BABE: Breastfeeding and Antenatal Breastmilk Expression Randomized Control Trial.
Merai Estafanous, Nicole Chong, Alexander Thomas, Gabrielle Cook, Elaine Hart
Loma Linda University School of Medicine
Category: Research
Background: The purpose of this randomized control trial was to improve the exclusive breastfeeding rate while hospitalized during the postpartum period, to improve the exclusive breastfeeding rate at 6 months, and to bolster mothers' self‐confidence in breastfeeding ability. Subjects were randomized to either initiate antenatal breast milk expression (ABE) at 37 weeks gestation combined with routine breastfeeding education, or routine education plus standard interventions. In the experimental group, the average amount of colostrum pumped was 52.3 mL (range 0.0 to 184.5mL); however, there were no statistically significant differences in exclusive breastfeeding between the experimental and control groups. The average amount of breastmilk produced antepartum was 54mL (median 6.8mL, range 0 ‐ 611mL). Subjects who produced more milk were more likely to exclusively breastfeed. There were no significant differences in safety outcomes between the ABE and control groups including gestational age at delivery, infant weight loss at discharge, 5 minute APGAR <6, or NICU admission rates. The ABE group had a significantly higher percentage of participants who presented in active labor and a significantly lower percentage of participants who had indicated Cesarean sections. The ABE group was also able to supplement with colostrum during the postpartum hospital admission at a significantly higher rate than the control group. This study did not identify a statistically significant increase in exclusive breastfeeding associated with ABE, however antepartum expression of breastmilk was shown to be safe and was associated with an increased likelihood of admission to Labor and Delivery for spontaneous labor.
Results: 32% of women in the Antenatal Breast Expression (ABE) group used formula supplementation, compared to 41% of women in the control group (p = 0.2).
Materials/Methods: The ABE group was instructed to pump 3x daily for 20 minutes starting at 37 weeks gestation. Breastfeeding at 6 months was examined in both groups.
Conclusions: Although not statistically significant, the study found that ABE decreased formula supplementation in the hospital suggesting that it may be an effective measure to help patients meet their goals and CMQCC benchmarks for exclusive breastfeeding.
The role of breastfeeding in racial and ethnic disparities in Sudden Unexpected Infant Death: A population‐based study of 13 million infants from the United States.
Background: Sudden Unexpected Infant Death (SUID) disproportionately affects non‐Hispanic Black (NHB) and American Indian/Alaskan Native (AI/AN) infants, who have lower rates of breastfeeding than other groups. No existing literature investigates if breastfeeding explains disparities in SUID rates.
Results: The overall SUID rate was 0.91/1,000 live births. NHB and AI/AN infants had the highest disparity in SUID relative to non‐Hispanic White (NHW) infants. Overall not‐breastfeeding was associated with SUID, adjusted Odds Ratio (aOR) 1.14 (95% Confidence Interval [CI]: 1.10, 1.19), the adjusted risk difference (AdjRD) was 0.12/1,000 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 SUID risk in Hispanic infants (2.1% mediated) relative to NHW infants. When adjusted for background risks, AI/AN mothers were more likely to initiate breastfeeding than similar NHW mothers, resulting in a negative mediation effect (‐0.9% mediated) relative to NHW infants. Asian mothers were less likely to initiate breastfeeding than similar NHW mothers.
Materials/Methods: Using 13,077,880 live birth certificates and 11,942 linked SUID death certificates from 2015‐2018, we calculated odds ratios and adjusted risk differences of SUID by not‐breastfeeding across 5 racial/ethnic strata in the United States, adjusting for 12 covariates. We analyzed mediation by not‐breastfeeding in the race/ethnicity‐SUID association, adjusting for 12 covariates.
Conclusions: Competing risks likely explain the lower aOR seen in NHB infants of not‐breastfeeding on SUID, suggesting that social/structural determinants must be addressed to reduce racial disparities in SUID. Reducing the rates of SUID of NHB and AI/AN infants will likely depend on confronting larger social and structural determinants of health through political solutions.
Peer‐to‐Peer Milk Sharing Network among OBGYN Co‐workers in an Academic Institution.
Abigail Liberty, Kimberley Bullard, Katherine Au
Oregon Health and Science University
Category: Research
Background: Less than one third of physicians reach their personal breastfeeding goals and approximately one third are breastfeeding at 12 months. The World Health Organization recommends the use of human donor milk before the use of artificial supplementation to achieve optimal infant nutrition. The use of formal and informal milk sharing among physician parents has not been previously described.
Results: Informal sharing occurred between 18 dyads which included 7 donors and 12 recipients over 7 years. Two individuals were both recipients and donors. Three recipients received milk from multiple donors. Two donors participated in both informal and formal milk donation. Milk sharing crossed traditional hierarchical boundaries with trainees sharing milk with supervisors and vice versa. Milk sharing was also noted between physician and nurse colleagues.
Materials/Methods: A retrospective database of individuals known to have shared milk within a single OB/Gyn department was created. A network map described 7 years of sharing events. The network was plotted chronologically by the birthdate of the donor or recipient. Informal milk sharing outside of the department was excluded. Formal sharing through a HMBANA Milk Bank was included.
Conclusions: This is the first ever milk sharing network analysis among physician co‐workers. This network highlights several key areas for future research including survey of recipient and donor experiences, the role of milk sharing in achieving personal breastfeeding goals, and the impact of personal experience with milk sharing on patient counseling.
Passing on Protection: Frequency of Breastfeeding and Protection Against COVID‐19 in Young Children of Vaccinated Mothers.
April Castillo
Stony Brook University
Category: Research
Background: Many lactating parents extended breastfeeding relationships beyond initially planned during the COVID‐19 pandemic to provide children some immunity. It is unknown how much protection is conferred, and whether there is a dose‐response relationship or minimum threshold for protection. Booster recommendations raised further questions. This study aims to elucidate a minimum number of feeds necessary for observable passive immunity, and whether maternal boosters provide increased protection to breastfed children.
Materials/Methods: This is a non‐blinded observational prospective cohort study of lactating physicians and their breastfed children assessing maternal COVID‐19 mRNA vaccination effects. One‐year outcome surveys were used for analysis including Chi square, Cochran‐Mantel‐Haenszel tests; logistic regression modeled factors affecting likelihood of COVID‐19 symptoms and diagnosis, estimating odds ratios controlling for high‐risk exposures. N = 534.
Results: Weaning (<2 breastfeeds/day) is associated with increased risk of COVID diagnosis (AOR 2.190, 95%CI[1.049‐4.571], p = .033), while maternal booster is protective (AOR 0.334, 95%CI[0.169‐0.65], p = .002). Continued breastfeeding (≥2 times/ day) is associated with a decreased risk of needing medical attention if symptoms develop (AOR 0.348, 95%CI[0.174‐0.682], p = 0.001). Maternal booster decreased risk of developing symptoms (AOR 0.508, 95%CI[0.272‐0.951], p = 0.032) and needing medical attention (AOR 0.345, 95%CI[0.183‐0.649], p < 0.001).
Conclusions: Both continued breastfeeding by mothers receiving mRNA COVID‐19 vaccines, and maternal booster dose, reduce children's risks of COVID‐19 diagnosis, symptoms, and needing medical attention compared to children weaned to <2 breastfeeds per day or whose mothers did not receive boosters, respectively. Lactating parents vaccinated against COVID‐19 may optimize children's protection by continuing breastfeeding relationships with minimum two feeds/day and getting the booster dose when recommended.
History of Breastfeeding and Stroke Prevalence among Parous Females: Findings from the National Health and Nutrition Examination Survey (NHANES), 1999–2012.
Gina Richardson1, Emily Mitchell2, Kalera Stratton3, Laura Kair4, Lynn Marshall5
1Oregon Health and Science University
2Oregon Health and Science University
3Oregon Health and Science University
4University of California Davis
5Oregon Health and Science University
Category: Research
Background: Stroke is the third leading cause of death for women in the United States, resulting in twice as many deaths as breast cancer. There is a known relationship between hypertension and stroke, as well as breastfeeding a child and hypertension. However, there has been little research connecting these associations to evaluate whether breastfeeding a child may be associated with stroke risk later in life.
Results: There is an inverse association between ever breastfeeding a child and prevalence of stroke that was significant in 20–64‐year‐olds (OR = 0.69, 95% CI: 0.47, 1.00).
Materials/Methods: Multivariable logistic regression models were used to estimate crude and adjusted prevalence odds ratios for the association between breastfeeding and stroke.
Conclusions: Ever breastfeeding a child was associated with lower prevalence of stroke in a nationally representative US sample of parous females 20 years and older. The inverse association was significant among those ages 20‐64 years but not among those 65 years and older.
Racial Inequities in Breastfeeding Counseling among Pregnant People who use Cannabis.
Laura Kair1, Adrienne Hoyt‐Austin2, Melissa Chen3, Brandie Bentley4, Karen Tabb5, Mishka Terplan6, Jennifer McAllister7, Scott Wexelblatt8, Aaron Murnan9, Chidiogo Anyigbo10, Christine Wilder11, Nichole Nidey12
1University of California Davis
2UC Davis Health
3UC Davis
4University of Illinois at Urbana Champaign
5University of Illinois at Urbana Champaign
6Friends Research Institute
7Cincinnati Children's Hospital
8Cincinnati Children's Hospital
9University of Cincinnati
10Cincinnati Children's Hospital
11University of Cincinnati
12Cincinnati Children's Hospital
Category: Research
Background: Cannabis use has increased in the US among pregnant and postpartum people. Disparities in breastfeeding rates persist across racial/ethnic groups, with Black dyads experiencing the lowest initiation and continuation rates. The extent to which breastfeeding guidance given by healthcare providers to pregnant patients who use cannabis varies by maternal race/ethnicity is unknown.
Results: 9.5% of respondents reported cannabis use during or 3 months prior to pregnancy. Of these respondents (weighted N = 51,793), 36.2% reported receiving advice from a provider prenatally not to breastfeed if using cannabis. This advice was associated with decreased odds of initiating breastfeeding (OR 0.6, 95%CI 0.3,0.99). Non‐Hispanic Black people were disproportionately advised not to breastfeed if using cannabis and had 4 times the odds of receiving this advice as non‐Hispanic white people (aOR 4.1, 95%CI 2.1,8.2).
Materials/Methods: We analyzed data from the 2017‐18 CDC Pregnancy Risk Assessment Monitoring System survey from 9 states (AK, IL, ME, ND, NJ, NM, NY, PA, WV) with data on breastfeeding advice and cannabis use using weighted logistic regression models, unadjusted and adjusted for insurance, year, smoking, education, age, and state.
Conclusions: In this study of birthing people who used cannabis prior to and/or during pregnancy, over one third of respondents reported advice to avoid breastfeeding if using cannabis. This advice was associated with lower odds of initiating breastfeeding, and non‐Hispanic Black birthing people were 4 times as likely as non‐Hispanic white people to be advised this. To achieve equitable maternal‐child health outcomes, interventions aimed at increasing breastfeeding initiation need to prioritize addressing structural and interpersonal racism in the context of maternal‐child healthcare.
The Influence of Family Support on Exclusive Breastfeeding Practice of Mothers attending the National Hospital, Abuja, Nigeria.
Opeyemi Oshodi
National Hospital, Abuja, Nigeria
Category: Research
Background: Exclusive breastfeeding practice has remained suboptimal despite global efforts to promote it. Unfortunately, most breastfeeding interventions target mothers, with no corresponding understanding of the role of the family. A focus on family support is imperative, as evidence suggests that the family is probably more influential than health professionals in breastfeeding‐related matters.
Results: High emotional support for exclusive breastfeeding from husbands (OR: 2.97; 95% CI: 1.28‐5.02) and high informational support for exclusive breastfeeding from husbands (OR: 3.72; CI: 1.91‐7.25) were significantly associated with the practice of exclusive breastfeeding among the mothers. Practical support from husbands as well as all dimensions of support from other family members were not associated with exclusive breastfeeding practice.
Materials/Methods: A cross‐sectional study using a systematic sampling technique was conducted among 393 mothers of infants under six months in a tertiary Hospital in Abuja, Nigeria. Data for variables on exclusive breastfeeding practice and family support were collected using validated tools. Factors associated with exclusive breastfeeding practice were analysed using logistic regression. A p‐value of 0.05 was considered as statistically significant.
Conclusions: Emotional and informational support specific for exclusive breastfeeding from husbands, is crucial in enabling mothers practice exclusive breastfeeding. As such, breastfeeding interventions should also be targeted towards these family members for maximum effectiveness.
The Effects of Oral Feeding on the Preterm Infants' Microbiome and Metabolome.
