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Bartick M. Losing Women, Losing Breastfeeding: A Crisis of Words. Breastfeed Med 2024; 19:313-315. [PMID: 38606817 DOI: 10.1089/bfm.2024.0102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Affiliation(s)
- Melissa Bartick
- -Melissa Bartick, MD, MS, MPH, Mount Auburn Hospital/Beth Israel Lahey Health
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2
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Bettinelli ME, Smith JP, Haider R, Sulaiman Z, Stehel E, Young M, Bartick M. ABM Position Statement: Paid Maternity Leave-Importance to Society, Breastfeeding, and Sustainable Development. Breastfeed Med 2024; 19:141-151. [PMID: 38489526 DOI: 10.1089/bfm.2024.29266.meb] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/17/2024]
Abstract
Background: Paid maternity leave benefits all of society, reducing infant mortality and providing economic gains. It is endorsed by international treaties. Paid maternity leave is important for breastfeeding, bonding, and recovery from childbirth. Not all mothers have access to adequate paid maternity leave. Key Information: Paid leave helps meet several of the 17 United Nations' Sustainable Development Goals (2, 3, 4, 5, 8, and 10), including fostering economic growth. A family's expenses will rise with the arrival of an infant. Paid leave is often granted with partial pay. Many low-wage workers earn barely enough to meet their needs and are unable to take advantage of paid leave. Undocumented immigrants and self-employed persons, including those engaging in informal work, are often omitted from maternity leave programs. Recommendations: Six months of paid leave at 100% pay, or cash equivalent, should be available to mothers regardless of income, employment, or immigration status. At the very minimum, 18 weeks of fully paid leave should be granted. Partial pay for low-wage workers is insufficient. Leave and work arrangements should be flexible whenever possible. Longer flexible leave for parents of sick and preterm infants is essential. Providing adequate paid leave for partners has multiple benefits. Increasing minimum wages can help more families utilize paid leave. Cash benefits per birth can help informal workers and undocumented mothers afford to take leave. Equitable paid maternity leave must be primarily provided by governments and cannot be accomplished by employers alone.
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Affiliation(s)
| | - Julie Patricia Smith
- National Centre for Epidemiology and Population Health, College of Health and Medicine, The Australian National University, Canberra, Australia
| | - Rukhsana Haider
- Training and Assistance for Health and Nutrition Foundation (TAHN), Dhaka, Bangladesh
| | - Zaharah Sulaiman
- School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
| | - Elizabeth Stehel
- Department of Pediatrics, University of Texas Medical Center, Dallas, Texas, USA
| | - Michal Young
- Department of Pediatrics and Child Health, Howard University College of Medicine, Washington, District of Columbia, USA
| | - Melissa Bartick
- Department of Medicine, Mount Auburn Hospital/Beth Israel Lahey Health, Cambridge, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
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Campbell JI, Shanahan KH, Bartick M, Ali M, Goldmann D, Shaikh N, Allende-Richter S. Racial and Ethnic Differences in Length of Stay for US Children Hospitalized for Acute Osteomyelitis. J Pediatr 2023; 259:113424. [PMID: 37084849 PMCID: PMC10527861 DOI: 10.1016/j.jpeds.2023.113424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 11/02/2022] [Accepted: 03/31/2023] [Indexed: 04/23/2023]
Abstract
OBJECTIVE To examine the associations between race and ethnicity and length of stay (LOS) for US children with acute osteomyelitis. STUDY DESIGN Using the Kids' Inpatient Database, we conducted a cross-sectional study of children <21 years old hospitalized in 2016 or 2019 with acute osteomyelitis. Using survey-weighted negative binomial regression, we modeled LOS by race and ethnicity, adjusting for clinical and hospital characteristics and socioeconomic status. Secondary outcomes included prolonged LOS, defined as LOS of >7 days (equivalent to LOS in the highest quartile). RESULTS We identified 2388 children discharged with acute osteomyelitis. The median LOS was 5 days (IQR, 3-7). Compared with White children, children of Black race (adjusted incidence rate ratio [aIRR] 1.15; 95% CI, 1.05-1.27), Hispanic ethnicity (aIRR 1.11; 95% CI, 1.02-1.21), and other race and ethnicity (aIRR 1.12; 95% CI, 1.01-1.23) had a significantly longer LOS. The odds of Black children experiencing prolonged LOS was 46% higher compared with White children (aOR, 1.46; 95% CI, 1.01-2.11). CONCLUSIONS Children of Black race, Hispanic ethnicity, and other race and ethnicity with acute osteomyelitis experienced longer LOS than White children. Elucidating the mechanisms underlying these race- and ethnicity-based differences, including social drivers such as access to care, structural racism, and bias in provision of inpatient care, may improve management and outcomes for children with acute osteomyelitis.
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Affiliation(s)
- Jeffrey I Campbell
- Division of Infectious Diseases, Boston Children's Hospital, Boston, MA.
| | | | - Melissa Bartick
- Department of Medicine, Mount Auburn Hospital, Cambridge, MA
| | - Mohsin Ali
- Division of Infectious Diseases, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Don Goldmann
- Division of Infectious Diseases, Boston Children's Hospital, Boston, MA
| | - Nadia Shaikh
- Department of Pediatrics, University of Illinois College of Medicine at Peoria, Peoria, IL
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Zimmerman D, Bartick M, Feldman-Winter L, Ball HL. ABM Clinical Protocol #37: Physiological Infant Care-Managing Nighttime Breastfeeding in Young Infants. Breastfeed Med 2023; 18:159-168. [PMID: 36927076 PMCID: PMC10083892 DOI: 10.1089/bfm.2023.29236.abm] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
A central goal of the Academy of Breastfeeding Medicine (ABM) is the development of clinical protocols for managing common medical problems that may impact breastfeeding success. These protocols serve only as guidelines for the care of breastfeeding mothers and infants and do not delineate an exclusive course of treatment or serve as standards of medical care. Variations in treatment may be appropriate according to the needs of an individual patient. The ABM empowers health professionals to provide safe, inclusive, patient-centered, and evidence-based care. Pregnant and lactating people identify with a broad spectrum of genders, pronouns, and terms for feeding and parenting. There are two reasons ABM's use of gender-inclusive language may be transitional or inconsistent across protocols. First, gender-inclusive language is nuanced and evolving across languages, cultures, and countries. Second, foundational research has not adequately described the experiences of gender-diverse individuals. Therefore, ABM advocates for, and will strive to use language that is as inclusive and accurate as possible within this framework. For more explanation, please read ABM Position Statements on Infant Feeding and Lactation-Related Language and Gender (https://doi.org/10.1089/bfm.2021.29188.abm) and Breastfeeding As a Basic Human Right (https://doi.org/10.1089/bfm.2022.29216.abm).
