was the primary explanation for termination of exclusive breastfeeding after premature delivery. Concerns regarding insufficient milk supply were not found associated with inadequate nutrients in the human milk, nor with low infant growth. IMPLICATIONS Breastfeeding support should remain in focus in this population.
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Affiliation(s)
- Diana Skaaning
- Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark (Drs Skaaning, Brødsgaard, Pryds, and Carlsen and Ms Kyhnæb); and Department of Public Health, Faculty of Health Sciences, Aarhus University, Aarhus, Denmark (Drs Skaaning, Brødsgaard, and Kronborg)
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6
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Tomlinson C, Haiek LN. Breastfeeding and human milk in the NICU: From birth to discharge. Paediatr Child Health 2023; 28:510-526. [PMID: 38638537 PMCID: PMC11022875 DOI: 10.1093/pch/pxad034] [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: 09/27/2021] [Accepted: 04/20/2022] [Indexed: 04/20/2024] Open
Abstract
It is well recognized that human milk is the optimal nutritive source for all infants, including those requiring intensive care. This statement reviews evidence supporting the importance of breastfeeding and human milk for infants, and why breastfeeding practices should be prioritized in the neonatal intensive care unit (NICU). It also reviews how to optimally feed infants based on their stability and maturity, and how to support mothers to establish and maintain milk production when their infants are unable to feed at the breast.
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Affiliation(s)
- Christopher Tomlinson
- Canadian Paediatric Society, Nutrition and Gastroenterology Committee, Ottawa, Ontario, Canada
| | - Laura N Haiek
- Canadian Paediatric Society, Nutrition and Gastroenterology Committee, Ottawa, Ontario, Canada
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Tran HT, Luu HM, Le TD, Pham NTQ, Sobel HL, Murray JCS. Factors associated with high exclusive breastfeeding rates among preterm infants under 34 weeks of gestation in Da Nang, Vietnam: A retrospective cohort study. J Glob Health 2023; 13:04121. [PMID: 37934970 PMCID: PMC10630854 DOI: 10.7189/jogh.13.04121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2023] Open
Abstract
Background Preterm infants have higher mortality than full-term infants. While breastfeeding dramatically reduces preterm death, it is limited by biological and practice barriers, particularly for babies born before 34 weeks gestational age. Da Nang Hospital for Women and Children developed a quality improvement approach to improve breastfeeding of preterm infants by strengthening feeding support, non-separation, and kangaroo mother care (KMC). Methods To determine breastfeeding outcomes following discharge and explore factors associated with improved feeding, mothers of infants under 34 weeks gestational age born October 2021 to March 2022 and discharged alive were interviewed at six months and their medical records were reviewed. Results Out of 104 preterm infants included, all were exclusively breastfed at discharge and one month, 86.5% at three months, and 63.5% at six months; 47.1% received immediate skin-to-skin contact, 31.7% immediate and continuous KMC, and the remaining 68.3% continuous KMC beginning at a median of three days. Exclusive breastfeeding at six months was associated with the mother antenatally seeking breastfeeding information (odds ratio (OR) = 14.5; 95% confidence interval (CI) = 1.2-173.6), avoiding bottle-feeding at home (OR = 7.7; 95% CI = 1.7-33.7) and reduced with each day delay between birth and full breastfeeding (OR = 0.8; 95% CI = 0.6-0.9). Conclusions Hospital environments that limit mother-baby separations and feeding delays, including rooming-in of mothers and infants, KMC, and breastfeeding support from birth, enabled 100% of preterm infants born before 34 weeks gestational age to breastfeed exclusively with continued rates higher than previously reported. Addressing antenatal and post-natal factors limiting practice can further improve longer-term breastfeeding outcomes. The approach can be adapted to achieve high exclusive breastfeeding rates, regardless of gestational age.
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Affiliation(s)
- Hoang Thi Tran
- Neonatal Unit, Da Nang Hospital for Women and Children, Da Nang, Vietnam
- Department of Paediatrics, School of Medicine and Pharmacy, Da Nang University, Vietnam
| | - Hanh My Luu
- Neonatal Unit, Da Nang Hospital for Women and Children, Da Nang, Vietnam
- Department of Paediatrics, School of Medicine and Pharmacy, Da Nang University, Vietnam
| | - Thao Dieu Le
- Neonatal Unit, Da Nang Hospital for Women and Children, Da Nang, Vietnam
- Department of Paediatrics, School of Medicine and Pharmacy, Da Nang University, Vietnam
| | - Nga Thi Quynh Pham
- World Health Organization Representative Office in Viet Nam, Ha Noi, Vietnam
| | - Howard L Sobel
- World Health Organization Western Pacific Regional Office, United Nations Avenue, Manila, Philippines
| | - JCS Murray
- World Health Organization Western Pacific Regional Office, United Nations Avenue, Manila, Philippines
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8
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Sparre S, Zachariassen G, Ellebæk MB, Husby S, Holm KG. Feeding Practice, Nutrition, and Growth in Infants with Abdominal Wall Defects and Esophageal Atresia: A Retrospective Case-Control Study. Eur J Pediatr Surg 2023; 33:367-376. [PMID: 36588282 DOI: 10.1055/s-0042-1757360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Infants born with abdominal wall defects and esophageal atresia (EA) are at risk of impaired growth. Little is known about the optimal nutritional strategy and its impact on growth for these infants. This study aims to explore nutrition, focusing on breastfeeding, and the presumed impact on infant growth during the first year of life. MATERIALS AND METHODS We performed a registry study. The participants comprised infants born with gastroschisis, omphalocele, or EA from 2009 to 2020. Breastfed healthy infants from the Odense Child Cohort served as the control group. Descriptive statistics were applied when presenting data on nutrition. Growth data were converted to weight z-scores at birth and at discharge, and estimated weight z-scores at 6 and 12 months were calculated. Univariate regression analysis was applied. RESULTS The study included 168 infants in the study group and 403 infants in the control group. Exclusive breastfeeding rates at discharge were as follows: 55.7% (gastroschisis), 58.3% (omphalocele), 50.9% (EA), and 7.7% (long-gap EA). For the study group our data demonstrate no difference in growth at 1 year of age when comparing mother's milk to formula feeding. During the first year of life, infants in the study group showed slower growth compared with the control group. At 12 months of age, all infants had a mean weight z-score above -2. CONCLUSION Breastfeeding in infants with abdominal wall defects and EA can be established without compromising growth. Mother's milk can be recommended for infants with abdominal wall defects and EA.
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Affiliation(s)
- Signe Sparre
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense C, Denmark
- Institute of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense C, Denmark
| | - Gitte Zachariassen
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense C, Denmark
- Institute of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense C, Denmark
- Odense Patient data Explorative Network, Odense University Hospital, Odense C, Denmark
| | - Mark Bremholm Ellebæk
- Surgical Research Unit, Odense University Hospital, Odense C, Denmark; University of Southern Denmark, Odense, Denmark
| | - Steffen Husby
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense C, Denmark
- Institute of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense C, Denmark
| | - Kristina Garne Holm
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense C, Denmark
- Institute of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense C, Denmark
- Odense Patient data Explorative Network, Odense University Hospital, Odense C, Denmark
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Chanda BM, Chen XQ. Breastfeeding during the COVID-19 pandemic. Front Pediatr 2023; 11:1120763. [PMID: 37342530 PMCID: PMC10277472 DOI: 10.3389/fped.2023.1120763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Accepted: 05/10/2023] [Indexed: 06/23/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused many significant changes to all aspects of day to day life. The disease has spread and reached pandemic proportions. The principle route of transmission is the respiratory route. Infants, pregnant women and breastfeeding mothers have all been affected. Many interventions and guidelines from important societies have been instituted in order to curb the transmission of the disease. These have involved both pharmacological and non-pharmacological methods. COVID-19 vaccines have also emerged as important methods of primary prevention of the disease. But several questions have been raised concerning the safety and efficacy of their use in pregnant and breastfeeding mothers. It has also not been clear if the vaccines are effective in generating a robust immune response in the pregnant women and breastfeeding mothers to confer passive immunity to the fetuses and infants, respectively. And they have not been tested in infants. The aspect of infant feeding has equally been affected. Although breast milk has not been known to serve as the vehicle of transmission of the virus, there is still some lack of uniformity of practice regarding breastfeeding when a mother has SARS-CoV-2 infection. This has led to infant feeding being done by the use of commercial formula feeds, pasteurized human donor breast milk, feeding on the mother's own expressed breast milk by a care giver and directly breastfeeding with skin to skin contact. This is despite breast milk being the most physiologically appropriate type of feed for infants. Therefore the pertinent question remains; should breastfeeding continue during the pandemic continue? This review also seeks to analyse the vast amount of scientific information regarding the subject and to synthesize science-based information.
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Affiliation(s)
- Bwalya Mpelwa Chanda
- Department of Pediatrics, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xiao-Qing Chen
- Department of Pediatrics, First Affiliation Hospital of Nanjing Medical University, Nanjing, China
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Nejsum FM, Måstrup R, Torp-Pedersen C, Løkkegaard ECL, Wiingreen R, Hansen BM. Exclusive breastfeeding: Relation to gestational age, birth weight, and early neonatal ward admission. A nationwide cohort study of children born after 35 weeks of gestation. PLoS One 2023; 18:e0285476. [PMID: 37224110 DOI: 10.1371/journal.pone.0285476] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 04/22/2023] [Indexed: 05/26/2023] Open
Abstract
OBJECTIVES Prematurity, being small for gestational age and early neonatal ward admission are the major neonatal conditions that may interfere with breastfeeding supportive practices in infants born at gestational age ≥35+0 weeks. We aimed to investigate the associations between gestational age, small for gestational age, early neonatal ward admission and exclusive breastfeeding at one and four months. METHODS A register-based cohort-study of all Danish singletons with gestational age ≥35+0 weeks born in 2014-2015. In Denmark, health visitors routinely conduct free home visits throughout infants' first year and thereby report breastfeeding data to The Danish National Child Health Register. These data were linked with data from other national registers. Logistic regression models estimated the odds ratio for exclusive breastfeeding at one and four months, adjusted for confounding variables. RESULTS The study population comprised 106,670 infants. Compared to gestational age 40 weeks, the adjusted odds ratio for exclusive breastfeeding at one month showed a decreasing tendency from gestational age ≥42 (n = 2,282) (1.07; 95% confidence interval (CI) 0.97-1.17) to 36 weeks (n = 2,062) (0.80; 95% CI 0.73-0.88). Small for gestational age (n = 2,342) was associated with decreased adjusted odds ratio for exclusive breastfeeding at one month (0.84; 95% CI 0.77-0.92). Neonatal ward admission was associated with increased adjusted odds ratio for exclusive breastfeeding at one month among late preterm infants (gestational age 35-36 weeks; n = 3,139) (1.31; 95% CI 1.12-1.54), as opposed to among early term (gestational age 37-38 weeks; n = 19,171) (0.84; 95% CI 0.77-0.92) and term infants (gestational age >38 weeks; n = 84,360) (0.89; 95% CI 0.83-0.94). The associations seemed to persist at four months. CONCLUSIONS Decreasing gestational age and small for gestational age were associated with decreased exclusive breastfeeding rates. Neonatal ward admission was associated with increased exclusive breastfeeding rates among late preterm infants, whereas the opposite was observed among early term and term infants.
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Affiliation(s)
- Freja Marie Nejsum
- Department of Pediatrics, Copenhagen University Hospital - North Zealand, Hillerød, Denmark
| | - Ragnhild Måstrup
- Department of Neonatology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Christian Torp-Pedersen
- Department of Cardiology, Copenhagen University Hospital - North Zealand, Hillerød, Denmark
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Ellen Christine Leth Løkkegaard
- Department of Gynaecology and Obstetrics, Copenhagen University Hospital - North Zealand, Hillerød, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Rikke Wiingreen
- Department of Pediatrics, Copenhagen University Hospital - North Zealand, Hillerød, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Bo Mølholm Hansen
- Department of Pediatrics, Copenhagen University Hospital - North Zealand, Hillerød, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Kronborg H, Skaaning D, Brødsgaard A. Breastfeeding Self-Efficacy, a Predictor of Early Cessation of Exclusive Breastfeeding Among Mothers Giving Birth Preterm. J Perinat Neonatal Nurs 2023:00005237-990000000-00008. [PMID: 37115956 DOI: 10.1097/jpn.0000000000000699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
The aim was to describe the prevalence of exclusive breastfeeding among mothers of premature infants and investigate the extent to which breastfeeding self-efficacy is associated with early cessation of exclusive breastfeeding. The study population consisted of 136 mother-infant dyads with information on the outcome of exclusive breastfeeding and exposure of self-efficacy, recruited between September 2016 and February 2018. Data were collected via questionnaires with follow-up at 6 months. The statistical analysis included descriptive analysis with survival curves and logistic regression analysis. At 2 months, 101 (74%) premature infants were exclusively breastfed; at 4 and 6 months, 82 (60%) and 41 (30%), respectively. Higher levels of self-efficacy were significantly associated with breastfeeding exclusively for 2 months (P = .03). In multivariate analysis, mothers who had a low level of early self-efficacy toward breastfeeding had 2½ times higher odds of breastfeeding cessation before 2 months (odds ratio = 2.63, 95% confidence interval: 1.16-5.96). The risk did not change when adjusted for potential confounders. Breastfeeding self-efficacy is an early predictor of exclusive breastfeeding for 2 months of the premature infant. Health professionals should use self-efficacy as a prognostic factor to identify mothers at risk of early cessation of breastfeeding and support those with low self-efficacy to increase duration of exclusive breastfeeding.