Keriann Schulkers Escalante1, Shiyu Bai‐Tong2, Megan Thoemmes3, Kelly Weldon4, Diba Mortazavi5, Jack Gilbert6, Sandra Leibel7
1University of California San Diego
2University of Southern California
3University of California San Diego
4University of California San Diego
5University of California San Diego
6University of California San Diego
7University of California San Diego
Category: Research
Background: Breast milk is beneficial for preterm infants. Direct breastfeeding is ideal but preterm infants initially receive breast milk through an orogastric/nasogastric tube. The effects of tube feeds on the preterm infants' oral and gut microbiome and the breast milk microbiome and human milk oligosaccharide (HMO) diversity is unknown. We hypothesize that the diversity of the breast milk microbiome and HMOs change upon oral feeding, which alter the infant's microbiome and metabolome. We aim to elucidate this by analyzing stool, saliva and milk samples collected from a cohort of infants from the study: “The Association Between Milk Feedings, the Microbiome and Risk of Atopic Disease in the Preterm Population (MAP) Study”.
Results: Previous analysis of a cohort of 54 infant stool samples showed a significant difference in bacterial community composition after the initiation of bottle (p = 0.014) and breastfeeding (p = 0.014), indicating changes to the stool microbiome at the onset of oral feeding. Further analysis of infant stool, saliva and maternal milk is ongoing.
Materials/Methods: Samples were obtained before and after initiation of oral feeds. 39 infant stool and 44 infant saliva samples will undergo metabolomic and microbiome analysis using untargeted gas chromatography‐mass spectrometry and shotgun metogenomics. HMO analysis of 43 maternal milk samples will be performed by high performance liquid chromatography.
Conclusions: Stool analysis revealed changes in the bacterial community composition after the initiation of oral feeds. Further analysis of saliva and maternal milk samples will determine any further variations in the microbial, metabolic and HMO signatures.
Validating a questionnaire regarding Knowledge, attitude and practice (KAP) of Lactation consultants regards breastfeeding mothers with COVID.
Shereen Abd Elghani Soliman
Pediatric & Neonatology Consultant
Category: Research
Background: Breastmilk is the best source of nutrition for babies and protects them against illness. Disruption of breastfeeding can lead to a drop in milk supply, refusal by the infant to take the breast, and a decrease in protective immune factors contained in breastmilk. But mothers will be understandably worried and asking themselves whether coronavirus can be passed on through breastmilk and what they can do to protect themselves and their babies. During the coronavirus disease 2019 (COVID‐19) pandemic, mothers who were exposed or infected, along with their family and health care professionals, were unsure about breastfeeding their infant or even feeding their breast milk to their babies and whether and how to start or continue breastfeeding. We as IBCLCs, LC or healthcare workers didn't know if mothers with COVID‐19 can spread the virus to infants through breast milk, but it is unlikely based on what we do know.
Women who have had COVID‐19 have high amounts of antibodies to the virus in their breast milk, which coat the inside of infants' noses and mouths, helping to block infection. Fresh (not frozen) milk is ideal because it has live infection‐fighting cells and offers the most protection.
Results: Based on our results, we validated a questionnaire regarding Knowledge, attitude and practice (KAP) of Lactation consultants regards breastfeeding mothers with COVID.
Materials/Methods: A questionnaire was developed following a standardized protocol that consisted of literature review, focused group discussions, and expert opinion
Conclusions: To the best of our knowledge, this is the first study that describes the development of a validated questionnaire with satisfactory content and reliability assessing the knowledge, attitude and practice of Lactation consultants regards breastfeeding mothers with COVID.
Preterm babies and experience of their mothers in breastfeeding.
Shereen Abd Elghani Soliman
Pediatric & Neonatology Consultant
Category: Research
Background: Breastfeeding support is important for breastfeeding mothers; however, it is clear how mothers of preterm infants (< 37 gestational weeks) experience barriers to succeed breastfeeding their preterm babies.
Results: Breastfeeding support to mothers of preterm infants was highly variable, either constructive or destructive depending on who provided support.
Materials/Methods: This is qualitative study used data from 150 Egyptian mothers from questionnaires with open‐ended questions from three different healthcare sectors divided into three groups.
Conclusions: Mothers of preterm infants lack much the support to breastfeed their preterm babies. The instructions that they receive was mainly destructive in both the governmental, University or private health care settings.
Knowledge, attitude, and practice regarding COVID‐19 among breastfeeding mothers.
Shereen Abd Elghani Soliman
Pediatric & Neonatology Consultant
Category: Research
Background: Global pandemic COVID‐19 cases are increasing day by day which has created threats among people of the world. Egypt is becoming more vulnerable to COVID‐19 cases. Although various strategies and measures are undertaken by the Government, but people's commitment towards the control measures is pivotal to control the transmission of COVID‐19, which is critically affected by knowledge attitude and practice of people.
Results: We assessed breastfeeding knowledge, attitudes and practices of 100 Egyptian mothers in the same household and their association with sociodemographic characteristics.
Materials/Methods: A pre‐designed validated questionnaire was distributed electronically to breastfeeding mothers and the results were statistically analysed.
Conclusions: The majority of the respondents are lacking confidence regarding the mode of transmission of COVID‐19, and majority of them believed that COVID‐19 is transmitted through breastfeeding which is incorrect.
The impact of training of the Primary Health Care Physicians (PHCP) and healthcare workers towards implementation of the breastfeeding hospital initiatives and how to help breastfeeding mothers.
Shereen Abd Elghani Soliman
Pediatric & Neonatology Consultant
Category: Research
Background: The absence of breastfeeding support policies at the hospitals, failure of any referral of mothers with breastfeeding problems or follow‐up following discharge. Besides, absence of trained healthcare professionals experienced in supporting breastfeeding mothers, with no breastfeeding support groups or lactation consultant/specialist nor breastfeeding support department in the hospital, leads to failure of breastfeeding practices among mothers [8].
Health care professionals need a continued highly specialized lactation education that provides common messaging to avoid maleficence and malpractice.
Results: Training of the PHCP will produce experienced professionals, capable of helping mothers breastfeed efficiently.
Materials/Methods: The participant physicians from selected primary health care facilities took a questionnaire to explore their experiences in supporting breastfeeding after being trained.
Conclusions: Training of the PHCP will produce a next generation of experienced professionals, capable of helping mothers breastfeed efficiently increasing the rates of exclusive breastfeeding among mothers and limit the faulty practices.
The Use of Auricular Acupuncture in Promoting Breastmilk Production in Lactating Mothers of Infants in the Neonatal Intensive Care Unit.
Rana Alissa1, Mary Lim2, Diane Hutsell3
1University of Florida Jacksonville
2University of Florida Jacksonville
3Baptist Health
Category: Research
Background: It has been well established that human milk is the gold standard for infant nutrition. All mothers of infants in the Neonatal Intensive Care Unit (NICU) are strongly encouraged to provide their own milk for their infants. Although donor milk from human milk banks is available, research has determined that mothers' own milk is superior in providing immunological and nutritional benefits. However, due to a variety of factors and despite many interventions to help mothers establish an adequate milk supply, milk production remains minimal for some.
Results: 29 mothers met the inclusion criteria for enrollment in the study. 7 mothers declined participation. 22 qualified mothers consented, enrolled in the study and received acupuncture intervention. Nine (41%) mothers' milk production remained the same and thirteen (59%) have shown an increase in their milk production for an average of 101.7 ml a day.
Materials/Methods: This study was conducted at level VI NICU in a major children's hospital and it was approved by the IRB. Mothers of infants born <35 weeks gestational age and admitted to NICU, whose breast milk production was <500 ml were qualified for this study. Two sessions of auricular acupuncture were performed and daily milk production was recorded one week later.
Conclusions: Acupuncture improved breast milk production in the majority of participant mothers.
BreastFeed Iowa Black Immigrant (BIBI) Partnership: Developing a framework for Culturally Sensitive Breastfeeding Interventions in a Black Immigrant Community.
Temitope Awelewa, Alexandra Murra
University of Iowa
Category: Program Development and Financing
Background: Breastfeeding (BF) initiation rates are high but retention rates remain a nationwide problem. About four out of five mothers start out BF; however, only half of these mothers are still BF at six months. The disparities in BF retention is widest among non‐Hispanic blacks (a group that includes African immigrants) as compared to majority white populations. There is paucity of data on the unique needs of each immigrant community. This project aims to improve breastfeeding retention rates among black immigrant mothers in Johnson County Iowa area by 1) exploring factors that influence BF duration and 2) developing a framework for culturally sensitive BF interventions
Materials/methods: Focus group discussions were conducted among black immigrant women who ever breastfed with a child of 0‐2years in the community. 40 Participants were recruited from the community by three community advisory group members who also assisted with focus group translations. Sessions were audio recorded and transcribed
Results: Many participants were unaware of BF benefits and the superiority of BF over formula feeding. Most women felt uncomfortable using a breast pump and many did not pump at work. Many did not feel comfortable feeding their babies breast milk left in the breast for long periods after work. Many women stopped BF after return to work.
Conclusions: Five themes emerged for developing a framework for interventions: knowledge gap of BF benefits, safety of expressed breastmilk, effect of acculturation on choice of formula feeding, influence of community leaders/peers on BF attitudes and using videos on social media for disseminating BF education.
Association of Maternal and Umbilical Cord Blood High Sensitivity C‐reactive Protein Levels and Breastfeeding Duration, Fetal Development and Neonatal Health.
Background: Previous studies have shown that elevated maternal CRP levels during pregnancy lead to fetal growth restriction, and are associated with endothelial, vascular dysfunction and suboptimal placental development.
Results: CRP levels in maternal and umbilical cord blood was significantly associated with preterm births, SGA, referrals in NICU, inversely correlated with full‐term births and the duration of breastfeeding period. Hospitalization frequency was significantly correlated with: LBW <2500 g ‐ p < 0.001; the duration of breastfeeding period ‐ p < 0.001. The frequency of referrals in outpatient care units was significantly correlated with: LBW r = 0.499, p = 0.004; the duration of breastfeeding period ‐ p < 0.001. The duration of breastfeeding period was significantly correlated with: birth weight 3500‐4999 g ‐ p = 0.019; LBW, p < 0.001.
Materials/Methods: Cohort Prospective Study, 32 women‐13‐17 week of pregnancy, Umbilical cord blood obtained during delivery Inclusion criteria: 13‐17 week of pregnancy; the informed consent of pregnants. − Exclusion criteria: extragenital diseases. The serum preparation was performed and stored from maternal blood specimens under lab‐specific conditions. CRP was determined by turbidimetry method.
Conclusions: Thus, the statistical distribution of frequencies in the groups divided by the CRP levels in umbilical cord blood is well shown that the group of patients with elevated CRP levels in umbilical cord blood showed significantly lower mean value of the duration of breastfeeding period, frequencies of full‐term newborns and significantly higher frequencies of SGA, RDS, LBW, referrals.
Breastfeeding peer support in the Baby Friendly Community in Italy: profile of the trained mothers and key education activities from mother to mother.
Maria Enrica Bettinelli, Jessica Pecora, Marta Guerrini
University of Milan
Category: Research
Background: The support of breastfeeding mothers at the community level is multifaceted, surely fundamental is that given by the peer counsellor mothers. In Italy, there is no well‐defined and structured training for the breastfeeding peer mothers. Milan was the first Baby Friendly Community in Italy and since 2014, it has trained peer mothers to provide breastfeeding and parenting support to mothers at the community level. These trained mothers work together with health professionals, particularly those of the Family Health Centers.
Results: 84 PCManswered. 94% are Italian, higher education, married or cohabit, mostly employed, prolonged breastfeeding. She received support in FHC for and want to help her peers.
Materials/Methods: This is a descriptive study using online questionnaire of 48 questions sent to 119 peer counsellor mothers (PCM) trained in 2014‐ 2021 in the BFCI of Milan.
Conclusions: The PCM is an Italian woman with higher education, emotional and economic stability. They contacted mothers on social media and phone calls. Knowledge of PCM by HP could strengthen the community breastfeeding support network.
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Racial and Ethnic Disparities in Care among Breastfeeding Infants with Ankyloglossia.
Michele Burtner
University of Rochester
Category: Research
Background: Racial and ethnic disparities in breastfeeding outcomes are most pronounced among Non‐Hispanic Black (NHB) women. As with many differences by race, this may be due to lower rates of appropriate care. One contributing factor is ankyloglossia (tongue‐tie), which occurs in about 10% of infants and can cause latch difficulty, nipple pain, poor milk transfer and poor weight gain. Therefore, we sought to determine whether Black families were referred for ankyloglossia evaluation and management as often as other races. Management of ankyloglossia is shared between Pediatric Otolaryngology (ENT) and the Breastfeeding and Lactation Medicine (BFLM) service, and can occur during the inpatient hospitalization or at outpatient clinic sites.
Results: Frequency of ankyloglossia diagnosis and frenotomy differed by race, though these differences did not persist after controlling for marital status and insurance type. Un‐referred Black infants were 70% less likely (than NHW infants) to be diagnosed with ankyloglossia, or undergo frenotomy (OR 0.33, 95%CI:0.230‐0.483).
Materials/Methods: Using data from our large academic medical center, we completed a retrospective data analysis of postpartum patients and their singleton full‐term newborn infants (2018‐2020). Records were examined for differences in breastfeeding outcomes, referral frequencies, ankyloglossia diagnosis, and frenotomy procedure code.