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Affiliation(s)
- Deena Zimmerman
- Maternal-Child and Adolescent Division, Public Health Service, Israel Ministry of Health, Jerusalem, Israel
| | - Melissa Bartick
- Department of Medicine, Mount Auburn Hospital, Cambridge, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Lori Feldman-Winter
- Department of Pediatrics, Cooper Medical School of Rowan University, Camden, New Jersey, USA
| | - Helen L Ball
- Durham Infancy and Sleep Centre, Department of Anthropology, Durham University, Durham, United Kingdom
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Campbell J, Shanahan KH, Bartick M, Ali M, Goldmann D, Shaikh N, Allende-Richter SH. 887. Race and ethnicity differences in hospital length of stay for children with acute osteomyelitis in the United States. Open Forum Infect Dis 2022. [DOI: 10.1093/ofid/ofac492.079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Abstract
Background
Changes in management of bone infections, particularly early transition to oral antibiotic therapy, have decreased length of stay (LOS) for children hospitalized with acute osteomyelitis. However, evaluation of differences in length of stay by race and ethnicity have been limited.
Methods
Using the Kids’ Inpatient Database, we conducted a cross-sectional study of children ages 0–20 years hospitalized in 2016 or 2019 with a primary or secondary diagnosis of acute osteomyelitis. Using survey-weighted negative binomial regression, we modeled length of study (LOS) by race and ethnicity, accounting for clinical and hospital characteristics and socioeconomic status. Secondary outcomes included predictors of LOS > 7 days (equivalent to LOS in the highest quartile), central venous catheter (CVC) placement, and time to debridement.
Results
We identified 2,388 patients discharged with acute osteomyelitis. Median LOS was 5 days (IQR 3–7). Black race (adjusted incidence rate ratio [aIRR] 1.15, 95%CI 1.05–1.27), Hispanic ethnicity (aIRR 1.11, 95% CI 1.02–1.21), and other race and ethnicity (aIRR 1.12, 95% CI 1.01–1.23) were associated with longer LOS, compared to White race (Figure 1). Additional factors associated with prolonged LOS were Medicaid/self-pay status (aIRR 1.14, 95% CI 1.07–1.21) and other insurance (aIRR 1.21, 95% CI 1.02–1.45), compared to private insurance; debridement procedure (aIRR 1.31, 95%CI 1.23–1.31); CVC placement (aIRR 1.41, 95% CI 1.31–1.51), and complex chronic condition (aIRR 1.21, 95% CI 1.11–1.33). The odds of Black children experiencing LOS > 7 days was 46% higher compared to White children (aOR 1.46, 95% CI 1.01–2.11; Figure 2). There were no differences by race and ethnicity on odds of CVC placement or time to debridement.
Model is adjusted for hospital location/teaching status, hospital region, year, debridement procedure, CVC placement, complex chronic condition, weekend admission, discharge quarter, hospital bed size, Zip code median income quartile.
Model is adjusted for hospital location/teaching status, hospital region, year, debridement procedure, CVC placement, complex chronic condition, weekend admission, discharge quarter, hospital bed size, Zip code median income quartile.
Conclusion
Black, Hispanic, and other race and ethnicity children with acute osteomyelitis experienced longer LOS than White children. Further research into mechanisms underlying these differences, including social determinants such as access to care or structural racism, may be important to improve care for children with osteomyelitis.
Disclosures
All Authors: No reported disclosures.
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Affiliation(s)
| | | | - Melissa Bartick
- Harvard TH Chan School of Public Health , Boston, Massachusetts
| | - Mohsin Ali
- Hospital for Sick Children , Toronto, Canada, Toronto, Ontario , Canada
| | | | - Nadia Shaikh
- University of Illinois College of Medicine at Peoria , Peoria, Illinois
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Bartick M, Barr AW, Feldman-Winter L, Guxens M, Tiemeier H. The Role of Breastfeeding in Racial and Ethnic Disparities in Sudden Unexpected Infant Death: A Population-Based Study of 13 Million Infants in the United States. Am J Epidemiol 2022; 191:1190-1201. [PMID: 35292797 DOI: 10.1093/aje/kwac050] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 02/15/2022] [Accepted: 03/10/2022] [Indexed: 01/26/2023] Open
Abstract
Sudden unexpected infant death (SUID) disproportionately affects non-Hispanic Black (NHB) and American Indian/Alaskan Native infants, who have lower rates of breastfeeding than other groups. Using 13,077,880 live-birth certificates and 11,942 linked SUID death certificates from 2015 through 2018, we calculated odds ratios and adjusted risk differences of SUID in infants who were not breastfed across 5 racial/ethnic strata in the United States. We analyzed mediation by not breastfeeding in the race/ethnicity-SUID association. The overall SUID rate was 0.91 per 1,000 live births. NHB and American Indian/Alaskan Native infants had the highest disparity in SUID relative to non-Hispanic White infants. Overall, not breastfeeding was associated with SUID (adjusted odds ratio (aOR), 1.14; 95% confidence interval (CI): 1.10, 1.19), and the adjusted risk difference was 0.12 per 1,000 live births. The aOR of not breastfeeding for SUID was 1.07 (95% CI: 1.00, 1.14) in NHB infants and 1.29 (95% CI: 1.14, 1.46) in Hispanic infants. Breastfeeding minimally explained the higher SUID risk in NHB infants (2.3% mediated) and the lower risk in Hispanic infants (2.1% mediated) relative to non-Hispanic White infants. Competing risks likely explain the lower aOR seen in NHB infants of not breastfeeding on SUID, suggesting that social or structural determinants must be addressed to reduce racial disparities in SUID.