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Affiliation(s)
- Hanne Kronborg
- Department of Public Health, Faculty of Health, Aarhus University, Aarhus, Denmark (Drs Kronborg and Brødsgaard); and Departments of Paediatrics and Adolescent Medicine (Drs Skaaning and Brødsgaard) and Obstetrics and Gynaecology (Dr Brødsgaard), Copenhagen University Hospital Amager Hvidovre, Capital Region of Denmark, Hvidovre, Denmark
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12
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Berns M, Bayramova S, Kusztrich A, Metze B, Bührer C. Trend over 25 years of risk factors of mother's own milk provision to very low birth weight infants at discharge. Early Hum Dev 2023; 177-178:105730. [PMID: 36822127 DOI: 10.1016/j.earlhumdev.2023.105730] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 02/11/2023] [Accepted: 02/12/2023] [Indexed: 02/18/2023]
Abstract
BACKGROUND Feeding mother's own milk (MOM) is associated with reduced morbidity of very low birth weight (VLBW) infants (<1500 g), but not all mothers are able to provide pumped breast milk or breastfeed until discharge. AIMS To investigate the duration of MOM feeding and identify risk factors for cessation. STUDY DESIGN Single-center retrospective cohort study. SUBJECTS 307 VLBW infants born 2012 and 2019 surviving beyond 7 days of life. OUTCOME MEASURES Analysis of MOM feeding at discharge, including comparison with a historical cohort of infants born 1992-1994. RESULTS MOM feeding was initiated in 178/180 infants (98.9 %) born in 2012 and in 123/127 infants (96.9 %) born in 2019 (p = 0.132), as compared to 73/89 (82 %) infants born 1992-1994 (p < 0.001). Median [range] duration of MOM feeding was similar for infants born in 2012 (45 [0-170] days) and 2019 (50 [0-190] days) (p = 0.396), but much longer than in the historical cohort (36 [0-152] days) (p < 0.001). The overall breastfeeding rate increased up to 69.2 % and 77.2 %. Factors associated with cessation of MOM feeding were smoking during pregnancy, single-mother status, short (<12 years) duration of maternal or paternal school education (all p ≤ 0.001), natural conception, birth weight ≥ 1000 g, and gestational age ≥ 29 weeks (p < 0.05). In Cox proportional hazard multivariate analysis, smoking during pregnancy and single-mother status remained independent risk factors. CONCLUSIONS Duration of MOM feeding and breastfeeding rates of VLBW infants during hospital stay have increased significantly during the last 30 years, while smoking and indicators of low socioeconomic status remain dominant predictors of cessation of MOM feeding.
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Affiliation(s)
- Monika Berns
- Department of Neonatology, Charité - Universitätsmedizin Berlin, Berlin, Germany.
| | - Sabahat Bayramova
- Department of Neonatology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Ariane Kusztrich
- Department of Neonatology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Boris Metze
- Department of Neonatology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Christoph Bührer
- Department of Neonatology, Charité - Universitätsmedizin Berlin, Berlin, Germany
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Abou-Rizk J, Jeremias T, Nasreddine L, Jomaa L, Hwalla N, Frank J, Scherbaum V. Infant Feeding Practices, Nutrition, and Associated Health Factors during the First Six Months of Life among Syrian Refugees in Greater Beirut, Lebanon: A Mixed Methods Study. Nutrients 2022; 14:nu14214459. [PMID: 36364722 PMCID: PMC9654662 DOI: 10.3390/nu14214459] [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: 09/14/2022] [Revised: 10/14/2022] [Accepted: 10/19/2022] [Indexed: 01/25/2023] Open
Abstract
The objective was to describe infant feeding practices, nutrition and related health aspects of infants under six months among Syrian refugees in Greater Beirut, Lebanon. A cross-sectional study was conducted among Syrian refugee mothers with infants under six months in July-October 2018 (N = 114). Additionally, eleven focus group discussions were conducted to explore supportive factors and barriers associated with early breastfeeding practices. The prevalence of pre-lacteal feeding was high (62.5%), whereas early initiation of breastfeeding was low (31%), and exclusive breastfeeding very low (24.6%). One-fifth of the infants were anemic (20.5%) and 9.6% were wasted. A significantly higher proportion of non-exclusively breastfed infants had a fever and took medicines than those who were exclusively breastfed. Supporting factors of adequate infant feeding practices comprised knowledge on maternal nutrition and exclusive breastfeeding, along with receiving support from healthcare professionals and family members. Identified barriers included preterm delivery, pre-lacteal feeding, an at-risk waist circumference and moderate to severe depression among mothers, bottle feeding, early introduction of food, maternal health reasons, breastmilk substitutes' distribution, and misinformation offered by mothers-in-law. To address sub-optimal feeding practices documented among Syrian refugees, awareness on proper breastfeeding practices, maternal nutrition, and psychosocial support should be provided to mothers and family members alike.
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Affiliation(s)
- Joana Abou-Rizk
- Institute of Nutritional Sciences, Faculty of Natural Sciences, University of Hohenheim, 70599 Stuttgart, Germany
- Correspondence: or
| | - Theresa Jeremias
- Institute of Nutritional Sciences, Faculty of Natural Sciences, University of Hohenheim, 70599 Stuttgart, Germany
| | - Lara Nasreddine
- Department of Nutrition and Food Sciences, Faculty of Agricultural and Food Sciences, American University of Beirut, Beirut 11-0236, Lebanon
| | - Lamis Jomaa
- Department of Human Sciences, College of Health and Sciences, North Carolina Central University, Durham, NC 27707, USA or
- Faculty of Agricultural and Food Sciences, American University of Beirut, Beirut 11-0236, Lebanon
| | - Nahla Hwalla
- Department of Nutrition and Food Sciences, Faculty of Agricultural and Food Sciences, American University of Beirut, Beirut 11-0236, Lebanon
| | - Jan Frank
- Institute of Nutritional Sciences, Faculty of Natural Sciences, University of Hohenheim, 70599 Stuttgart, Germany
| | - Veronika Scherbaum
- Institute of Nutritional Sciences, Faculty of Natural Sciences, University of Hohenheim, 70599 Stuttgart, Germany
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Correlation between Pacifier Use in Preterm Neonates and Breastfeeding in Infancy: A Systematic Review. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9101585. [PMID: 36291521 PMCID: PMC9600199 DOI: 10.3390/children9101585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 10/17/2022] [Accepted: 10/18/2022] [Indexed: 11/05/2022]
Abstract
Background: Breastfeeding is very important for the proper nutrition and growth of the child, as well as, the health of the mother. To start breastfeeding, the neonate must have extensive oral capacities for sucking functions but, premature neonates may not have the muscle strength needed to suck successfully. However, the non-nutritive sucking achieved by using a pacifier, has been identified by previous research as a factor associated with shorter duration and exclusivity of breastfeeding. This study aims to perform a systematic review to investigate the relationship between pacifier use in preterm neonates and breastfeeding in infancy. Methods: We included prospective studies, as well as randomized controlled studies that evaluated the association between pacifier use by preterm neonates and of breastfeeding in infancy. Ten research articles from PubMed/Medline, Google Scholar and Crossref were included in the review from a total of 1455 articles. The results differ depending on the type of study.Most prospective studies have shown a negative correlation between pacifier use and breastfeeding, while the randomized controlled studies found a positive correlation. Conclusions: Pacifier use in preterm infants helps transition from tube to oral feeding, breastfeeding, faster weight gain and earlier discharge from the NICU. However, the relationship between pacifiers and breastfeeding is more complicated, as it appears to be influenced by additional risk factors.
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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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Encourage, Assess, Transition (EAT): A Quality Improvement Project Implementing a Direct Breastfeeding Protocol for Preterm Hospitalized Infants. Adv Neonatal Care 2022; 23:107-119. [PMID: 36037212 DOI: 10.1097/anc.0000000000001037] [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
BACKGROUND The opportunity to establish a direct breastfeeding (DBF) relationship with a preterm infant, if desired by the mother or lactating parent, is a known driver of positive healthcare experiences. Preterm birth is an independent risk factor for early human milk (HM) cessation, and DBF at the first oral meal promotes continued DBF during hospitalization and HM duration beyond discharge. While the Spatz 10-step model for protecting and promoting HM and breastfeeding in vulnerable infants provides best practices, lack of standardized implementation results in missed opportunities to meet parents' DBF goals. PURPOSE To standardize clinical practices to increase DBF at the first oral meal, total DBF meals during hospitalization, and use of test weighing to measure milk transfer for preterm infants. METHODS Quality improvement methods were used to develop and implement Encourage, Assess, Transition (EAT): a DBF protocol for infants less than 37 weeks gestation at birth, in a level II neonatal intensive care unit. RESULTS Thirty-eight (45%) infants from 27.7 to 36.7 weeks of gestation initiated the protocol. The proportion of infants' DBF at first oral meal increased from 22% to 54%; mean DBF meals during hospitalization increased from 13.3 to 20.3; and use of test weighing increased by 166%. IMPLICATIONS FOR PRACTICE AND RESEARCH Standardizing DBF practices with the EAT protocol increased DBF during hospitalization-a known driver of patient experience-and HM duration beyond discharge, in hospitalized preterm infants. Researchers should validate the reported benefits of EAT (increased DBF during hospitalization, use of test weighing, and improved patient experience), methods to promote passive dissemination of evidence, and sustain change.Video abstract available at: https://journals.na.lww.com/advancesinneonatalcare/pages/videogallery.aspx?autoPlay=false&videoId=61.
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17
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Moon RY, Carlin RF, Hand I. Evidence Base for 2022 Updated Recommendations for a Safe Infant Sleeping Environment to Reduce the Risk of Sleep-Related Infant Deaths. Pediatrics 2022; 150:188305. [PMID: 35921639 DOI: 10.1542/peds.2022-057991] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Every year in the United States, approximately 3500 infants die of sleep-related infant deaths, including sudden infant death syndrome (SIDS) (International Statistical Classification of Diseases and Related Health Problems 10th Revision [ICD-10] R95), ill-defined deaths (ICD-10 R99), and accidental suffocation and strangulation in bed (ICD-10 W75). After a substantial decline in sleep-related deaths in the 1990s, the overall death rate attributable to sleep-related infant deaths have remained stagnant since 2000, and disparities persist. The triple risk model proposes that SIDS occurs when an infant with intrinsic vulnerability (often manifested by impaired arousal, cardiorespiratory, and/or autonomic responses) undergoes an exogenous trigger event (eg, exposure to an unsafe sleeping environment) during a critical developmental period. The American Academy of Pediatrics recommends a safe sleep environment to reduce the risk of all sleep-related deaths. This includes supine positioning; use of a firm, noninclined sleep surface; room sharing without bed sharing; and avoidance of soft bedding and overheating. Additional recommendations for SIDS risk reduction include human milk feeding; avoidance of exposure to nicotine, alcohol, marijuana, opioids, and illicit drugs; routine immunization; and use of a pacifier. New recommendations are presented regarding noninclined sleep surfaces, short-term emergency sleep locations, use of cardboard boxes as a sleep location, bed sharing, substance use, home cardiorespiratory monitors, and tummy time. In addition, additional information to assist parents, physicians, and nonphysician clinicians in assessing the risk of specific bed-sharing situations is included. The recommendations and strength of evidence for each recommendation are published in the accompanying policy statement, which is included in this issue.