Conclusions: Lower rates of diagnosis and treatment of ankyloglossia in Black and Hispanic infants in our cohort was largely explained by marital status and insurance type. Referral was an important mode of access to frenotomy for Black families.
Hospital‐Grade Breast Pumps for WIC‐Eligible Mothers of NICU Babies: An Interdisciplinary Quality Assessment and Quality Improvement to Advance Health Equity.
April Castillo1, Lauren Brand2, Kristin Thayer3, Sarah McCormick4
1Stony Brook University
2Stony Brook WIC Program
3Stony Brook University Hospital
4Stony Brook WIC Program
Category: Quality Improvement Advocacy
Background: Increasing breastfeeding rates in premature infants is essential for prevention of necrotizing enterocolitis and reducing deaths, however social determinants of health make breastfeeding less likely for families at highest risk of preterm‐birth and infant loss. Many low‐income families cannot access resources like hospital‐grade pumps. Interventions must improve lactation service parity, advancing health equity. This interprofessional quality improvement project aims to identify and remove barriers for low‐income women to express breastmilk for their low‐birthweight NICU neonates.
Results: The local Special Supplemental Nutrition Program for Women, Infants and Children (WIC) offers free loans of hospital‐grade pumps for WIC‐certified NICU mothers, however program use was minimal. We compiled an interdisciplinary team for needs assessment. The WIC director and breastfeeding coordinator, preventive medicine resident, and inpatient lactation support coordinator mapped the current process, creating a logic model and new work‐flow to streamline the registration process. Inpatient IBCLCs and NICU social workers were in‐serviced. A pre‐post evaluation was arranged for one year.
Materials/Methods: Fliers were made in both English and Spanish. QR codes bring participants to a language‐matched survey initiating WIC‐certification; phone numbers also listed for accessibility. Surveys alerted staff to complete certification for discharge. Pumps can now be brought to patients at discharge or obtained in the medical center's WIC office, removing barriers.
Conclusions: An interdisciplinary approach helped to remove barriers to receiving WIC hospital‐grade pumps, aiming to improve breastfeeding rates in this population. We await post‐ data to assess efficacy. Increasing breastfeeding in low‐birthweight neonates will decrease morbidity and mortality, particularly relating to necrotizing enterocolitis.
Prenatal counseling on the maternal health benefits of lactation, a randomized trial.
Melissa Chen1, Caidon Iwuagwu2, Margaret Fix3, Laura Kair4, Adrienne Hoyt‐Austin5, E. Bimla Schwarz6
1UC Davis
2University of California Davis
3University of California Davis
4University of California Davis
5University of California Davis
6University of California San Francisco
Category: Research
Background: US breastfeeding rates remain suboptimal.
Results: On enrollment, participants in both groups wanted to breastfeed (88% vs 93%, p = 0.44). Overall awareness of the maternal health benefits of lactation was similarly poor in both groups. At 1‐month postpartum, those counseled about the maternal health benefits of lactation were more likely to be aware that breastfeeding delays return of menses (86% vs 70%, p = 0.03), lowers risk of breast cancer (89% vs 69%, p = 0.002), ovarian cancer (80% vs 53%, p = 0.0007), diabetes (72% vs 37%, p < 0.0001), blood pressure and heart disease (67% vs 38%, p = 0.0002), and offers protection from arthritis (38% vs 8%, p < 0.0001). Most participants (99% in each group) had provided their own milk to their babies at least once and received support from a lactation consultant (87% vs 84%, p = 0.56). There was no difference in exclusive breastfeeding at 1‐month postpartum (34% vs 37%, p = 0.64); however, those counseled about the maternal health benefits of lactation were less likely to have stopped breastfeeding (8.3% vs 9.3%, p = 0.053) by one month postpartum.
Materials/Methods: We conducted a randomized attention‐controlled trial to evaluate the effects of structured counseling about the maternal health benefits of lactation on breastfeeding rates at 1‐month postpartum. We used online ads to recruit 184 nulliparous US‐born women with singleton pregnancies at 28+ weeks' gestation. After completing a baseline survey, participants received 15 minutes of structured counseling. The attention control group was counseled on the benefits of smoke‐free homes.
Conclusions: Structured counseling increases awareness of the maternal health benefits of lactation and may improve breastfeeding at 1‐month postpartum.
What Do Health Professionals Believe About Skin‐To‐Skin Care During a Cesarean?
Jeannette Crenshaw1, Ellise Adams2, Richard Gilder3, Hannah Nolte4
1Texas Tech University Health Sciences Center
2University of Alabama Huntsville
3Texas Tech University Health Sciences Center
4Vanderbilt University
Category: Research
Background: Women giving birth by cesarean are vulnerable to absent or delayed skin‐to‐skin care (SSC) with their newborns despite supporting evidence. The aims of the study were to 1) develop an instrument, Health Professionals' Beliefs About Skin‐to‐Skin Care During a Cesarean (SSCB); 2) test its validity and reliability; and 3) describe the beliefs of health professionals (HPs) about immediate and uninterrupted SSC during medically uncomplicated cesareans.
Results: Content validity was 0.831; reliability, α = 0.9. The nurse role scores were higher than physician role (p = .001), but both reflected support. Four drivers of positive responses were a belief that SSC reduces maternal stress, supports newborn stability, improves breastfeeding, and requires education.
Materials/Methods: We used quantitative and qualitative methods to test SSCB and describe HPs' beliefs. SSCB contains 23 statements measured on a 6‐point Likert scale and 8 qualitative items. Participants were grouped as nurse or physician role measure beliefs, report findings, and describe differences.
Conclusions: The SSCB can be used to identify cultural and site‐specific barriers to immediate and uninterrupted SSC during cesareans, increasing access to SSC. Focus on the 4 drivers of positive sentiment toward SSC can enhance SSC improvement efforts, which can lead to improved breastfeeding outcomes.
“Smart” SMS Lactation Support to Prevent Perceived Insufficient Milk among Nulliparous‐to‐Primiparous Individuals: Results from Single‐Center Randomized Controlled Trial.
Jill Demirci1, Susan Sereika2, Brian Suffoletto3, Melissa Glasser4, Jack Doman5, Judy Chang6, Debra Bogen7
1University of Pittsburgh
2University of Pittsburgh
3Stanford University
4University of Pittsburgh
5University of Pittsburgh Medical Center
6University of Pittsburgh
7Allegheny County Health Department
Category: Research
Background: Perception of insufficient milk (PIM) is among the most common reasons for early, unintended reduction or cessation of direct chest/breastfeeding or provision of parent's own milk. Primary anatomical or physiologic aberrations causing insufficient milk (e.g., mammary gland hypoplasia) are considered rare. Rather, most often, PIM is thought to originate from misinterpretations of normal infant behavior and milk production and/or poor technique, resulting in infrequent or ineffective milk removal. Therefore, PIM may be highly amenable to prevention or reduction through education and support. SMS, or text messages, are a ubiquitous technology that has been previously used to provide cost‐effective general lactation education and support. Its application to prevent PIM specifically is unknown. The purpose of the MILK Trial (a Mobile, semi‐automated‐automated text message‐–based Intervention to prevent perceived Low or insufficient milK supply) was to examine the impact of a theory‐driven, prenatal‐to‐postpartum, semi‐automated lactation support text message system for first‐time birthing people on lactation outcomes, including PIM, in the first two months postpartum.
Materials/Methods: We recruited and randomized 250 nulliparous individuals at 13‐25 gestational weeks who intended to breastfeed and planned to give birth at a large, birthing hospital in southwestern Pennsylvania to either an interactive SMS intervention to prevent PIM (n = 126) or a control group receiving SMS support on general perinatal topics via Text4Baby (n = 124).
Results: Treatment groups were similar on all baseline characteristics. There were no differences between groups over time in any lactation outcomes, including PIM out to 8 weeks postpartum (via the H&H Lactation Scale; p = .71) and any and exclusive breastfeeding out to six months postpartum (p > .10).
In a group of nulliparous‐to‐primiparous individuals with high prenatal intention to exclusively breastfeed, an interactive prenatal‐to‐postpartum SMS support system to prevent PIM was not more effective than a SMS system providing general perinatal support in improving lactation outcomes.
Four studies suggest that the innovative evidence‐based ‘Sleep, Baby and You’ and “The Possums Sleep Program” benefit both health professionals and parents and protect breastfeeding.
Pamela Douglas
Possums & Co.
Category: Research
Background: Over the past ten years, an innovative evidence‐based approach which offers a paradigm shift in clinical support of infant sleep challenges has been delivered to Australian parents and adapted by Durham Infancy and Sleep Centre.
Results:
The Possums Infant Sleep Program results in sustained breastfeeding and improved breastfeeding rates compared to usual care.
Sleep, Baby & You promotes responsive care; changes in parent attitude, behaviour, and well‐being; reduction of negative thinking.
Health professionals report improvements in sleep knowledge and quality of sleep; in psychological flexibility; and reduced burnout and secondary traumatic stress.
The Possums Infant Sleep Program is highly valued by parents, resulting in reduced stress, less concern about perceived sleep problems, and better quality of life.
Materials/Methods: Four evaluations have been published:
Conclusions: An infant sleep intervention, developed in Australia and adapted for the UK, which aims to promote and protect breastfeeding and responsivity to the infant, shows positive preliminary evaluations.
Reconsidering breast compression and massage in breastfeeding women: a review of the evidence.
Pamela Douglas
Possums & Co.
Category: Research
Background: Massage of blocked ducts and mastitis, breast compressions, Therapeutic Breast Massage (TBM), and Manual Lymphatic Drainage (MLD) are often advised to lactating women.
Results: There is no reliable evidence to suggest that these approaches benefit. Applying the mechanobiological model of lactation‐related breast inflammation, massage of inflammation risks a cascade of worsened inflammation, predisposing to abscess. Breast compression during direct breastfeeding does not increase total fat content of breastfeeds or an infant's caloric intake over time, and worsens underlying problems of fit and hold and associated breast tissue drag.
Materials/Methods: The latest research concerning stromal tension and lymphatic vasculature in the lactating breast and the evidence supporting the new mechanobiological model of lactation‐related breast inflammation are examined. Studies which investigate TBM and MLD for lactation are analysed. The potential effect of external mechanical pressure is explored from the perspective of functional anatomy and physiology and the mechanobiological model of breast inflammation.
Conclusions: Very gentle manual movement of the whole of the breasts with their own palms may be helpful for some women in prevention of, or management of, breast inflammation. There is no evidence to support other commonly used breast massage techniques, such as breast compressions during breastfeeding, massage for breast inflammation (e.g. blocked ducts or mastitis), or Therapeutic Breast Massage and Manual Lymphatic Drainage. These four techniques risk worsened outcomes.
A brief gestalt intervention changes ultrasound measures of tongue movement during breastfeeding: case series.
Pamela Douglas
Possums & Co.
Category: Research
Background: Approaches to fit and hold (latch and positioning) vary widely, with limited evidence of benefits. Effects of fit and hold on tongue movement has not been examined. This preliminary study aimed to show effects of brief gestalt intervention on ultrasound measures of infant suck.
Results: Ultrasound demonstrated that the distance from nipple tip to junction of the hard and soft palate decreased, intra‐oral nipple and breast tissue dimensions increased, and nipple slide decreased after a brief gestalt intervention. These findings are consistent with changes observed in other ultrasound studies of breastfeeding pairs to be associated with improved milk transfer and less nipple pain. The changes are also similar to the ultrasound changes measured in a single case study of an infant pre‐ and post‐frenotomy.
Materials/Methods: Ultrasound measurements were conducted in five breastfeeding dyads, infants aged 4–20 weeks, while feeding in their usual or ‘standard’ position and again after brief application of gestalt principles of fit and hold. Four of the mother‐baby pairs, who had received comprehensive lactation support, reported persisting nipple pain. Three of these infants had difficulty latching and fussed at the breast; three had been diagnosed with oral ties. A fifth pair was breastfeeding successfully.
Conclusions: These preliminary findings suggest that changes in fit and hold impact on infant tongue movement and contour. Further research investigating short‐ and long‐term outcomes of a gestalt breastfeeding intervention in larger cohorts is required. This study was published February 2022 in BMC Pregnancy and Childbirth https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-021-04363-7#Fun.
A Model for Breastfeeding Anticipatory Guidance in Well‐Child Care Clinics.
Deena Zimmerman, Ravit Baruch, Tunie Dweck
Ministry of Health Israel
Category: Medical Education
Background: Breastmilk is the infant nutrition norm for the child's first two years of life. Many breastfeeding protocols and instructions are focused on breastfeeding in the first few weeks of life. We report on a program of anticipatory guidance on breastfeeding issues throughout the first two years of life, put in place by Israel's national government as part of routine well‐child care in Maternal‐Child Health Centers (MCHC). Israel's MCHC provide universal, free of charge care to infants and preschool children (0–6 years) including developmental surveillance, growth monitoring, routine childhood immunizations and anticipatory guidance on topics including nutrition, parenting, and child safety.