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Bartick M, Young M, Louis-Jacques A, McKenna JJ, Ball HL. Bedsharing may partially explain the reduced risk of sleep-related death in breastfed infants. Front Pediatr 2022; 10:1081028. [PMID: 36582509 PMCID: PMC9792691 DOI: 10.3389/fped.2022.1081028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 11/24/2022] [Indexed: 12/14/2022] Open
Affiliation(s)
- Melissa Bartick
- Department of Medicine, Mount Auburn Hospital/Beth Israel Lahey Health, Cambridge, MA, United States.,Department of Medicine, Harvard Medical School, Boston, MA, United States
| | - Michal Young
- Department of Pediatrics and Child Health, Howard University College of Medicine, Washington, DC, United States
| | - Adetola Louis-Jacques
- Department of Obstetrics and Gynecology, University of Florida Health, Gainesville, FL, United States
| | - James J McKenna
- Department of Anthropology, Santa Clara University, Santa Clara, CA, United States.,Department of Anthropology, University of Notre Dame, South Bend, IN, United States
| | - Helen L Ball
- Department of Anthropology, Durham Infancy & Sleep Centre, Durham University, Durham, United Kingdom
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Bartick M, Hernández-Aguilar MT, Wight N, Mitchell KB, Simon L, Hanley L, Meltzer-Brody S, Lawrence RM. ABM Clinical Protocol #35: Supporting Breastfeeding During Maternal or Child Hospitalization. Breastfeed Med 2021; 16:664-674. [PMID: 34516777 DOI: 10.1089/bfm.2021.29190.mba] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
A central goal of the Academy of Breastfeeding Medicine is the development of clinical protocols for managing common medical problems that may impact breastfeeding success. These protocols serve only as guidelines for the care of breastfeeding mothers and infants and do not delineate an exclusive course of treatment or serve as standards of medical care. Variations in treatment may be appropriate according to the needs of an individual patient. The Academy of Breastfeeding Medicine recognizes that not all lactating individuals identify as female. Using gender-inclusive language, however, is not possible in all languages and all countries and for all readers. The position of the Academy of Breastfeeding Medicine (https://doi.org/10.1089/bfm.2021.29188.abm) is to interpret clinical protocols within the framework of inclusivity of all breastfeeding, chestfeeding, and human milk-feeding individuals.
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Affiliation(s)
- Melissa Bartick
- Department of Medicine, Mount Auburn Hospital and Harvard Medical School, Cambridge and Boston, Massachusetts, USA
| | | | - Nancy Wight
- Retired; Neonatology, Sharp Mary Birch Hospital for Women and Newborns, San Diego, California, USA
| | - Katrina B Mitchell
- Breast Surgical Oncology, Ridley Tree Cancer Center at Sansum Clinic, Santa Barbara, California, USA
| | - Liliana Simon
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Lauren Hanley
- Department of Psychiatry, UNC Center for Mood Disorders, University of North Carolina Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
| | - Samantha Meltzer-Brody
- Department of Obstetrics and Gynecology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Robert M Lawrence
- Division of Pediatric Infectious Disease, Department of Pediatrics, University of Florida, Gainesville, Florida, USA
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Bartick M, Stehel EK, Calhoun SL, Feldman-Winter L, Zimmerman D, Noble L, Rosen-Carole C, Kair LR. Academy of Breastfeeding Medicine Position Statement and Guideline: Infant Feeding and Lactation-Related Language and Gender. Breastfeed Med 2021; 16:587-590. [PMID: 34314606 PMCID: PMC8422264 DOI: 10.1089/bfm.2021.29188.abm] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Melissa Bartick
- Department of Internal Medicine, Mount Auburn Hospital, Cambridge, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Elizabeth K. Stehel
- Department of Pediatrics, University of Texas Medical Center, Dallas, Texas, USA
| | - Sarah L. Calhoun
- Department of Family & Community Medicine, University of Missouri, Columbia, Missouri, USA
| | - Lori Feldman-Winter
- Children's Regional Hospital, Cooper University Healthcare, Cooper Medical School of Rowan University, Camden, New Jersey, USA
| | - Deena Zimmerman
- Maternal-Child and Adolescent Division, Public Health Service, Israel Ministry of Health, Jerusalem, Israel
| | - Lawrence Noble
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York City Health + Hospitals/Elmhurst, Elmhurst, New York, USA
| | - Casey Rosen-Carole
- University of Rochester School of Medicine & Dentistry, Departments of Pediatrics and Obstetrics and Gynecology, Rochester, New York, USA
| | - Laura R. Kair
- Department of Pediatrics, University of California Davis Medical Center, Sacramento, California, USA
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Haiek LN, LeDrew M, Charette C, Bartick M. Shared decision-making for infant feeding and care during the coronavirus disease 2019 pandemic. Matern Child Nutr 2021; 17:e13129. [PMID: 33404146 PMCID: PMC7883116 DOI: 10.1111/mcn.13129] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 11/18/2020] [Accepted: 12/02/2020] [Indexed: 12/23/2022]
Abstract
Despite decades of research establishing the importance of breastfeeding, skin-to-skin contact and mother-infant closeness, the response to the coronavirus disease 2019 (COVID-19) pandemic has underscored the hidden assumption that these practices can be dispensed with no consequences to mother or child. This article aims to support shared decision-making process for infant feeding and care with parents and health care providers during the unprecedented times of the pandemic. It proposes a structure and rationale to guide the process that includes (1) discussing with parents evidence-based information and the different options to feed and care for an infant and young child in the context of the pandemic as well as their potential benefits, risks and scientific uncertainties; (2) helping parents to recognize the sensitive nature of the decisions and to clarify the value they place on the different options to feed and care for their infant or young child; and (3) providing guidance and support needed to make and implement their decisions. A shared decision-making process will help parents navigate complex feeding and care decisions for their child as we face the different stages of the COVID-19 pandemic.