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Affiliation(s)
- Rachel Y Moon
- Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Rebecca F Carlin
- Division of Pediatric Critical Care and Hospital Medicine, Department of Pediatrics, Columbia University Irving Medical Center, NewYork-Presbyterian Hospital, New York City, New York
| | - Ivan Hand
- Department of Pediatrics, SUNY-Downstate College of Medicine, NYC Health + Hospitals, Kings County, Brooklyn, New York
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18
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Cabrera-Lafuente M, Alonso-Díaz C, Pumarega MTM, Díaz-Almirón M, Haiek LN, Maastrup R, Pallás-Alonso C. Breastfeeding practices in neonatal wards in Spain. Neo-BFHI international survey. An Pediatr (Barc) 2022; 96:300-308. [PMID: 35523686 DOI: 10.1016/j.anpede.2021.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 04/15/2021] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION In 2017, a worldwide survey was conducted on compliance with the practices promoted by Neo-BFHI (Baby-friendly Hospital Initiative expansion to neonatal wards). OBJECTIVE To present the results of the Spanish wards that participated in the global survey and compare them with those obtained internationally. MATERIAL AND METHODS Cross-sectional study through a survey on compliance with the Neo-BFHI ("Three basic principles", "Ten steps adapted to neonatal wards" and "the compliance with the International Code of Marketing of Breast-milk Substitutes" and subsequent relevant World Health Assembly resolutions). Compliance was calculated as the mean in each indicator and a final mean score for each neonatal unit. For the partial and final scores for each country and at the international level, the median was used. All scores ranged between 0 and 100. RESULTS The response rate in Spain was 90%. The range of the national mean for neonatal wards were from 37 to 99, with no differences in the final score according to the level of care. The global score for Spain (72) is below the international median (77) and this also occurs in 8 of 14 items. The neonatal wards from BFHI designated hospitals, obtained a significantly higher mean global score, and in 9 of 14 items than the non-accredited ones. CONCLUSIONS Both international and national results indicate an improvement in breast feeding practices in neonatal units. The benefits of the BFHI accreditation of maternity reach neonatal wards. Spain has several key points below the international score.
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Affiliation(s)
| | - Clara Alonso-Díaz
- Servicio de Neonatología, Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | | | - Laura N Haiek
- Ministère de la santé et des Services sociaux, Direction générale de la santé publique, Quebec, Canada; McGill University, Department of Family Medicine, Montreal, Quebec, Canada
| | - Ragnhild Maastrup
- Department of Neonatology, Copenhagen University Hospital Rigshospitalet, University Hospital Rigshospitalet, Department of Neonatology, Blegdamsvej, Denmark
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Martínez-Vázquez S, Hernández-Martínez A, Rodríguez-Almagro J, Peinado-Molina RA, Martínez-Galiano JM. Determinants and Factors Associated with the Maintenance of Exclusive Breastfeeding after Hospital Discharge after Birth. Healthcare (Basel) 2022; 10:healthcare10040733. [PMID: 35455909 PMCID: PMC9028310 DOI: 10.3390/healthcare10040733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 03/30/2022] [Accepted: 04/12/2022] [Indexed: 11/26/2022] Open
Abstract
The benefits of exclusive breastfeeding are well known for both mother and baby. Despite this, rates of exclusive breastfeeding remain low. The present study aimed to determine the factors associated with the maintenance of this type of feeding after being discharged from the hospital after childbirth. A cross-sectional study was carried out with 1200 postpartum women in Spain. Sociodemographic, obstetric, and neonatal data were collected. Odds ratios (OR) and adjusted odds ratios (aOR) with 95% confidence intervals were calculated. Early breastfeeding initiation was identified as a factor that favors breastfeeding after hospital discharge (aOR: 2.47; 95%CI: 1.77, 3.45). Other factors that favor breastfeeding after discharge included the woman feeling very supported by her partner during pregnancy, childbirth, and the puerperium (aOR: 2.54; 95%CI:1.30, 5.00) and having previously breastfed other children (aOR: 1.97; 95%CI: 1.40, 2.76). Among the factors that hindered exclusive breastfeeding after discharge were multiple or twin pregnancies (aOR: 0.31; 95%CI 0.12, 0.83), induction of labor (aOR: 0.73; 95%CI: 0.53, 0.99), admission of the newborn to the neonatal intensive care unit (NICU) (aOR: 0.31; 95%CI 0.19, 0.52), using epidural pain relief during labor (aOR: 0.41; 95%CI: 0.27, 0.64), or a preterm newborn (aOR: 0.38; 95%CI: 0.21, 0.69). For all these reasons, it is essential to promote certain practices such as the early start of breastfeeding or the induced onset of labor, among others, in order to promote the maintenance of exclusive breastfeeding beyond hospital discharge after childbirth.
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Affiliation(s)
| | - Antonio Hernández-Martínez
- Department of Nursing, Faculty of Nursing of Ciudad Real, University of Castilla-La Mancha, 13071 Ciudad Real, Spain; (A.H.-M.); (J.R.-A.)
| | - Julián Rodríguez-Almagro
- Department of Nursing, Faculty of Nursing of Ciudad Real, University of Castilla-La Mancha, 13071 Ciudad Real, Spain; (A.H.-M.); (J.R.-A.)
| | | | - Juan Miguel Martínez-Galiano
- Department of Nursing, University of Jaen, 23071 Jaen, Spain;
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain
- Correspondence: ; Tel.: +34-953-211-740
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20
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Maastrup R, Hannula L, Hansen MN, Ezeonodo A, Haiek LN. The Baby-friendly Hospital Initiative for neonatal wards. A mini review. Acta Paediatr 2022; 111:750-755. [PMID: 34932843 DOI: 10.1111/apa.16230] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 12/01/2021] [Accepted: 12/20/2021] [Indexed: 11/30/2022]
Abstract
The Baby-friendly Hospital Initiative for Neonatal Wards (Neo-BFHI) is an expansion of the WHO/UNICEF Ten Steps to Successful Breastfeeding to address the needs of infants and families in all levels of neonatal care. The Neo-BFHI includes Three Guiding Principles as basic tenets, Ten Steps to protect, promote and support breastfeeding closely following the original Baby-friendly Hospital Initiative, and adherence to the International Code of Marketing of Breast-milk Substitutes. In 2020, the WHO/UNICEF published recommendations for breastfeeding small, sick and preterm newborns that aligns with the Neo-BFHI. Conclusion: This mini review provides a brief description of the content in the Neo-BFHI.
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Affiliation(s)
- Ragnhild Maastrup
- Knowledge Centre for Breastfeeding Infants with Special Needs Department of Neonatology, Rigshospitalet Copenhagen University Hospital Copenhagen Denmark
- Research Unit Women's and Children's Health Juliane Marie Centre Rigshospitalet Copenhagen University Hospital Copenhagen Denmark
| | - Leena Hannula
- School of Health Care Metropolia University of Applied Sciences Metropolia Finland
| | - Mette Ness Hansen
- Norwegian National Advisory Unit on Breastfeeding Division of Gynaecology and Obstetrics Rikshospitalet Oslo University Hospital Oslo Norway
| | - Aino Ezeonodo
- School of Health Care Metropolia University of Applied Sciences Metropolia Finland
| | - Laura N. Haiek
- Ministère de la Santé et des Services sociaux Québec QC Canada
- McGill University Department of Family Medicine and St. Mary's Research Centre Montréal QC Canada
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Scholten N, Mause L, Horenkamp-Sonntag D, Klein M, Dresbach T. Initiation of lactation and the provision of human milk to preterm infants in German neonatal intensive care units from the mothers' perspective. BMC Pregnancy Childbirth 2022; 22:158. [PMID: 35216574 PMCID: PMC8881865 DOI: 10.1186/s12884-022-04468-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 02/07/2022] [Indexed: 11/25/2022] Open
Abstract
Background If infants with a very low birth weight (VLBW) are to be fed exclusively with human milk, it is essential to focus on lactation initiation. The aim of the study is to learn more about the current state of lactation initiation and human milk provision in neonatal intensive care units in Germany from the mothers' perspective. Methods Written surveys were conducted with mothers of VLBW infants to learn more about the timing of initiation of lactation, pumping frequency during the first three days postpartum and feeding of the preterm infant during hospitalisation. Results The data of 437 mothers (response rate: 44.7%) were included in the analyses. Of these, only 7.8% stated that they had initiated lactation immediately after delivery and 38.2% within 6 h. In terms of pumping frequency, 50.1% pumped 7–9 times a day within the first 3 days postpartum; 60.9% reported that their infant received formula feedings during the hospital stay. Conclusion Overall, deficits were still evident with regard to the initiation of lactation in mothers of VLBW infants in Germany, resulting in a large proportion of VLBW infants receiving formula in the hospital. Trial registration German Clinical Trial Register: DRKS00017755.
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Affiliation(s)
- N Scholten
- Institute of Medical Sociology Health Services Research and Rehabilitation Science, Faculty of Human Sciences and Faculty of Medicine, University of Cologne, Cologne, Germany.
| | - L Mause
- Institute of Medical Sociology Health Services Research and Rehabilitation Science, Faculty of Human Sciences and Faculty of Medicine, University of Cologne, Cologne, Germany
| | | | - M Klein
- DAK Gesundheit, Hamburg, Germany
| | - T Dresbach
- Department of Neonatology and Pediatric Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
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Gato S, Biziyaremye F, Kirk CM, De Sousa CP, Mukuralinda A, Habineza H, Asir M, de Silva H, Manirakiza ML, Karangwa E, Nshimyiryo A, Tugume A, Beck K. Promotion of early and exclusive breastfeeding in neonatal care units in rural Rwanda: a pre- and post-intervention study. Int Breastfeed J 2022; 17:12. [PMID: 35193639 PMCID: PMC8864904 DOI: 10.1186/s13006-022-00458-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 02/08/2022] [Indexed: 11/27/2022] Open
Abstract
Background Early initiation of breastfeeding after birth and exclusive breastfeeding for the first six months improves child survival, nutrition and health outcomes. However, only 42% of newborns worldwide are breastfed within the first hour of life. Small and sick newborns are at greater risk of not receiving breastmilk and often require additional support for feeding. This study compares breastfeeding practices in Rwandan neonatal care units (NCUs) before and after the implementation of a package of interventions aimed to improve breastfeeding. Methods This pre-post intervention study was conducted at two district hospital NCUs in rural Rwanda from October–December 2017 (pre-intervention) and September 2018–March 2019 (post-intervention). Only newborns admitted before their second day of life (DOL) were included. Data were extracted from patient charts for clinical and demographic characteristics, feeding, and patient outcomes. Exclusive breastfeeding at discharge was based on last recorded infant feeding on the day of discharge. Logistic regression analysis was used to evaluate factors associated with exclusive breastfeeding at discharge. Results Pre-intervention, 255 newborns were admitted in the NCUs and 793 were admitted in post-intervention. Exclusive breastfeeding on the day of birth (DOL0) increased from 5.4% (12/255) to 35.9% (249/793). At discharge, exclusive breastfeeding increased from 69.6% (149/214) to 87.0% (618/710). The mortality rate decreased from 16.1% (41/255) to 10.5% (83/793). Factors associated with greater odds of exclusive breastfeeding at discharge included admission during the post-intervention period (aOR 4.91; 95% CI 1.99, 12.11), and admission for infection (aOR 2.99; 95% CI 1.13, 7.93). Home deliveries (aOR 0.15; 95% CI 0.05, 0.47), preterm delivery (aOR 0.36; 95% CI 0.15, 0.87) and delayed first breastmilk feed (aOR 0.04 for DOL3 vs. DOL0; 95% CI 0.01, 0.35) reduced odds of exclusive breastfeeding at discharge. Conclusions Expansion and adoption of evidenced-based guidelines, using innovative approaches, aimed at the unique needs of small and sick newborns may help to improve earlier initiation of breastfeeding, decrease mortality, and improve exclusive breastfeeding on discharge from hospital among small and sick newborns. These interventions should be replicated in similar settings to determine their effectiveness.
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Affiliation(s)
- Saidath Gato
- Partners In Health/Inshuti Mu Buzima, Rwinkwavu, Rwanda.
| | | | | | - Chiquita Palha De Sousa
- Partners In Health/Inshuti Mu Buzima, Rwinkwavu, Rwanda.,Boston Children's Hospital, Boston, USA
| | | | | | | | | | | | | | | | - Alex Tugume
- Rwinkwavu District Hospital, Ministry of Health, Kigali, Rwanda
| | - Kathryn Beck
- Partners In Health/Inshuti Mu Buzima, Rwinkwavu, Rwanda
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Karapati E, Sulaj A, Krepi A, Pouliakis A, Iacovidou N, Paliatsiou S, Sokou R, Volaki P, Boutsikou T, Iliodromiti Z. Mothers in Need of Lactation Support May Benefit from Early Postnatal Galactagogue Administration: Experience from a Single Center. Nutrients 2021; 14:nu14010140. [PMID: 35011014 PMCID: PMC8747006 DOI: 10.3390/nu14010140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 12/25/2021] [Accepted: 12/27/2021] [Indexed: 11/17/2022] Open
Abstract
Background: Galactagogues are substances that promote lactation, although data on their effects on humans remain limited. We investigated the efficacy of Silitidil to increase milk supply and duration of breastfeeding of a specific subgroup of mothers in need of lactation support. Methods: 161 mothers from November 2018 until January 2021 were the study subjects in this retrospective study; during their hospitalization, due to neonatal or maternal factors that inhibited lactation, they were prescribed galactagogues. Mothers were surveyed by telephone interview via a 13-item questionnaire. Results: 73.91%, were primigravidas, 78.26% gave birth by cesarean section (CS) and 72.05% continued to take galactagogues after hospital discharge. Of the neonates, 24.22% were preterm ≤37 weeks of gestation, and 55.9% had birth weight (BW) between 2500 and 3500 g. With respect to breastfeeding rates, 100% were breastfed during their first week, 98.8% breastfed during the first month, 87% during the first 4 months, dropping to 56.5% at 6 months, 41% at 1 year and 19.3% over 1 year of age. Conclusions: This study demonstrates that administration of a galactagogue containing Silitidil (Piulatte-Humana) improves breastfeeding rates at from 1 until 12 months of life in mothers with low milk supply during their hospital stay. Further studies are needed to generate evidence-based strategies to improve breastfeeding outcomes.