Materials/Methods: National breastfeeding anticipatory guidance guidelines of anticipatory care on breastfeeding were written for MCHC nurses to ensure uniform evidence‐based advice is given at every regularly scheduled visit.
Results: The anticipatory guidance includes suggested age‐appropriate breastfeeding issues for each routine visit.At every MCHC visit, nurses should ask mothers how they are managing with breastfeeding and if exist any specific difficulties or questions. In addition, the mothers should be asked about baby feeding patterns to evaluate if age‐appropriate. Ideally, nurses will observe breastfeeding on all first visits and at subsequent visits as necessary.
Conclusions: Age‐related breastfeeding anticipatory guidance implementation by MCHC nurses MCHC helps ensure education and support. This educational model can help ensure consistent breastfeeding guidelines are implemented on a national level and can be adapted for use with other well‐child care models. These guidelines are in the process of being converted to an ABM protocol.
First Years' Experience in Operation of Israel's National Milk Bank.
Background: Human milk is the biological norm for nutrition in infants, with mother's own milk recognized as the ideal nutritional source for optimal infant health especially for premature infants. When a mother's own milk is unavailable, donor human milk is the optimal alternative for premature babies. After over 10 years of planning, the first national human milk bank of Israel began routine functioning in January 2021. The goal is to report on unique aspects of the Israeli milk bank, lessons learned and challenges over the first year of operation of the national human milk bank in Israel.
Results: Quality standards include donor traceability, batch testing, and food safety regulations. Challenges include waste prevention, acceptance and use.
Materials/Methods: The milk bank is a Health Ministry and Magen David Adom (MDA) National Blood Services joint venture. There are no out‐of‐pocket costs to parents.
Conclusions: Description of Israel's National Human Milk Bank establishment can assist other locations establishing or improving their milk banks. The first year of operation has revealed challenges for which discussion with ABM experts may be helpful.
Effects of Long‐Term Freezer Storage and Holder Pasteurization on Vitamin C Levels in Expressed Human Milk at a Nonprofit Milk Bank.
Anne Eglash1, Summer Kelly2, Jinnene Hoggarth3, Laura Hernandez4, Pedro Monteiro5
1University of Wisconsin School of Medicine
2Mothers' Milk Bank Western Great Lakes
3Mothers' Milk Bank Western Great Lakes
4University of Wisconsin
5University of Wisconsin
Category: Research
Background: Research has demonstrated that macronutrients in human milk remain relatively stable during freezer storage. However, few studies have investigated the impact of long‐term freezer storage on vitamin C. In addition to being sensitive to oxidation in cold storage, vitamin C is heat labile. Processing milk via Holder pasteurization (HoP) in the milk bank setting may further decrease vitamin C levels.
Results: Vitamin C concentrations in unpasteurized milk samples decreased over the course of long‐term freezer storage, with the greatest mean loss occurring from baseline (T0) to 3 months, 2.5 mg/100 ml to 1.5 mg/100 ml respectively, (p < 0.01). The HoP process decreased mean vitamin C concentration in pooled batches from 1.3 mg/100ml to 0.4 mg/100ml (p < 0.01).
Materials/Methods: Mature, unpasteurized milk samples from 30 individual milk bank donors were analyzed for vitamin C concentration by high performance liquid chromatography (HPLC) at baseline and after 3, 6, and 9 months of freezer storage. A subset of 30 pooled milk samples were also analyzed for vitamin C content before and after HoP.
Conclusions: Vitamin C loss occurs in unpasteurized samples after long‐term freezer storage. In addition, vitamin C content decreases after HoP heat processing. Vitamin supplementation may be warranted for infants under 6 months of age whose sole source of vitamin C is derived from frozen mother's own milk, frozen shared milk, or pasteurized donor human milk. Additional studies are needed to establish clinical guidelines.
Effectiveness of a Lactation Training Curriculum in the NICU
Grecia Ferreyra, Maria Miranda
Nicklaus Children's Hospital
Category: Quality Improvement Advocacy
Background: The WHO emphasizes breastfeeding as an important aspect of high‐quality care, proven to improve neonatal outcomes (World Health Organization [WHO], 2020). However, inconsistencies exist among breastfeeding support offered by healthcare providers (Froh et al., 2017). The purpose of this quality improvement is to integrate a lactation training program that improves breastfeeding knowledge among healthcare providers by at least 10% and to sustain exclusive breastfeeding rates in infants from birth through six months of age, in order to achieve a target rate above 42.4% in the Neonatal Intensive Care Unit (NICU), as delineated by Health People 2030 (Office of Disease Prevention and Health Promotion [ODPHP], 2021).
Results: Analysis of the ten‐question pre‐test and post‐test scores demonstrated an average of 19.12% gained lactation knowledge among NICU nurses. The five point Linkert Scale survey showed 66.3% of participants selected strongly agreed and 33.6% selected agreed on the effectiveness of the lactation training. Prior to implementing the lactation training, quantitative business intelligence results showed breastfeeding rates for discharged infants as follows: July 2021, 90%. August 2021, 74%; September 2021, 85%. Post‐training, quantitative business intelligence results showed breastfeeding rates for discharged infants as follows: October 2021, 95%; November 2021, 94%; December 2021, 90%. Breastfeeding rates improved post‐training above target rate of 42.4% as delineated by Healthy People Goals 2030.
Materials/Methods: Using Bloom's Taxonomy framework of learning, a mixed method approach was utilized for the training, including an in‐person instructor‐led course with animations, infographics, videos, role play, multimedia presentations, simulation scenarios, and peer‐review feedback exercises. 80 NICU nurses completed the lactation training, including pre and post‐tests to measure breastfeeding knowledge acquisition. A five point Linkert Scale survey was utilized to evaluate training program.
Conclusions: Based on the results of this quality improvement project, a lactation training program would be highly recommended in all baby care areas within any healthcare organization.
Providing breastfeeding care in a rural community during the COVID‐19 pandemic: Experiences of healthcare professionals.
Christine Garner, Hana Setterquist, Jasmine Chan, Emily Hecox, Skyler McLaurin‐Jiang,
Texas Tech University Health Sciences Center
Category: Research
Background: Breastfeeding support from healthcare professionals (HCPs) is known to impact breastfeeding initiation and duration. The COVID‐19 pandemic disrupted care broadly, as well as the provision of numerous allied health services, particularly in community health care settings serving rural populations. The aim of this study was to explore HCPs' experiences and perceptions related to breastfeeding care (education, lactation services, clinician management, ambulatory lactation support) during the first year of the COVID‐19 pandemic.
Results: HCPs perceived that breastfeeding care was less available before, during, and after the hospital stay, as classes and support groups were canceled, and lactation services staffing in hospitals varied from furloughs and repurposing of staff. HCPs also believed that less care was sought or provided due to fears of exposure to COVID‐19.
Materials/Methods: Semi‐structured interviews were conducted with 19 HCPs who were purposively sampled, including obstetricians, pediatricians, nurses, and lactation consultants, who provided perinatal care in two community hospitals. Interviews were transcribed, verified and coded using content analysis; researchers discussed and agreed on analysis.
Conclusions: HCPs discussed multiple ways in which the pandemic had negative effects on breastfeeding care. Prenatal, hospital‐based, and postnatal lactation services need to be preserved during pandemic situations to promote and support breastfeeding for the health of both mothers and infants.
The use of telelactation to decrease disparities in access to outpatient breastfeeding support,
Background: Historically, patients from low‐income and minoritized communities have reduced access to outpatient breastfeeding support with IBCLCs. Telelactation may increase access particularly when appointments can be self‐scheduled.
Results: 2,023 patients made 2,791 visits, including 1,378 in‐person (49.4%) and 1,413 telelactation (50.6%) visits. Of those who used telelactation, most (75.9%) had one visit, 16% had 2, and 8.1% had 3+ visits (range 3‐11). 46.1% of telelactation visits were self‐scheduled, with higher show rates than non‐self‐scheduled (61.5% vs 45.3%; p < 0.001). The most common reasons for telelactation were latching problems, nipple pain, milk supply concerns, and general breastfeeding support. Most wanted to exclusively/primarily breastfeed at the time of telelactation (92.6%), yet only 66% were meeting their goal. Of the patients who had a breastfeeding support visit of any type, 60.4% were English‐speakers, 72.8% self‐identified as Latinx and 15.1% as Black, and 75.1% were publicly insured. Latinx and publicly insured patients made most telelactation appointments (59.9% and 75.2% respectively). English‐speakers (68.9%) used telelactation more than Spanish‐speakers (36.1%) or other language speakers (3.5%). On an adjusted model, commercially insured patients had 8 times greater odds of self‐scheduling vs. publicly insured (aOR 8.85; 95% CI (5.89‐13.32)).
Materials/Methods: Starting in March 2020, our program's IBCLCs provided in‐person and telelactation visits. Telelactation via our hospital's electronic health record app were offered for follow‐ups and new patient appointments. A retrospective chart review was performed from 4/1/20‐12/30/21. We assessed the impact of demographics (language, ethnicity, race, and insurance) on scheduling patterns using chi square and multivariate analyses.
Conclusions: Telelactation is a sought‐after modality to address breastfeeding problems, particularly for publicly insured, Latinx and Black mothers who historically have had limited access to outpatient IBCLCs. Self‐scheduling resulted in a lower no‐show rate. Future research is needed to determine how best to leverage telelactation among non‐English speakers and to hone self‐scheduling capability for publicly insured patients.
Arranging double electric breast pumps for all NICU mothers significantly impacts breast feeding rates.
Shruti Gupta, Dana Czuczka
Yale School of Medicine, Stamford Hospital
Category: Quality Improvement Advocacy
Background: Breast feeding rates can be extremely low for preterm mothers due to the challenges faced by them. This obviously includes separation from their baby and inability of preterm sick infant to directly breast feed. But another major challenge is not having the right equipment to pump with. Inspite of having laws in united states that require all insurance companies to cover cost of breast pumps parents are unable to obtain them in a timely manner. Mothers are often discharged home with manual breast pumps and asked to obtain electric pumps on their own. They are so overwhelmed at discharge that they are not in a position to make lengthy phone calls to insurance companies hence they eventually give up pumping and their infant does not get breast milk. The parents who have the ability to rent a pump are given hospital grade rental pumps upon discharge increasing their success at nursing however this practice unfairly lets the rich breast feed their infant leaving the low income population on their own.
Results: Breast feeding rates increased from 50% to 82.6% by arranging home electric pumps for mothers of NICU babies.
Materials/Methods: We looked at Stamford Hospital's breast feeding rates in the national Vermont Oxford database from 2017‐2020.
Conclusions: Breast feeding rates can be increased all women regardless of ability to pay by unviversally arranging breast pumps for them prior to discharge
NICU transition to home program helps to significantly increase duration of breast feeding.
Shruti Gupta, Dana Czuczka
Yale School of Medicine, Stamford Hospital
Category: Program Development and Financing
Background: Families are often overwhelmed post neonatal intensive care unit (NICU) discharge and have less support. Infants are discharged home maternal milk feeding but not fully breastfeeding due to oral feeding immaturity. Therefore, the transition to breastfeeding occurs post‐NICU discharge. To continue specialized care post‐NICU discharge, a unique NICU to home transition care program (NTC) was designed that included visits with a neonatologist and a lactation consultant a few days after discharge. The visit included observation of a breastfeeding session and providing clear feeding instructions for the mother and pediatrician as the infant transitions from bottle feeding to breast feeding.
Results: NTC participants (n = 59) breast‐fed on average 6.61 months (SD = 3.70), while their non‐NTC (n = 41) counterpart averaged 2.69 months (SD = 3.26) (p‐value <0.001). Participants in NTC were 3.3 times (95% CI 1.6, 6.7) more likely to breastfeed for at least 6 months compared to those who did not attend NTC (58 vs. 17.5%, respectively).
Materials/Methods: Descriptive data were reported for both groups and a group t‐test were performed to compare duration of breastfeeding between NTC and non‐NTC cohorts with a chi‐square test. Mean and standard deviation (SD) were calculated. An a‐priori p‐value of (p < 0.05) to denote significance was used for both analyses.
Conclusions: Programmatic post discharge help was positively received and related to significantly increased breastfeeding post‐NICU discharge.
Digital information tool for breastfeeding support in the Covid‐19 era.
Alejandra Gutierrez, Mariana Colmenares, Laia Aguilar, Alba Padro
ACCLAM, ACCLAM, LactApp, LactApp
Category: Medical Education
Background: Breastfeeding promotion and support is a public health strategy with undeniable public health benefits. The SARS‐CoV‐2 pandemic has led to a shift from face‐to‐face care to often encountering difficulties in the management of breastfeeding difficulties.
Results: Literature reviewed states that SARS‐CoV‐2 infection is fully compatible with breastfeeding. Even so, multiple studies indicate that during the COVID era the lack of support for mothers to continue breastfeeding has been aggravated due to lack of actualization of health professionals.
Materials/Methods: We studied one strategy recognized as an online tool to support women and families. During 2020, LactApp answered more than 7 million queries from its users, of which 353959 were about Covid‐19. Of the Covid‐19 related queries, the most queried were about Covid‐19 vaccine with 182760 from users.