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Affiliation(s)
- Laura N. Haiek
- Direction générale de la santé publiqueMinistère de la Santé et des Services sociauxQuebecQuebecCanada
- Department of Family Medicine, MontrealMcGill UniversityMontrealQuebecCanada
- Queen Elizabeth Academic Family Medicine GroupMontrealQuebecCanada
| | - Michelle LeDrew
- National BCC Baby‐Friendly ProjectBreastfeeding Committee for CanadaSherwood ParkAlbertaCanada
| | - Christiane Charette
- Direction générale de la santé publiqueMinistère de la Santé et des Services sociauxQuebecQuebecCanada
- Département de pédiatrie, CISSS de la Montérégie‐EstUniversity of SherbrookeSaint‐HyacintheQuebecCanada
| | - Melissa Bartick
- Mount Auburn HospitalCambridgeMassachusetts02138USA
- Department of MedicineHarvard Medical SchoolBostonMassachusettsUSA
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11
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Feldman-Winter L, Bartick M, Marinelli K, Seo T, Stehel E, Adams A. Academy of Breastfeeding Medicine Recommendations on Changes to Classification of Levels of Evidence for Clinical Protocols. Breastfeed Med 2021; 16:185-188. [PMID: 33577370 DOI: 10.1089/bfm.2020.0272] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Lori Feldman-Winter
- Children's Regional Hospital, Cooper University Health Care, Cooper Medical School of Rowan University, Camden, New Jersey, USA
| | - Melissa Bartick
- Department of Internal Medicine, Mount Auburn Hospital, Harvard Medical School, Cambridge, Massachusetts, USA
| | - Kathleen Marinelli
- Division of Neonatology, Department of Pediatrics, Connecticut Children's Medical Center, University of Connecticut School of Medicine, Hartford, Connecticut, USA
| | - Tomoko Seo
- Greenwoods Children Clinic, Okazaki, Japan
| | - Elizabeth Stehel
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Amanda Adams
- Cooper Medical School of Rowan University, Camden, New Jersey, USA
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Affiliation(s)
- Melissa Bartick
- Department of Medicine, Cambridge Health Alliance and Harvard Medical School, Cambridge, Massachusetts
| | - Barbara L Philipp
- Department of Pediatrics, Boston University School of Medicine, Boston, Massachusetts
| | - Lori Feldman-Winter
- Department of Pediatrics, Cooper Medical School of Rowan University, Camden, New Jersey
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Feldman-Winter L, Bartick M. Use of cross-sectional design for determining Baby-Friendly success. J Pediatr 2020; 219:280. [PMID: 31987657 DOI: 10.1016/j.jpeds.2019.12.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 12/30/2019] [Indexed: 10/25/2022]
Affiliation(s)
- Lori Feldman-Winter
- Division of Adolescent Medicine, Department of Pediatrics, Cooper Medical School of Rowan University, Camden, New Jersey
| | - Melissa Bartick
- Department of Medicine, Cambridge Health Alliance and Harvard Medical School, Cambridge, Massachusetts
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Bartick M, Boisvert ME, Philipp BL, Feldman-Winter L. Trends in Breastfeeding Interventions, Skin-to-Skin Care, and Sudden Infant Death in the First 6 Days after Birth. J Pediatr 2020; 218:11-15. [PMID: 31753326 DOI: 10.1016/j.jpeds.2019.09.069] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 08/28/2019] [Accepted: 09/25/2019] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To determine if implementation of skin-to-skin care and the Baby-Friendly Hospital Initiative (BFHI) contributes to sudden unexpected infant death (SUID) and asphyxia in the first 6 days after birth. STUDY DESIGN Survey data were used to determine a correlation between BFHI and deaths from SUID and asphyxia among infants <7 days in the US and Massachusetts. Using data from the Centers for Disease Control and Prevention, implementation of BFHI was tracked from 2004-2016 and skin-to-skin care was tracked from 2007-2015. Using data from Centers for Disease Control and Prevention WONDER and the Massachusetts Department of Public Health, SUID and asphyxia were tracked from 2004-2016. RESULTS Nationally, births in Baby-Friendly facilities rose from 1.8% to 18.3% and the percentage of facilities in which most dyads experienced skin-to-skin care rose from 40% to 83%. SUID prevalence among infants <7 days was rare (0.72% of neonatal deaths) and decreased significantly from 2004-2009 compared with 2010-2016, from 0.033 per 1000 live births to 0.028, OR 0.85 (95% CI 0.77, 0.94). In Massachusetts, births in Baby-Friendly facilities rose from 2.8% to 13.9% and skin-to-skin care rose from 50% to 97.8%. SUID prevalence decreased from 2010-2016 compared with 2004-2009: OR 0.32 (95% CI 0.13, 0.82), with 0 asphyxia deaths during the 13-year period. CONCLUSION Increasing rates of breastfeeding initiatives and skin-to-skin care are temporally associated with decreasing SUID prevalence in the first 6 days after birth in the US and Massachusetts.
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Affiliation(s)
- Melissa Bartick
- Department of Medicine, Cambridge Health Alliance and Harvard Medical School, Cambridge, MA.
| | | | - Barbara L Philipp
- Department of Pediatrics, Boston University School of Medicine, Boston, MA
| | - Lori Feldman-Winter
- Department of Pediatrics, Cooper Medical School of Rowan University, Camden, NJ
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15
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Mitchell KB, Fleming MM, Anderson PO, Giesbrandt JG, Noble L, Reece-Stremtan S, Bartick M, Calhoun S, Dodd S, Elliott-Rudder M, Kair LR, Lappin S, Lawrence RA, LeFort Y, Marinelli KA, Marshall N, Murak C, Myers E, Okogbule-Wonodi A, Roberts A, Rosen-Carole C, Rothenberg S, Schmidt T, Seo T, Sriraman N, Stehel EK, Fleur RS, Wight N, Winter L. ABM Clinical Protocol #30: Radiology and Nuclear Medicine Studies in Lactating Women. Breastfeed Med 2019; 14:290-294. [PMID: 31107104 DOI: 10.1089/bfm.2019.29128.kbm] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
A central goal of the Academy of Breastfeeding Medicine is the development of clinical protocols for managing common medical problems that may impact breastfeeding success. These protocols serve only as guidelines for the care of breastfeeding mothers and infants and do not delineate an exclusive course of treatment or serve as standards of medical care. Variations in treatment may be appropriate according to the needs of an individual patient.