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Affiliation(s)
- Eleni Karapati
- Neonatal Department, Medical School, National and Kapodistrian University of Athens, Aretaieio Hospital, 11526 Athens, Greece; (E.K.); (A.S.); (A.K.); (N.I.); (S.P.); (R.S.); (P.V.); (T.B.)
| | - Alma Sulaj
- Neonatal Department, Medical School, National and Kapodistrian University of Athens, Aretaieio Hospital, 11526 Athens, Greece; (E.K.); (A.S.); (A.K.); (N.I.); (S.P.); (R.S.); (P.V.); (T.B.)
| | - Adamantia Krepi
- Neonatal Department, Medical School, National and Kapodistrian University of Athens, Aretaieio Hospital, 11526 Athens, Greece; (E.K.); (A.S.); (A.K.); (N.I.); (S.P.); (R.S.); (P.V.); (T.B.)
| | - Abraham Pouliakis
- Second Department of Pathology, Medical School, National and Kapodistrian University of Athens, University General Hospital Attikon, 12462 Athens, Greece;
| | - Nicoletta Iacovidou
- Neonatal Department, Medical School, National and Kapodistrian University of Athens, Aretaieio Hospital, 11526 Athens, Greece; (E.K.); (A.S.); (A.K.); (N.I.); (S.P.); (R.S.); (P.V.); (T.B.)
| | - Stella Paliatsiou
- Neonatal Department, Medical School, National and Kapodistrian University of Athens, Aretaieio Hospital, 11526 Athens, Greece; (E.K.); (A.S.); (A.K.); (N.I.); (S.P.); (R.S.); (P.V.); (T.B.)
| | - Rozeta Sokou
- Neonatal Department, Medical School, National and Kapodistrian University of Athens, Aretaieio Hospital, 11526 Athens, Greece; (E.K.); (A.S.); (A.K.); (N.I.); (S.P.); (R.S.); (P.V.); (T.B.)
| | - Paraskevi Volaki
- Neonatal Department, Medical School, National and Kapodistrian University of Athens, Aretaieio Hospital, 11526 Athens, Greece; (E.K.); (A.S.); (A.K.); (N.I.); (S.P.); (R.S.); (P.V.); (T.B.)
| | - Theodora Boutsikou
- Neonatal Department, Medical School, National and Kapodistrian University of Athens, Aretaieio Hospital, 11526 Athens, Greece; (E.K.); (A.S.); (A.K.); (N.I.); (S.P.); (R.S.); (P.V.); (T.B.)
| | - Zoi Iliodromiti
- Neonatal Department, Medical School, National and Kapodistrian University of Athens, Aretaieio Hospital, 11526 Athens, Greece; (E.K.); (A.S.); (A.K.); (N.I.); (S.P.); (R.S.); (P.V.); (T.B.)
- Correspondence:
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24
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Parker MG, Stellwagen LM, Noble L, Kim JH, Poindexter BB, Puopolo KM. Promoting Human Milk and Breastfeeding for the Very Low Birth Weight Infant. Pediatrics 2021; 148:peds.2021-054272. [PMID: 34635582 DOI: 10.1542/peds.2021-054272] [Citation(s) in RCA: 72] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Provision of mother's own milk for hospitalized very low birth weight (VLBW) (≤1500 g) infants in the NICU provides short- and long-term health benefits. Mother's own milk, appropriately fortified, is the optimal nutrition source for VLBW infants. Every mother should receive information about the critical importance of mother's own milk to the health of a VLBW infant. Pasteurized human donor milk is recommended when mother's own milk is not available or sufficient. Neonatal health care providers can support lactation in the NICU and potentially reduce disparities in the provision of mother's own milk by providing institutional supports for early and frequent milk expression and by promoting skin-to-skin contact and direct breastfeeding, when appropriate. Promotion of human milk and breastfeeding for VLBW infants requires multidisciplinary and system-wide adoption of lactation support practices.
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Affiliation(s)
- Margaret G Parker
- Department of Pediatrics, Boston Medical Center, School of Medicine, Boston University, Boston, Massachusetts
| | - Lisa M Stellwagen
- University of California Health Milk Bank, San Diego, California.,Department of Pediatrics, University of California, San Diego, Health, San Diego, California
| | - Lawrence Noble
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York.,New York City Health + Hospitals/Elmhurst
| | - Jae H Kim
- Division of Neonatology, Perinatal Institute, Cincinnati Children's Hospital Medical Center and College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Brenda B Poindexter
- Children's Healthcare of Atlanta and School of Medicine, Emory University, Atlanta, Georgia
| | - Karen M Puopolo
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, and Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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25
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A Statewide Evaluation of the Breastfeeding Resource Nurse Model. Nurs Womens Health 2021; 25:337-345. [PMID: 34478735 DOI: 10.1016/j.nwh.2021.07.007] [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: 11/24/2020] [Revised: 05/26/2021] [Accepted: 07/21/2021] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To evaluate a statewide initiative to increase the provisioning of human milk in NICUs. DESIGN A survey of nurses before participation in an educational session, immediately after education, and again 9 months later. SETTING Nurses from 22 hospitals throughout Florida. PARTICIPANTS We surveyed 121 participants, including some nurses who had prior breastfeeding education or certification as well as those without specialized breastfeeding training. INTERVENTION An educational project called the Breastfeeding Resource Nurse Master program was intended to educate NICU nurses to implement the "Ten Steps to Promote and Protect Human Milk and Breastfeeding in Vulnerable Infants." MEASUREMENT A quantitative needs assessment survey was administered to participants to determine current hospital practices, policies, and perceived areas for improvement. Pre- and immediate posttraining surveys assessed NICU nurses' knowledge, attitudes, and beliefs about human milk feeding of critical care infants and their self-efficacy for implementing the program in their respective NICUs. A follow-up, open-ended survey was administered at 9 months to yield information on program implementation. RESULTS NICU breastfeeding practices varied widely at baseline. Nurses' scores for knowledge, beliefs, and behavioral intentions improved postsession, but the implementation of practice changes related to the Ten Steps for Vulnerable Infants proved difficult. Nurses identified insufficient time and resources as barriers to educating others and changing practice. CONCLUSIONS Policies and regulations that make hospitals accountable for increasing human milk provision to vulnerable infants may be necessary to ensure that hospitals devote adequate resources to implementing practice changes in this area.
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Feeding Twins with Human Milk and Factors Associated with Its Duration: A Qualitative and Quantitative Study in Southern Italy. Nutrients 2021; 13:nu13093099. [PMID: 34578976 PMCID: PMC8464927 DOI: 10.3390/nu13093099] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 08/23/2021] [Accepted: 08/28/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Over the past year, there has been a rise in twin births. The current scientific consensus recommended breast-feed milk for all newborns for at least 6 months. They stated that it is possible to meet the nutritional needs of two or more newborns with only one mother's milk. More information would be desirable about the factors that influence or lead to the initiation and interruption of breastfeeding. The quality of the evidence available from multiple studies has been inconclusive and therefore led to controversial interpretations and practices. AIMS The first aim of this study was to analyze the extent of the feeding of multiples with breast milk in the experience of our clinical unit in terms of incidence and duration. The second objective was to evaluate the correlation between maternal, perinatal and neonatal variables with breast milk feeding rates and duration. METHODS The study was conducted between 2015 and 2020, in a NICU in Southern Italy (San Giovanni Rotondo, Foggia). Sixty-one women who have given birth to multiples were enrolled into the study. Newborn data were retrospectively collected by informatic database and breastfeeding information were collected by a questionnaire. RESULTS In our centre, the percentage of twins out of the total number of births over the years has almost doubled from 1.28% in 2015 to 2.48% in 2020 and the 88% of twins are premature. 18.1% received breast milk for more than 6 months and 6.3% received it for more than 12 months. Infants of lower gestational age and weight, born to multiparous, more mature and medium-high schooling mothers received breast milk for a longer period. 35% of women explained that the interruption of breastfeeding was due to the insufficient milk production and 41% to the stress and difficulties in managing the twins. Qualitative analysis of maternal narrative revealed, for many of them, the awareness of the importance of breastfeeding and the efforts made to try to give breast milk, but also fears about the quantity of milk and satiety of their children. CONCLUSIONS It is important to identify the factors both favoring and obstructing maternal milk feeding of multiples and it would be desirable the activation of a network of training and support for mothers after discharge, with particular regard to the categories found to be less inclined.
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Heine E, Mehler K, Schöpping M, Ganesh L, Klein R, Kribs A, Keller T. Privacy, Early Colostrum, and Gestational Age are Associated with Exclusive Breastfeeding in Preterm and Sick Term Infants. Z Geburtshilfe Neonatol 2021; 225:346-352. [PMID: 34384133 DOI: 10.1055/a-1524-3328] [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]
Abstract
Our study was designed to assess the rates of exclusive breastfeeding (defined as direct breastfeeding) and the use of mother's own milk (MOM) in preterm infants and sick term infants at discharge and to identify potential influencing factors such as gestational age, early colostrum, and privacy. The study was conducted at a German level III neonatal department. All preterm and sick term infants admitted to the neonatal intensive care unit, the pediatric intensive care unit, the intermediate care unit, and the low care ward were included in the study. Infants were recruited between March and October 2015 (phase 1) and April to July 2016 (phase 2). Due to an emergency evacuation, privacy was limited during the first phase. Breastfeeding and the use of MOM were assessed daily using a self-designed score. In total, 482 infants of 452 mothers were included. More than 90% initiated breastfeeding and one-third were exclusively breastfed at discharge. Extremely immature infants and late preterm infants were less likely to be exclusively breastfed at discharge. Privacy (p<0.001) and early colostrum (p=0.002) significantly increased exclusive breastfeeding. Conclusion Extremely immature and late preterm infants were least likely to be exclusively breastfed at discharge and need special support. Interventions such as privacy and early colostrum should be promoted to increase breastfeeding.
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Affiliation(s)
- Eva Heine
- Division of Neonatology, Children's Hospital, University of Cologne, Cologne, Germany
| | - Katrin Mehler
- Division of Neonatology, Children's Hospital, University of Cologne, Cologne, Germany
| | - Michiko Schöpping
- Division of Neonatology, Children's Hospital, University of Cologne, Cologne, Germany
| | - Lisa Ganesh
- Division of Neonatology, Children's Hospital, University of Cologne, Cologne, Germany
| | - Ruth Klein
- Division of Neonatology, Children's Hospital, University of Cologne, Cologne, Germany
| | - Angela Kribs
- Division of Neonatology, Children's Hospital, University of Cologne, Cologne, Germany
| | - Titus Keller
- Division of Neonatology, Children's Hospital, University of Cologne, Cologne, Germany
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Silva MDB, de Oliveira RDVC, Alves DDSB, Melo ECP. The effect of risk at birth on breastfeeding duration and exclusivity: A cohort study at a Brazilian referral center for high-risk neonates and infants. PLoS One 2021; 16:e0255190. [PMID: 34358227 PMCID: PMC8346259 DOI: 10.1371/journal.pone.0255190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 07/11/2021] [Indexed: 11/23/2022] Open
Abstract
Background and aim Both breastfeeding and the use of human milk are strategies that provide better conformation to health throughout an individual’s life and bring countless short- and long- term benefits, which are well established in the scientific literature. For at-risk newborns (NBs), these strategies are crucial interventions to enable neonatal survival with better quality of life due to the distinctive and complex composition of human milk, which serves as personalized food-medicine-protection. However, there is limited knowledge about breastfeeding practices in high-risk NBs. The aim was to estimate the duration of EBF and to investigate the effect of risk at birth on EBF discontinuity in the first six months of life’. Methods This cohort study included 1,003 NBs from a high-risk referral center, followed up from birth to the sixth month of life, between 2017 and 2018. Correspondence and cluster analysis was used to identify neonatal risk clusters as the main exposure. The object of interest was the time until EBF discontinuity. The Kaplan-Meier methods and the Cox proportional hazards model were used to estimate the hazard ratio and 95% confidence intervals. Results The prevalence and median duration of EBF decreased proportionally in the three groups. The multiple model revealed a gradient in EBF discontinuity, which was 40% higher in risk group 1 and 111% higher in risk group 2 compared to healthy full-term NBs. Additionally, EBF during hospitalization predicted a longer median duration of this practice for high-risk NBs. Conclusion This study confirms a high proportion of high-risk NBs who have EBF discontinued before six months of life. The risk of EBF discontinuity is higher in risk groups, with a gradual effect even when adjusted by several factors. Effective interventions are needed to promote, protect, and support breastfeeding in different profiles of risk-at-birth groups.
