O'HaraMaryAnnMD, MPH*
Seattle Breastfeeding Medicine, Seattle, WA
BLEB HISTOLOGY REVEALS INFLAMMATORY INFILTRATE THAT REGRESSES WITH TOPICAL STEROIDS; A CASE SERIES
Indicates presenting author.
Background: Rubbery white nipple lesions (“blebs”) can cause severe, prolonged pain and obstruct milk outflow in breastfeeding women. Data and consensus are lacking about the nature and effective treatment of blebs.
Objective: To identify the histologic composition of blebs, and use this information to hypothesize and pilot clinical therapy.
Methods: Case series from a specialty breastfeeding medicine clinic.
Results: No blebs presenting over a couple of months' period improved with conventional putative treatments. The blebs caused 5 women so much pain that they requested excision of the lesions, which they tolerated well in an outpatient clinic using a punch biopsy tool after local anesthesia. Every woman's symptoms resolved shortly after removal of the rubbery, scar-like tissue. Histology consistently revealed 1) lack of any bacteria or fungi, and 2) histiocytes with foamy cytoplasmic vacuoles and fibrin deposition. These immune cells indicated a tissue reaction to milk that has leaked from ducts into surrounding tissue. Based on these findings, subsequent patients with blebs have been treated effectively with a short daily course of a very thin layer of a mid-potency steroid under occlusion to enhance penetration into the inflamed and fibrotic tissue.
Conclusion: Nipple blebs are an inflammatory response to nipple trauma. While the lesion and symptoms usually regress with topical steroid treatment, clinicians should check for and treat any underlying causes of the recurrent trauma.
Funding Sources: Each woman's insurance company paid for the excision of the blebs and the histologic analysis.
StuebeAlison M.MD*1SchillerCrystalPhD2Meltzer-BrodySamanthaMD2GrewenKarenPhD2
Department of Obstetrics and Gynecology, University of North Carolina School of Medicine
Department of Psychiatry, University of North Carolina School of Medicine
MATERNAL MOOD MODIFIES ASSOCIATIONS BETWEEN ESTRADIOL AND OXYTOCIN RELEASE DURING BREASTFEEDING
Background: Estrogen increases secretion of oxytocin in animal models. We hypothesized that this relationship is dysregulated among women with postpartum mood symptoms.
Objective: To quantify the association between estradiol and oxytocin during breastfeeding among women with or without postpartum mood symptoms.
Methods: We recruited 52 women who intended to breastfeed, half of whom had a history of depression or anxiety. During laboratory visits at 2 and 8 weeks postpartum, we obtained blood samples at baseline, at 1, 3, 7 and 10 minutes of breastfeeding, and 10 minutes after feeding. We assessed maternal mood using the Edinburgh Postnatal Depression Scale and the Spielberger State Anxiety Inventory. We defined as symptomatic women with EPDS ≥10 and/or STAI ≥34. We used linear regression to model associations between estradiol, mood symptoms, and oxytocin levels.
Results: At 2 weeks, 42 women were breastfeeding, among whom 17 (40%) were symptomatic. Among asymptomatic women, estradiol levels were positively associated with oxytocin levels during feeding, whereas among symptomatic women, there was no association (p for interaction <.05 for interaction at 1, 3 and 7 minutes and for OT area under the curve). At 8 weeks, 36 women were breastfeeding, among whom 9 (25%) were symptomatic. We found no difference in associations between estradiol and oxytocin by maternal mood symptoms at the 8-week visit (all p for interaction >.2).
Conclusion: Early mood symptoms are associated with loss of the association between estradiol and oxytocin, which implicates dysregulated hormone signaling in the pathophysiology of postpartum mood changes.
Breastfeeding Medicine of Northeast Ohio, Cleveland, Ohio
Senders Pediatrics, Cleveland, Ohio
Department of Family Medicine, Case Western Reserve University, Cleveland, Ohio
Department of Epidemiology & Biostatistics, Case Western Reserve University, Cleveland, Ohio
BACTERIAL SPECIES AND COLONY COUNT GROWTH IN BREASTFEEDING WOMEN WITH CHRONIC BREAST PAIN AS COMPARED TO CONTROLS
Background: An infectious etiology for chronic breast pain in breastfeeding women continues to be debated. Recent studies suggest bacterial causes for chronic pain including coagulase-negative Staphylococcus (CNS) overgrowth.
Objectives: Compare bacterial species growth and colony count between breastfeeding women with chronic pain (cases) and those without pain (controls).
Methods: A prospective, descriptive cohort study involving 120 breastfeeding women was conducted. Cases (n=66) were defined as breastfeeding women with breast pain >1 week and no signs of acute infection. Controls (n=54) were breastfeeding women without pain matched by weeks of postpartum and parity to cases. Initial visit involved collection of breast milk cultures, demographic, history, and exam data.
Results: Case and controls were similar with regard to insurance, parity, weeks postpartum, work status, delivery type and breastfeeding intent. Cases significantly differed from controls by history of mastitis (14% vs 2%; p=0.036), cracked nipples (64% vs 17%; p=0.00) and other breastfeeding difficulties. The two most common bacterial species grown were CNS and Staphylococcus aureus (SA). Cases had a significantly higher growth of SA growth (17% vs 4%; p=0.021). CNS frequency (77% vs 78%; p=0.912) and mean colony count growth (8,038 CFU/ml vs 9450 CFU/ml) were not statistically different between cases and controls.
Conclusion: CNS breast milk growth is similar between cases and controls. The increased incidence of SA growth in women with chronic pain suggests SA as a possible cause of chronic pain. Further study is needed to evaluate the role of antibiotic treatment in resolving chronic breast pain.
Funding Sources: This project was completed in part by: the Culture of Inquiry Fellowship, funded by a Title VII grant from the Health Resources and Services Administration (D54HP05444, 2008). REDCap project and CTSC grant support (1 UL1 RR024989 from NCRR/NIH).
Pediatric Department Benha Faculty of Medicine, Benha University
Molecular Biology Unit, Benha Faculty of Medicine, Benha University
Pediatric Department Qena Faculty of Medicine, South Valley University
NICU PRACTICES THAT INFLUENCE FADS2 GENE EXPRESSION LINKED WITH INTELLIGENCE
Background: The FADS2 gene expression is linked with intelligence as it is responsible for the formation of omega fatty acids that are important for brain development. Preterm babies have immature brains and are particularly vulnerable to brain damage.
Objective: To study the effect of neonatal Intensive Care Units (NICU) practices on the FADS2 gene expression in preterms.
Methods: A survey of NICU feeding practices was conducted for 900 cases from Lower Egypt and 100 cases in Upper Egypt. Blood samples for study of FADS2 were taken from 30 neonates at birth and 3 months later. They were grouped according to mode of feeding: exclusively breastfed (15) and formula fed (15). They were followed-up from birth, during their stay in the NICU and 3 months after discharge for medical events, growth and nutritional status.
Results: Fewer than one third of LBW were exposed to exclusive breast milk feeding in the NICUs, and was affected by marketing practices of formula companies. FADS2 expression increased 10 fold in breastfed compared to two fold in the formula fed. Hypoxia, necrotizing enterocolitis (NEC), sepsis and jaundice reduced FADS2 expression by 10%-20% in breastfed compared to 50%-60% in formula fed. Blood indices at 3 months were lower in formula fed infants.
Conclusion: Mode of feeding appears to be a significant factor that influences FADS2 expression. The findings may explain the mechanism by which brains of formula fed preterm babies remains immature compared to breastfed preterm babies. The mammary gland's functions appear to go beyond nutrition in controlling gene expression.
Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
Department of Pediatrics, University of California Davis Medical Center, Sacramento, CA
Department of Nutrition, University of California Davis, Davis, CA
AMONG FIRST-TIME MOTHERS IN A DIVERSE U.S. COHORT, BREASTFEEDING PROBLEMS ARE HIGHLY PREVALENT AND CONTRIBUTE TO EARLY BREASTFEEDING CESSATION
Background: National surveillance data indicate many U.S. women fail to meet their breastfeeding goals.
Objective: To characterize breastfeeding concerns reported by participants in the Early Lactation Success Study and their association with breastfeeding cessation.
Design/Methods: At 0, 3, 7, 14, 30, and 60 days postpartum, participants described feeding problems/concerns. We coded mothers' descriptions, grouped codes into major themes and examined themes for trends over time and contribution to breastfeeding cessation.
