Estimated Breastfeeding to Support Breastfeeding in the Neonatal Intensive Care Unit

ObjectiveTo evaluate the effects of estimated breastfeeding on infant outcomes in comparison to test weighing and to describe staff members’ experiences of estimated breastfeeding as a method for supporting the transition from tube feeding to breastfeeding.DesignA mixed method evaluation.SettingNeonatal Intensive Care Unit (NICU) in Sweden.ParticipantsThe study included 365 preterm (25^th–36^th gestational weeks) infants and 45 nurses or nurse assistants.MethodsA retrospective comparative medical record study was used to assess infant outcomes during a period of test weighing (196 infants) and again after the implementation of estimated breastfeeding (169 infants). A qualitative survey was conducted to explore the staff experiences of estimated breastfeeding.ResultsNo differences were found between groups regarding duration of tube feeding, length of hospital stay, gestational age, weight at discharge, and rate of any breastfeeding. Infants in the estimated breastfeeding group had a higher risk of not being exclusively breast milk fed than infants in the test‐weighing group (OR = 2.76, CI [1.5, 5.1]). Staff perceived estimated breastfeeding as a more facilitative and less stressful method for mothers than test weighing. Some staff had difficulty following guidelines while simultaneously providing person‐centered care.ConclusionsEstimated breastfeeding is a nonintrusive and feasible method for assessing and supporting the transition from tube feeding to breastfeeding among preterm infants in a NICU. However, the increased risk for not being exclusively breastfed is of concern. Additional research is needed to assess whether this method is appropriate and feasible in varying contexts and cultures.     

An Integrative Review of Factors that Influence Breastfeeding Duration for Premature Infants after NICU Hospitalization

ObjectiveTo determine what factors affect breastfeeding duration after discharge home from the neonatal intensive care unit (NICU) for high‐risk mothers and their premature infants.Data SourcesThe electronic databases of CINAHL and PubMed were used to identify studies published in English. Date of publication did not limit inclusion in the review.Study SelectionUsing exclusion and inclusion criteria, 292 articles were initially assessed for relevance to the research question through abstract review. Further screening resulted in full review of 52 articles. Reference list searching added an additional six articles. Finally, in‐depth review of these 58 articles resulted in 24 studies that fully met inclusion and exclusion criteria.Data ExtractionStudies were reviewed for information related to factors associated with breastfeeding duration for high‐risk mothers and preterm infants after NICU discharge home.Data SynthesisStudies were categorized into five themes, including NICU factors, feeding and soothing methods, maternal characteristics, maternal experiences, and support programs. Most significant factors affecting duration included exposure to kangaroo mother care, prenatal education, and quantity of maternal breast milk supply during the first week after discharge. Breastfeeding also was affected by maternal breastfeeding knowledge and perception of providing appropriate volumes.ConclusionsMothers face many challenges breastfeeding their premature infants after NICU discharge. Ideally, all mothers need to receive support after NICU discharge, and the transition to home can be challenging even if breastfeeding is well established. However, NICU professionals are in a perfect position to provide guidance to families so they are able to anticipate and effectively solve lactation challenges at home.     

Breastfeeding Promotion for Management of Neonatal Abstinence Syndrome

ObjectiveTo review the literature about the association between breastfeeding and neonatal abstinence syndrome (NAS) severity, need for pharmacologic treatment for NAS, and length of hospital stays in neonates with in‐utero exposure to methadone or buprenorphine opioid replacement therapy.Data SourcesPubMed, CINAHL, and Medline were searched for articles published between January 1990 and April 2013 using the terms opioid dependency in pregnancy, neonatal abstinence syndrome, methadone, buprenorphine, neonatal length of stay, breastfeeding, methadone in breast milk, buprenorphine in breast milk, swaddling, and rooming‐in.Study SelectionInclusion criteria included studies written in English on the topic of breastfeeding for management of NAS.Data ExtractionThe author independently reviewed each article.Data SynthesisBreastfeeding can effectively decrease NAS symptoms because methadone and buprenorphine are transferred to the breast milk. Maternal contact while breastfeeding also plays a role in ameliorating the NAS symptoms. Interventions that also support breastfeeding in the treatment of NAS include skin‐to‐skin contact, swaddling, and rooming‐in.ConclusionsUnderstanding the benefits of breastfeeding for opioid‐dependent pregnant women and their neonates will enable clinicians to safely recommend breastfeeding for long‐term health of these high‐risk women and their infants. This review of the effects of in‐utero exposure to opioids on infant development can assist clinicians to more effectively support opioid‐dependent women to breastfeed their infants.     