Conclusions: Having an easy‐to‐access, fully online digital tool makes it possible to reach more users by providing them with effective and accurate information about their breastfeeding, and has the capacity to act as a complement to face‐to‐face medical care.
Breastfeeding during the COVID‐19 pandemic: A closer look at factors associated with breastfeeding during the COVID‐19 pandemic.
Nicole Hackman, Sarah Ramirez, Caroline Maltese, Chintan Gandhi, Kristin Sznajder
Penn State College of Medicine
Category: Research
Background: The breastfeeding dyad is in a unique position to benefit from and be harmed by the COVID‐19 pandemic. Pregnant women infected with COVID‐19 are at increased risk for ICU admission and assisted ventilation; however, the breastfeeding experience is understudied. The COVID‐19 in Pregnancy Study is a longitudinal prospective study examining the impact of the pandemic on pregnant women and their newborns. The primary objective of this analysis was to examine the breastfeeding outcomes for COVID‐19 positive (COVID‐19+) mothers and their infants at one‐month (1‐mo) postpartum.
Results: 281 women enrolled and 8% (N = 23) were COVID‐19+. Most planned to breastfeed (93.2%) and for one year (51.4%), but prenatal education was reduced. No association between COVID‐19+ women and breastfeeding initiation/duration, nor interaction between maternal symptoms and breastfeeding at 1‐mo. There is a bivariate association between exclusive breastfeeding at 1‐mo and being married OR = 2.04 (1.14, 3.65), attending breastfeeding class OR = 1.81 (1.04, 3.16) and reporting very good/excellent health OR = 2.79 (1.55, 4.99). Women were less likely to breastfeed if obese OR = 0.42 (0.23, 0.77), reported more stressors overall OR = 0.90 (0.82, 0.99), trouble paying bills OR = 0.39 (0.17, 0.94) or high family stress OR = 0.49 (0.28, 0.83). Multiple regression modeling showed family stress as a significant negative predictor of breastfeeding continuation.
Materials/Methods: Women were included in the study if they were over 18 years of age. Participants completed a baseline survey during pregnancy, monthly until delivery, and at 1‐mo postpartum. Enrollment began May 2020 and is ongoing. Bivariate and multiple logistic regression models were used to estimate breastfeeding intention during pregnancy and breastfeeding at 1‐mo post‐partum.
Conclusions: Consistent with pre‐pandemic trends, married women, of normal weight, and who attended prenatal education were more likely to breastfeed at 1‐mo. Our analysis adds to the literature defining the breastfeeding experience for women during the COVID‐19 pandemic and highlights the negative impact of stressors on breastfeeding outcomes.
Case reports of breastfeeding challenges from Bangladesh.
Rukhsana Haider, Virginia Thorley
Training and Assistance for Health and Nutrition, University of Queensland
Category: Clinical Practice/ Lactation Management
Background: Exclusive breastfeeding prevalence in infants aged 0‐6 months has increased considerably in Bangladesh, but mothers who need additional physical or emotional support remain at risk of early breastfeeding supplementation or cessation.
Results: We will present case reports of preterm and VLBW twins, inverted nipple in an overweight mother, mothers without family support, previous history of breast surgery, postpartum depression and sexual abuse during childhood. Challenges were faced when these mothers were referred to a health facility or a specialist. Either they were not accepted for hospitalisation, mismanaged, or advised to stop exclusive breastfeeding.
Materials/Methods: In our programme areas in Dhaka and Chattogram, community‐based peer counsellors are usually the first contact to provide breastfeeding information during pregnancy, and hands‐on skills and support after delivery. They correct position and attachment at the breast, and manage common problems such as breast engorgement, cracked nipples, and perceptions of insufficient breast milk adequately during home visits. If the peer counsellors identify breastfeeding difficulties that are beyond their scope, or suspect clinical problems in the newborns, they inform their supervisors for further guidance. Sometimes higher educated mothers outside the programme area directly contact the lactation consultant for advice.
Conclusions: There is thus a need to explore feasible and culturally appropriate means of providing updated breastfeeding information and skills to relevant health and nutrition staff, and to develop referral linkages, so that exclusive breastfeeding can be facilitated and adequately supported both at health facility and community level. Qualitative research will be required to identify inequalities in delivering breastfeeding care, as well as to understand what contributes to mothers' resilience.
Clinical Breastfeeding Education for Primary Care Residents Using Telesimulation
Adrienne Hoyt‐Austin1, Anna Sadovnikova2, Lee Donohue3, Daniel Tancredi4, Laura Kair5
1UC Davis Health
2University of California Davis
3University of California Davis
4University of California Davis
5University of California Davis
Category: Medical Education
Background: Most primary care physicians lack practical skills to manage common breastfeeding problems. Additionally, in person education for physicians has been virtualized during the pandemic. High‐fidelity simulation with standardized patients in a videoconference (telesimulation) increases medical student and physician confidence and competence in clinical lactation skills, yet it is not known whether clinical lactation practice via telesimulation results in the translation of lactation skills to patient care.
Results: Of 62 residents who received breastfeeding education, 44 consented to study participation, and 23/44 (52%) completed surveys to 3‐month follow up. 74% of participants identified as female and 2 (8.6%) had breastfed or supported a breastfeeding partner. Control group participants had a 9.36‐point increase in mean confidence summative scale scores from enrollment to 3‐month follow up, while intervention group participants had a 7.63‐point increase, a mean difference in change scores of 1.73 (95% CI: ‐2.91 ‐ 6.38, p = 0.44). Control group participants had a 5.38‐point increase in their mean practice patterns (e.g., performing a focused breast examination) from enrollment to 3‐months, while intervention group had a 10.0‐point increase, a difference in mean change scores of ‐4.62 (95% CI: ‐19.34 ‐ 10.11; p = 0.51).
Materials/Methods: In this pilot randomized trial, pediatric and family medicine residents were randomized to receive one breastfeeding education experience in a videoconference via either (1) traditional didactics (control) or (2) a standardized patient encounter (intervention). Demographic information, clinical lactation self‐efficacy, and practice patterns with maternal‐newborn dyads were collected. Self‐confidence and clinical lactation practice patterns were collected following the educational experience. Mean change scores and T‐Tests were analyzed using SAS statistical software.
Conclusions: High‐fidelity simulation through use of telemedicine is a promising modality for provision of graduate medical clinical lactation education in the newborn nursery setting.
Effect of Centralized Milk Room on Rates of Mother's Own Milk (MOM) Feeds in Very Low Birth Weight (VLBW) Infants, Sarah Jordan‐Crowe, Rainbow Babies and Children's Hospital.
Jessica Madden, Tara Glenn
Rainbow Babies and Children's Hospital, Rady Children's Hospital
Category: Quality Improvement Advocacy
Background: MOM use improves growth and neurodevelopment, and decreases risk of morbidities, such as sepsis and necrotizing enterocolitis, in preterm infants when compared with donor human milk. Our team aimed to increase use of MOM for first feeds in VLBW infants (birthweight less than 1500 g) from an initial baseline of 47% (as of February 2021) to 57% in 3 months.
Results: The mean shifted down to 23% after process change of unit milk room for preparation of human milk feedings was fully operational October 2020 (Figure 1). The mean nearly doubled to 55% after 100% compliance was reached in July 2021 in delivery room counseling on milk expression. We monitored hour of life of first feed as a balancing measure and noted no delay.
Materials/Methods: A multidisciplinary interdepartmental team created Key Driver Diagram (Figure 2) and project charter. Interventions tested with Plan‐Do‐Study‐Act cycles and included daily milk collection from postpartum unit, counseling parents in delivery room on milk expression, dashboard of high‐risk dyads, and signs on milk expression in patient rooms.
Conclusions: Our control (p) chart shows there was special cause variation after introduction of a central milk room resulting in a significantly decreased number of VLBW infants receiving any MOM for their first feed. By counselling parents on milk expression in the delivery room we were able to not only ameliorate this decrease but nearly accomplish our goal rate.
Ramadan and Breastmilk.
Nalan Karabayir1, Mine Basilbuyuk2, Şule Aktaç3
1Istanbul Medipol University
2Istanbul Medipol University
3Marmara University
Category: Research
Background: Breast milk is a amazing food that alone is sufficient for the baby's growth, development and strong immune system. For the healthy growth and development of babies, the World Health Organization recommends breastfeeding alone for the first 6 months, and then continuing breastfeeding with complementary feeding until at least 2 years of age. The content of breast milk, which is a dynamic biofluid, may vary according to the duration and time of breastfeeding, the age of the baby and the mother's health status. There are some studies on the effect of maternal nutrition on the content of breast milk. However, studies investigating the effect of fasting on breast milk content are limited. In our study, it was aimed to compare the mother content of mothers who fasted and did not fast during Ramadan.
Results: The energy, carbohydrate, protein and fat contents of breast milk were similar in both groups. It was determined that the daily energy, protein, carbohydrate, fiber and vitamin amounts did not differ between fasting and non‐fasting groups.
Materials/Methods: Energy, carbohydrate, protein and fat measurements were made in breast milk samples taken from 21 volunteer mothers who fed their babies only with breast milk, fasted and 27 non‐fasting mothers. In addition, nutritional records of fasting and non‐fasting mothers were taken.
Conclusions: In our study, it was determined that fasting did not have a significant effect on the energy and macronutrient content of breast milk.
Finger Feeding Method and Relactation.
Nalan Karabayir, Sümeyye Karaman, Edanur Mertturk Potak, Fatih Sebirli, Mustafa Beykan Istanbullu, Mehmet Potak, Burcu Gizem Teber
Istanbul Medipol University
Category: Research
Background: Breastfeeding is one of the most important factors that ensure healthy growth and development for babies. Preterm babies, babies with metabolic, neurological, or developmental delays, separated from their mothers for any reason, and adopted babies may have difficulties in breastfeeding. Alternative feeding methods are of great importance in relactation.
Results: Of 41 babies, 29.3% girls and 70.7% boys, 82.9% were term. Seventeen (41.5 %) were born with spontaneous vaginal delivery and 24 (58.5%) with cesarean section. The most common reason for admission was found to be the inability to latch. While 30 (73.1 %) of the babies fed with finger feeding were able to suckle , 9 cases continued to be fed with a bottle, a case with a spoon, and a case with supplemental nursing system (SNS). The breastfeeding starting time was 23.1 ± 27.5 (1‐100) days.
Materials/Methods: In this retrospective study, infants who were admitted to the Istanbul Medipol University breastfeeding counseling clinic between January 2020 and June 2021 and were recommended to be fed with finger feeding were evaluated. Gender, gestation, mode of delivery, birth weight, age, cause for admission, feeding type, breastfeeding starting time, finger feeding time, and breastfeeding duration of the cases were recorded from the counseling forms
Conclusions: The FF method is an effective alternative feeding method in successful breastfeeding. There is a need for studies to be conducted with more babies, both preterm and term, in this regard.
Withdrawn
Medication use during childbirth and lactation outcomes during Baby Friendly Hospital implementation.
Background: Medication use during labor has been identified as a risk factor for earlier than desired lactation cessation. Intravenous opioids and epidural anesthesia are frequently employed for pain management. Synthetic oxytocin is frequently used for the induction or augmentation of labor as well as for the prevention and treatment of postpartum hemorrhage. There is limited research on how Baby Friendly Hospital Initiative (BFHI) implementation influences associations between medication use during childbirth and lactation outcomes.
Results: Use of IV fentanyl during labor reduced the odds of breastfeeding at discharge by 52% (OR = 0.48, 95% CI 0.25 ‐ 0.93), while epidural use reduced the odds by 53% (OR = 0.47, 95% CI = 0.29 ‐ 0.78). For every 10 units of synthetic oxytocin received across labor, there was a 28% lower odds of any breastfeeding at 2 to 8 weeks postpartum (OR = 0.72, 95% CI 0.58 – 0.90).
Materials/Methods: A retrospective chart review was undertaken. Logistic regression models were fitted to assess the effect of labor medication exposures on lactation outcomes after controlling for mother and infant characteristics. The effect of BFHI implemention was also examined. A total of 991 mother‐baby pairs met criteria for inclusion.
Conclusions: Pain medication appeared to influence infant feeding decisions prior to discharge, while higher synthetic oxytocin doses in labor were associated with lactation cessation at 2 to 8 weeks postpartum. The effects of medication use during childbirth on lactation outcomes should be considered during perinatal care.
A single‐center study of Attitudes, Barriers and Breastfeeding behaviors of healthcare providers and other hospital personnel.
Background: Exclusive breastfeeding for 6 months is the gold standard for infant feeding according to UNICEF/WHO recommendation. However, breastfeeding in healthcare providers and hospital personnel has many obstacles such as working schedule, short maternity leave, separation issues.
Results: There were 110 mothers participated in the study. Mean maternal age was 32.5 + 4.21 years, 66.36% came from the nursing department, infant's age were 6‐24 months, Our 6‐month exclusive breastfeeding rate was 63.64%. Breastfeeding attitudes, behaviors and perception of barriers, were the significant factors influencing successful breastfeeding.