Results: Mothers reported 4,179 concerns over 2,730 interviews, comprising 50 distinct concerns coded into 9 major themes. Concerns peaked at Day 3 (92% prevalence), and remained high at Day 7 (83%). Predominant Day 3 concerns were: infant difficulty with breastfeeding (52%), pain with breastfeeding (44%), milk quantity (40%), and uncertainty regarding breastfeeding ability/technique (28%). At Days 3 and 7, women reporting ≥1 concern (vs. 0) had greater risk of weaning by Day 60 (P<0.001), with “difficulty feeding” having the largest population attributable risk (PAR, 25% at both time points). At Day 14, milk quantity concerns had the largest PAR (14%). Women reporting no concerns at Day 3 (positive outliers) were more likely to be Hispanic, <25 y, deliver vaginally (all P<0.05) and have strong breastfeeding social support (p=0.004).
Conclusions: Among first-time mothers breastfeeding problems/concerns are highly prevalent and persistent. Women experiencing infant breastfeeding difficulty during week 1 and milk quantity concerns in week 2 have >2-fold risk of early breastfeeding cessation. Examination of positive outliers suggests that unmedicated births and social support may contribute to successfully establishing breastfeeding.
Funding Sources: HD063275-01A1 (LN-R) and MC 04294 (KGD).
KohlerJohn A.Sr., MD*PerkinsAmy M.MSBassW. ThomasMD
Department of Pediatrics, Children's Hospital of The King's Daughters, Eastern Virginia Medical School, Norfolk, VA, USA
BREAST MILK AFTER GASTROSCHISIS: PRESCRIPTION FOR SUCCESS
Background: Infants with gastroschisis have a post-operative course complicated by prolonged ileus, extended duration on total parenteral nutrition and lengthy hospital stays.
Objective: To determine if feeding type (breast milk vs. formula) is related to time to full feeds and length of hospital stay in post-operative gastroschisis infants.
Methods: We performed a retrospective study of infants with gastroschisis treated between 2000–2010 looking at demographic data, time to full feeds and length of stay between those infants who were fed breast milk versus those infants fed formula.
Results: Ninety babies with gastroschisis were identified, 3 expired prior to initiation of feeds and 8 had complex lesions (atresia, necrosis and volvulus - all within the formula fed group) and were excluded from analysis. Forty infants were formula fed and 39 infants were fed breast milk. Length of stay was significantly shorter in the breast milk group compared to the formula group (mean 33, median 23, interquartile range 20–23 days vs. 35, 30, 24–42, p-value 0.04). After the exclusion of outliers, length of stay (mean 24, median 22, interquartile range 19–26 days vs. 35, 30, 24–42) and age at full feeds (21, 21, 18–24 vs. 30, 27, 21–34) were both significantly different (p-value 0.001).
Conclusions: Based on these data breast milk is the preferred enteral feeding choice for infants who have undergone gastroschisis repair.
KhoranaMeeraMBBSLamloetviriyakitPornpanMDApornviriyawongsePorncharatMD
Queen Sirikit National Institute of Child Health, School of Medicine, Rangsit University, Bangkok, Thailand
OUTCOMES OF TWO DIFFERENT INTERVENTIONS IN TERM NEONATES WITH BREAST MILK JAUNDICE
Background: Breast milk jaundice (BMJ) is often seen in healthy growing infants who are exclusively breast feeding. There are many treatment regimens, one of which is the discontinuation of breast milk for a short duration.
Objective: To compare the treatment outcomes between infants with BMJ who continued vs. discontinued breastfeeding.
Methods: A quasi-experimental study was conducted from June 1, 2006 to May 31, 2008 among newborn infants admitted to the hospital with BMJ. The control group consisted of infants switched to formula for 24 hours instead of breast milk; and the study group infants were continued on breast milk. All infants were simultaneously treated with phototherapy. Data were analyzed by using Chi-square or Fisher's exact test and t-test.
Results: Sixty-two infants were included; 36 in the control and 26 in the study group. Demographic data were comparable between both groups. Mean admission serum bilirubin level were 19.99±1.65 mg/dl and 20.28±2.10 mg/dl (p=0.55) in control group and study group, respectively. Rate of bilirubin decrement and duration of phototherapy were 0.35±0.11 mg/dl/h versus 0.36±0.01 mg/dl/h (p=0.83), and 30.28±12.64 hours vs. 24.71±9.90 hours (p=0.07), in the control and study groups, respectively. Weight gained and lengths of hospital stay were 25.98±14.43 g/day versus 34.09±12.52 g/day (p=0.025), and 3 vs. 2.7 days (p=0.006) in the control and study groups, respectively.
Conclusions: Since the outcomes of the study seem comparable, infants with BMJ do not need to discontinue breast milk during phototherapy treatment.
Discipline of General Practice, School of Medicine, The University of Queensland, Australia
Queensland Centre for Mothers & Babies, The University of Queensland, Australia
DOES BFHI ACCREDITATION IMPROVE BREASTFEEDING RATES AT 4 AND 17 WEEKS?: A POPULATION BASED SURVEY
Background: BFHI accreditation, based on the Ten Steps to Successful Breastfeeding, is designed to improve care within maternity facilities and thus increase breastfeeding initiation and continuation. Some authors question whether BFHI accreditation influences breastfeeding duration when breastfeeding initiation rates are high.
Objective: This study investigated whether BFHI accreditation or hospital practices influenced breastfeeding rates at 4 and 17 weeks.
Methods: This retrospective cohort study included all women who birthed in Queensland, Australia, from 1st February to 31st May 2010. Women (n=20914) were mailed a 167 item survey when their infants were around 4 months old. Survey completion could be in hard copy, online or by telephone, with interpreters available if required. Response rate was 34.4% (n=7194).
Results: Breastfeeding initiation rates were high (95.9% in BFHI hospitals, 96.2% in non-BFHI hospitals). At four weeks, women who birthed in a non-BFHI hospital had higher odds of breastfeeding than women who birthed in a BFHI accredited hospital (OR 1.39, 95% CI 1.12–1.70). At 17 weeks there was no difference in breastfeeding rates. However, having experienced skin-to-skin contact, rooming-in, no formula supplementation and the first feed occurring within 60 minutes of birth was associated with more than four times the odds of breastfeeding at 17 weeks (OR 4.42, 95% CI 3.01–6.50).
Conclusion: BFHI accreditation did not improve breastfeeding rates in this study, although experiencing BFHI hospital practices did. BFHI accreditation can be utilized as a quality improvement program to ensure hospitals use evidence-based practices, but compliance is essential to be effective.
University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania, USA
University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
“HELLO, ARE YOU ALIVE?!”: THE INTERPLAY OF UNCERTAINTY, EXHAUSTION, HOPE AND DISAPPOINTMENT IN MOTHERS BREASTFEEDING LATE PRETERM INFANTS
Background: Poor breastfeeding outcomes among late preterm infants (LPIs) have been attributed to inadequate breast milk transfer stemming from physiological immaturities. However, breastfeeding is more than a biological phenomenon, and it is unclear how mothers of LPIs manage contextual factors that may also impact the breastfeeding course.
Objective: To describe and explain the process of breastfeeding establishment among late preterm mother-infant dyads.
Methods: Using grounded theory methods and incorporating serial postpartum interviews with several novel data collection techniques, we examined breastfeeding establishment over a 6–8 week period among 10 late preterm mother-infant dyads recruited from a maternity hospital in Pittsburgh, Pennsylvania, USA.
Results: We found that breastfeeding in the LPI population was a fluctuating, cascade-like progression of trial and error, influenced by a host of contextual factors and events and culminating with breastfeeding continuation (with or without future caveats for duration or exclusivity of breastfeeding) or cessation. The trajectory was explained by the basic psychosocial process Weighing Worth against Uncertain Work, which encompassed the tension between breastfeeding motivation, the intensity of breastfeeding work, and ambiguity surrounding infant behavior and feeding cues. Several sub-processes were also identified: Playing the Game; Letting Him be the Judge vs. Accommodating Both of Us; and Questioning Worth vs. Holding out Hope.
Conclusions: If valid, our theoretical model indicates a need for earlier, more extensive, and more qualified breastfeeding support for mothers of late preterm infants which emphasizes management strategies, “hands-on” assistance, and awareness of the connection between prematurity and observed feeding behaviors.
Funding Sources: National Institute of Nursing Research (grant: F31NR011562); Sigma Theta Tau International, Eta Chapter.