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Affiliation(s)
- Maíra Domingues Bernardes Silva
- Human Milk Bank at the National Institute of Women, Children and Adolescents Health Fernandes Figueira (IFF) of the Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, RJ, Brazil
- * E-mail:
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29
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Grundt H, Tandberg BS, Flacking R, Drageset J, Moen A. Associations Between Single-Family Room Care and Breastfeeding Rates in Preterm Infants. J Hum Lact 2021; 37:593-602. [PMID: 33035125 PMCID: PMC8414820 DOI: 10.1177/0890334420962709] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Hospitalization in neonatal intensive care units with a single-family room design enables continuous maternal presence, but less is known regarding the association with milk production and breastfeeding. RESEARCH AIM To compare maternal milk production, breastfeeding self-efficacy, the extent to which infants received mother's milk, and rate of direct breastfeeding in a single-family room to an open bay neonatal intensive care unit. METHODS A longitudinal, prospective observational study comparing 77 infants born at 28- 32° weeks gestational age and their 66 mothers (n = 35 infants of n = 30 mothers in single family room and n = 42 infants of n = 36 mothers in open bay). Comparisons were made on milk volume produced, the extent to which infants were fed mother's milk, and rate of direct breastfeeding from birth to 4 months' corrected infant age. Breastfeeding self-efficacy was compared across mothers who directly breastfed at discharge (n = 45). RESULTS First expression (6 hr vs. 30 hr, p < .001) and first attempt at breastfeeding (48 hr vs. 109 hr, p < .001) occurred significantly earlier, infants were fed a greater amount of mother's milk (p < .04), and significantly more infants having single-family room care were exclusively directly breastfed from discharge until 4 months' corrected age; OR 6.8 (95% CI [2.4, 19.1]). Volumes of milk produced and breastfeeding self-efficacy did not differ significantly between participants in either units. CONCLUSION To increase the extent to which infants are fed mother's own milk and are exclusively directly breastfed, the design of neonatal intensive care units should facilitate continuous maternal presence and privacy for the mother-infant dyad.
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Affiliation(s)
- Hege Grundt
- 60498 Department of Neonatology, Haukeland University Hospital
| | - Bente Silnes Tandberg
- 155273 Department of Pediatric and Adolescent Medicine, Drammen Hospital, Vestre Viken Hospital Trust.,Lovisenberg Diaconal University College.,Department of Clinical Science, Faculty of Medicine and Dentistry, University of Bergen
| | - Renée Flacking
- 3317 School of Education, Health and Social Studies, Dalarna University, Sweden
| | - Jorunn Drageset
- 1658 Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen.,Institute of Nursing, Faculty of Health and Social sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Atle Moen
- 155273 Department of Pediatric and Adolescent Medicine, Drammen Hospital, Vestre Viken Hospital Trust.,Department of Neonatology, Oslo University Hospital
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Cooijmans KHM, Beijers R, Brett BE, de Weerth C. Daily skin-to-skin contact in full-term infants and breastfeeding: Secondary outcomes from a randomized controlled trial. MATERNAL AND CHILD NUTRITION 2021; 18:e13241. [PMID: 34236131 PMCID: PMC8710110 DOI: 10.1111/mcn.13241] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 06/12/2021] [Accepted: 06/17/2021] [Indexed: 11/27/2022]
Abstract
This randomized controlled trial evaluated the effect of a 5-week daily skin-to-skin contact (SSC) intervention between mothers and their full-term infants, compared with care-as-usual, on exclusive and continued breastfeeding duration during the first post-natal year. Healthy pregnant women (n = 116) from a community sample were enrolled and randomly allocated to the SSC or care-as-usual condition. SSC mothers were requested to provide one daily hour of SSC for the first five post-natal weeks. Twelve months post-partum, mothers indicated the number of exclusive and continued breastfeeding months. Multiple regression analyses were conducted using intention-to-treat, per-protocol and exploratory dose-response frameworks. In intention-to-treat analyses, exclusive and continued breastfeeding duration was not different between groups (exclusive: 3.61 ± 1.99 vs. 3.16 ± 1.77 months; adjusted mean difference 0.28, 95% confidence interval [CI] -0.33 to 0.89; p = 0.36; continued: 7.98 ± 4.20 vs. 6.75 ± 4.06 months; adjusted mean difference 0.81, 95% CI -0.46 to 2.08; p = 0.21). In per-protocol analyses, exclusive and continued breastfeeding duration was longer for SSC than care-as-usual dyads (exclusive: 4.89 ± 1.26 vs. 3.25 ± 1.80 months; adjusted mean difference 1.28, 95% CI 0.31-2.24; p = 0.01; continued: 10.81 ± 1.97 vs. 6.98 ± 4.08 months; adjusted mean difference 2.33, 95% CI 0.13-4.54; p = 0.04). Exploratory dose-response effects indicated that more SSC hours predicted longer exclusive and continued breastfeeding duration. This study demonstrates that for the total group, the 5-week daily SSC intervention did not extend exclusive and continued breastfeeding duration. However, for mothers performing a regular daily hour of SSC, this simple and accessible intervention may extend exclusive and continued breastfeeding duration by months. Future studies are required to confirm these promising findings. Trial registration: Netherlands Trial Register (NTR5697).
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Affiliation(s)
- Kelly H M Cooijmans
- Department of Developmental Psychology, Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands.,Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Roseriet Beijers
- Department of Developmental Psychology, Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands.,Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Bonnie E Brett
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Carolina de Weerth
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
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Cabrera-Lafuente M, Alonso-Díaz C, Moral Pumarega MT, Díaz-Almirón M, Haiek LN, Maastrup R, Pallás-Alonso C. [Breastfeeding practices in neonatal wards in Spain. Neo-BFHI international survey]. An Pediatr (Barc) 2021; 96:S1695-4033(21)00178-8. [PMID: 34045162 DOI: 10.1016/j.anpedi.2021.04.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 04/09/2021] [Accepted: 04/15/2021] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION In 2017, a worldwide survey was conducted on compliance with the practices promoted by Neo-BFHI (Baby-friendly Hospital Initiative expansion to neonatal wards). OBJECTIVE Present the results of the Spanish wards that participated in the global survey and compare them with those obtained internationally. MATERIAL AND METHODS Cross-sectional study through a survey on compliance with the Neo-BFHI ("Three basic principles", "Ten steps adapted to neonatal wards" and "the compliance with the International Code of Marketing of Breast-milk Substitutes" and subsequent relevant World Health Assembly resolutions). Compliance was calculated as the mean in each indicator and a final mean score for each neonatal unit. For the partial and final scores for each country and at the international level, the median was used. All score ranged between 0 and 100. RESULTS The response rate in Spain was 90%. The range of the national mean for neonatal wards were from 37 to 99, with no differences in the final score according to the level of care. The global score for Spain (72) is below the international median (77) and this also occurs in 8 of 14 items. The neonatal wards from BFHI designated hospitals, obtained a significantly higher mean global score, and in 9 of 14 items than the non-accredited ones. CONCLUSIONS Both international and national results indicate an improvement in breastfeeding practices in neonatal units. The benefits of the BFHI accreditation of maternity reach neonatal wards. Spain has several key points below the international score.
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Affiliation(s)
| | - Clara Alonso-Díaz
- Servicio de Neonatología, Hospital Universitario 12 de Octubre, Madrid, España
| | | | - Mariana Díaz-Almirón
- Sección de Bioestadística, IdiPAZ, Hospital Universitario La Paz, Madrid, España
| | - Laura N Haiek
- Ministère de la Santé et des Services sociaux, Direction générale de la santé publique, Quebec, Canadá; McGill University, Department of Family Medicine, Montreal, Quebec, Canada
| | - Ragnhild Maastrup
- Department of Neonatology, Copenhagen University Hospital Rigshospitalet, University Hospital Rigshospitalet, Department of Neonatology, Blegdamsvej, Dinamarca
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Abstract
Breastfeeding is associated with a risk reduction for several acute and chronic diseases in women and their infants. Health benefits of breastfeeding are especially important for small, sick and preterm infants. The objective of this article is to summarize essential steps for healthcare personnel and facilities to improve breastfeeding practices in this vulnerable population. Health facilities can support breastfeeding through the establishment of breastfeeding-supportive policies, staff training and the design of facilities to support rooming-in. Direct support to breastfeeding includes the provision of counseling to mothers at critical time points, skin-to-skin and kangaroo care, and support of responsive (on-demand) breastfeeding. Where direct breastfeeding is not possible, facilities should show mothers how to express their breastmilk and teach mothers alternative feeding modalities. Medically-indicated supplementation of small, sick and preterm may be needed in certain circumstances.
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Affiliation(s)
- Melissa A Theurich
- LMU Ludwig-Maximilians-Universität Munich, Div. Metabolic and Nutritional Medicine, Dept. Pediatrics, Dr. von Hauner Children's Hospital, LMU University Hospital, Lindwurmstr. 4, 80337 Munich, Germany
| | - Megan McCool-Myers
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Berthold Koletzko
- LMU Ludwig-Maximilians-Universität Munich, Div. Metabolic and Nutritional Medicine, Dept. Pediatrics, Dr. von Hauner Children's Hospital, LMU University Hospital, Lindwurmstr. 4, 80337 Munich, Germany.
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Maastrup R, Rom AL, Walloee S, Sandfeld HB, Kronborg H. Improved exclusive breastfeeding rates in preterm infants after a neonatal nurse training program focusing on six breastfeeding-supportive clinical practices. PLoS One 2021; 16:e0245273. [PMID: 33534831 PMCID: PMC7857627 DOI: 10.1371/journal.pone.0245273] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 12/27/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Early breast milk expression, prolonged skin-to-skin contact, rooming-in, use of test-weighing and minimizing use of pacifiers are positively associated with exclusive breastfeeding of preterm infants, whereas use of nipple shields is negatively associated. AIM To test whether a training program for neonatal nurses with a focus on these six breastfeeding-supportive clinical practices affects the rate of preterm infants exclusively breastfed at discharge to home, the postmenstrual age at establishment of exclusive breastfeeding, and maternal self-reported use of the practice in the neonatal intensive care unit, the. METHODS A quasi-experimental multi-centre intervention study from 2016-2019 including a control group of 420 preterm mother-infant dyads, an intervention with a training program for neonatal nurses and implementation of weekly breastfeeding meetings for neonatal nurses, and an intervention group of 494 preterm mother-infant dyads. RESULTS Significantly more preterm infants in the intervention group were exclusively breastfed at discharge to home (66.6%) than in the control group (58.1%) p = 0.008. There was no significant difference in postmenstrual age at establishment of exclusive breastfeeding between control and intervention group (37.5 vs.37.8 weeks, p = 0.073). Compared to the control group the number of infants continuing daily skin-to-skin contact after incubator care increased (83.2% vs. 88.3%, p = 0.035), infants using a nipple shield decreased (61.8% vs. 54.2%, p = 0.029), and the number of mothers initiating breast milk expression before six hours post-partum increased (32.6% vs. 42.4%, p = 0.007). There was a significant correlation between percentage of neonatal nurses participating in the breastfeeding training program and changes in exclusive breastfeeding rates (Pearson Correlation 0.638, p = 0.047). CONCLUSION Exclusive breastfeeding rates in preterm infants and maternal self-reported use of breastfeeding-supportive practices increased by training neonatal nurses in the six clinical practices. It is important to include all nurses in the breastfeeding training program to ensure positive effect on exclusive breastfeeding rates.