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Affiliation(s)
- Katrina B Mitchell
- 1 Presbyterian Healthcare Services-MD Anderson Cancer Network, Albuquerque, New Mexico
| | | | - Philip O Anderson
- 3 Division of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, San Diego, La Jolla, California
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Mitchell KB, Johnson HM, Eglash A, Noble L, Reece-Stremtan S, Bartick M, Calhoun S, Dodd S, Elliott-Rudder M, Kair LR, Lappin S, Larson I, Lawrence RA, LeFort Y, Marinelli KA, Marshall N, Murak C, Myers E, Okogbule-Wonodi A, Roberts A, Rosen-Carole C, Rothenberg S, Schmidt T, Seo T, Sriraman N, Stehel EK, Fleur RS, Winter L, Weissman G, Wight N. ABM Clinical Protocol #30: Breast Masses, Breast Complaints, and Diagnostic Breast Imaging in the Lactating Woman. Breastfeed Med 2019; 14:208-214. [PMID: 30892931 DOI: 10.1089/bfm.2019.29124.kjm] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
A central goal of The Academy of Breastfeeding Medicine is the development of clinical protocols, free from commercial interest or influence, for managing common medical problems that may impact breastfeeding success. These protocols serve only as guidelines for the care of breastfeeding mothers and infants and do not delineate an exclusive course of treatment or serve as standards of medical care. Variations in treatment may be appropriate according to the needs of an individual patient.
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Affiliation(s)
- Katrina B Mitchell
- 1 Breast Surgical Oncology, Presbyterian Healthcare Services-MD Anderson Cancer Network, Albuquerque, New Mexico
| | - Helen M Johnson
- 2 Department of Surgery, Brody School of Medicine, East Carolina University, Greenville, North Carolina
| | - Anne Eglash
- 3 Department of Family and Community Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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Bartick M, Tomori C. Sudden infant death and social justice: A syndemics approach. Matern Child Nutr 2019; 15:e12652. [PMID: 30136404 PMCID: PMC7198924 DOI: 10.1111/mcn.12652] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 06/01/2018] [Accepted: 06/21/2018] [Indexed: 01/31/2023]
Abstract
Sudden unexpected infant death (SUID) and sudden infant death syndrome (SIDS) prevention has focused on modifying individual behavioural risk factors, especially bedsharing. Yet these deaths are most common among poor and marginalized people in wealthy countries, including U.S. Blacks, American Indians/Alaskan Natives, New Zealand Māori, Australian Aborigines, indigenous Canadians, and low-income British people. The United States now has the world's highest prevalence of SUID/SIDS, where even Whites' SIDS prevalence now approaches that of the Māori. Using public databases and the literature, we examine SUID/SIDS prevalence and the following risk factors in selected world populations: maternal smoking, preterm birth, alcohol use, poor prenatal care, sleep position, bedsharing, and formula feeding. Our findings suggest that risk factors cluster in high-prevalence populations, many are linked to poverty and discrimination and have independent effects on perinatal outcomes. Moreover, populations with the world's lowest rates of SUID/SIDS have low income-inequality or high relative wealth, yet have high to moderate rates of bedsharing. Employing syndemics theory, we suggest that disproportionately high prevalence of SUID/SIDS is primarily the result of socially driven, co-occurring epidemics that may act synergistically to amplify risk. SUID must be examined through the lens of structural inequity and the legacy of historical trauma. Emphasis on bedsharing may divert attention from risk reduction from structural interventions, breastfeeding, prenatal care, and tobacco cessation. Medical organizations play an important role in advocating for policies that address the root causes of infant mortality via poverty and discrimination interventions, tobacco control, and culturally appropriate support to families.
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Affiliation(s)
- Melissa Bartick
- Department of MedicineCambridge Health Alliance and Harvard Medical SchoolCambridgeMassachusetts
| | - Cecília Tomori
- Department of Anthropology, Parent–Infant Sleep LabDurham UniversityDurhamUK
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Hernández-Aguilar MT, Bartick M, Schreck P, Harrel C, Noble L, Calhoun S, Dodd S, Elliott-Rudder M, Lappin S, Larson I, Lawrence RA, Marinelli KA, Marshall N, Mitchell K, Reece-Stremtan S, Rosen-Carole C, Rothenberg S, Seo T, Wonodi A. ABM Clinical Protocol #7: Model Maternity Policy Supportive of Breastfeeding. Breastfeed Med 2018; 13:559-574. [PMID: 30457366 DOI: 10.1089/bfm.2018.29110.mha] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
A central goal of The Academy of Breastfeeding Medicine is the development of clinical protocols for managing common medical problems that may impact breastfeeding success. These protocols serve only as guidelines for the care of breastfeeding mothers and infants and do not delineate an exclusive course of treatment or serve as standards of medical care. Variations in treatment may be appropriate according to the needs of an individual patient.