Department of Pediatrics, Loma Linda University School of Medicine, Loma Linda University Medical Center, Loma Linda, CA, USA
Department of Obstetrics and Gynecology, Loma Linda University School of Medicine, Loma Linda University Medical Center, Loma Linda, CA, USA
CHANGING THE PRACTICE OF SKIN-TO-SKIN CONTACT IN THE FIRST HOUR AFTER BIRTH TO INCREASE BREASTFEEDING RATES
Background: Even through our hospital has been designated as a “Baby Friendly Hospital” since 2008, exclusive breastfeeding rates at time of discharge had been steadily decreasing. We noted that while most babies were placed skin to skin with mother sometime during the first hour after birth, most babies were left there only a brief time and skin-to-skin contact was often interrupted before the first breastfeeding.
Objective: To determine if increasing the rates of uninterrupted skin-to-skin contact during the first hour after birth correlated with an increase in exclusive breastfeeding rates.
Methods: All maternity and postpartum staff as well as OBGYN physicians were educated about the benefits of uninterrupted skin-to-skin contact in the first hour after birth, which we named “The Sacred Hour.” Nursing protocols were changed to support uninterrupted skin-to-skin contact during the first hour after both vaginal and cesarean deliveries. Parents were shown a DVD and given a handout about skin-to-skin contact after birth. We compared rates of skin-to-skin contact in the first hour after birth and rates of exclusive breastfeeding at discharge before and 6 months after the intervention.
Results: Rates of uninterrupted skin-to-skin contact during the first hour after birth significantly increased after the intervention, as did rates of exclusive breastfeeding at discharge (from 28% to 45%).
Conclusion: With education, protocol changes, and administrative support, firmly entrenched care practice patterns can be changed. Maternal-infant skin-to-skin contact practices can be improved, even in a Baby Friendly Hospital, with a corresponding increase in exclusive breastfeeding rates at discharge.
Funding Sources: Total Care Birth Center, Loma Linda University Medical Center.
Northeast Ohio Medical University, Rootstown, Ohio
Nationwide Children's Hospital, Columbus, Ohio
EFFECTIVENESS OF A PEER COUNSELOR-BASED BREASTFEEDING PROGRAM AMONG HIGH-RISK INFANTS
Indicates presenting author.
Background: In 2007, Nationwide Children's Hospital implemented a breastfeeding peer counselor program to provide additional support to women during NICU hospitalization. However, the impact of breastfeeding peer counselors among this population has not been evaluated.
Objective: To assess the effectiveness of a breastfeeding peer counselor-based program by comparing the proportion of patients receiving maternal breast milk during NICU stay and patients discharged on mother's milk pre- and post-program implementation.
Methods: A retrospective chart review was conducted on NICU admissions pre-program implementation (8/1/06-5/31/07) as well as year 1 (1/1/08-6/30/08) and year 4 (1/1/11-6/30/11) post-program implementation. Infants who were not admitted to the NICU within seven days of birth, expired during hospital stay and/or whose mother expired during hospital stay, not admitted long enough to be impacted by peer/lactation counselors, or who attempted direct breastfeeding unsuccessfully were excluded. Chi-squared tests were performed using SPSS statistical analysis software.
Results:Table below summarizes outcomes at baseline, year 1, and year 4.
Conclusions: The use of breastfeeding peer counselors likely contributed to significant increases in the number of infants receiving maternal breast milk during NICU stay post-program implementation. Outcome rates at both time points post-program implementation were higher than baseline, indicating the sustained impact of the peer counselor breastfeeding program.
Funding Sources: None.
BoiesEylaMD, FABM*VaucherYvonneMD, MPHStellwagenLisaMDLawsonTerryBridgeReneeKimJaeMD, PhD
Department of Pediatrics, University of California, San Diego
LIQUID FORTIFICATION OF EXPRESSED BREASTMILK FOR PRETERM INFANTS PILOT STUDY
Background: Problems in fortifying expressed breastmilk (EBM) include difficulties in preparation, displacement of breastmilk with formula, and contamination of powdered formula.
Objective: Assess feasibility of a nutrient dense liquid formula for fortification of EBM for preterm infants at discharge.
Methods: A convenience sample of premature infants <34 weeks gestation or <1.8 Kg in the UCSD neonatal intensive care unit (NICU) from 2/09-07/11 whose mothers were providing ≥75% of feedings as EBM were enrolled and received a nutrient dense liquid formula [Similac Special Care 30 (Sim30)]. Fortification was provided from shortly before to 12 weeks after discharge. Infants were followed in the Premature Infant Nutrition Clinic. Compliance, ease of administration, tolerance, and growth were evaluated.
Results: Mean birth weight and gestational age of the 19 enrolled subjects were 1.2 Kg±0.48 and 29.5 weeks±3.0. Sim30 was discontinued in 4 infants before discharge [intolerance (2), low milk supply (2)]. After discharge, infants received 60–120 mls of Sim30 mixed with EBM in 15–60 ml aliquots. Spitting, reflux, fussiness, abdominal discomfort were reported in 11/19 (58%) infants. Sim30 was discontinued for intolerance (5/19), low milk supply (6/19), and sudden infant death (1/19). Weight centiles for the 7/15 infants who received Sim30 for 12 weeks increased from a mean of 0.13 at NICU discharge to 0.29 at 12 weeks after discharge.
Conclusion: Infants who received Sim30 for 12 weeks achieved adequate weight gain, however, gastrointestinal symptoms were frequently reported and resulted in discontinuing the supplement in 26%. Slower introduction and frequent, smaller volume feedings may improve tolerability.
Funding Sources: Abbott Nutrition provided Similac Special Care 30 formula.
Penn State Milton S. Hershey Medical Center, Department of Obstetrics & Gynecology, Philadelphia, Pennsylvania
Penn State College of Medicine, Department of Public Health Sciences, Philadelphia, Pennsylvania
Penn State College of Medicine, Department of Pediatrics, Philadelphia, Pennsylvania
Penn State Milton S. Hershey Medical Center, Philadelphia, Pennsylvania
PREVALENCE AND CAUSES OF EARLY TERMINATION OF BREASTFEEDING IN FIRST-TIME MOTHERS
Background: The health benefits of breastfeeding to both mother and child are well-established. While it is known that certain sociodemographic factors are associated with initiation of breastfeeding, little data exists to address why women who plan to breastfeed terminate their breastfeeding efforts prematurely.
Objective: To investigate factors associated with breastfeeding at 1 month postpartum among first time mothers.
Methods: 3,006 women aged 18 to 36 were enrolled in 2009–2011 and interviewed before (in the 3rd trimester) and 1 month after first childbirth in a longitudinal study called the First Baby Study (FBS). Data from both interviews was used in our analysis.
Results: Among the 3,006 study participants, 2772 (92.2%) reported that they intended to breastfeed. One month after childbirth 2,084 (75.2%) were still breastfeeding. Based on logistic regression we found that pre-pregnancy BMI was most strongly associated with breastfeeding success, followed by maternal education, age and having taken one or more breastfeeding/ childcare classes during pregnancy (all p<.0001). Among those who planned to breastfeed, those who were normal weight prior to pregnancy were most likely to still be breastfeeding 1 month after delivery (81.5%), followed by underweight (74.2%), overweight (74.1%), and obese (60.4).
Conclusions: Women who are normal weight prior to pregnancy are most likely to succeed with plans to breastfeed at first childbirth. Some women, particularly those who are obese prior to pregnancy, may need additional support, encouragement and help to be able to achieve their goal of breastfeeding their first child.
Funding Sources: We acknowledge the support of this research by grant number R01 HD052990 from the Eunice Kennedy Shriver National Institute of Child Health & Human Development, National Institutes of Health.
Department of Neonatology, Kawaguchi Municipal Medical Center
Maternal and Perinatal Center, Tokyo Women's Medical University
AN INVESTIGATION FOR GROWTH DEVELOPMENT AT THREE YEARS OF AGE OF AN EXTREMELY LOW BIRTH WEIGHT INFANT WHO CONTINUED BREASTFEEDING
Background: Although the benefits of breastfeeding in preterm infants are well known, reports of long-term exclusive breastfeeding (no formula) after discharge in extremely low birth weight infants (ELBWI) are limited.
Purpose: To compare physical growth and developmental quotient (DQ) in ELBWI, who continued long-term breastfeeding without formula, to infants who stopped breastfeeding.
Methods: We performed a prospective cohort study examining growth and DQ at three years of age in two groups. Subjects included 39 ELBWI (weight appropriate for gestational age) who were hospitalized from 2002 to 2006 in our NICU and could be followed up for more than three years. We defined the continuous group (n=16) as those who continued breastfeeding without formula at one year of age, and the discontinuous group (n=16) as those who stopped breastfeeding before age 1 year. Seven others were mixed feeding.