Integrative Review of Antenatal Milk Expression and Mother–Infant Outcomes During the First 2 Weeks After Birth

ObjectiveTo explore the practice of antenatal milk expression (AME) and related outcomes for mother–infant dyads during the first 2 weeks after birth.Data SourcesWe searched the electronic databases MEDLINE, Embase, CINAHL, Emcare, Maternity & Infant Care Database, Scopus, and Web of Science for relevant literature. We also conducted backward reference searches on relevant publications and nondatabase searches after review of the full texts.Study SelectionArticles were eligible for inclusion if they reported primary studies focused on AME, included samples of mother–infant dyads, and were published in English. We did not impose time or design limitations given the sparse availability of literature on AME. We identified 766 articles. After the removal of duplicates, we screened 588 articles, and of these, we included 15 articles in our review.Data ExtractionWe used the Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA) guidelines to guide data extraction and reporting. We evaluated the quality of evidence using the Melnyk and Fineout-Overholt rating system and the Joanna Briggs Institute critical appraisal tools.Data SynthesisWe synthesized data from the included articles into four themes: Breastfeeding Self-Efficacy, Milk Supply, Infant Well-Being, and Infant Feeding Methods.ConclusionAME may support breastfeeding by improving breastfeeding self-efficacy and milk supply and by decreasing early formula use. Synthesized literature on AME shows the safety of the practice and that infants of women who practice AME have a greater likelihood of breastfeeding exclusivity during the short term.     

Expressed breast milk feeding practices in Hong Kong Chinese women: A descriptive study

IntroductionThere is an increasing prevalence of breast milk expression and expressed breast milk feeding in healthy full-term infants. The purpose of this study was to provide up-to-date evidence on the practice of expressed breast milk feeding and to identify factors associated with expressed breast milk feeding in Hong Kong Chinese mothers of healthy full-term infants.MethodWe used a prospective cohort study design to recruit 821 mothers who gave birth to healthy full-term infants in two public hospitals in Hong Kong. Participants completed self-administered baseline questionnaires during their postpartum stay and were followed-up by a series of telephone calls over a 6 months period or until they stopped breastfeeding, whichever came first. The proportion, mode, and type of infant feeding (direct breastfeeding, expressed breast milk feeding and infant formula feeding) were assessed at each telephone follow-up.ResultsIn our sample, 14.6%, 20.2% and 15% of the participants fed expressed breast milk only to their infants at 1.5, 3 and 6 months respectively. Less than one-half were giving only direct breastfeeding only at 1.5 and 3 months. Within the first six months postpartum, 84.6% of the participants had given expressed breast milk. More than 80% of participants obtained a breast pump before giving birth, with the majority obtaining electric pumps. The most common reason for expressing breast milk within the first 1.5 months postpartum was experiencing breastfeeding difficulties (35%). Returning to employment was the strongest predictor of expressed breast milk feeding at three months postpartum (adjusted odds ratio [aOR]=8.71, 95% Confidence interval [CI]= 5.12–14.8).ConclusionA high proportion of Hong Kong Chinese mothers of healthy, full-term infants pump and feed expressed breast milk at some point during the first 6 months postpartum. Participants purchase or obtain breast pumps before giving birth, often in anticipation of breastfeeding difficulties and returning to work.     

Effect of Pre- and Postdischarge Interventions on Breastfeeding Outcomes and Weight Gain Among Premature Infants

ObjectiveTo investigate the effect of pre- and postdischarge interventions on breastfeeding outcomes and weight gain among preterm infants.Data SourcesPubMed and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) database were searched for study selection using MeSH terms infant/premature, breastfeeding, weight gain, patient discharge, postnatal care, and counseling.Study SelectionInclusion criteria included studies that involved preterm infants who were born less than or equal to 37 weeks of gestation, randomized controlled trials that were in English, conducted in developed countries, and had breastfeeding and weight gain outcomes. A total of 8 articles met inclusion criteria.Data ExtractionAll data related to breastfeeding outcomes including duration, exclusivity, maternal satisfaction, and weight gain were extracted from the randomized controlled trials for the purpose of data synthesis.Data SynthesisA total of 310 studies were reviewed. Eight randomized controlled trials met the inclusion criteria. Gestational age of the infants in the studies ranged from 26 to 37 weeks. The results revealed that kangaroo care, peer counseling, in-home breast milk intake measurement, and postdischarge lactation support improved breastfeeding outcomes among preterm infants, and that maternal satisfaction improved with postdischarge interventions. No significant evidence of pre- and postdischarge interventions on weight gain was found.ConclusionsPre- and postdischarge interventions were effective in promoting breastfeeding exclusivity, duration, and maternal satisfaction among mothers of preterm infants. These findings have important clinical implications that support the need for evidence-based breastfeeding interventions for preterm infants before discharge and vigilant postdischarge support. Research to determine more effective interventions to promote exclusive and long-term breastfeeding among preterm infants is required.     