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Affiliation(s)
- Ragnhild Maastrup
- Department of Neonatology, Knowledge Centre for Breastfeeding Infants with Special Needs, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,Research Unit Women's and Children's Health, Juliane Marie Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Ane L Rom
- Research Unit Women's and Children's Health, Juliane Marie Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Sisse Walloee
- Dept of Clinical Research, OPEN-Patient data Explorative Network, University of Southern Denmark, Odense, Denmark
| | | | - Hanne Kronborg
- Department of Public Health, Section for Nursing, Aarhus University, Aarhus, Denmark
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34
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Sinkiewicz-Darol E, Bernatowicz-Łojko U, Łubiech K, Adamczyk I, Twarużek M, Baranowska B, Skowron K, Spatz DL. Tandem Breastfeeding: A Descriptive Analysis of the Nutritional Value of Milk When Feeding a Younger and Older Child. Nutrients 2021; 13:277. [PMID: 33478010 PMCID: PMC7835967 DOI: 10.3390/nu13010277] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 01/17/2021] [Accepted: 01/18/2021] [Indexed: 11/16/2022] Open
Abstract
Breastfeeding is a gold standard of feeding of newborns and infants. Tandem breastfeeding (TBF) is feeding two children of different ages at the same time. The knowledge about the composition of human milk in prolonged lactation is still scarce. Milk from tandem breastfeeding women and after weaning was examined. Milk samples were collected from 13 TBF mothers. A 24-h milk collection was done. Analyses of fat, protein, carbohydrate and energy content were performed using MIRIS. Sociodemographic characteristics of TBF mothers was done. Higher fat content, energy value and total protein concentration was found in TBFM milk during tandem breastfeeding, than in milk after weaning the older child. The carbohydrate content remained stable. The composition of breastmilk, in terms of macronutrients, changes after weaning, taking into account the nutritional requirements of the younger child. The milk of nursing mothers in tandem did not show diurnal variability in individual components. These findings suggest an adaptive role of human milk to nutrient requirements of newborn and older children. The results may support the promotion of long breastfeeding, including tandem breastfeeding.
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Affiliation(s)
- Elena Sinkiewicz-Darol
- Human Milk Bank, Ludwik Rydygier’ Provincial Polyclinical Hospital in Torun, 87-100 Toruń, Poland; (U.B.-Ł.); (I.A.)
| | - Urszula Bernatowicz-Łojko
- Human Milk Bank, Ludwik Rydygier’ Provincial Polyclinical Hospital in Torun, 87-100 Toruń, Poland; (U.B.-Ł.); (I.A.)
- Centre of Postgraduate Medical Education, Departament of Midwifery, 01-813 Warsaw, Poland;
| | - Katarzyna Łubiech
- Department of Physiology and Toxicology, Faculty of Biological Sciences, Kazimierz Wielki University, Chodkiewicza 30 St., 85-064 Bydgoszcz, Poland; (K.Ł.); (M.T.)
| | - Iwona Adamczyk
- Human Milk Bank, Ludwik Rydygier’ Provincial Polyclinical Hospital in Torun, 87-100 Toruń, Poland; (U.B.-Ł.); (I.A.)
- Department of Physiology and Toxicology, Faculty of Biological Sciences, Kazimierz Wielki University, Chodkiewicza 30 St., 85-064 Bydgoszcz, Poland; (K.Ł.); (M.T.)
| | - Magdalena Twarużek
- Department of Physiology and Toxicology, Faculty of Biological Sciences, Kazimierz Wielki University, Chodkiewicza 30 St., 85-064 Bydgoszcz, Poland; (K.Ł.); (M.T.)
| | - Barbara Baranowska
- Centre of Postgraduate Medical Education, Departament of Midwifery, 01-813 Warsaw, Poland;
| | - Krzysztof Skowron
- Department of Microbiology, Nicolaus Copernicus University in Toruń, Ludwik Rydygier Collegium Medicum, 85-067 Bydgoszcz, Poland;
| | - Diane L. Spatz
- University of Pennsylvania School of Nursing, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA;
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Silva MDB, de Oliveira RDVC, da Silveira Barroso Alves D, Melo ECP. Predicting risk of early discontinuation of exclusive breastfeeding at a Brazilian referral hospital for high-risk neonates and infants: a decision-tree analysis. Int Breastfeed J 2021; 16:2. [PMID: 33397423 PMCID: PMC7783998 DOI: 10.1186/s13006-020-00349-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 12/09/2020] [Indexed: 12/01/2022] Open
Abstract
Background Determinants at several levels may affect breastfeeding practices. Besides the known historical, socio-economic, cultural, and individual factors, other components also pose major challenges to breastfeeding. Predicting existing patterns and identifying modifiable components are important for achieving optimal results as early as possible, especially in the most vulnerable population. The goal of this study was building a tree-based analysis to determine the variables that can predict the pattern of breastfeeding at hospital discharge and at 3 and 6 months of age in a referral center for high-risk infants. Methods This prospective, longitudinal study included 1003 infants and was conducted at a high-risk public hospital in the following three phases: hospital admission, first visit after discharge, and monthly telephone interview until the sixth month of the infant’s life. Independent variables were sorted into four groups: factors related to the newborn infant, mother, health service, and breastfeeding. The outcome was breastfeeding as per the categories established by the World Health Organization (WHO). For this study, we performed an exploratory analysis at hospital discharge and at 3 and at 6 months of age in two stages, as follows: (i) determining the frequencies of baseline characteristics stratified by breastfeeding indicators in the three mentioned periods and (ii) decision-tree analysis. Results The prevalence of exclusive breastfeeding (EBF) was 65.2% at hospital discharge, 51% at 3 months, and 20.6% at 6 months. At hospital discharge and the sixth month, the length of hospital stay was the most important predictor of feeding practices, also relevant at the third month. Besides the mother’s and child’s characteristics (multiple births, maternal age, and parity), the social context, work, feeding practice during hospitalization, and hospital practices and policies on breastfeeding influenced the breastfeeding rates. Conclusions The combination algorithm of decision trees (a machine learning technique) provides a better understanding of the risk predictors of breastfeeding cessation in a setting with a large variability in expositions. Decision trees may provide a basis for recommendations aimed at this high-risk population, within the Brazilian context, in light of the hospital stay at a neonatal unit and period of continuous feeding practice. Supplementary Information The online version contains supplementary material available at 10.1186/s13006-020-00349-x.
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Affiliation(s)
- Maíra Domingues Bernardes Silva
- Human Milk Bank at the National Institute of Women, Children and Adolescents Health Fernandes Figueira (IFF) of the Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, RJ, Brazil.
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Miani A, Di Bernardo GA, Højgaard AD, Earp BD, Zak PJ, Landau AM, Hoppe J, Winterdahl M. Neonatal male circumcision is associated with altered adult socio-affective processing. Heliyon 2020; 6:e05566. [PMID: 33299934 PMCID: PMC7702013 DOI: 10.1016/j.heliyon.2020.e05566] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 09/21/2020] [Accepted: 11/17/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Neonatal male circumcision is a painful skin-breaking procedure that may affect infant physiological and behavioral stress responses as well as mother-infant interaction. Due to the plasticity of the developing nociceptive system, neonatal pain might carry long-term consequences on adult behavior. In this study, we examined whether infant male circumcision is associated with long-term psychological effects on adult socio-affective processing. METHODS We recruited 408 men circumcised within the first month of life and 211 non-circumcised men and measured socio-affective behaviors and stress via a battery of validated psychometric scales. RESULTS Early-circumcised men reported lower attachment security and lower emotional stability while no differences in empathy or trust were found. Early circumcision was also associated with stronger sexual drive and less restricted socio-sexuality along with higher perceived stress and sensation seeking. LIMITATIONS This is a cross-sectional study relying on self-reported measures from a US population. CONCLUSIONS Our findings resonate with the existing literature suggesting links between altered emotional processing in circumcised men and neonatal stress. Consistent with longitudinal studies on infant attachment, early circumcision might have an impact on adult socio-affective traits or behavior.
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Affiliation(s)
- Alessandro Miani
- Department of Nuclear Medicine and PET, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Institute of Work and Organizational Psychology, University of Neuchâtel, Switzerland
| | - Gian Antonio Di Bernardo
- Department of Education and Human Sciences, University of Modena and Reggio Emilia, Reggio Emiilia, Italy
| | | | - Brian D. Earp
- Departments of Philosophy and Psychology, Yale University, New Haven, CT, USA
| | - Paul J. Zak
- Center for Neuroeconomics Studies, Claremont Graduate University, Claremont, CA, USA
| | - Anne M. Landau
- Department of Nuclear Medicine and PET, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Translational Neuropsychiatry Unit, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Jørgen Hoppe
- Department of Nuclear Medicine and PET, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Michael Winterdahl
- Department of Nuclear Medicine and PET, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Vizzari G, Morniroli D, Consales A, Capelli V, Crippa BL, Colombo L, Sorrentino G, Bezze E, Sannino P, Soldi VA, Plevani L, Mosca F, Giannì ML. Knowledge and attitude of health staff towards breastfeeding in NICU setting: are we there yet? An Italian survey. Eur J Pediatr 2020; 179:1751-1759. [PMID: 32424743 DOI: 10.1007/s00431-020-03678-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 04/24/2020] [Accepted: 05/06/2020] [Indexed: 10/24/2022]
Abstract
The benefits of human milk in preterm infants, a population at high risk for developing adverse outcomes for which breast milk is a protective factor, are widely acknowledged. However, preterms' admission in a neonatal intensive care unit (NICU) and newborn's clinical conditions have been described as significant barriers, leading to lower rates of breastfeeding initiation and duration. Healthcare workers play a crucial role in encouraging breastfeeding. We conducted a cross-sectional survey among nurses working in six Italian NICUs, exploring their knowledge and attitude towards breastfeeding. Although the majority of nurses had a specific breastfeeding education, our results show still some variations among answers regarding aspects of breastfeeding support in this setting. Specifically, family-centered care, transition feeding to the breast, and skin-to-skin practice, despite being extensively addressed by the Neo Baby-Friendly Hospital Initiative, are the items that highlighted a range of answers that could result in conflicting information to mothers.Conclusion: By underlining the gaps of knowledge and attitude towards breastfeeding of nurses working in NICUs, this study provides an insight into what needs to be improved, with the aim of promoting higher rates of breastfeeding in the preterm population. What is Known: • Breastfeeding is particularly challenging in the preterm population, despite its universally recognized health benefits. • Improving healthcare professionals' knowledge and attitude towards breastfeeding has been shown to be crucial for promoting breastfeeding in NICUs. What is New: • Our results provide useful insight into nurses' knowledge and attitude towards breastfeeding in NICU settings. • By acknowledging strengths and weaknesses highlighted by this study, tailored strategies could be developed to improve health staff breastfeeding education and support to parents in NICU settings.
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Affiliation(s)
- Giulia Vizzari
- Department of Clinical Sciences and Community Health, University of Milan, Via Commenda, 19, Milan, Italy
| | - Daniela Morniroli
- NICU, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Commenda 12, 20122, Milan, Italy.
| | - Alessandra Consales
- Department of Clinical Sciences and Community Health, University of Milan, Via Commenda, 19, Milan, Italy.,NICU, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Commenda 12, 20122, Milan, Italy
| | - Valentina Capelli
- NICU, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Commenda 12, 20122, Milan, Italy
| | - Beatrice Letizia Crippa
- NICU, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Commenda 12, 20122, Milan, Italy
| | - Lorenzo Colombo
- NICU, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Commenda 12, 20122, Milan, Italy
| | - Gabriele Sorrentino
- NICU, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Commenda 12, 20122, Milan, Italy
| | - Elena Bezze
- NICU, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Commenda 12, 20122, Milan, Italy
| | - Patrizio Sannino
- Direzione Professioni Sanitarie, Fondazione I.R.C.C.S. Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 28, 20122, Milan, Italy
| | - Valeria Andrea Soldi
- NICU, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Commenda 12, 20122, Milan, Italy
| | - Laura Plevani
- NICU, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Commenda 12, 20122, Milan, Italy
| | - Fabio Mosca
- Department of Clinical Sciences and Community Health, University of Milan, Via Commenda, 19, Milan, Italy.,NICU, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Commenda 12, 20122, Milan, Italy
| | - Maria Lorella Giannì
- Department of Clinical Sciences and Community Health, University of Milan, Via Commenda, 19, Milan, Italy.,NICU, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Commenda 12, 20122, Milan, Italy
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Skaaning D, Carlsen E, Brødsgaard A, Kyhnæb A, Pedersen M, Ravn S, Pryds O, Kronborg H. Randomised oral stimulation and exclusive breastfeeding duration in healthy premature infants. Acta Paediatr 2020; 109:2017-2024. [PMID: 31954063 DOI: 10.1111/apa.15174] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 11/12/2019] [Accepted: 01/03/2020] [Indexed: 11/28/2022]
Abstract
AIM Although exclusive breastfeeding is recommended for all newborn in the first 6 months of life, only 13% of Danish premature infants complies with this. This trial aimed to examine whether oral stimulation prolonged exclusive breastfeeding in premature infants. METHOD A randomised controlled trial was conducted at the Neonatal Intensive Care Unit, Hvidovre Hospital, Denmark between 2016 and 2018. Systematic oral stimulation was performed by the parents after training by occupational therapists. Primary outcome was exclusive breastfeeding duration with 6 months' follow-up, analysed by intention-to-treat. RESULTS Included were 211 infants (53% boys) with a mean gestational age of 231 days, allocated in ratio 1:1 to oral stimulation or standard care. There was no difference in exclusive breastfeeding duration between infants orally stimulated and control infants. Thus, for orally stimulated infants, median duration was 122 days (interquartile range 40-183) in contrast to 154 days (interquartile range 61-183) for the controls, P value .16. At 6 months of age, 27% of orally stimulated infants were exclusively breastfed compared with 25% of controls. CONCLUSION In healthy premature infants, oral stimulation performed by parents has no long-lasting effect on breastfeeding duration. Attention should be directed to parental education and involvement.