Result: The gestational age (weeks) and the birth weight (grams) of the two groups were 26.4±1.4 and 26.8±1.0, and 841±115 and 867±97, respectively. There were no differences in physical growth and total DQ at three years of age in the two groups. Although the averages of the cognitive score were 93.1 in the continuous group and 88.7 in the discontinuous group, there was no significant difference. There were no differences in the background of the two groups.
Conclusion: Our study suggests that long-term breastfeeding is possible with appropriate supports after discharge, and that there may be no difference in the growth and development of ELBWI who continued long-term breastfeeding versus not.
Department of Community and Global Health, The University of Tokyo, Japan
Kitamura Institute of Mental Health, Tokyo, Japan
CAN BREASTFEEDING ENHANCE MATERNAL-INFANT BONDING?
Background: Breastfeeding is associated with maternal-infant bonding, a process that plays a critical role in the cognitive development of infants. However, causal relationship between breastfeeding and maternal-infant bonding remains unknown.
Objective: To determine if maternal-infant bonding can be enhanced by a breastfeeding intervention.
Methods: In this intervention study in Japan, we allocated 276 pregnant women receiving antenatal care in two Baby-Friendly Hospitals into two groups. While the control group (n=140) had access to the conventional in-hospital support services, the intervention group (n=136) received an educational workbook to improve breastfeeding outcomes in their third trimester in addition to the conventional support services. We then measured infant feeding status and maternal-infant bonding at 4 weeks and 12 weeks postpartum using self-administered questionnaires. To measure maternal-infant bonding, we used a 10-item scale, and then analyzed the difference in maternal-infant bonding between the two groups using multiple linear regression analysis.
Results: Women in the intervention group had significantly higher exclusive breastfeeding rates than those in the control group at 4 weeks postpartum (AOR=3.2, 95% CI: 1.4–7.6). However, the intervention group did not exhibit better maternal-infant bonding scale scores compared with the control group at 4 weeks postpartum (β=-.02, r=-.05, p=.77). At 12 weeks postpartum, no significant differences were observed in breastfeeding exclusivity or maternal-infant bonding between the two groups.
Conclusions: An intervention of providing the educational workbook improves breastfeeding exclusivity but it does not improve maternal-infant bonding at 4 weeks postpartum. Long-term effects are also limited.
SchreckPaulaMD*RonnischKimberlyWrightTamika
St. John Hospital and Medical Center, Warren, Michigan
CERTIFIED LACTATION EDUCATOR PRESENCE ON NIGHT SHIFT INCREASES BREASTFEEDING EXCLUSIVITY RATES AT AN URBAN HOSPITAL
Background: Although breastfeeding initiation rates on our Birthing Center are consistently around 60%, exclusivity rates have lagged behind, ranging 10–15%. Low exclusivity rates have been attributed to lack of lactation support on the night shift, coupled with separation of mother/baby through the promotion of a night nursery. The cost of night-shift lactation consultants have precluded night coverage. Previous attempts at “rooming-in” have met opposition from nursing staff.
Objective: Our objective was to establish night-shift lactation support that was affordable and effective in increasing exclusivity rates.
Methods: A breastfeeding peer counselor, with 7 years of community experience, was hired as night-shift lactation support. The peer counselor initially spent 16 weeks shadowing LC's on day shift 36 hours per week. She completed requirements for Certified Lactation Educator through CAPPA. She also completed a curriculum modeled after IBCLC and CLE objectives. Exclusivity was measured by retrospective review of EMR from a random sample of 20% of term babies discharged.
Results: Prior to initiation, breastfeeding exclusivity rates were 12%. After night coverage began, exclusivity rose to 25% within the first month. With the addition of “rooming-in,” exclusivity rose to 42%. The “rooming-in” initiative met minimal resistance from night nursing staff, attributed to their satisfaction with enhanced lactation presence.
Conclusion: Night-shift CLE lactation support is effective in increasing exclusivity. The transition to “rooming-in” can also be facilitated. The use of a CLE represents cost savings of over 55%, when compared to RN/IBCLC's.
Funding Sources: This work was part of the St. John Mother Nurture Project, a WK Kellogg Foundation grant initiative.
City of Pasadena, Department of Public Health Pasadena, CA, and Loma Linda University School of Medicine, Loma Linda, CA
Loma Linda University, School of Public Health, Loma Linda, CA
Loma Linda University, Behavioral Health Institute and School of Behavioral Health, Loma Linda, CA
IMPACT OF BREASTFEEDING ON CHILDHOOD OBESITY IN A PREDOMINANTLY LATINO WIC POPULATION
BABIES <33 WEEKS GESTATION AT BIRTH WHO ARE NOT RECEIVING ANY OF THEIR OWN MOTHER'S MILK AT DISCHARGE FROM THE NEONATAL UNIT
Background: The benefits of breastfeeding have long been established. It is shown to improve cognitive skills, improve behavior rating and decrease hospitalization. The suck reflex is established between 32 and 36 weeks gestation. Previous studies have shown NICU admission reduces breastfeeding but a recent study in USA has shown NICU admission has a positive effect on breastfeeding.
Objective: The aim of the audit is to compare the proportion of babies <33 weeks gestation who are discharged on mother's own milk compared to international standards and to try to establish factors affecting breastfeeding in the NICU.
Methods: This was a retrospective chart review of babies born at <33 weeks gestation who were discharged from the NICU between January 1, 2012 and March 31, 2012. Data were collected regarding babies birth weight, discharge weight, gestational age, day of life feeding was introduced, type of feeding on discharge, maternal age, parity, health insurance status and mode of delivery.
Results: From the 35 charts reviewed, 48% of infants born before 33 weeks gestation were receiving any mother's milk at discharge (only breast milk and breast milk and formula). Thus, 51% were not receiving any mother's milk at discharge.
Conclusion: Our breastfeeding rate among babies born <33 weeks gestation is comparable to the UK national rate (44.1%) but ideally we would like to improve our breastfeeding rate. Recommendations would be for specific breastfeeding classes for mothers who have babies in the NICU, as they have a different experience to those who have their babies on the ward with regards to bonding and establishing feeding due to prematurity.
Mount Sinai School of Medicine—Elmhurst Medical Center, Pediatrics
Kings County Hospital–SUNY–Downstate School of Medicine
Hebrew University, Hadassah School of Nursing of the Faculty of Medicine
FOCUS ON FAMILY TO IMPROVE BREASTFEEDING
Background: Recent breastfeeding statistics reveal 6 month rates of 43%, well short of the 2020 objective of 61%. Breastfeeding in the Latino community decreases with acculturation.
Objective: The purpose of this study was to understand the barriers to breastfeeding in the US as compared to Central and South America and to explore culturally appropriate interventions.
Methods: Using a community-based participatory approach, we qualitatively assessed interventions to increase breastfeeding in the Hispanic, inner-city community in Queens, NY. Two focus groups were conducted in the community. Interpreters assisted at sessions which were audio-taped, transcribed and translated. Using ATLAS.ti, coding was performed, categories identified and emerging themes agreed upon by consensus.
Results: Mothers agreed that breastfeeding support from healthcare professionals is greater in the US. However, breastfeeding is more difficult in the US secondary to lack of family presence, less societal acceptance of public breastfeeding and mother's requirement to return to work. Family support is more evident in the countries of origin where cultural norms include that family provide physical and emotional support and whereby postpartum mothers stay home, breastfeed and rest. Women grow up observing family members and others in the community breastfeed, even in public.
Conclusions: Interventions to increase breastfeeding need to address the lack of family support, negative attitudes towards public breastfeeding and work issues. The paradigm of our approach to breastfeeding support needs to shift, as breastfeeding education starts with the family. As many immigrants lack family supports, new models need to be developed to support breastfeeding mothers.
Funding Sources: This study was supported by a National Center for Research Resources Grant with CDC/AAMC.
Boston Medical Center, Boston, Massachusetts
Boston University School of Medicine, Boston, Massachusetts
BAG-FREE IN THE BAY STATE
Background: The deleterious effect of formula company-sponsored gift bags on breastfeeding is well-established. As of July 2012, all 49 maternity facilities in Massachusetts had banned these bags, making it the second “bag-free” state in the US. Obstacles to changing this longstanding practice were numerous including concerns regarding the cost of a substitute gift.
Objective: To describe what practices maternity facilities in Massachusetts have adopted in lieu of giving out a formula-company gift bag.
Methods: Maternity facilities in Massachusetts were surveyed regarding gift bag practices. Information was collected regarding gifts given and cost.