Scoping Review of Barriers and Facilitators of Breastfeeding in Women on Opioid Maintenance Therapy

ObjectiveTo synthesize the literature on the barriers and facilitators of breastfeeding among women on opioid maintenance therapy (OMT) to inform nursing interventions and improve breastfeeding outcomes.Data SourcesWe searched 11 databases using the following key terms: breastfeeding, barriers, facilitators, promotion, and opioid.Study SelectionWe included articles published in English since 2015 that addressed barriers and facilitators of breastfeeding in women on OMT. We did not limit our search to specific types of studies. Our search produced 65 records. After reviewing titles and abstracts, we assessed 21 full-text articles and excluded seven for lack of data related to our key terms. As a result, we included five qualitative studies, three reviews, three mixed-methods studies, two retrospective cohort studies, and one case report (14 articles) in our final review.Data ExtractionWe extracted data from each article and sorted them in a table for analysis and synthesis. Data included study purpose, research questions, design and methodology, and findings specifically pertaining to the identification of barriers and facilitators of breastfeeding for women on OMT.Data SynthesisWe identified three themes related to facilitators of and barriers to breastfeeding: Information, Support, and Health Care System Factors.ConclusionThe results of our review suggest that most barriers and facilitators of breastfeeding in women on OMT are manageable with improved health care practices. Primary and acute care health professionals should modify practices to minimize barriers to breastfeeding. Nurses should provide better breastfeeding education and preparation, sensitive care in the immediate postpartum period, and extended follow-up after hospital discharge for women on OMT.     

Integrative Review of Fathers’ Perspectives on Breastfeeding Support

ObjectiveTo critically review and summarize the results of published articles on fathers’ perspectives regarding breastfeeding support for their partners.Data SourcesWe searched the following databases for articles published between January 2010 and May 2019: CINAHL, MEDLINE, PubMed, Scopus, Web of Science, ThaiJo, and ThaiLis. We included articles published in English and Thai.Study SelectionAfter duplicates were removed, our initial search yielded 3,927 articles. We excluded articles in accordance with pre-established criteria. We performed a quality appraisal of the selected full-text articles and ultimately included 27 in this review.Data ExtractionWe analyzed studies that met inclusion criteria and extracted and organized data related to fathers’ perspectives on breastfeeding support into a structured table.Data SynthesisThe data were synthesized into three themes: Attitude Toward Breastfeeding, Knowledge of Breastfeeding, and Fathers’ Perceptions of the Breastfeeding Support They Provided.ConclusionOur results showed that fathers’ perspectives on breastfeeding support were shaped by their knowledge of breastfeeding and participation in the breastfeeding process. To promote breastfeeding, further research is required to design and implement appropriate interventions to help fathers effectively support their breastfeeding partners.     

Views of fathers in Ireland on the experience and challenges of having a breast-feeding partner

Objectivethis study investigated the relationship between fathers and breast feeding in Ireland.Design and methoda cross-sectional semi-quantitative questionnaire with closed-ended and open-ended questions was posted to 1398 men with an Irish partner who had given birth 4–7 months previously. Fathers who specified that their partner breast fed their last or only child were questioned about their: influence on the breast feeding decision; ability to assist with breast feeding challenges; preferred type of information on breast feeding; perceived advantages and disadvantages to breast feeding; and views on breastfeeding in public. Data from closed-ended questions on breast feeding were presented using frequencies and associated percentages. Answers to open-ended questions on breast feeding were categorised into themes using content analysis. Each theme was assigned a numerical code and the themes developed were quantitatively counted and presented as frequencies and percentages.Findingsof the 583 respondents (42% response rate), 417 (71.5%) had a partner who had breast-fed their last or only child. Most of the 417 fathers were employed (95.7%, n399), college-educated (76.7%, n320) and married (87.8%, n366). Most (75.5%, n315) fathers were involved in the breast feeding decision. The majority (77.5%, n323) of fathers were unprepared for at least one aspect of breast feeding, most commonly that their partner encountered difficulties in establishing breast feeding. Of those fathers with a partner who experienced difficulties with breastfeeding (56.8%, n237), half (49.4%, n117) were unable to help their partner to overcome her breast feeding difficulties. Two-fifths (41.0%, n133) of fathers felt deprived of bonding time. Almost one in ten (9.4%, n39) fathers felt uncomfortable with an unrelated woman breast feeding in public, and this increased to three in ten or one third (34.3%, n143) if the woman in question was their partner.Key conclusionwhile fathers in a well-educated and socially advantaged sample are largely supportive of breast feeding, significant challenges remain in terms of their ability to support breast feeding in an informed and practical manner.Implications for practicewomen who are practically and emotionally supported by their partners are more likely to successfully breast feed, but the male perspective of breast feeding in Ireland has been given little attention. This study supports earlier and more effective engagement of fathers throughout the breast feeding process, and highlights areas of concern with respect to the role of fathers in breast feeding.     