Materials/Methods: This was a cross‐sectional study. Participants were female hospital personnel who took maternity leave within 2 years. Participants were asked to fill the paper/electronics questionnaire including factors related to breastfeeding practice such as mothers education, income, work schedule, breastfeeding attitudes, behaviors and barriers
Conclusions: Maternal attitude to breastfeeding and breastfeeding behaviors were more important to successful breastfeeding than work schedule, breastfeeding experience, and support from workplace or colleagues.
Ketamine transfer into breastmilk: a case series.
Kaytlin Krutsch, Elleana Majdinasab, Kathy Felkins, Palika Datta, Thomas Hale
Texas Tech University Health Sciences Center
Category: Research
Background: Mothers with postpartum depression have many treatment options that have been studied during lactation. However, many mothers and prescribers are fearful of continued drug exposure to the infant through breastmilk. Ketamine has recently gained traction for the off‐label management of treatment‐resistant depression, acute suicidality, and post‐partum depression. Ketamine's anti‐depressive effects potentiate for longer than the drug and metabolite are present, presenting an opportunity for lactating mothers to receive treatment without exposing their infant to repeated drug residues. However, more knowledge on the transfer of ketamine into breastmilk is needed to provide informed recommendations for infant safety.
Results: Average maximum ketamine concentration was 285.47 ng/mL at 1 hour, steadily declining thereafter. RID was 0.43%. No reports of infant adverse effects.
Materials/Methods: Ketamine concentrations were determined from samples volunteered by 3 breastfeeding women at 0, 1, 2, 4, 6, 8, 12, and 24 hours following infusion.
Conclusions: Though limited by sample size, our findings are consistent with the literature and suggest minimal transfer of ketamine into breastmilk, as estimated by our average RID <1%. Substances with RID <10% are generally regarded as insignificant and safe.
Transfer of Mycophenolate Mofetil into Breastmilk ‐ Less than Feared.
Kaytlin Krutsch1, Tess Maxfield2, Jordan Burkham3, Palika Datta4, Thomas Hale5
1Texas Tech University Health Sciences Center
2Texas Tech University Health Sciences Center
3Miller School of Medicine
4Texas Tech University Health Sciences Center
5Texas Tech University Health Sciences Center
Category: Research
Background: Mothers requiring immunosuppressive therapies (e.g. solid transplant recipients, lupus patients) have few studied options if they desire to breastfeed. One of the drugs of choice for these patients, mycophenolic acid (MPA), has thus far been unstudied. MPA reversibly inhibits inosine monophosphate dehydrogenase (IMPDH), an enzyme important for synthesis and proliferation of T‐ and B‐lymphocytes. Product labeling for MPA includes a boxed warning for increased risk of congenital malformations and is not recommended during pregnancy. Because transplant recipients must receive immunosuppressive therapy, lactating mothers who require MPA after delivery are currently advised to discontinue breastfeeding due to an abundance of caution with unknown infant risk. Therefore, the opportunity to study the transfer of MPA into breastmilk is uncommon. This case report documents the transfer of the MPA active moiety into breastmilk from a lactating mother diagnosed prescribed mycophenolate mofetil (MMF, CellCept), the ester prodrug of MPA, for lupus nephritis.
Results: The relative infant dose (RID) after oral doses of 500 mg and 1 gm BID doses was 0.02% Maximum concentrations were found 1‐hour post‐dose at 60.5 and 126.9 ng/mL, respectively.
Materials/Methods: MPA was quantified at steady‐state concentrations using an Agilent 1260 Quadrupole mass spectrometer and a Phenomenex Luna column, 50 x 2 mm, 3 μm.
Conclusions: The RID in this mother was well below the most conservative levels of concern for breastfeeding, suggesting MMF is unlikely to pose significant risk to breastfed infants. MMF is a good candidate for further research as a treatment in lactating mothers.
Factors Impacting Clinical Confidence in Breastfeeding Management and Supportive Behavior Among Healthcare Providers.
Melissa Kuriloff1, Lauren Keenan‐Devlin2, Julie Lester3, Perpetua Goodall4, Ann Borders5
1University of Chicago School of Medicine
2NorthShore University Health System
3University of Chicago Medicine
4University of Chicago Medicine
5NorthShore University Health System
Category: Research
Background: Healthcare providers have an important influence on patients' breastfeeding (BF) intention, exclusivity, and duration in the perinatal period. This study sought to analyze factors including knowledge, attitudes, and clinical confidence impacting BF supportive behavior among healthcare professionals involved in the care of BF dyads. BF supportive behavior includes prenatal counseling, hands‐on support, regular referral to BF resources, and BF‐friendly prescribing practices. The results may be useful in guiding educational interventions that promote BF supportive behavior among pediatric and obstetric (OB) physicians, nurses, and advanced practice providers.
Results: >1 year of personal BF experience had the largest effect on confidence (OR 7.7, CI 1.9, 30.4) after adjusting for age, gender, provider type, years in clinical role, and knowledge and attitude. The strongest predictor of BF supportive behavior was high confidence (OR 4.6, CI 1.9, 11.0). Neither high knowledge nor high attitude was significantly associated with BF supportive behavior.
Materials/Methods: 175 OB and pediatric providers and nurses were surveyed. Respondents self reported demographics. Attitudes and knowledge were measured via the Health Professional BF KAP questionnaire, and clinical confidence and BF supportive behavior were measured via 14 items on a Likert scale. Multiple logistic regression evaluated factors associated with top quartile clinical confidence and BF supportive behavior scores.
Conclusions: Clinical confidence associated with personal breastfeeding experience, rather than knowledge or attitudes, was the strongest predictor of clinician BF supportive behavior. Thus, confidence‐building strategies to promote BF supportive behavior, such as simulation involving interactive experiential learning and skill building, may be a promising modality to improve clinical confidence and BF supportive behavior.
The power of the concertation in the pandemic context for breastfeeding families.
Background: For the past forty years, the Direction of Public Health in the Quebec City area , Canada, has promoted and actively supported breastfeeding support's groups while following international recommendations. Cocogren, a concertation's table regrouping the five breastfeeding support groups from this area, was founded more than twenty years ago. It works in partnership with community perinatal nurses and hospital ones. The pandemic situation has particularly challenged this organization, while a lot of perinatal services stopped.
Results: It provided prenatal learning video for free online (downloaded more than 1000 times), held a reliable system to rent breast‐pump without contact and delivered to the houses (318 rentals in 9 months), 275 postnatal virtual or face to face meetings, 1598 lactation consultations by IBCLCs in the Quebec area, Canada where annually 7000 births are recorded.
Materials/Methods: Cocogren encourages pooling of human resources, training for volunteers and employees, growing of free lactation consultations by IBCLCs whom, when necessary, are coupled with osteopaths. It collaborates with perinatal nurses in co‐hosted prenatal classes, implements free postnatal meetings, provides breast‐pump for rent or for free.
Conclusions: The strength of this well‐run organization, supported by public funds, resulted in the protection, upkeeping and adaptation of the breastfeeding support despite the pandemic situation.
California Mothers' Lived Experience Obtaining Maternity Leave.
Background: Paid family leave benefits mothers, families, and employers but is not required by US federal law. California is one of nine states with paid family leave programs; however, pregnant mothers bear the responsibility of navigating and integrating employer, state, and federal policies to obtain leave. While anecdotal evidence describes the process as stressful, there is limited examination of lived experiences identifying the specific parts that are stressful, particularly during the COVID‐19 pandemic.
Results: Overarching themes included 1) limited baseline knowledge of maternity leave, 2) unclear Human Resources (HR) policies and legal paperwork, and 3) varied impacts of COVID‐19. New mothers described learning that “maternity leave” is not monolithic but a combination of paid time off, state‐level programs, and the federal Family Medical Leave Act. Participants who successfully obtained family leave almost always had guidance from female colleagues with experience navigating family leave through their employer. During the pandemic, pregnant mothers working from home took less time off for pregnancy‐related illnesses but those who had to take time off for childcare struggled to meet the eligibility criteria for family leave.
Materials/Methods: We interviewed 12 pregnant and postpartum mothers from across California about their experiences obtaining family leave. Eligible participants were at least eighteen years old, pregnant or delivered within three years of the study, and employed during their pregnancy. Participants were recruited using a flier distributed on social media and at daycare centers. Interviews were transcribed, coded, and analyzed iteratively using inductive thematic analysis with a constant comparative approach.
Conclusions: Navigating maternity leave is a frustrating and stressful process for California mothers despite more state‐level coverage compared to other states in the US. Therefore, efforts to expand paid family leave must also include improved policy education, clearer legal paperwork, and more sophisticated policies that can account for the unpredictable circumstances pregnant mothers face.
Antenatal Milk Expression: The Initiation of a Program in Central Minnesota to Promote A Practice for Women Who Will Breast Milk Feed.
Jeanne Friebe, Edward Martin‐Chaffee
CentraCare Health
Category: Clinical Practice/ Lactation Management
Background: Antenatal Milk Expression (AME) can be an important practice for women that plan on breastfeeding or breast milk feeding. Multiple benefits can be realized with successful AME. However, this emerging practice is not widely performed or even known. Our Lactation Specialists in Central Minnesota embarked on a comprehensive program to inform women of this practice, discuss AME's benefits and contraindications, and supply educational materials to women on the correct techniques for successful AME.
Results: AME resulted in varying amounts of colostrum production, and an increased confidence with and a relaxed approach toward breastfeeding.
Materials/Methods: Introductory conversations about AME, educational handouts, and links to AME videos were made available starting at the 28 week prenatal visit and AME was initiated at 37 weeks.
Conclusions: Introduction of AME, its' benefits, and demonstration how to perform AME resulted not only in an increase of exclusive breastfeeding initiation rates in our community but also increased awareness and practice of AME.
Speed Up: Addressing barriers to early expression of breast milk in medically fragile mothers of preterm very low birthweight infants.
Carolyn Glendye, Rebecca Moore, Jagdish Desai, Sara Presley, Marianna Riley, Sissy Frost, Isabella De Soler, Chelsey Walker, Austin Southern, India Hemphill, Mobolaji Famuyide
University of Mississippi Medical Center
Category: Quality Improvement Advocacy
Background: Mothers with acute or chronic illness at the time of delivery are at high risk for postponement of breast milk expression and complete lack of breast milk expression. Very low birthweight (VLBW; <1500 grams) infants who are born extremely preterm receive tremendous health benefits from their mother's own milk. From November 2020 ‐ June 2021, this QI project aimed to reduce the time to first breast milk expression in medically fragile mothers of preterm VLBW infants by one hour.
Results: At the end of 3 PDSA cycles, mean time to first breast milk expression since birth was 14 hours, compared to the pre implementation mean of 16 hours, a decrease of 13%. We learned that the highest risk groups for delayed breast milk expression included C‐section delivery, general anesthesia, maternal magnesium, pre‐eclampsia and manual pump method.
Materials/Methods: Learning materials, including a video and patient hand‐out, were designed to educate faculty and staff on the hand expression technique of maternal breast milk. These educational interventions were applied strategically during each PDSA cycle.
Conclusions: Medically fragile moms are at high risk for delayed breast milk expression. Our QI project successfully decreased time to initial pump by two hours, or 13%. Next steps include improving maternal education, increasing breast pump accessibility and addressing barriers in mothers with pre‐eclampsia who require a C‐section under general anesthesia.
A Descriptive Analysis of the Culture‐Dependent Microbiome of Donated Human Milk.
Yamini Mulla1, Tambari Piawah2, Shelley Thibeau3, Elizabeth Miller4, Adetola Louis‐Jacques5
1USF Health Morsani College of Medicine
2USF Health Morsani College of Medicine
3Mothers' Milk Bank of Louisiana
4USF College of Anthropology
5UF College of Medicine
Category: Other
Background: Human milk is a source of probiotic bacteria that can colonize the neonatal gut and help mature the immune system. Identifying the bacteria can help to further understand this relationship.
Results: 246 donors and 1006 milk samples were included. At the genera level, the most common bacteria were Staphylococcus (n = 536), Pseudomonas (n = 274), and Actinobacter (n = 248). At the class level were Gammaproteobacteria (n = 930) and Bacilli (n = 570). The most common bacteria at the phyla level were Proteobacteria (n = 975) and Firmicutes (n = 570).
Materials/Methods: Previously pumped, frozen human milk were collected from donors from 2018 ‐ 2020. Defrosted milk was cultured before pasteurization by inoculating blood agar plates with 0.1 mL of milk, then incubated for 48 hours at 32 ‐ 35°C. Bacteria cultures were taxonomically classified. Descriptive analysis was performed with Microsoft Excel 2016.
Conclusions: Our study is unique compared to many studies of culture‐ and non‐culture‐dependent bacteria in human milk, where Firmicutes tends to be more common than Proteobacteria. Proteobacteria play a role in equipping the infant gut to be colonized by anaerobes. Limitations include non‐standardized sample collection and culture‐dependent methods.