Results: Response rate was 100%. 59% of facilities replaced the formula gift bag with their own gift bag carrying the hospital's logo. Bags were either given empty or contained educational materials and/or a gift such as a T-shirt, hat or baby's first book. 14% of facilities gave a gift that did not include a bag. 27% of facilities gave no gift. Cost of the gifts ranged from $1–$35, with a mean cost of $10.67. Hospital budget was used to partially or fully fund 58% of gifts; 22% were covered in part by donations.
Conclusions: Although most maternity facilities surveyed replaced the formula company bag with a different gift, one-quarter gave no replacement. These data indicate that discontinuing discharge gifts can be a cost-neutral step towards evidence-based breastfeeding best practice.
Department of Pediatrics, Minia Medical School, Minia University, Minia, Egypt
Department of Community Medicine, Minia Medical School, Minia University, Minia, Egypt
EVALUATION OF BREASTFEEDING SKILLS IN A PREVIOUSLY DESIGNATED BABY-FRIENDLY HOSPITAL AFTER 15 YEARS FROM ITS RECOGNITION
Breastfeeding Medicine of Northeast Ohio, Cleveland, Ohio
Senders Pediatrics, Cleveland, Ohio
Department of Family Medicine, Case Western Reserve University, Cleveland, Ohio
Department of Epidemiology & Biostatistics, Case Western Reserve University, Cleveland, Ohio
BREASTFEEDING WOMEN WITH CHRONIC BREAST PAIN WHO FAIL CONSERVATIVE THERAPY: IS THERE A ROLE FOR ORAL ANTIBIOTICS?
Background: 33% of breastfeeding women wean because of breast pain. Uncertainty remains regarding an infectious cause. Some studies propose bacterial causes and treatment with oral antibiotics.
Objectives: Describe patient history, exam, and bacterial breast milk growth in breastfeeding women with chronic breast pain. Compare pain resolution and breastfeeding complications in patients responding to conservative therapy (CTX)(n=30) versus failing CTX and receiving oral antibiotics (OTX)(n=34).
Methods: A prospective, descriptive cohort study involving 66 breastfeeding women with breast pain lasting greater than 1 week. Initial visit included collection of breast milk culture. Follow-up survey data collected at 5 days and 2,4,6,9 and 12 weeks.
Results: Both groups presented with a median three week history of chronic pain. Baseline patient characteristics did not differ between groups except for antibiotics at delivery (18%OTX vs 45%CTX; p=0.03). OTX had higher baseline nipple tenderness (6.5/10 vs. 4.5/10, p=0.007) and S. aureus growth (33% vs. 0%). Breast pain remained higher for OTX at 5 day (5.5/10 vs. 2.62/10; p=0.00) and 2 week survey (2.47/10 vs. 1.44/10; p=0.000), but by 4 weeks there was no difference (1.77/10 vs. 1.57/10; p=0.605) between groups. Repeated measures ANOVA analysis found more rapid breast pain reduction between 5 day and 2 week survey for OTX(3.1 vs. 1.2; p=0.006). Mean length of OTX was 12.7 days. Weaning frequency(20%) was similar between groups.
Conclusion: Nipple and breast pain reduced over time regardless of type of treatment. OTX was associated with more rapid pain reduction in the first 2 weeks and higher S. aureus growth.
Funding Sources: This project was completed in part by the Culture of Inquiry Fellowship, funded by a Title VII grant from the Health Resources and Services Administration (D54HP05444, 2008). REDCap project and CTSC grant support (1 UL1 RR024989 from NCRR/NIH).
Loudoun Pediatric Associates, Loudoun Medical Group, Leesburg, Virginia, Charlottesville, Virginia
School of Nursing, University of Virginia, Department of Pediatrics, Charlottesville, Virginia
University of Virginia Health System, Charlottesville, Virginia
EVALUATION OF A CLINICAL PROTOCOL IN THE PRIMARY CARE SETTING TO INCREASE THE EXCLUSIVITY AND DURATION OF BREASTFEEDING
Background: The 2011 U.S. Surgeon General's Call to Action to Support Breastfeeding states “models should be established to integrate assistance with breastfeeding into routine practice settings.” The pediatric primary care setting is well situated for supporting breastfeeding mothers. However, there are no published studies regarding the effect of a “Breastfeeding-Friendly” protocol in pediatric primary care in the United States.
Objective: To determine whether implementing a program based on a clinical protocol affects breastfeeding rates within a pediatric primary care setting.
Methods: The Academy of Breastfeeding Medicine clinical protocol “The Breastfeeding-Friendly Physician's Office Part 1: Optimizing Care for Infants and Children” was used as a template for breastfeeding services within a pediatric primary care clinic. A two group pre- and post-protocol design was used. Data collection points included the hospital stay, the newborn visit, and the 2-, 4-, and 6-month health maintenance visits. The pre-intervention and post-intervention groups were compared to observe the protocol's effectiveness as a method of increasing breastfeeding rates.
Results: There were 757 mother-infant pairs included in the study. The results of this evaluation were positive for exclusive breastfeeding with group comparisons showing a statistically significant increase in exclusive breastfeeding rates at all five time points (p≤.003).
Conclusion: Families who receive care in a pediatric primary care setting that has implemented the ABM clinical protocol may have increased rates of exclusive breastfeeding. This study evaluated a “Breastfeeding-Friendly” protocol in a clinical setting under real-world circumstances and provided useful data for clinical practice and further research.
Funding Sources: Loudoun Pediatric Associates.
GuardinoNancy*PerksPattiMSTaddikenKaraSchuttMichelleEd.D., MSNKellamsAnnMD
University of Virginia Health System, Charlottesville, VA
CLINICIANS AND BREASTFEEDING SUPPORT: A QUALITY IMPROVEMENT INITIATIVE
Background: Hospital clinicians play a vital role in promoting breast milk feeding (BMF), yet the literature reports that clinician knowledge, attitude and beliefs can be barriers to providing effective support of BMF.
Objective: To determine if a one-hour educational intervention can improve clinician attitudes, knowledge and beliefs regarding BMF in the clinical setting.
Methods: A pretest/posttest design was used. Participants received a survey before and after a BMF educational intervention. The pre-survey also served as a needs assessment to guide the design of the educational intervention by identifying attitudes, knowledge and beliefs that were barriers to effective support of BMF.
Results: 156 clinicians completed the pre-survey, 300 attended the education, and 52 completed the post-survey. The assessment identified common barriers as: lack of time; the belief that “formula fed babies are just as healthy as breastfed babies in the long run”; and lack of practical knowledge to effectively assist mothers with BMF. Participant comments expressed concern for making the mother feel “coerced into breastfeeding” or “guilty” for not BMF. T-tests comparing pre- and post-surveys showed a significant, positive increase in clinician knowledge (p=0.001), and beliefs (p=0.004) and an upward trend in attitudes (p=0.056).
Conclusion: A one-hour educational intervention resulted in a significant increase in knowledge and beliefs, and an upward trend in attitudes regarding BMF. By creating a shift in hospital culture regarding BMF, a brief, targeted education can lay the groundwork for the efficacy of future, more focused educational interventions.
RevaiKrystalMD, MPH, FABM*PerezPatriceMS
University of Illinois Chicago
IMPACT OF A VOLUNTEER PEER COUNSELOR PROGRAM ON BREASTFEEDING RATES
Background: The implementation of peer counseling programs in hospitals is one of the strategies called for in the Surgeon General's Call to Action to Support Breastfeeding. Resource strapped hospitals may not have the funds to support a peer counselor program. In December 2011 the University of Illinois Hospital implemented a volunteer peer counselor program.
Methods: Breastfeeding (BF), breast milk feeding (BMF) or milk expression data was collected from February 2011. Rates were compared before and after the implantation of the peer counselor program. Rates were compared by Chi-square analysis.
Results: There were a total of 3131 women who had live births between February 2011 and December 2011 and 1666 from January 2012 through May 2012.
Conclusion: Volunteer peer counselors significantly impact exclusive breastfeeding rates and NICU milk expression rates. There was no change in the rate of any breastfeeding and the rate of mother's breast milk feeding decreased suggesting a shift towards exclusive breastfeeding.
SchochDeborah EMSN, PhD*LawhonGretchenMSN, PhDWickerLindaMSNYeccoGiselleMSN
Cooper University Hospital, Camden, New Jersey
AN INTERDISCIPLINARY AND MULTI-DEPARTMENTAL EDUCATIONAL PROGRAM TOWARD BABY FRIENDLY HOSPITAL DESIGNATION
Background: Given our emphasis on breastfeeding in patient care and education for those women who deliver at Cooper University Hospital, our hospital decided to strive for Baby Friendly Hospital designation.