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Affiliation(s)
- Diana Skaaning
- Department of Paediatrics and Adolescent Medicine Copenhagen University Hospital Hvidovre Hvidovre Denmark
| | - Emma Carlsen
- Department of Paediatrics and Adolescent Medicine Copenhagen University Hospital Hvidovre Hvidovre Denmark
| | - Anne Brødsgaard
- Department of Paediatrics and Adolescent Medicine Copenhagen University Hospital Hvidovre Hvidovre Denmark
- Department of Public Health Faculty of Health Sciences Aarhus University Aarhus Denmark
| | - Anne Kyhnæb
- Department of Paediatrics and Adolescent Medicine Copenhagen University Hospital Hvidovre Hvidovre Denmark
| | - Maj Pedersen
- Department of Physiology and Occupational Therapy Copenhagen University Hospital Hvidovre Hvidovre Denmark
| | - Stine Ravn
- Department of Physiology and Occupational Therapy Copenhagen University Hospital Hvidovre Hvidovre Denmark
| | - Ole Pryds
- Department of Paediatrics and Adolescent Medicine Copenhagen University Hospital Hvidovre Hvidovre Denmark
| | - Hanne Kronborg
- Department of Public Health Faculty of Health Sciences Aarhus University Aarhus Denmark
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Skaaning D, Kronborg H, Brødsgaard A, Solmer R, Pryds O, Carlsen EM. No long-term effect of oral stimulation on the intra-oral vacuum in healthy premature infants. Acta Paediatr 2020; 109:2025-2032. [PMID: 32259301 DOI: 10.1111/apa.15289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 02/28/2020] [Accepted: 03/27/2020] [Indexed: 10/24/2022]
Abstract
AIM Exclusive breastfeeding is recommended for the first 6 months of life, but the breastfeeding rate in premature infants is low. We examined the effect of oral stimulation on infant's strength of suction and the relation between this intra-oral vacuum and breastfeeding duration. METHOD Between 2016 and 2018, 211 infants in a Danish neonatal unit were randomised 1:1 and of these 108 to oral stimulation intervention and 103 to control. Suction was measured as peak vacuum at enrolment and a corrected age of 6 weeks. Breastfeeding duration was registered. RESULTS Vacuum increased from enrolment to a corrected age of 6 weeks in all infants, and no effect of oral stimulation intervention was demonstrated P = .08. Infants born ≤32 gestational weeks had lower vacuum compared with infants born after, 350 vs 398 mbar P < .001. For infants born after 32 gestational weeks, the odds ratio for exclusive breastfeeding at 6 months was 1.99 per 100 mbar increase in vacuum P = .01. CONCLUSION In our study, infant's intra-oral vacuum increased with age and was not affected by the oral stimulation intervention. For infants born after 32 gestational weeks, the exclusive breastfeeding rate was positively associated with a strong vacuum.
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Affiliation(s)
- Diana Skaaning
- Department of Paediatrics and Adolescent Medicine Copenhagen University Hospital Hvidovre Hvidovre Denmark
| | - Hanne Kronborg
- Department of Public Health Faculty of Health Sciences Aarhus University Aarhus Denmark
| | - Anne Brødsgaard
- Department of Paediatrics and Adolescent Medicine Copenhagen University Hospital Hvidovre Hvidovre Denmark
- Department of Public Health Faculty of Health Sciences Aarhus University Aarhus Denmark
| | - Rasmus Solmer
- Department of Product Development Technical University of Denmark Lyngby Denmark
| | - Ole Pryds
- Department of Paediatrics and Adolescent Medicine Copenhagen University Hospital Hvidovre Hvidovre Denmark
| | - Emma Malchau Carlsen
- Department of Paediatrics and Adolescent Medicine Copenhagen University Hospital Hvidovre Hvidovre Denmark
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Parker MG, Hwang SS, Forbes ES, Colvin BN, Brown KR, Colson ER. Use of the Theory of Planned Behavior Framework to Understand Breastfeeding Decision-Making Among Mothers of Preterm Infants. Breastfeed Med 2020; 15:608-615. [PMID: 32678988 PMCID: PMC7575351 DOI: 10.1089/bfm.2020.0127] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Background: Mothers of preterm infants face significant challenges to breastfeeding. The theory of planned behavior (TPB) is a well-known framework comprising three domains (attitudes, perceived control, and social norms), which has been used to conceptualize the array of factors that influence health-related behaviors and develop interventions to promote behaviors. Aim: We used the TPB framework to determine the array of factors that contribute to breastfeeding among mothers of preterm infants. Materials and Methods: Using qualitative research methods, we conducted in-depth, semistructured interviews with mothers regarding their experiences feeding their preterm infants according to TPB domains. We developed themes based on an iterative process of review of transcripts and conducted interviews until thematic saturation was reached. Results: We interviewed 23 mothers in 3 states 2 to 6 months after hospital discharge; 22 mothers initiated milk production and 6 were breastfeeding at the time of the interview. Factors that were positive and negative toward breastfeeding were present for all three TPB domains. Regarding attitudes, mothers felt that breastfeeding was a way to bond, that breast milk was healthy and protective, and that breast milk alone was insufficient for a growing preterm infant. Regarding perceived control, mothers felt empowered to breastfeed due to encouragement from hospital staff, friends, and family, and had difficulty overcoming their infant's immature oral feeding skills, competing responsibilities, and perceived infant preference for bottle feeding. Regarding social norms, mothers reported support for and against breastfeeding among hospital and Special Supplemental Nutrition Program for Woman, Infants, and Children (WIC) providers, family, friends, and the media. Conclusion: Interventional studies geared toward breastfeeding promotion among mothers of preterm infants may focus on addressing barriers to direct breastfeeding during the neonatal intensive care unit and early post-discharge time periods.
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Affiliation(s)
- Margaret G Parker
- Department of Pediatrics, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA.,Slone Epidemiology Center, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Sunah S Hwang
- Department of Neonatology, Colorado Children's Hospital, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Emma S Forbes
- Slone Epidemiology Center, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Bryanne N Colvin
- Department of Pediatrics, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Kyria R Brown
- Graduate School of Social Work, Colorado School of Public Health at the University of Colorado-Anschutz, Aurora, Colorado, USA
| | - Eve R Colson
- Department of Pediatrics, Washington University School of Medicine, Saint Louis, Missouri, USA
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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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Tada K, Shimpuku Y, Sunguya B, Horiuchi S. Evaluation of breastfeeding care and education given to mothers with low-birthweight babies by healthcare workers at a hospital in urban Tanzania: a qualitative study. Int Breastfeed J 2020; 15:36. [PMID: 32375834 PMCID: PMC7201530 DOI: 10.1186/s13006-020-00280-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 04/22/2020] [Indexed: 11/27/2022] Open
Abstract
Background The total neonatal mortality in Tanzania remains high reaching as much as 44,900 deaths per year, particularly among low birthweight (LBW) babies. This makes Tanzania the fourth African country with the highest number of annual neonatal deaths. Studies have shown the advantages of breast milk for LBW babies and the effectiveness of interventions from healthcare workers (HCWs) to encourage mothers to achieve exclusive breastfeeding (EBF). Although these interventions can substantially reduce mortality in this vulnerable group, they remain insufficient in practice particularly in resource-limited countries. Therefore, there is an urgent need to establish the most appropriate interventions for mothers with LBW babies, particularly in these countries. To help address this need, we evaluated the breastfeeding care and education given to mothers with LBW babies by HCWs during hospitalization in Tanzania. Methods A qualitative study using semi-structured interviews with mothers of LBW babies at an urban hospital in Tanzania was conducted. We assessed their understanding of breastfeeding at discharge. All the interviews were conducted in local Swahili and then translated to English. Data were analyzed using content analysis. Results Among the 19 mothers interviewed, only four breastfed their baby within an hour after birth. Nine mothers received no support from HCWs when they breastfeed their baby for the first time. Ten mothers received no education on EBF, and there were mothers who misunderstood the EBF definition. Eight answered that they had difficulty breastfeeding their baby at discharge. Four mothers were dissatisfied with the care and education given by HCWs, and six mothers provided suggestions for improvements. Although six mothers had a high reliance on HCWs, they had difficulty asking HCWs questions because of their authoritative attitude and behavior. Conclusions Mothers with LBW babies need special support to increase their ability to breastfeed and ensure EBF continuance. To address the gaps between the currently provided breastfeeding interventions and the ideal breastfeeding interventions, improvements in the quality and quantity of breastfeeding care and education are required. Training HCWs to systematize standard interventions, confirming mothers’ understanding, and ensuring a comfortable environment for mothers are absolutely needed.
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Affiliation(s)
- Kyoko Tada
- St. Luke's International Hospital, 9-1 Akashi-cho, Chuo-ku, Tokyo, 104-8560, Japan.
| | - Yoko Shimpuku
- Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minamiku, Hiroshima, 734-8551, Japan
| | - Bruno Sunguya
- Department of Community Health, Muhimbili University of Health and Allied Sciences, United Nation Road, Upanga, Ilala Municipality, Dar es Salaam, Tanzania
| | - Shigeko Horiuchi
- St. Luke's International University, 10-1 Akashi-cho, Chuo-ku, Tokyo, 104-0044, Japan
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Mӧrelius E, Kling K, Haraldsson E, Alehagen S. You can't flight, you need to fight-A qualitative study of mothers' experiences of feeding extremely preterm infants. J Clin Nurs 2020; 29:2420-2428. [PMID: 32223034 DOI: 10.1111/jocn.15254] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Revised: 02/02/2020] [Accepted: 03/14/2020] [Indexed: 01/05/2023]
Abstract
AIM To describe mother's experiences of feeding their extremely preterm infant. BACKGROUND When an infant is born extremely preterm, there is a long rocky road for the mother if she wants to breastfeed. Some manage to reach their goals, others do not. Studies of feeding extremely preterm infants in the neonatal intensive care unit (NICU) are scarce. DESIGN A qualitative method with an inductive approach. METHODS Nine mothers giving birth to extremely preterm infants were interviewed by telephone after discharge from the NICU. The interviews were transcribed verbatim and analysed with qualitative content analysis. The COREQ checklist was followed. RESULTS The overall theme was "you can't flight, you need to fight." The theme reflects the mothers' will to do the best for their infants even if the struggle with milk expression and breastfeeding practice evoked feelings of helplessness, exposure, worry and disappointment. The categories forming the theme were as follows: The wish to provide own breastmilk; For the infant's best; Loss of control; and Help to reach the goals. CONCLUSION The mothers had a strong will to provide breastmilk to their infants but requested more support in order to be successful. RELEVANCE TO CLINICAL PRACTICE There is a need for evidence-based support programmes for mothers of extremely preterm infants to encourage them to persevere with milk expression and breastfeeding over time.
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Affiliation(s)
- Evalotte Mӧrelius
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia.,Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Kajsa Kling
- Division of Nursing Sciences and Reproductive Health, Department of Health, Medicine and Caring Sciences, Faculty of Health Sciences, Linköping University, Linköping, Sweden
| | - Eva Haraldsson
- Division of Nursing Sciences and Reproductive Health, Department of Health, Medicine and Caring Sciences, Faculty of Health Sciences, Linköping University, Linköping, Sweden
| | - Siw Alehagen
- Division of Nursing Sciences and Reproductive Health, Department of Health, Medicine and Caring Sciences, Faculty of Health Sciences, Linköping University, Linköping, Sweden
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Hägi-Pedersen MB, Dessau RB, Norlyk A, Stanchev H, Kronborg H. Comparison of video and in-hospital consultations during early in-home care for premature infants and their families: A randomised trial. J Telemed Telecare 2020; 28:24-36. [PMID: 32228143 PMCID: PMC8721551 DOI: 10.1177/1357633x20913411] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Introduction Early in-home care is increasingly being used in Scandinavian countries for clinically stable premature infants. Due to challenges with travel and hospital resources, alternative ways to support parents during early in-home care are being considered. The aim of this study was to test whether the proportion of mothers exclusively breastfeeding, parental confidence and mother–infant interaction increased after early in-home care with premature infants, and to compare the outcomes of in-home care involving the use of video communication and a mobile application with those of in-home care involving in-hospital consultations. Methods This study was conducted in four neonatal wards offering premature infant in-home care in Denmark. Premature infants were randomised using 1:1 block randomisation. During early in-home care, families had planned consultations two to three times a week, during which they received support from nurses: the intervention group had video consultations, while the control group had in-hospital consultations. Results The proportion of exclusively breastfeeding mothers at discharge was 66.7% in the intervention group vs 66% in the control group and decreased to 49.4% vs 55%, respectively, 1 month after discharge. No significant improvements were found in the intervention group compared with the control group. In the intervention group, some video consultations were changed to telephone consultations due to problems with the video function, or to in-hospital consultations due to infants’ requirement for medical services. No significant differences in secondary outcomes were observed. Discussion The study showed similar breastfeeding proportions at discharge. No unfavourable effects of video consultation compared with in-hospital consultation were found, indicating that video consultation could be a viable option and an important supplement during early in-home care. Trial registration ClinicalTrials.gov ID: NCT02581800.