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Affiliation(s)
- Maria-Teresa Hernández-Aguilar
- 1 Breastfeeding Clinical Unit Dr. Peset, University Hospital Dr. Peset, National Health Service, Valencia, Spain .,2 National Coordinator of Spain Baby-Friendly Initiative (IHAN-España Iniciativa para la Humanización de la Asistencia al Nacimiento y la Lactancia), Madrid, Spain
| | - Melissa Bartick
- 3 Department of Medicine, Cambridge Health Alliance , Cambridge, Massachusetts.,4 Harvard Medical School, Boston, Massachusetts
| | - Paula Schreck
- 5 Department of Pediatrics, Ascension St. John , Detroit, Michigan
| | - Cadey Harrel
- 6 Department of Family Medicine, University of Arizona , Tucson, Arizona
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Affiliation(s)
- Melissa Bartick
- Department of Medicine Cambridge Health Alliance and Harvard Medical School Cambridge, Massachusetts
| | - Lori Feldman-Winter
- Department of Pediatrics Children's Regional Hospital at Cooper University Health Care Cooper Medical School of Rowan University Camden, New Jersey
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Bartick M, Tomori C, Ball HL. Babies in boxes and the missing links on safe sleep: Human evolution and cultural revolution. Matern Child Nutr 2017; 14:e12544. [PMID: 29047226 DOI: 10.1111/mcn.12544] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 08/29/2017] [Accepted: 09/18/2017] [Indexed: 11/28/2022]
Abstract
Concerns about bedsharing as a risk for sudden infant death syndrome and other forms of sleep-associated infant death have gained prominence as a public health issue. Cardboard "baby boxes" are increasingly promoted to prevent infant death through separate sleep, despite no proof of efficacy. However, baby boxes disrupt "breastsleeping" (breastfeeding with co-sleeping) and may undermine breastfeeding. Recommendations enforcing separate sleep are based on 20th century Euro-American social norms for solitary infant sleep and scheduled feedings via bottles of cow's milk-based formula, in contrast to breastsleeping, an evolutionary adaptation facilitating the survival of mammalian infants for millennia. Interventions that aim to prevent bedsharing, such as the cardboard baby box, fail to consider the implications of evolutionary biology or of ethnocentrism in sleep guidance. Moreover, the focus on bedsharing neglects more potent risks such as smoking, drugs, alcohol, formula feeding, and poverty. Distribution of baby boxes may divert resources and attention away from addressing these other risk factors and lead to a false sense of security wherein we overlook that sudden unexplained infant deaths also occur in solitary sleep environments. Recognizing breastsleeping as the evolutionary and cross-cultural norm entails re-evaluating our research and policy priorities, such as providing greater structural support for families, supporting breastfeeding and safe co-sleeping, investigating ways to safely minimize separation for formula-fed infants, and mitigating the potential harms of mother-infant separation when breastsleeping is disrupted. Resources would be better spent addressing such questions rather than on a feel-good solution such as the baby box.
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Affiliation(s)
- Melissa Bartick
- Department of Medicine, Cambridge Health Alliance and Harvard Medical School, Cambridge, Massachusetts, USA
| | - Cecília Tomori
- Department of Anthropology, Durham University, Durham, UK
| | - Helen L Ball
- Department of Anthropology, Parent-Infant Sleep Lab, Durham University, Durham, UK
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Abstract
The American Academy of Pediatrics (AAP) issued recommendations in 2005 and 2011 to reduce sleep-related infant death, which advise against all bedsharing for sleep. These recommendations overemphasize the risks of bedsharing, and this overemphasis has serious unintended consequences. It may result in increased deaths on sofas as tired parents try to avoid feeding their infants in bed. Current evidence shows that other risks are far more potent, such as smoking, shared sleep on sofas, sleeping next to impaired caregivers, and formula feeding. The emphasis on separate sleep is diverting resources away from addressing these critical risk factors. Recommendations to avoid bedsharing may also interfere with breastfeeding. We examine both the evidence behind the AAP recommendations and the evidence omitted from those recommendations. We conclude that the only evidence-based universal advice to date is that sofas are hazardous places for adults to sleep with infants; that exposure to smoke, both prenatal and postnatal, increases the risk of death; and that sleeping next to an impaired caregiver increases the risk of death. No sleep environment is completely safe. Public health efforts must address the reality that tired parents must feed their infants at night somewhere and that sofas are highly risky places for parents to fall asleep with their infants, especially if parents are smokers or under the influence of alcohol or drugs. All messaging must be crafted and reevaluated to avoid unintended negative consequences, including impact on breastfeeding rates, or falling asleep in more dangerous situations than parental beds. We must realign our resources to focus on the greater risk factors, and that may include greater investment in smoking cessation and doing away with aggressive formula marketing. This includes eliminating conflicts of interest between formula marketing companies and organizations dedicated to the health of children.
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Affiliation(s)
- Melissa Bartick
- 1 Department of Medicine, Cambridge Health Alliance and Harvard Medical School , Cambridge, Massachusetts
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Affiliation(s)
- Melissa Bartick
- Assistant Professor, Department of Medicine, Cambridge Health Alliance and Harvard Medical School , Boston, Massachusetts
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23
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Abstract
BACKGROUND Non-exclusive breastfeeding among Latina women is commonly seen in the newborn period. The reasons behind las dos cosas ("both things") are not well understood but have included the beliefs that formula has vitamins and that adding formula will result in a chubbier baby, which is desirable. Many previous studies involved Mexican and Puerto Rican women living in the mainland United States. METHODS We performed detailed semistructured interviews with 17 Latina mothers in late pregnancy or the newborn period at a community hospital and an affiliated clinic in Massachusetts, serving a large Dominican population. Women were asked about their beliefs about breastfeeding, colostrum, and infant formula. Transcripts were analyzed using Nvivo 9 software (QSR International Pty. Ltd., Melbourne, Australia) to identify the frequencies of common trends. RESULTS The most common reasons for introducing formula were treatment for insufficient milk, to keep the baby fuller longer, and planning for return to work. None of the women understood the potential risks of introducing formula on the establishment of breastfeeding, particularly on milk supply. Many thought that even limited amounts of breastfeeding were sufficient to produce a healthier child, failing to understand a negative dose-response effect of formula on health and milk production. While every woman saw breastfeeding as healthier, only one saw formula as unhealthy, an important distinction. None of the women expressed familiarity with medical recommendations around breastfeeding duration or exclusivity, with many believing that breastmilk alone would be insufficient to satisfy the hunger or nutritional needs of a growing child after as little as 3 months. Women consistently demonstrated a willingness to learn from health professionals. CONCLUSIONS In counseling Latina women, it may be important to discuss the risks of formula to infant health, breastfeeding, and milk supply and to include the medical recommendations for breastfeeding exclusivity. Educational opportunities exist in the prenatal setting and when postpartum women request formula.