Objective: Complete step two of the Baby Friendly Hospital Initiative (BFHI) with an educational clinical experience program to prepare all staff in knowledge and skills required to support breastfeeding.
Methods: This program was designed to educate an interdisciplinary team of over 200 nurses, physicians, management and ancillary staff in both inpatient and outpatient settings related to the management and skills for successful breastfeeding. Our approach utilized five interdisciplinary simulations chosen from our gap analysis identifying immediate learning needs including: breastmilk expression; common breastfeeding challenges; skin-to-skin contact; and couplet care on admission. In addition to didactic information on BFHI and our current practice, each station provided hands on simulation with model breasts, pumps, breastfeeding aids and dynamic scenarios requiring interdisciplinary and multi-departmental collaboration and consensus. Groups of ten to fifteen staff rotated among the forty-five minute station experiences with the required fifth hour accomplished through follow-up clinical supervision.
Results: Two hundred nineteen staff completed this educational program given on five different dates. An additional 32 nurses were inspired to become certified breastfeeding counselors.
Conclusions: The evaluations for this educational experience were extremely positive and postulated that future educational programs utilize this model of active participation. Our most valuable outcome was that Interdisciplinary and multi-departmental collaboration substantiated our ability to work toward the common goal of achieving the Baby Friendly Hospital designation.
Funding Sources: The Pediatric Council on Research and Education (PCORE), New Jersey.
First 5 Commission, Riverside County, Riverside, California
Inland Empire Breastfeeding Coalition, Riverside, California
THE IMPACT OF FIRST 5 COMMISSIONS' GRANTS ON PROMOTION OF BREASTFEEDING AND BABY FRIENDLY HOSPITAL DESIGNATION IN THE INLAND EMPIRE
Background: There is clear and convincing evidence that exclusive breastfeeding results in improved children's physical and mental health and school readiness. Therefore, First 5 commissions of Riverside and San Bernardino counties (Inland Empire) initiated a comprehensive program of breastfeeding promotion based on the Model Hospital Policy developed by the Inland Empire Breastfeeding Coalition. At the inception of this program the average rate of breastfeeding initiation in maternity hospitals was between 2–18%. The goal of this program was for every participating hospital to qualify for Baby Friendly Hospital (BFH) designation.
Materials and Methods: Funding was allocated for staff training (Birth and Beyond), Physicians' education, establishment of follow-up breastfeeding clinics and employment of lactation consultants. Hospital's compliance with the program was monitored to assure improvements in exclusive breastfeeding initiation, skin to skin contact, couplet care and staff and physicians' education.
Results: At the inception of the program there were no BFHs in the Inland Empire. However, at the present, 16 BFHs have been designated. The program's success was incumbent upon the cooperation and networking by a number of organizations, including Inland Empire Breastfeeding Coalition, AAP chapter 2 Ca, Inland Empire Perinatal Services and WIC Program.
Conclusion: BFH designation of the majority of the hospitals in the Inland Empire is quite significant and indicates the importance of networking between various organizations and individuals, including our political and business leaders, to accomplish these goals.
Department of Information Services, Nationwide Children's Hospital, Columbus, Ohio
Department of Clinical Nutrition and Lactation, Columbus, Ohio
Nationwide Children's Hospital, Columbus, Ohio
A RETROSPECTIVE TWO YEAR STUDY OF BREAST MILK ERROR PREVENTION IN THE NEONATAL INTENSIVE CARE UNIT
Background: Errors in administering breast milk to a wrong recipient are a common occurrence in the NICU. Breast milk bar-coding was implemented in our NICUs in May 2009.
Objectives: Our objectives were to determine if: 1) the error reductions were sustainable; 2) there was an additional decrease in errors with the implementation of a milk room technician.
Methods: Retrospective study design was applied to evaluate system reports of error rates over a two year period using the bar-coding system's (MOMS) database.
Results: The number of scans of expired bottles in the barcoding system was reduced by 40% (from 1992 to 1185 bottles). Concurrently, the number of bottles of wrong milk that were attempted to be fed to the wrong baby was reduced by 22% (from 541 to 426 bottles).
On the unit with the milk tech, the total number of scans of expired bottles during her working hours were reduced by 58% (from 303 to 128 bottles) from the 1st to 2nd year. During this same period, the number of expired bottles that were scanned during her non-working hours was reduced by 40% (from 1090 to 650 bottles). Clinical significance can be ascertained from the reduction of expired milk use attempts and also from the wrong milk use attempts.
Conclusions: The use of barcoding breast milk in the NICU has improved patient safety by reducing the number of breast milk errors. In units that combine a milk technician with barcoding, the error rate is even lower than just barcoding alone.
Center for Breastfeeding Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
Division of Nutritional Sciences, Cornell University, Ithaca, New York
TRENDS IN BREASTFEEDING: IT'S NOT ONLY AT THE BREAST ANYMORE
Background: The past characterizations of breastfeeding as being only at the breast of the mother may no longer be applicable in the United States as mothers now frequently express their milk.
Methods: We conducted a retrospective cohort study with women who visited the Cincinnati Children's Breastfeeding Medicine Clinic to understand breast milk feeding behaviors of healthy mothers and infants that included questions specifically about breast milk expression.
Results: All 40 mothers in the cohort expressed their milk and all 40 infants were fed expressed milk. One infant was fed another mother's milk for 30 days. Two-thirds (13/40) of infants received their mother's expressed milk at least a week after it was first expressed and 25% (10/40) of infants continued to be fed expressed breast milk after mothers had stopped expressing milk. There were 14 sequences of breast milk production by the mothers and 16 sequences of consumption by the infants. Mothers started expressing milk even though the infants were consuming all of the breast milk that they needed at the breast.
Conclusions: As a result of breast milk expression by all mothers in this cohort, we observed highly variable patterns of maternal breast milk production and infant breast milk consumption, which were not necessarily synchronous within a dyad. It is now time to develop appropriate ways to characterize the production and consumption of breast milk more accurately and investigate whether these behaviors have consequences for the health of mothers and infants.
PerezPatriceMS*Jackson-ArtisRebeccaStokesVanessaRevaiKrystalMD, MPH, FABM
University of Illinois Hospital & Health Sciences Systems, Monolatry Group, Hinsdale, Illinois
DETERMINING MINIMAL FREQUENCY OF BREASTFEEDING DATA COLLECTION TO APPROXIMATE THE TRUE BREASTFEEDING RATE
Background: This study compares frequency of breastfeeding rate data collection to determine the frequency that most closely approximates the true rate.
Methods: Exclusive breastfeeding, mixed breastfeeding, any breast milk feeding and milk expression data for mothers with babies in the neonatal intensive care unit (NICU) was collected daily Monday – Friday from February 2011 to April 2012. Exclusive breastfeeding is defined as infants who received breast milk as the sole source of nutrition. Any breast milk feeding was defined as any breastfeeding or feeding expressed milk. Count variables were computed for each day and summed up for each week. A total sum across all measured weeks was computed. In addition, 5000 samples were created in which one week was chosen at random out of each month and one week was chosen at random out of each quarter and the sum computed. Analysis focused on reporting the distribution of proportions in the random samples.
Results: We collected feeding information from 4778 mothers with healthy babies and 974 mothers with babies in the NICU. Proportions based on feeding pattern are in the table below.
Daily
Monthly estimate (SD)
Quarterly estimate (SD)
Exclusive breastfeeding
0.32
0.32 (.019)
0.33 (.034)
Any breastfeeding
0.48
0.47 (.019)
0.49 (.036)
Any breast milk
0.63
0.63 (.015)
0.64 (.033)
NICU mothers pumping
0.76
0.76 (.033)
0.76 (.064)
Conclusion: Breastfeeding rates collected one week out of the month are within 3% of the results obtained when collecting data daily.
University of Memphis School of Public Health, Memphis, TN
BARRIERS TO BREASTFEEDING IN THE AFRICAN AMERICAN POPULATION OF MEMPHIS, TENNESSEE – A FOCUS GROUP STUDY
Background: Memphis has one of the lowest breastfeeding rates in the country, along with high rates of infant mortality, childhood obesity, and poverty. Disparities in intention to breastfeed rates between African Americans and Caucasians are pronounced.
Objective: To explore the disparity in breastfeeding, seek possible solutions from the target population, and obtain input on a planned media campaign.
Methods: Focus groups were conducted in community settings primarily serving a low-income, African American population. Focus groups consisted of young women, men, grandmothers or teens. An African American facilitator led each group discussion with a structured interview format.