Intervention for promoting breast milk use in neonatal intensive care unit: a pilot study

Abstract

Objective: The health benefits provided by breast milk are significant in preterm infants. Despite recommendations, rates of breastfeeding in preterm infants are lower than in term infants. The aim of this study was to evaluate the efficacy of a multidisciplinary intervention in promoting any breastfeeding in preterm infants at discharge.

Methods: A prospective non-randomized interventional cohort study was conducted. One hundred and twenty-two preterm infants constituted the historical group. A multidisciplinary intervention was performed including staff training and setting up and implementation of a written breastfeeding procedure.

Results: One hundred and ten preterm infants were enrolled in the intervention group. The percentage of infants fed human milk at discharge was 69 and 62 in the intervention group and in the historical group, respectively. The percentage change from any breastfeeding at full enteral feeding attainment to formula feeding at discharge was lower in the intervention group than in the historical group (?9 versus ?23). Belonging to the intervention group and having at least one stress factor during pregnancy were independently associated with any breast milk feeding at discharge.

Conclusions: The multidisciplinary intervention performed appears to be effective in promoting any breastfeeding in preterm infants at discharge.     

An Institutional Ethnography of Nurses’ Support of Breastfeeding on the Night Shift

ObjectiveTo describe nurses’ support of breastfeeding on the night shift and to identify the interpersonal interactions and institutional structures that affect this support.DesignInstitutional ethnography.SettingThe mother/baby unit of a tertiary care hospital with 4200 births per year.ParticipantsRegistered nurses (N = 16) who provided care on the night shift to mother/infant dyads in the immediate postpartum period.MethodsData were collected using focus groups, individual and group interviews, and mother/baby unit observations. The focus groups were held before the night shift and had five participants. The nine individual and group interviews were conducted between 0100 and 0230 on the mother/baby unit. Three unit observations were conducted. Interviews were recorded, professionally transcribed, and analyzed using a content analysis method.ResultsData analysis yielded three themes that described these nurses’ support of breastfeeding on the night shift: competing priorities, incongruent expectations, and influential institutional structures. The need of visitors to see their new family members competed with the needs of mothers to rest and breastfeed their newborns. Helping breastfeeding dyads who experienced difficulties competed with providing care to other patients. Parents’ expectations regarding newborn behavior were incongruent with the reality of newborn feeding and sleeping patterns. Institutional structures that affected the provision of breastfeeding support by nurses included hospital breastfeeding practices, staffing, and policies.ConclusionNurses’ support of breastfeeding on the night shift encompasses a complex interplay of interpersonal interactions with new families and visitors regarding priorities and expectations and negotiating institutional structures such as feeding policies and staffing.     

Integrative Review of the Experiences of Registered Nurses Who Support Breastfeeding Women