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Affiliation(s)
- Melissa Bartick
- Department of Medicine, Cambridge Health Alliance and Harvard Medical School, Cambridge, Massachusetts 02139, USA.
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Labbok M, Marinelli KA, Bartick M, Calnen G, Gartner LM, Lawrence RA, Meek JY, Gorrin-Peralta JJ, Parrilla-Rodriguez AM, Powers NG. Regulatory monitoring of feeding during the birth hospitalization. Pediatrics 2011; 128:e1311-4; author reply e1317-9. [PMID: 22167859 DOI: 10.1542/peds.2011-2698b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Miriam Labbok
- Carolina Global Breastfeeding Institute Gillings School of Global Public Health University of North Carolina Chapel Hill, NC 27599
| | - Kathleen A. Marinelli
- Neonatology and Lactation Services Connecticut Children's Medical Center Hartford, CT 06106 Department of Pediatrics University of Connecticut School of Medicine Farmington, CT 06030 Connecticut Chapter American Academy of Pediatrics Hartford, CT 06106
| | - Melissa Bartick
- Department of Medicine Cambridge Hospital and Harvard Medical School Boston, MA 02115
| | - Gerald Calnen
- Academy of Breastfeeding Medicine New Rochelle, NY 10801
| | - Lawrence M. Gartner
- Departments of Pediatrics and Obstetrics/Gynecology University of Chicago Chicago, IL 60637
| | - Ruth A. Lawrence
- Departments of Pediatrics and Obstetrics/Gynecology University of Rochester School of Medicine Rochester, NY 14642
| | - Joan Younger Meek
- Department of Pediatrics Orlando Health/Arnold Palmer Medical Center Florida State University College of Medicine Orlando, FL 32806
| | | | - Ana M. Parrilla-Rodriguez
- Maternal and Child Health Program Graduate School of Public Health- Medical Sciences Campus University of Puerto Rico San Juan, PR 00936
| | - Nancy G. Powers
- University of Kansas School of Medicine–Wichita Wichita, KS 67028
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Abstract
BACKGROUND A recent study showed that current suboptimal U.S. breastfeeding rates cost the U.S. economy $13 billion per year in 2007 dollars for pediatric health cost and premature death. Cost data of excess maternal disease are not yet published but are thought to be substantial. Little is known about other costs. METHODS The approximate annual costs of many entities that impact breastfeeding or are impacted by breastfeeding were calculated and converted to 2010 dollars. Calculations assumed the United States went from 2007 breastfeeding rates to 90% compliance with medical recommendations. We included pediatric health costs, formula costs, cost of extra food for lactating women, paid leave, and additional factors. RESULTS If 90% of mothers could comply with current medical recommendations around breastfeeding, our economy could save $3.7 billion in direct and indirect pediatric health costs, with $10.1 billion in premature death from pediatric disease. We would spend $3.9 billion less per year on infant formula. Additional food for nursing mothers would cost up to $1.6-2.1 billion, and more Baby-Friendly® (World Health Organization, Geneva, Switzerland/UNICEF, New York, NY) births would cost $0.145 billion. Paid leave would cost $6.2 billion for 12 weeks at 55% pay. Note that current formula company rebates of $2 billion to Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) are equal to 32% of net WIC expenditures. CONCLUSIONS Even including paid leave, the net cost to our economy of our suboptimal breastfeeding rates would still be at least $8.7 billion. Paid leave would be expected to improve breastfeeding duration and reduce disparities. The WIC budget is dependent on formula company rebates, a conflicting situation.
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Affiliation(s)
- Melissa Bartick
- Department of Medicine, Cambridge Health Alliance and Harvard Medical School, Cambridge Hospital, Cambridge, Massachusetts 02139, USA.
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Bartick M, Edwards RA, Walker M, Jenkins L. The Massachusetts baby-friendly collaborative: lessons learned from an innovation to foster implementation of best practices. J Hum Lact 2010; 26:405-11. [PMID: 20876344 DOI: 10.1177/0890334410379797] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Collaborative efforts among hospitals can facilitate the exchange of ideas, provide a forum for discussing the development of new policies or practices or changes to existing policies and practices, and increase the implementation of best practices. In November 2008, the Massachusetts Breastfeeding Coalition formed a collaborative of maternity facilities wishing to pursue Baby-Friendly designation. Members provided insights from experiences and shared models and examples from outside. We describe highlights from the first 15 months of the Collaborative and present 4 recommendations for overcoming barriers: (1) manage expectations of patients, family/friends, and staff; (2) restrict access to materials that can undermine breastfeeding; (3) adopt the appropriate perspectives to creatively implement change; and (4) bundle, reframe, and harness larger forces. The strategies can be applied across diverse hospital settings.
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Affiliation(s)
- Melissa Bartick
- Department of Medicine, Cambridge Health Alliance and Harvard Medical School, Cambridge, Massachusetts 02139, USA.
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28
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Abstract
BACKGROUND AND OBJECTIVE A 2001 study revealed that $3.6 billion could be saved if breastfeeding rates were increased to levels of the Healthy People objectives. It studied 3 diseases and totaled direct and indirect costs and cost of premature death. The 2001 study can be updated by using current breastfeeding rates and adding additional diseases analyzed in the 2007 breastfeeding report from the Agency for Healthcare Research and Quality. STUDY DESIGN Using methods similar to those in the 2001 study, we computed current costs and compared them to the projected costs if 80% and 90% of US families could comply with the recommendation to exclusively breastfeed for 6 months. Excluding type 2 diabetes (because of insufficient data), we conducted a cost analysis for all pediatric diseases for which the Agency for Healthcare Research and Quality reported risk ratios that favored breastfeeding: necrotizing enterocolitis, otitis media, gastroenteritis, hospitalization for lower respiratory tract infections, atopic dermatitis, sudden infant death syndrome, childhood asthma, childhood leukemia, type 1 diabetes mellitus, and childhood obesity. We used 2005 Centers for Disease Control and Prevention breastfeeding rates and 2007 dollars. RESULTS If 90% of US families could comply with medical recommendations to breastfeed exclusively for 6 months, the United States would save $13 billion per year and prevent an excess 911 deaths, nearly all of which would be in infants ($10.5 billion and 741 deaths at 80% compliance). CONCLUSIONS Current US breastfeeding rates are suboptimal and result in significant excess costs and preventable infant deaths. Investment in strategies to promote longer breastfeeding duration and exclusivity may be cost-effective.