Results: A total of 86 participants were represented among 9 focus groups, ranging in age from 11 to 78 years. The breastfeeding rate among participants was similar to the baseline “intention to breastfeed” rate for African Americans in the county. Common thematic barriers to breastfeeding included: embarrassment with public nursing, concern about pain with breastfeeding, concern about “partying” and breastfeeding, and “just not wanting to.” A notable finding was a concern about sexuality and breastfeeding. Nearly one-fourth of participants mentioned substance abuse as “The Biggest Barrier.” As possible strategies for improvement, participants recommended putting breastfeeding educational materials “everywhere,” including healthcare institutions, schools, churches, and even juvenile court. Participants also chose a favorite image for a planned media campaign and suggested slogans.
Conclusion: Barriers to breastfeeding in Memphis are consistent with other areas, with pronounced concerns about sexuality and partying. Specific recommendations from the target populations will be incorporated into local breastfeeding promotion efforts.
Funding Sources: AAP CATCH Grant Funds were used for the Focus Group study.
Breastfeeding Medicine of Northeast Ohio, Cleveland, Ohio
Senders Pediatrics, Cleveland, Ohio
Department of Family Medicine-Research Division, Case Western Reserve University, Cleveland, Ohio
Moscow, Russia
INCORPORATING RUSSIAN MASSAGE TECHNIQUES IN A U.S. PRACTICE: A REVIEW OF CASE STUDIES
Background: Although breastfeeding mothers are commonly instructed to use breast massage at home to relieve plugged ducts, milk stasis, and engorgement, many continue to have difficulties. In Russia, mothers turn to providers trained in hand expression and breast massage techniques (HE&BM) to resolve these complications. Given that 33% of U.S. women wean because of breast pain, additional complementary measures to assist breastfeeding women with quick pain resolution could facilitate breastfeeding continuation.
Objectives: Describe HE&BM commonly used in Russia. Provide a case series describing the successful in-office implementation of Russian HE&BM for complementary treatment of breastfeeding complications. Describe clinical response and patient satisfaction to these techniques.
Methods: Descriptive, case series (n=20) of breastfeeding mothers benefiting from in-office breast massage and demonstration of techniques for home use. Cases recorded from an outpatient breastfeeding medicine clinic, based within a breastfeeding supportive pediatric practice employing 3 part-time lactation consultants (LC). Commonly used Russian HE&BM techniques were learned by practice LC, a Russian native, through the course of several trips to Russia.
Results: For those mothers whose symptoms persisted despite home treatment, in-office massage by a trained professional provided immediate pain relief. Mothers typically had 50–100% improvement of symptoms in the office. Patient satisfaction was positive and included descriptions of the massage being “amazing,” decreasing pain level, size of the plugged duct and improving milk flow.
Conclusions: Techniques learned from colleagues in Russia, wherein HE&BM are the norm, may provide a complementary treatment strategy in the U.S. for recurrent plugged ducts, mastitis, and engorgement.
Funding Sources: This project was completed in part by a scholarship grant by the Ohio Lactation Consultant Association for travel to Russia.
Department of Pediatrics, University of California San Diego, San Diego
Neonatology Group
Naval Medical Center San Diego
San Diego County Breastfeeding Coalition
American Red Cross WIC, San Diego, California
COMMUNITY BASED PROGRAM THROUGH THE SAN DIEGO COUNTY BREASTFEEDING COALITION (SDCBC) TO PROVIDE BREAST PUMPS TO MOTHERS AT RISK FOR BREASTFEEDING FAILURE
Background: Mothers who are separated from their infants due to prematurity, illness, and return to school or work may lack access to breast pumps needed to sustain lactation.
Objective: To describe a community-based program to provide high quality breast pumps to mothers at medical or social risk for discontinuing breastfeeding prematurely.
Methods: SDCBC conducted a community-wide needs assessment in 2011 which included an online survey and a community forum. Through local grant funding, a program was developed to purchase and provide breast pumps and supplies to mothers through existing health resources which took responsibility for pump distribution, tracking and maintenance.
Results: Over 80% of the survey respondents indicated their clients had a need for breast pumps. Representatives of NICUs, WIC, County Public Health Nursing, Community Health Centers, public schools, lactation consultants, and pump companies participated in the forum. Mothers of premature infants, mothers returning to school, incarcerated, or homeless, and low-income mothers without access to WIC were identified as the highest priorities. Over a six month period, hospital grade preemie pumps(10), multi-use pumps(52) and personal pumps(5) with kits were distributed to nine hospital NICUs, six Public Health Centers, one Family Health Center, San Diego Adolescent Pregnancy and Parenting program and Black Infant Health program. Excluding hospital NICUs, 60 mothers, including 22 teen mothers, received pumps.
Conclusion: SDCBC in conjunction with community agencies and a local philanthropy successfully developed a community-wide program to provide high quality, electric breast pumps to mothers at risk for breastfeeding failure.
Funding Sources: Rest Haven Children's Health Fund, San Diego, CA, (9/2010-8/2011), second year extension (9/2011-8/2012).
Department of Pediatrics, Boston Medical Center, Boston University School of Medicine, Boston, MA
Department of Pediatrics, Stanford University, Stanford, California
UTILIZATION OF PASTEURIZED HUMAN DONOR MILK IN U.S. LEVEL 3 NICUS
Background: Although pasteurized human donor milk (DM) is recommended when mother's own milk (MOM) is unavailable for infants admitted to the neonatal intensive care unit (NICU), it is not universally implemented. It is unclear what factors predict DM use.
Objective: Our goals were to determine (1) current utilization of DM among infants admitted to U.S. level 3 NICUs and (2) predictors of DM use; and (3) describe criteria for DM use among participating U.S. level 3 NICUs.
Methods: We surveyed medical directors of U.S. level 3 NICUs. We assessed NICU/hospital characteristics and beliefs of DM accessibility, benefit, safety and receptiveness. We used multivariable logistic regression to determine predictors of DM use and assessed qualification criteria for DM use.
Results: 169/311 (55%) completed our survey. 43% were DM users and 57% were DM non-users. DM users and non-users varied by geographic region with 35% v. 15% in the West, 32% v. 25% in the Midwest, 14% v. 32% in the Northeast and 19% v. 28% in the South, respectively (p=0.02). In multivariate analyses, >800 v. <400 annual NICU admissions (OR 1.14 [95% C.I. 1.20–10.29]) and NICU location in the Midwest (OR 3.10 [95% C.I. 1.16–8.24]) and West (OR 6.15 [95% C.I. 2.15–17.56]) v. Northeast was associated with DM use. The most commonly reported criteria for DM use was when MOM is unavailable (84%), an infant was born below a birth weight (81%) or specified gestational age (75%), or per parental request (74%).
Conclusions: DM utilization is greater among larger NICUs and among NICUs in the West and Midwest compared to the Northeast. Criteria for use vary widely.
Funding Sources: Joel Alpert Grants - internal grant in the Department of Pediatrics, Boston Medical Center.
LandyCynthiaMD*CollitonJenniferRegtsJanetStorozukShelly
South Calgary Primary Care Network, Calgary, Alberta, Canada
A MULTI-DISCIPLINARY MODEL TO ASSIST FAMILIES TO REACH THEIR BREASTFEEDING GOALS
Background: Although breastfeeding has been identified by both the World Health Organization and Health Canada as the best method of feeding infants, many mothers discontinue breastfeeding prematurely because of lack of support. While there are several reasons for the cessation of breastfeeding, women who wish to continue breastfeeding should be assisted in reaching their goals.
Objective: The South Calgary Primary Care Network developed a centralized program that offers access to a physician-supported breastfeeding team. This program aims to provide same day access to a lactation consultant while improving the longevity of breastfeeding rates.
Methods: The program is based out of an existing family practice and runs 3 evenings per week. The team consists of a physician and lactation consultants. Patients can be referred by a physician or self-refer. Methods: Patient level data is collected by the lactation consultant at the point of contact. Data includes reason for visit, current and goal feeding method, age of infant and need for physician consult.
Results: Since opening in 2008 there have been 1272 patient visits, with 61% being new patients. 60% of infants seen at the clinic are less than 6 weeks of age. Clinic visits are primarily for perceived low milk supply, latch issues, and general support/advice. Utilization data indicate the majority of our patients fall into a demographic for which AHS provides a breastfeeding service.
Conclusion: Many breastfeeding issues are easily resolved with timely intervention in a multi-disciplinary setting.
Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania
The Geisel School of Medicine at Dartmouth, Hanover, NH
Dartmouth-Hitchcock Medical Center, Lebanon, NH
EXCLUSIVE BREASTFEEDING: KNOWLEDGE, ATTITUDES AND PRACTICES AMONG MOTHERS IN TANZANIA AND RURAL NEW HAMPSHIRE/VERMONT
Background: Exclusive breastfeeding (EBF) prevents acute and chronic childhood conditions, is economically feasible and safe, and often the perfect nutrition for young infants. Globally, 13% of under-five deaths could be prevented if infants exclusively breastfed for 6 months.
Objective: To compare EBF knowledge, attitudes and practices of mothers in Tanzania (TZ) with those in rural New Hampshire (NH)/Vermont (VT).
Methods: Pretested client-assisted Kiswahili questionnaires were administered orally to 202 mothers of infants >6 months at the Amtulabhai RCH clinic in Dar es Salaam, TZ. Similar questionnaires were mailed to 194 mothers who delivered at Dartmouth-Hitchcock Medical Center in Lebanon, NH>6 months earlier; 71 mothers responded. Data was analyzed using SPSS 18.0.
Results: 34.2% Tanzanian mothers exclusively breastfed for 6 months compared with 18.3% NH/VT mothers (95% CI; .093, .273).
Conclusions: EBF is more common in Tanzanian than NH/VT mothers despite greater overall breastfeeding benefit knowledge among the latter. In both cultures there is a need for increased maternal education to improve knowledge, attitudes, and practices regarding EBF.
Funding Sources: The Dickey Center for International Understanding, Dartmouth-Hitchcock Medical Center.
OwinoVictor O.MSc, PhD
University of California—Davis, Davis, California
WE BREASTFEED ALL BUT EXCLUSIVELY BREASTFEED ALMOST NONE: KENYA'S PARADOX
Background: Exclusive breastfeeding (EBF) for 6 months is crucial for neonatal survival, growth and development of infants. This review compares Kenyan BF patterns to other resource poor settings and sets out what may be done to improve.
Method: Literature review on reported breastfeeding trends and measured breast milk (BM) intake across other resource poor settings compared to the prevailing situation in Kenya.
Results: The breastfeeding rate in Kenya is above 95%. Most studies report very low EBF rates (2–15%). Only 1/3 of Kenyan infants receive breast milk within 1 hour after birth and a similar proportion receive liquids other than BM within 3 days of life. In contrast, the rates of EBF in most Eastern/Southern African countries are reported to be rising and are currently at about 42%, still low but encouraging. Kenyan infants below 6 months of age consume 300g less BM compared to global average (i.e., 572 g/d versus 780 g/d). Only 49% of HIV-exposed Kenyan infants are breastfed compared to Zambia (80%), for example, where deliberate EBF messages have been designed for HIV-infected mothers. There is a dearth of data on accurately measured BM intake, especially among HIV-exposed infants. Additionally, BF and BM intake assessments need to be standardized.
Conclusion: Kenyan breastfeeding indicators are worse than those from other settings. Breastfeeding promotion campaigns must consider household food insecurity, be content specific and, sensitive to practice modifiers, like maternal HIV sero-positivity. BM intake quantification is recommended to enable assessment of the impact of BF counseling.
Centre for Health Communication, University of Technology, Sydney, Australia
Faculty of Medicine, Indiana University, Evansville, Indiana
THE COST OF USING DONOR HUMAN MILK IN THE NICU TO ACHIEVE EXCLUSIVELY HUMAN MILK FEEDING THROUGH 32 WEEKS POSTMENSTRUAL AGE
Background: Donor human milk (DHM) is used in neonatal intensive care units (NICU) to achieve exclusive human milk (EHM) feedings in preterm infants. Few cost studies examine the cost of DHM utilized.
Objectives: To determine the cost of DHM to achieve EHM feeding for very preterm infants.
Methods: Preterm infants admitted to an American Level III NICU (<1500 gm birth weight or <33 weeks post menstrual age (PMA)) were retrospectively evaluated for 1 year. Infants were categorized according to exposure to mother's own milk (MOM), DHM and formula feeding during NICU admission and at discharge. A DHM feeding log was retrospectively analyzed and the volume, duration, and cost of DHM were calculated.
Results: 46 of the 64 (72%) infants admitted to the NICU who were <33 weeks PMA received DHM. The mean costs of DHM were: US$27 for infants of mothers who provided sufficient breastmilk through to discharge; US$154 for infants of mothers who had insufficient milk supply during NICU admission; US$281 for infants of mothers who went home on formula but received any volume of MOM during NICU admission; and, US$590 for infants who received no MOM during their NICU admission.
Conclusions: The cost of DHM per infant to achieve EHM feeding through 32 weeks PMA ranged from US$27–$590. Cost was moderated by the mother's willingness or ability to provide sufficient volumes of MOM.
University of Virginia School of Medicine, Charlottesville, Virginia
Children's Hospital of the King's Daughters/Eastern Virginia Medical School, Norfolk, Virginia
Virginia Department of Health, Richmond, Virginia
HIT-Global Consulting Services, Inc, Montreal, Quebec, Canada
THE EFFECTS OF A PHYSICIAN-CENTERED WEB-BASED PERFORMANCE IMPROVEMENT INITIATIVE ON BREASTFEEDING INITIATION, DURATION, AND EXCLUSIVITY
Background: The Virginia Department of Health in collaboration with the University of Virginia Office of Continuing Medical Education and the Virginia Chapter of the American Academy of Pediatrics developed a web-based Breastfeeding Friendly Performance Improvement activity (www.breastfeedingpi.org) approved by the American Board of Pediatrics for MOC Part 2 and Part 4 credit, as part of an effort to identify performance gaps, and provide learning activities and tools to improve breastfeeding exclusivity.
Objective: Evaluate the effectiveness of this web-based activity's use of self-audit of past clinical performance, guided learning and self-reflection, and goal-setting to improve a gap in performance related to initiation, duration, and exclusivity of breastfeeding.
Methods: Quantitative and qualitative data drawn from participant's patient profiles, their selection of learning activities, and desired improvement goal for selected gaps in performance were examined using descriptive statistics to determine degree of change in performance and goal attainment.
Results: Of 81 physicians who completed the activity, 69% met their individual goals for improvement with 52% exceeding their goal. The standards of care showing the greatest percentage change in performance included documentation of exclusive breastfeeding (35%), every 12 hour breastfeeding assessment (79%), 24 hour rooming in (40%) and ongoing breastfeeding support (47%). The least improvement was seen in reducing use of pacifiers and artificial nipples in the first 4 weeks with 64% of participants not meeting their desired goal.
Conclusions: Clinicians effectively used a self-directed performance improvement activity to improve breastfeeding initiation, duration and exclusivity for their patients.
Neonatology, Connecticut Children's Medical Center, Hartford, CT, USA
Human Lactation, Connecticut Children's Medical Center, Hartford, CT, USA
Department of Pediatrics, University of Connecticut School of Medicine, Farmington CT, USA
WEIGHT GAIN AND SODIUM MONITORING IN VLBW INFANTS (VLBWI) FED DONOR HUMAN MILK (DM+) VERSUS NO DONOR MILK (DM-)
Background and aims: The impact of supplementing mother's milk (MM) with donor milk (DM) upon VLBWI weight gain and serum Na is unclear. This study aimed to compare weight gain, lowest serum Na, and number of serum Na samples (NumSerumNa) between birth and 56 days in DM+ versus DM- VLBWI.
Methods: Single-center clinical/nutritional data, weekly weights and all serum Na during the first 56 days were collected between 10/2009-9/2011 for inborn VLBWI still hospitalized at 28 days. DM was tested for association with weight gain, lowest serum Na, and NumSerumNa.
Results: 95 VLBWI were studied, with GA 28.4±2.8 weeks, birth weight 1031±295 grams, and 29 (31%) DM+. Median enteral intake in the first 28 days (EI28) was 1791 ml (range 0–5882); among DM+, median DM intake (DMI28) was 787 ml (range 76–2105). DM+ versus DM- did not differ in GA, birth weight, gender, race, EI28, days on ventilator, CPAP or parenteral nutrition in the first 28 days. At 56 days, overall median (IQR) weight gain was 1047 (902, 1192) gm/kg birth weight, overall lowest serum Na was 132 (128.5, 135) mEq/L. NumNa was 19 (9.5, 37). In univariate analysis, DM+ and DM- did not differ regarding weight gain, LowNa, or NumSerumNa. In multivariable linear mixed modeling DMI28 was associated with a statistically significant but clinically trivial decrease in lowest serum Na, and was not an independent determinant of weight gain or NumSerumNa.
Conclusions: DM supplement to MM supports growth in VLBWI without adversely affecting lowest serum Na or NumSerumNa.