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Affiliation(s)
- Mai-Britt Hägi-Pedersen
- Department of Paediatrics, Slagelse Hospital, 4200 Slagelse, Denmark.,Department of Public Health, Faculty of Health, Aarhus University, 8000 Aarhus, Denmark
| | - Ram B Dessau
- Department of Clinical Microbiology, Slagelse Hospital, 4200 Slagelse, Denmark
| | - Annelise Norlyk
- Department of Public Health, Faculty of Health, Aarhus University, 8000 Aarhus, Denmark
| | - Hristo Stanchev
- Department of Paediatrics, Slagelse Hospital, 4200 Slagelse, Denmark
| | - Hanne Kronborg
- Department of Public Health, Faculty of Health, Aarhus University, 8000 Aarhus, Denmark
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Degaga GT, Sendo EG, Tesfaye T. Prevalence of Exclusive Breast Milk Feeding at Discharge and Associated Factors Among Preterm Neonates Admitted to a Neonatal Intensive Care Unit in Public Hospitals, Addis Ababa, Ethiopia: A Cross-Sectional Study. PEDIATRIC HEALTH MEDICINE AND THERAPEUTICS 2020; 11:21-28. [PMID: 32021552 PMCID: PMC6980858 DOI: 10.2147/phmt.s215295] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 12/07/2019] [Indexed: 11/23/2022]
Abstract
Background Studies show that rates of breast milk feeding are much lower among preterm infants than term infants, and breast milk feeding at discharge varies widely between countries. However, research examining factors associated with exclusive breast milk feeding at discharge among preterm neonates in Ethiopia is limited. The study aimed to assess the prevalence of exclusive breast milk feeding at discharge and associated factors among preterm neonates at the neonatal intensive care unit (NICU) in public hospitals, Addis Ababa, Ethiopia. Methods This facility-based cross-sectional study was conducted from February to March 2017 among preterm infants discharged from the NICU of public hospitals. Data were collected using pretested structured questionnaires. Purposive sampling technique was used. Factors associated with exclusive breast milk-fed infants at discharge among preterm neonates were determined using bivariate and multivariate logistic regression models. Statistically significant associations were declared at P<0.05. Results The study assessed 263 mother-preterm dyads. The findings from this study revealed that 71.9% of exclusive breast milk-fed infants at discharge at NICU of the selected Public hospitals in Addis Ababa. Factors associated with exclusive breast milk-fed infants at discharge included duration of hospital stay for 7-14 days (AOR 0.19, 95% CI 0.049-0.808) and more than 14 days (AOR 0.20, 95% CI 0.046,0.891), Initiation of breast milk expression later than 48 hrs postpartum (AOR 0.10, 95% CI 0.032-0.365) and receiving hospital support (AOR 39.00, 95% CI 11.676-130.290). Conclusion In this study, nearly ¾ of the NICU premature population exclusively breast milk fed at discharge, which designates to establish exclusive breastfeeding in the majority of preterm infants in this cohort. Thus, support for exclusive breast milk fed should be at the forefront of maternity practice in hospital and mothers of preterm infants to be guided to initiation of early breast milk expression as soon after delivery as possible and frequent expression thereafter.
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Affiliation(s)
| | - Endalew Gemechu Sendo
- School of Nursing and Midwifery, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Tewodros Tesfaye
- School of Nursing and Midwifery, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Pineda R, Prince D, Reynolds J, Grabill M, Smith J. Preterm infant feeding performance at term equivalent age differs from that of full-term infants. J Perinatol 2020; 40:646-654. [PMID: 32066844 PMCID: PMC7117861 DOI: 10.1038/s41372-020-0616-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 01/21/2020] [Accepted: 02/04/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To identify differences in feeding skill performance among preterm infants at term equivalent age compared with full-term infants. STUDY DESIGN Ninety-two infants (44 preterm infants born ≤32 weeks gestation at term equivalent age and 48 full-term infants within 4 days of birth) had a standardized oral feeding assessment. RESULT Preterm infants at term equivalent age had lower Neonatal Eating Outcome Assessment scores (67.8 ± 13.6 compared with 82.2 ± 8.1; p < 0.001) and were more likely to have poor arousal (p = 0.04), poor tongue positioning (p = 0.04), suck-swallow-breathe discoordination (p < 0.001), inadequate sucking bursts (p = 0.01), tonal abnormalities (p < 0.001), discoordination of the jaw and tongue during sucking (p < 0.001), lack of positive engagement with the feeder and/or discomfort (p < 0.001), signs of aspiration (p < 0.001), difficulty regulating breathing (p < 0.001), and have an inability to maintain an appropriate state (p < 0.001), and complete the feeding (<0.001). CONCLUSION A broad range of feeding-related difficulties appear to remain evident in preterm infants at term equivalent age.
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Affiliation(s)
- Roberta Pineda
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO, USA. .,Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA. .,University of Southern California, Chan Division of Occupational Science and Occupational Therapy, Keck School of Medicine-Pediatrics, California, USA.
| | - Danielle Prince
- 0000 0001 2355 7002grid.4367.6Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO USA
| | - Jenny Reynolds
- 0000 0001 2167 9807grid.411588.1Baylor University Hospital, Division of Baylor Scott & White Rehabilitation Hospital, Dallas, TX USA
| | - Molly Grabill
- 0000 0001 2355 7002grid.4367.6Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO USA
| | - Joan Smith
- 0000 0000 9953 7617grid.416775.6Department of Quality, Safety, and Practice Excellence, Saint Louis Children’s Hospital, St. Louis, MO USA
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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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Holdren S, Fair C, Lehtonen L. A qualitative cross-cultural analysis of NICU care culture and infant feeding in Finland and the U.S. BMC Pregnancy Childbirth 2019; 19:345. [PMID: 31601193 PMCID: PMC6785867 DOI: 10.1186/s12884-019-2505-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 09/12/2019] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The benefits of family-centered care for the health and well-being of preterm infants and their families include increased parent-infant closeness, improved lactation, and positive mental health outcomes; however, it is known that the extent to which family-centered care is adopted varies by unit. This study aimed to understand how differences in neonatal care culture in two units in Finland and the U.S. were translated to parents' infant feeding experiences in the hope of improving relationally focused feeding practices in both locations. METHODS This qualitative, cross-sectional study utilized narrative methodologies to understand the lived experiences of 15 families hospitalized in a tertiary neonatal intensive care unit in Finland (n = 8) and the U. S (n = 7). RESULTS A global theme of lactation as a means or an end showed that lactation and infant feeding were framed differently in each location. The three supporting themes that explain families' perceptions of their transition to parenthood, support as a family unit, and experience with lactation include: universal early postnatal challenges; culture and space-dependent nursing support; and controlled or empowering breastfeeding experiences. CONCLUSIONS Care culture plays a large role in framing all infant caring activities, including lactation and infant feeding. This study found that in the unit in Finland, breastfeeding was one method to achieve closeness with an infant, while in the unit in the U.S., pumping was only an end to promote infant nutritional health. Therefore, breastfeeding coupled with closeness was found to be supportive of a salutogenic, or health-promoting, care approach for the whole family.
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Affiliation(s)
- Sarah Holdren
- Department of Pediatrics, Turku University Hospital, Turku, Finland
| | - Cynthia Fair
- Public Health Studies & Department Chair, Elon University Department of Public Health Studies, Elon, North Carolina USA
| | - Liisa Lehtonen
- Department of Pediatrics, Neonatology & Professor of Pediatrics, Turku University Hospital, Turku, Finland
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Jónsdóttir RB, Jónsdóttir H, Skúladóttir A, Thorkelsson T, Flacking R. Breastfeeding progression in late preterm infants from birth to one month. MATERNAL AND CHILD NUTRITION 2019; 16:e12893. [PMID: 31595692 PMCID: PMC7038874 DOI: 10.1111/mcn.12893] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 08/07/2019] [Accepted: 08/29/2019] [Indexed: 12/01/2022]
Abstract
This study aimed to describe and compare breastfeeding progression, infants' feeding behaviours, maternal feeding difficulties, and mothers' usage of breastfeeding interventions for singleton late preterm (LPT) and term infants. A further aim was to identify associated factors for exclusive breastfeeding at breast at 1 month in LPT infants. This was a cohort study where mothers of LPT infants from a neonatal unit (n = 60), LPT infants from a maternity unit (n = 62), and term infants from a maternity unit (n = 269) answered a questionnaire approximately 1 month after delivery. Findings showed no significant differences in exclusive breastfeeding at breasts between LPT infants admitted to the neonatal unit compared with the maternity unit, during the first week at home (38% vs. 48%), or at 1 month of age (52% vs. 50%). Term infants were more likely to be exclusively breastfed at the breast (86% and 74%, p < 0.05) compared with LPT infants. Multiple regression analysis showed that usage of a nipple shield, not feeding breast milk exclusively during the first week at home, or feeding less than 10 times per day at 1 month were statistically significant for not exclusively breastfeed at the breast. A protective factor was the mothers' experience of having an abundance of milk during the first week at home. In conclusion, LPT infants are less likely to be exclusively breastfed at the breast than term infants, highlighting the need for further research to guide interventions aimed at optimising exclusive breastfeeding rates.
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Affiliation(s)
- Rakel B Jónsdóttir
- Neonatal Intensive Care Unit, Landspitali-The National University Hospital of Iceland, Reykjavík, Iceland.,Faculty of Nursing, School of Health Sciences, University of Iceland, Reykjavík, Iceland
| | - Helga Jónsdóttir
- Faculty of Nursing, School of Health Sciences, University of Iceland, Reykjavík, Iceland
| | - Arna Skúladóttir
- Faculty of Nursing, School of Health Sciences, University of Iceland, Reykjavík, Iceland
| | - Thordur Thorkelsson
- Neonatal Intensive Care Unit, Landspitali-The National University Hospital of Iceland, Reykjavík, Iceland.,Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavík, Iceland
| | - Renée Flacking
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
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Maastrup R, Walloee S, Kronborg H. Nipple shield use in preterm infants: Prevalence, motives for use and association with exclusive breastfeeding-Results from a national cohort study. PLoS One 2019; 14:e0222811. [PMID: 31539900 PMCID: PMC6754237 DOI: 10.1371/journal.pone.0222811] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 09/07/2019] [Indexed: 12/18/2022] Open
Abstract
Background and aim Prevalence and motives for nipple shield use are not well studied in preterm infants and recommendations of nipple shield use in preterm infants are inconsistent. The aim of this study was to determine the prevalence of nipple shield use, explore the motives for nipple shield use and elucidate the association with exclusive breastfeeding in preterm infants. Methods The study was part of a prospective survey of a Danish national cohort of preterm infants based on questionnaires answered by the 1221 mothers of 1488 preterm infants with gestational age of 24–36 weeks. Data on nipple shield use was available for 1407 infants. Results Nipple shields were used by 54% of the mother-infant dyads for many different motives and was more often related to breastfeeding problems associated with the infant than with the mother. The most common motive for nipple shield use was “infant slipped the nipple” (52%). The lower the gestational age, the more frequently nipple shields were used for motives related to the infant. For those using a nipple shield, only the motive “infant fell asleep at the breast” was associated with a higher risk of not breastfeeding exclusively at discharge (OR 1.90 (95% CI 1.15; 3.13), p = 0.012), and “breast too engorged” with a lower risk of not breastfeeding exclusively (OR 0.32 (0.16; 0.63), p = 0.001), but overall nipple shield use was associated with failure of exclusive breastfeeding. Conclusion The present study does not give justifiable motives for nipple shield use, except for “breast too engorged”. Nipple shields should not be recommended for infants falling asleep at the breast, instead, staff and mothers should be patient, allowing the dyad time skin-to-skin. The results indicate that the use of a nipple shield does not promote exclusive breastfeeding in preterm infants.
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Affiliation(s)
- Ragnhild Maastrup
- Knowledge Centre for Breastfeeding Infants with Special Needs, Department of Neonatology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Research Unit Women’s and Children’s Health, Juliane Marie Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- * E-mail:
| | - Sisse Walloee
- Research Unit Women’s and Children’s Health, Juliane Marie Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Obstetrics and Gynecology, Slagelse Hospital, Slagelse, Denmark
| | - Hanne Kronborg
- Department of Public Health, Section for Nursing, Aarhus University, Aarhus, Denmark
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