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Affiliation(s)
- Melissa Bartick
- Department of Medicine, Cambridge Health Alliance and Harvard Medical School, Boston, Massachusetts, USA.
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Bartick M, Stuebe A, Shealy KR, Walker M, Grummer-Strawn LM. Closing the quality gap: promoting evidence-based breastfeeding care in the hospital. Pediatrics 2009; 124:e793-802. [PMID: 19752082 DOI: 10.1542/peds.2009-0430] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Evidence shows that hospital-based practices affect breastfeeding duration and exclusivity throughout the first year of life. However, a 2007 CDC survey of US maternity facilities documented poor adherence with evidence-based practice. Of a possible score of 100 points, the average hospital scored only 63 with great regional disparities. Inappropriate provision and promotion of infant formula were common, despite evidence that such practices reduce breastfeeding success. Twenty-four percent of facilities reported regularly giving non-breast milk supplements to more than half of all healthy, full-term infants. Metrics available for measuring quality of breastfeeding care, range from comprehensive Baby-Friendly Hospital Certification to compliance with individual steps such as the rate of in-hospital exclusive breastfeeding. Other approaches to improving quality of breastfeeding care include (1) education of hospital decision-makers (eg, through publications, seminars, professional organization statements, benchmark reports to hospitals, and national grassroots campaigns), (2) recognition of excellence, such as through Baby-Friendly hospital designation, (3) oversight by accrediting organizations such as the Joint Commission or state hospital authorities, (4) public reporting of indicators of the quality of breastfeeding care, (5) pay-for-performance incentives, in which Medicaid or other third-party payers provide additional financial compensation to individual hospitals that meet certain quality standards, and (6) regional collaboratives, in which staff from different hospitals work together to learn from each other and meet quality improvement goals at their home institutions. Such efforts, as well as strong central leadership, could affect both initiation and duration of breastfeeding, with substantial, lasting benefits for maternal and child health.
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Affiliation(s)
- Melissa Bartick
- Department of Medicine, Harvard Medical School, Boston, Massachusetts 02139, USA.
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30
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Abstract
BACKGROUND Discontinuation of breast-feeding is linked with an increased risk of acute and chronic diseases in children, as well as increased risk of maternal disease. Mothers and physicians often depend on pharmacists for accurate drug information. Their information is only as good as the sources available to them. OBJECTIVE To determine the reliability of safety recommendations for drugs used during lactation, based on current research and information, and determine whether resources may be inappropriately advising the interruption of breast-feeding. METHODS A comparison of 10 frequently used sources for information on medication used during breast-feeding was done for 14 commonly used drugs. Our sources included the databases used by 2 retail pharmacy chains, available text references, and electronic references. We assessed the number of drugs thought to be safe in breast-feeding for each source. The drugs reviewed included those widely accepted as safe, widely regarded as not safe, and drugs that fit into neither category. RESULTS We found that many sources did consider the most recent research. For drugs thought to be unequivocally safe, the 2 retail pharmacy databases gave an alternative recommendation at least 75% of the time. CONCLUSIONS If healthcare practitioners are using outdated sources for making safety recommendations to their patients, such a practice may result in many women being inappropriately advised to stop breast-feeding, thus increasing the potential health risks to them and their infants. As the most accessible medication expert, the pharmacist needs to be well educated and continually updated using the most reliable resources for lactation recommendations.
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Affiliation(s)
- Monica Akus
- Department of Pharmacy, Cambridge Health Alliance, Somerville, MA 02143, USA.
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Grizzard TA, Bartick M, Nikolov M, Griffin BA, Lee KG. Policies and practices related to breastfeeding in massachusetts: hospital implementation of the ten steps to successful breastfeeding. Matern Child Health J 2006; 10:247-63. [PMID: 16496220 DOI: 10.1007/s10995-005-0065-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2005] [Accepted: 12/29/2005] [Indexed: 10/25/2022]
Abstract
BACKGROUND Hospital policies and practices related to breastfeeding may have long-term health effects. The Ten Steps to Successful Breastfeeding (WHO/UNICEF) provide an evidence-based standard, which may be used to assess individual hospitals. We assessed implementation, and factors related to implementation, of the Ten Steps in Massachusetts hospitals. METHODS We surveyed postpartum nurse managers at 43 (88%) of the 49 Massachusetts maternity hospitals by telephone. Survey items characterized hospital policies, breastfeeding education, and support practices. We classified hospital implementation of the Ten Steps as high, moderately high, partial, or low and used Massachusetts Department of Public Health hospital data to analyze factors related to implementation. RESULTS Levels of implementation of the Ten Steps ranged from high to partial. Overall, we classified implementation of 2% of hospitals as high, 58% moderately high, 40% partial, and 0% as low. Hospitals with high/moderately high levels of implementation significantly differed from hospitals with partial implementation with respect to pacifier usage (p=0.0017) and postpartum breastfeeding instruction (p=0.0001). Requirement of a physician order for formula was a statistically significant (p=0.02) predictor of Step 1 implementation but did not reach significance (p=0.14) overall. Acceptance of free formula was significantly associated (p=0.03) with overall Ten Steps implementation. CONCLUSION Rates of self-reported implementation of the Ten Steps are relatively high in Massachusetts. Step 1 implementation is significantly associated with formula availability, and overall implementation with acceptance of free formula. Continued assessment is needed to confirm these results in larger samples and to examine the relationship of implementation of individual steps, breastfeeding rates, and health outcomes.
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Affiliation(s)
- Tarayn A Grizzard
- Pediatrics, Harvard Medical School, 260 Longwood Avenue, Boston, Massachusetts 02115, USA.
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