Timing of Lactogenesis II & Volume of Human Milk in Mothers of Preterm Infants
Background: Mothers who give birth to preterm infants may have delayed lactogenesis II. The aim of this study was to examine the timing of lactogenesis II and the amount of human milk volume at 1 & 3 weeks postpartum in mothers of preterm infants.
Materials/Methods: Mothers who gave birth to preterm infants, 24 – 33 weeks, who wanted to express milk for their infants were eligible for the study. Four instruments were used: the Premature Baseline In‐Hospital Questionnaire, the Premature Three‐week Follow‐up Interview Questionnaire, the Maternal Report: Human Milk Expressing & Feeling Fullness, and the Infant Feeding Intake Sheet.
Results: The average amount of human milk per day in the first week was 220 + 175 ml and in the third week 819 + 630 ml. 75% of mothers had lactogenesis II in the first 72 hours. Mothers who reported delayed lactogenesis II produced significantly less milk, both in the first (166 + 126 vs. 293 + 207 ml/d, p = .03) and third week (658 + 343 vs. 1080 + 900 ml/d, p = 0.0002). Expressing milk within the first 9 hours of life did not have a significant effect on the amount of milk in the first week. The amount of milk expressed in the first week was significantly correlated with the amount in the third week (P < .0001).
Conclusions: Delayed lactogenesis II is associated with decreased milk supply in the first and third week. These findings may form the basis for developing interventions to increase milk expression in this population.
Premature Weaning: Are Clinicians Part of the Problem? A Retrospective Study of Patient Experiences with Medications, Imaging Studies and Procedures during Lactation.
Sara Oberhelman1, Jacqueline Zayas2
1Mayo Clinic
2Medical College of Wisconsin
Category: Research
Background: Concerns regarding medications and medical events can lead to premature breastfeeding cessation. We sought to understand the experiences of lactating patients receiving medical care at our institution and impacts on breastfeeding goals. We hypothesized that patients often receive insufficient or inappropriate breastfeeding safety counseling leading to premature weaning.
Results: We contacted 8,677 patients that met inclusion criteria and received 1609 responses for analysis (Response rate = 18.5%.) Of the respondents, 146 (9.34%) had a surgery/procedure, 182 (11.6%) had an imaging study, and 1150 (73.5%) took a medication while lactating. Overall, 44% of respondents received lactation‐related advice from their health care team; 40% of those who received advice self‐initiated that discussion. Of respondents who had surgeries, imaging studies and medication use (respectively) , 96, 77 and 1309 (59%, 32%, 44%) discussed breastfeeding with a provider, 36, 15, and 29 (38%, 19% and 2%) received the advice to interrupt/cease breastfeeding, and 7, 0 and 20 (7%, 0%, 2%) reported that the recommendation negatively impacted their ability to meet their personal breastfeeding goal.
Materials/Methods: Adult patients at Mayo Clinic with a live birth between 2014‐2018 were identified using an institutional database and sent an online Redcap survey via email. Participants were asked about medications, imaging studies, and procedures/surgeries undertaken while lactating, provider recommendations regarding lactation and impacts of these recommendations on goals.
Conclusions: Our study showed that less than half of lactating patients exposed to medications, imaging studies or surgeries recalled any safety counseling. Unfortunately, 7 individuals who underwent surgery and 20 whom took medications felt that the advice they did receive interfered with their ability to meet their breastfeeding goals – most likely unnecessarily. This study further illustrates that there is room for improvement in both providing advice and the advice in which is provided to help support lactating individuals meet their lactation goals.
Oral Cares for preterm babies through early provision of buccal colostrum.
Background: Oral care is very important especially in preterm babies to maintain hygiene, positive oral coordination skill improvement experience, early support towards development of sense of taste and smell. Especially when colostrum or breast milk used in a neonate as early as possible to a neonate will be in advantageous condition through its constituents. Advantages : Gut development, Boosting immune system, Barrier to infection, Assists with breastfeeding‐ short and long term gains. Need for Change: No Oral care framework or pathway at our institution, Propose assessment of existing practice → quality improvement project → best practice of provision of buccal colostrum in neonatal intensive care unit.
Results: Babies receiving buccal colostrum: Post‐project: 11% received buccal colostrum within 6 hours; 25% within 24 hours, Day of Life of First Tastes and Discharge: First tastes from DOL 18 pre‐project to 4 post‐project, Positive feed back 75% parents 100% staff, cost saving of €204,876* across the 36 babies, Length of stay reduced from 43 to 36
Materials/Methods: Staff Training , Educational video for antenatal settings Poster to promote oral cares to parents Leaflet tall parents Hands‐on sessions for parents, Data collection from feedback questionnaire from parents and staff Analysis of data on outcome measures, Safety Cross‐ Daily compliance with target and PDSA ( Plan, Do, Study and Act) .
Conclusions: Early provision of buccal colostrum in babies especially preterm babies is very important and it is achievable with team approach of family centered care with several advantages including increased breast feeding rates, reduction in morbidity especially sepsis and necrotising enterocolitis by developing healthy flora in gut starting from oral cavity
Influence of Breastfeeding Practices on Neurodevelopmental Outcomes in an Enhanced Risk Cohort for Autism Spectrum Disorder.
Ruchi Punatar, Kathleen Angkustsiri, Laura Kair, Daniel Tancredi, Rebecca Schmidt
UC Davis
Category: Research
Background: Breastfeeding (BF) patterns for children diagnosed with autism spectrum disorder (ASD) might differ from those of typically developing (TD) peers. To our knowledge, BF practices have not been studied prospectively in a group with elevated risk for ASD. This study aims to describe the BF patterns of younger siblings of children with ASD, an elevated ASD risk cohort, from prospectively collected data. Additionally, this study will investigate if longer breastfeeding duration is associated with differences in neurodevelopmental outcomes in this cohort.
Results: 309 participants born between December 2006 and January 2017 were included in the analysis. In this enhanced‐risk cohort, the mean duration of BF was 11.7 mos (SD 9.9 mos). 94.5% of the mothers initiated BF. The rate of BF was 79.9% at 4 mos, 70.5% at 6 mos, and 49.7% at 12 mos. There were no significant differences in the mean duration of BF, frequency of initiation of BF, and frequency of BF at 4, 6, and 12 mos among children in the three clinical outcome categories. There was no significant difference in clinical classification, ADOS comparison score, or MSEL scores based on the duration of breastfeeding.
Materials/Methods: Data from the MARBLES (Markers of Autism Risk in Babies Learning Early Signs) Study, a prospective enhanced‐risk cohort study of siblings of children with ASD, was analyzed. BF practices data was collected via survey and developmental evaluations were conducted by experienced expert clinicians. Participants were clinically classified into three groups based on an evaluation at three years of age: TD, ASD, and non‐typical development (Non‐TD).
Conclusions: While there is a trend towards earlier cessation of BF in the ASD group, the results are not statistically significant. The strength of this study is the prospectively‐collected data. Limitations are that the cohort is not representative of the general population.
Withdrawn
“Improving Breastfeeding and Lactation Support for Medical Trainees”.
Ashley Reeves, Ashley Farge, Julie Gallois
Louisiana State University Health Sciences Center New Orleans
Category: Quality Improvement Advocacy
Background: Medical trainees face a variety of barriers meeting personal breastfeeding goals. The literature specifically identifies five challenges including: time to pump, space to pump, challenging work hours, colleague support and institutional support. A collaborative led by the AAP and AAFP and funded by the CDC specifically addressed these challenges with ten medical trainee programs across the country. Louisiana State University Health Sciences Center Department of Pediatrics was chosen as a participant in this collaborative. At the time of the collaborative initiation, there was no official lactation policy for either LSU Pediatrics trainees or employees at Children's Hospital of New Orleans (CHNOLA).
Results: LSU Pediatrics' pre‐survey revealed our model policy alignment score was 26/100. A pre‐survey of lactating residents revealed they were meeting 33% of their lactation goals.
Materials/Methods: Methods included pre‐survey data to support a case for change presented to the CHNOLA administration allowing for successful adoption of an official lactation policy based on the AAFP Model Policy for all employees, including trainees.
Conclusions: Improved breastfeeding education will continue through the Lactation Committee. Post‐intervention data among residents will be collected.
Official actions reflect the acknowledgement of the importance of breastfeeding at the institutional level and continued awareness in the workplace may improve breastfeeding goals among medical trainees.
Current Understanding and Practice of Breast Imaging During Lactation Among Multidisciplinary Breast Team Members in Scotland.
Justice Reilly1, Sau Lee Chang2
1NHS Lanarkshire
2NHS Tayside Ninewells Hospital
Category: Research
Background: Ultrasound is the main imaging technique in assessing lactating patients, alongside mammography and MRI for suspicious lesions. However, due to the concern of radiation and contrast exposure, some practitioners still advise delayed imaging or breastfeeding cessation, causing potential delay in cancer detection, pain and emotional distress to the dyad.
Results: 24 responses were received. 54% knew of the negligible risk of mammogram. 50% would perform diagnostic mammograms, 75% would postpone surveillance mammograms during pregnancy and lactation. 8% knew the NHS / WHO recommended duration of breastfeeding. There was variable and incomplete knowledge on the potential impact of breastfeeding cessation.
Materials/Methods: An online questionnaire was conducted to assess current understanding and practice in imaging pregnant and lactating patients in NHS Greater Glasgow and Clyde, and NHS Lanarkshire.
Conclusions: There is a considerable gap in lactation knowledge among members of the sampled healthcare professionals, which is likely to impact informed consent and patient care.
The Louisiana mPINC Challenge: Using the mPINC Survey to Achieve State‐Wide Change.
Paula Schreck1, Marci Brewer2, Janene Hebert3, Jennifer Alleman4, Kelli Waller5, Clark Bucko6
1Louisiana Bureau of Family Health
2Louisiana Department of Health
3Coffective
4Louisiana Department of Health
5Louisiana Department of Health
6Louisiana Department of Health
Category: Quality Improvement Advocacy
Background: The Gift is the Louisiana birthing center collaborative that provides technical assistance and interim designation to support hospitals in their quest for improved breastfeeding outcomes through the implementation of Baby‐Friendly practices.. The CDC biannual mPINC Survey is a tool that also focuses on implementation of these practices. Louisiana’'s state‐wide score for 2018 was 75/100. Louisiana’'s identified areas of improvement from the 2018 mPINC survey included: · Parents of formula fed infants are taught feeding techniques and how to safely prepare / feed formula (LA score = 66) · Direct observation of at least 1 effective feeding at the breast within 8 hours of discharge (LA score = 57)· Nurses are required to demonstrate competency in assessing breastfeeding (LA score = 68)
Results: The execution of the Louisiana mPiNC Challenge, using live presentation, video, and toolkit, resulted in a 8% increase in participation and 6 pt increase in the 2020 LA state mPINC score.
Materials/Methods: The Gift team worked with Louisiana hospitals through multiple avenues to improve implementation of evidence‐based maternity care practices, which in turn would improve mPINC scores. Regional collaborative meeting presentations, 1:1 coaching by improvement coaches, and state‐wide quick wins, were utilized to provide hospitals guidance, assistance with quality improvement projects, and tools directly related to these mPINC questions.
Conclusions: The mPINC provides a free interval assessment that should be used to identify opportunities for changes in process to improve breastfeeding outcomes. The state report can be used to inspire improvement across regional and state hospital groups.
Wee Nuzzle: A Quality Initiative to Promote Non‐Nutritive Breast Feeding in Order to Increase Breast Milk at Discharge for Preterm Infants in the Neonatal Intensive Care Unit.
Background: Non‐nutritive breast feeding (NNBF) is breast/chest feeding after pumping. Reduced opportunities for infants to practice direct latching may discourage parents, impact breastmilk supply, and reduce breastmilk feeding at discharge. Our level III NICU at the University of California San Diego has seen NNBF attempts delayed for various reasons. Therefore, we developed “Wee Nuzzle” as a pre‐feeding developmental pathway to promote breast feeding. Our smart aim is to decrease the time to first NNBF attempt by one week from a baseline of two weeks among infants born <34 weeks within one year. The global aim is to increase the number of preterm infants receiving breastmilk at discharge.
Results: 138 infants met inclusion criteria with a mean gestational age of 31.1 weeks. From May to November 2021, we saw a shift in the mean number of days to first NNBF attempt from a baseline 13.5 to 5.2 days, from initial date of eligibility. Current results have been maintained. We are following several process and balancing measures.
Materials/Methods: A multidisciplinary team developed a key driver diagram, fishbone analysis, and guidelines. Three PDSA cycles have been completed thus far: 1) education of staff, 2) implementing the pathway into daily rounds, and 3) automating it in the order set.
Conclusions: This initiative led to a decrease in the mean days to first NNBF attempt by one week. Further PDSA cycles are being planned to guide additional interventions and to support our aim of increasing the number of preterm babies being discharged with breastmilk.
Why do Women Attend Video Lactation Support Groups?