ObjectiveTo describe the experiences of registered nurses (RNs) who support breastfeeding women and to understand the factors that they believe affect practices that support breastfeeding.Data SourcesWe conducted an online search using five databases: Scopus, MEDLINE, Cumulative Index of Nursing and Allied Health Literature (CINAHL), the Cochrane Database of Systematic Reviews, and Joanna Briggs Institute of Systematic Reviews.Study SelectionWe included original research articles on the experiences of RNs who support breastfeeding women that were published in 2009 or after and were available in English. After title and abstract review of 785 articles, we included 22 articles for full text review. Nine articles met the eligibility criteria and were included in the review.Data ExtractionWe used Whittemore and Knafl’s five-step framework and the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guidelines to guide this integrative review. Three authors reviewed and appraised the articles independently.Data SynthesisWe categorized the findings into three themes: Workplace Issues, Personal Experiences, and Breastfeeding Knowledge and Education. Workplace Issues included the subthemes Lack of Time and Workload and Infant Health Stability. Personal Experiences included the subthemes Attitudes, Individual Experiences With Breastfeeding, and The Experiences of Family and Friends. Breastfeeding Knowledge and Education included the subthemes Prelicensure Education and Workplace Education and Training. Most researchers identified deficits in knowledge and education among RNs. The concept of confidence was influenced by all the other themes. Participants in the included studies reported that they developed confidence after learning from lactation consultants and having role models who supported the development of their knowledge and skills.ConclusionDespite the heterogeneity among the studies, findings highlighted the need for an increased focus on the preparation of RNs to support women to effectively breastfeed within health care organizations. Multitargeted efforts, such as orientation programs and in-depth breastfeeding education using role modeling, mentorship, and role playing with practical scenarios, may improve RNs’ abilities and confidence to support breastfeeding women.     

Breastfeeding support in low and middle-income countries: Secondary analysis of national survey data

BackgroundEarly initiation of breastfeeding and exclusive breastfeeding can reduce infant mortality. Breastfeeding support interventions such as counselling may improve adherence to recommended practices. However, it is not known if these interventions work at the population level.ObjectiveThe aim of this study was to assess the relationship between early postnatal breastfeeding support and recommended breastfeeding practices.Design/settingWe pooled data from 11 Demographic and Health Surveys in Africa (n = 7), South East Asia (n = 2), the Americas (n = 1), and Europe (n = 1) to analyse these associations at the population level.ParticipantsWe limited the data to the most recent live births in the two years before the survey, including 41,431 births.AnalysisWe fitted three multivariable logistic regression models to estimate the relationship between early postnatal breastfeeding support (a newborn postnatal check within an hour of birth plus counselling and observation of breastfeeding within two days) and three breastfeeding outcomes (early initiation of breastfeeding, absence of prelacteal feeding, and exclusive breastfeeding), adjusting for sociodemographic characteristics and birth-related factors.FindingsEarly breastfeeding support was associated with a 24% increase (OR=1.24 95%CI=1.11,1.39) in the odds of initiating breastfeeding within one hour of birth. No relationships were found between breastfeeding support and prelacteal feeding in the first three days or exclusive breastfeeding at six months.Key conclusionWhile postnatal breastfeeding counselling and observation may improve early initiation of breastfeeding, impact is not persistent for longer term breastfeeding outcomes.Implication for practiceImproved training for breastfeeding support and an enabling policy environment are required to improve breastfeeding practices for women and newborns.     

Influence of the Quality of Antenatal Care on Early Breastfeeding Initiation and Exclusive Breastfeeding Among Haitian Women

ObjectiveTo assess the influence of the quality of antenatal care on early breastfeeding initiation and exclusive breastfeeding among Haitian women.DesignSecondary analysis of a cross-sectional household survey.SettingHaiti Demographic and Health Survey, 2016 to 2017.ParticipantsWomen (N = 2,489) who were 15 to 49 years of age with children younger than 24 months of age.MethodsWe used multivariable adjusted logistic regression analysis to examine the independent associations between quality of antenatal care and early breastfeeding initiation and exclusive breastfeeding.ResultsThe prevalence of early breastfeeding initiation and exclusive breastfeeding were 47.7% and 39.9%, respectively. Approximately 76.0% of the participants received intermediate antenatal care. The odds of early breastfeeding initiation were greater among participants who received antenatal care of intermediate quality than among those who did not receive antenatal care, adjusted OR (AOR) = 1.58, 95% confidence interval (CI) [1.13, 2.20]. Additionally, maternal age of 35 to 49 years (AOR = 1.53, 95% CI [1.10, 2.12]) was positively associated with early breastfeeding initiation. Factors negatively associated with early breastfeeding initiation were cesarean birth (AOR = 0.23, 95% CI [0.12, 0.42]), birth at home (AOR = 0.75, 95% CI [0.34, 0.96]), and birth in a private facility (AOR = 0.57, 95% CI [0.34, 0.96]). Factors negatively associated with exclusive breastfeeding were employment (AOR = 0.57, 95% CI [0.36, 0.90]) and birth in a private facility (AOR = 0.21, 95% CI [0.08, 0.52]).ConclusionAntenatal care of intermediate quality was positively associated with early breastfeeding initiation among women in Haiti, which highlights the influence that care during pregnancy can have on breastfeeding outcomes.