Jennifer Somers, Alejandra Velez Alicea, Taylor Lautzenhiser
Greater Lawrence Family Health Center
Category: Research
Background: Despite the WHO's recommendation to exclusively breastfeed infants for 6 months, there are known disparities across racial and socioeconomic groups: higher rates in populations with higher income, as well as White and Asian groups, compared to Hispanic and non‐Hispanic Black groups. Some proposed reasons why Hispanic immigrants have lower breastfeeding rates include the belief that breastfeeding in public is offensive in the U.S, Cesarean birth, lack of knowledge, low socioeconomic status and inadequate support. While not all of these can be modified, breastfeeding groups can decrease disparities by addressing common concerns, such as maintaining breastfeeding after returning to work, as well as by providing peer support. Tele‐lactation groups allow for increased availability of services to vulnerable communities, and offer a safer alternative since the start of the COVID‐19 pandemic. The study is located in Lawrence, Massachusetts, where 80% of residents identify as Hispanic and 21% of residents live in poverty. The intervention is a bilingual tele‐lactation support group at a community health center with access to a Breastfeeding Medicine Physician and WIC peer counselors.
Results: The study seeks to identify themes regarding barriers to breastfeeding, available information and support, and potential benefits of our group model. Anticipated themes are: increased knowledge, support and community.
Methods: 10 structured interviews from 20 patients who have attended >3 telehealth support groups producing co‐generative thematic analysis.
Conclusions: Study is in progress. We expect to find that patients who attend the groups will receive practical breastfeeding information, mother‐to‐mother support and access to community resources.
Mother and nurse experiences of a mother‐baby unit late preterm infant program.
Katherine Standish1, Christina Pindar2, HaEun Kim3, Ginny Combs4, Lisa Zani5, Marcy McMahon6, Cheryl Slater7, Barbara Philipp8
1Boston Medical Center
2Boston University
3Boston University School of Public Health
4Boston Medical Center
5Boston Medical Center
6Boston Medical Center
7Boston Medical Center
8Boston University
Category: Research
Background: Late preterm infants (LPI) have lower rates of breastfeeding than term infants. Enhanced breastfeeding support, often tasked to postpartum nurses, is recommended for late preterm dyads, yet maternal and nurse perspectives on such interventions have not been evaluated in non‐intensive settings.
Results: Among nurses, 3 major themes emerged: 1) increased confidence caring for LPI due to the program's education on LPI pathophysiology; 2) program components facilitate improved care for LPI; and 3) continued barriers to breastfeeding support including lack of overnight lactation consultants and no involvement of labor & delivery staff in the program. Among mothers, the following themes emerged: 1) kind and supportive attitudes of nursing and lactation staff was important for giving mothers confidence breastfeeding 2) breastfeeding support resources—hand expression kit and educational videos—were less helpful or not recalled and few mothers used hand expression beyond the first day; 3) mothers had mixed knowledge of LPI both in general and in regards to feeding.
Materials/Methods: We performed a qualitative evaluation on the mother‐baby unit (MBU) at a Baby‐Friendly designated hospital in the U.S. In 2019, the unit implemented an LPI breastfeeding support program which includes: nurse training on LPI neurodevelopment and common problems, immediate lactation consult, availability of donor milk, hand expression teaching and kit, and daily interdisciplinary team huddles. We distributed an email survey to MBU nurses (n = 43) regarding the program and LPI breastfeeding support. We conducted semi‐structured interviews with LPI mothers (n = 9) post‐discharge. Nurse open‐ended write‐in responses and mother interview transcripts were analyzed by the study team using grounded theory to allow for the emergence of themes.
Conclusions: These findings highlight the benefits of a MBU program specific to LPI, empowering nurses with the knowledge and confidence. Although nurses felt well equipped with knowledge on LPI, this knowledge didn't always translate to mothers.
Encouraging and Reinforcing Safe Breastfeeding Practices During the COVID‐19 Epidemic.
Background: The need to urgently implement policies within existing guidelines to address emergent health threats cannot be overstated. Meeting national breastfeeding goals remains an ongoing challenge that can be further compromised by lack of adequate support during the COVID‐19 pandemic. This is particularly important for African Americans who record the highest risk for COVID‐19, while also recording the lowest breastfeeding rates. The aim of this project is to increase the number of minority mothers who breastfeed adequately and safely during the COVID‐19 pandemic.
Results: Mothers were unlikely to use facemask while breastfeeding. Group I was more aware of breastfeeding contraindications. Source of COVID‐19 safety information was family/friends/media (56.6%) and doctors/nurses/CLC (15.4%). Exclusive breastfeeding at one month at the onset and one year into the pandemic were respectively 41.9% to 12.8%, p < 0.006.
Materials/Methods: The intervention was based on national breastfeeding goals/objectives and CDC COVID‐19 Breastfeeding Guidelines and disseminated by a trained educator. Data was colleced by interview from 39 mothers at the Nashville General Hospital (Grooup I: Dec 2019 to May 2020) and 97 pregnant women (Group II: June 2020 ‐ Dec 2021) who were followed up postpartum.
Conclusions: Mothers were not more knowledgeable about safe COVID‐19 breastfeeding one year into the pandemic. Breastfeeding ambivalence can be prevented once health care providers confidently reinforce healthy safe breastfeeding behavior, advising they wear facemask when doing so, and that COVID‐19 vaccination is safe for pregnant and nursing mothers.
Barriers and Facilitators to Exclusive Breastfeeding in Cincinnati Latina Mothers.
Laura Ward1, Clara Chlon2, Jennifer McAllister3, Rylee Stephenson4, Olga Tamayo5, Kylie Mena6, Amy Rule7
1Cincinnati Children's Hospital Medical Center
2Cincinnati Children's Hospital Medical Center
3Cincinnati Children's Hospital Medical Center
4Healthy Moms and Babes
5Cincinnati Children's Hospital Medical Center
6Cincinnati Children's Hospital Medical Center
7Cincinnati Children's Hospital Medical Center
Category: Research
Background: Although breastfeeding rates are increasing in the United States, significant cultural disparities in duration and exclusivity remain. Nationally, Hispanic infants are less likely to exclusively breastfeed at 6 months than non‐Hispanic white infants. In our community, data demonstrates that Latina mothers initiate breastfeeding at or above rates of the general population, but exclusive breastfeeding rates are disproportionately low. We sought to explore reasons for supplementation and non‐exclusive breastfeeding in our local Latinx population, and to evaluate facilitators and barriers to exclusive breastfeeding after hospital discharge.
Results: Of 49 participants, 96% breastfed, 82% supplemented, 51% supplemented in the hospital, 81% agreed that most mothers have enough milk to feed their babies. Most women agreed that breastfeeding was the healthier feeding choice, and breastfeeding was more convenient and less expensive than formula feeding., The most common reason for breastfeeding discontinuation was that the infant was still hungry/not enough milk, 46% reported supplementing because they didn't have enough milk, 62% thought it was hard to tell when the baby was getting enough milk, 69% reported receiving breastfeeding education, and 91% felt that the education influenced their feeding decision
Materials/Methods: We recruited self‐identified Latinx mothers > = 18 years old through community partners to complete a survey exploring breastfeeding knowledge, infant feeding practices, attitudes about formula, and demographic data.
Conclusions: Though breastfeeding was common, and most reported positive breastfeeding attitudes, supplementation occurred frequently and early. Our results underscore an opportunity to tailor prenatal education, addressing the common concern for insufficient milk supply and highlighting the importance of exclusive breastfeeding.
Prolonged Antibody Responses Among Lactating Mothers Who Receive SARS‐CoV‐2 Vaccination.
Julie Ware, Katie McElhinney, Teresa Latham, Adam Lane, Krista Dienger‐Stambaugh, David Hildeman, Paul Spearman, Russell Ware
Cincinnati Children's Hospital Medical Center
Category: Research
Background: SARS‐CoV‐2 (COVID) vaccination for breastfeeding dyads and its effects on lactation are not well described. Antibody Detection of Vaccine‐Induced Secretory Effects (ADVISE, NCT04895475) prospectively evaluates breastmilk responses after initial and booster vaccines, specifically formation and persistence of secretory IgA (sIgA) antibodies.
Results: In 66 mothers, vaccination led to milk sIgA antibodies with neutralizing activity. sIgA titers increased after second and third booster doses, but were not associated with dyad characteristics or vaccine type. Milk IgG antibodies were higher and more sustained. Vaccine‐induced antibodies from milk were not detected in the infant circulation.
Materials/Methods: Dyad demographics, breastfeeding characteristics, vaccine type, and side‐effects were recorded. Milk before vaccination, weekly after Dose 1 and Dose 2, and biweekly after Dose 3 (booster), plus dyad blood samples were collected. Milk was tested by ELISA for Spike and RBD antibodies, and neutralizing activity by a pseudo‐virus blocking assay.
Conclusions: COVID vaccination during lactation is well tolerated and generates a strong and sustained immune response in breastmilk. sIgA and IgG antibodies are routinely detected in breastmilk with viral neutralizing activity, and titers increase after booster vaccinations, supporting universal immunization for all breastfeeding mothers.
The effects of breastfeeding on serum asymmetric dimethylarginine levels and body composition in children.
Anna Wasilewska
Medical University of Bialystok
Category: Research
Background: The purpose of this work was to investigate the association of serum asymmetric dimethylarginine (ADMA) and high‐sensitivity C‐reactive protein (hs‐CRP) levels with duration of breastfeeding and body composition in children.
Results: We found significantly higher serum ADMA levels in never breastfed compared with the fully breastfed group (p < 0.05) and was inversely associated with HDL and breastfeeding
Materials/Methods: The study group consisted of 88 patients aged of 12 months (42 boys, 46 girls), never breastfed or fully breastfed. ADMA and hs‐CRP were measured by ELISA kits.
Conclusions: In never breastfed children, increased ADMA is observed; however, further studies are needed to assess whether breastfeeding duration affects body fat and body composition at older ages.
The Lactisoporte telelactation model in the duration of exclusive breastfeeding in infants older than 6 months, Peru 2021.
Mario Yrigoyen, Jackeline Ashiyama, Betzabe Mamani Calderon, Erika De la O, Yajaira Castaneda, Gabriela Flores, Jenny Poma, Karen Melissa Coronado Bulege, Andrea Aguirre, Irma Garabito
Crianzamor
Category: Research
Background: The WHO recommends exclusive breastfeeding up to 6 months and COVID‐19 has decreased its indicator. In the Americas, this indicator is around 38%. Lactisoporte telelactation (LST) was created during the pandemic to provide free virtual assistance to mothers with breastfeeding difficulties, using its own telelactation model to mothers from anywhere in the world. The LST model consists of a comprehensive approach to breastfeeding difficulties, through daily monitoring by a support team until the mother achieves her breastfeeding goals.
Results: There was no significant difference between the ages of the infants (p < 0.24) with control group. The 3 frequent reasons for requesting assistance were similar in both groups: insufficient milk production, problems with the nipples and breasts, and rejection of the breast. A statistically significant difference (p < 0.001) was found regarding the longer duration of EBF after care and a high degree of satisfaction (p < 0.001) in Lactisoporte compared to the control.
Materials/Methods: Peruvian mothers with breastfeeding difficulties with children under 6 months of age sought virtual care at Lactisoporte (n = 37) or at the INSN Virtual Breastfeeding Clinic (n = 43) as control group. When they completed more than 6 months, time of EBF, the months of duration of EBF post‐telelactation were counted, through a telephone survey.
Conclusions: The LST model causes a high degree of satisfaction in the user mothers and a longer duration of EBF compared to the control group.
Community Breastfeeding Promotion Initiative: FeedingYourBaby.org.
Madeline Zimilover, Kristina Bianco, Henry Bernstein
Cohen Children's Medical Center
Category: Clinical Practice/ Lactation Management
Background: Efforts to support breastfeeding are key to reducing healthcare inequity. Primary care providers can play a crucial role in improving breastfeeding rates by offering targeted support. We hypothesize that FeedingYourBaby.org, an online breastfeeding tutorial and parental needs assessment to help target provider counseling, will increase rates of exclusivity and duration during the first 6 months of life.
Materials/Methods: We plan to implement a prospective randomized controlled trial to evaluate the impact of this web‐based tool designed to educate parents and facilitate breastfeeding counseling in our diverse pediatric population in the New York metropolitan area. We will study two parallel groups, one that completes the online breastfeeding tutorial and needs assessment before each well‐baby exam vs. control group, who complete a questionnaire without education or needs assessment.
Results: A previous pilot study demonstrated a 14.5% increase in any breastfeeding at 6 months, with an overall trend towards increased breastfeeding outcomes in the intervention group. Recent efforts have also identified potential challenges and solutions to improve workflow while implementing FeedingYourBaby.org in clinical practice.
Conclusions: We aim to evaluate the impact of providing online breastfeeding education and support to improve exclusivity and duration. This randomized controlled trial will provide evidence intended to strengthen the generalizability of FeedingYourBaby.org as a clinical care delivery model to meet the needs of lactating parents. Additionally, it will provide our pediatric residents with the opportunity and tools needed to deliver basic breastfeeding counseling.
