Ann Kellams

Evaluation of an Office Protocol to Increase Exclusivity of Breastfeeding

OBJECTIVE: The purpose of this study was to determine whether implementing a program based on a clinical protocol affects breastfeeding rates within a pediatric primary care setting. Increasing breastfeeding rates is an important public health initiative identified by multiple agencies. METHODS: The Academy of Breastfeeding Medicine (ABM) clinical protocol (“The Breastfeeding-Friendly Physician’s Office, Part 1: Optimizing Care for Infants and Children”) was used as a template for the provision of breastfeeding services within a pediatric primary care clinic. There were 757 mother–infant pairs included in the study. A retrospective before-and-after study design was used. Data collection points included the hospital stay, the newborn visit, and the 2-, 4-, and 6-month health maintenance visits. The 2 groups were compared to estimate the protocol’s effectiveness as a method of increasing breastfeeding rates. RESULTS: The results of this evaluation were positive for exclusive breastfeeding, with group comparisons showing a statistically significant increase in exclusive breastfeeding rates at all 5 time points. CONCLUSIONS: Our diverse patient population within a pediatric practice had increased initiation rates and exclusive breastfeeding rates after implementation of the ABM’s breastfeeding-friendly protocol. Families who receive care in a pediatric primary care setting that has implemented the ABM clinical protocol may have increased rates of exclusive breastfeeding.

ABM Clinical Protocol #3: Supplementary Feedings in the Healthy Term Breastfed Neonate, Revised 2017

A central goal of The Academy of Breastfeeding Medicine is the development of clinical protocols for managing common medical problems that may impact breastfeeding success. These protocols serve only as guidelines for the care of breastfeeding mothers and infants and do not delineate an exclusive course of treatment or serve as standards of medical care. Variations in treatment may be appropriate according to the needs of an individual patient.

The Impact of a Prenatal Education Video on Rates of Breastfeeding Initiation and Exclusivity during the Newborn Hospital Stay in a Low-income Population

Background: Guidelines recommend prenatal education to improve breastfeeding rates; however, effective educational interventions targeted at low-income, minority populations are needed as they remain less likely to breastfeed. Objective: To determine whether a low-cost prenatal education video improves hospital rates of breastfeeding initiation and exclusivity in a low-income population. Methods: A total of 522 low-income women were randomized during a prenatal care visit occurring in the third trimester to view an educational video on either breastfeeding or prenatal nutrition and exercise. Using multivariable analyses, breastfeeding initiation rates and exclusivity during the hospital stay were compared. Results: Exposure to the intervention did not affect breastfeeding initiation rates or duration during the hospital stay. The lack of an effect on breastfeeding initiation persisted even after controlling for partner, parent, or other living at home and infant complications (adjusted odds ratio [OR] = 1.05, 95% CI, 0.70-1.56). In addition, breastfeeding exclusivity rates during the hospital stay did not differ between the groups (P = .87). Conclusion: This study suggests that an educational breastfeeding video alone is ineffective in improving the hospital breastfeeding practices of low-income women. Increasing breastfeeding rates in this at-risk population likely requires a multipronged effort begun early in pregnancy or preconception.

The Effect of Nursing Quality Improvement and Mobile Health Interventions on Infant Sleep Practices: A Randomized Clinical Trial.

Importance Inadequate adherence to recommendations known to reduce the risk of sudden unexpected infant death has contributed to a slowing in the decline of these deaths. Objective To assess the effectiveness of 2 interventions separately and combined to promote infant safe sleep practices compared with control interventions. Design, Setting, and Participants Four-group cluster randomized clinical trial of mothers of healthy term newborns who were recruited between March 2015 and May 2016 at 16 US hospitals with more than 100 births annually. Data collection ended in October 2016. Interventions All participants were beneficiaries of a nursing quality improvement campaign in infant safe sleep practices (intervention) or breastfeeding (control), and then received a 60-day mobile health program, in which mothers received frequent emails or text messages containing short videos with educational content about infant safe sleep practices (intervention) or breastfeeding (control) and queries about infant care practices. Main Outcomes and Measures The primary outcome was maternal self-reported adherence to 4 infant safe sleep practices of sleep position (supine), sleep location (room sharing without bed sharing), soft bedding use (none), and pacifier use (any); data were collected by maternal survey when the infant was aged 60 to 240 days. Results Of the 1600 mothers who were randomized to 1 of 4 groups (400 per group), 1263 completed the survey (78.9%). The mean (SD) maternal age was 28.1 years (5.8 years) and 32.8% of respondents were non-Hispanic white, 32.3% Hispanic, 27.2% non-Hispanic black, and 7.7% other race/ethnicity. The mean (SD) infant age was 11.2 weeks (4.4 weeks) and 51.2% were female. In the adjusted analyses, mothers receiving the safe sleep mobile health intervention had higher prevalence of placing their infants supine compared with mothers receiving the control mobile health intervention (89.1% vs 80.2%, respectively; adjusted risk difference, 8.9% [95% CI, 5.3%-11.7%]), room sharing without bed sharing (82.8% vs 70.4%; adjusted risk difference, 12.4% [95% CI, 9.3%-15.1%]), no soft bedding use (79.4% vs 67.6%; adjusted risk difference, 11.8% [95% CI, 8.1%-15.2%]), and any pacifier use (68.5% vs 59.8%; adjusted risk difference, 8.7% [95% CI, 3.9%-13.1%]). The independent effect of the nursing quality improvement intervention was not significant for all outcomes. Interactions between the 2 interventions were only significant for the supine sleep position. Conclusions and Relevance Among mothers of healthy term newborns, a mobile health intervention, but not a nursing quality improvement intervention, improved adherence to infant safe sleep practices compared with control interventions. Whether widespread implementation is feasible or if it reduces sudden and unexpected infant death rates remains to be studied. Trial Registration clinicaltrials.gov Identifier: NCT01713868

TodaysBaby Quality Improvement: Safe Sleep Teaching and Role Modeling in 8 US Maternity Units

A multicenter safe sleep QI campaign in 8 US maternity units to teach and role model safe sleep practices during the newborn hospital stay. BACKGROUND AND OBJECTIVES: Nursing education and role modeling can increase adherence to safe sleep practices. Eight US hospital maternity units with variable baseline approaches to education participated in a national multicenter nursing quality improvement (QI) intervention to promote safe sleep practices. The goals at participating maternity units were to (1) increase the rate of mothers who reported receiving safe sleep information from nurses to ≥90% and (2) increase the rates of infants observed sleeping supine in a safe environment to ≥90%. METHODS: A safe sleep QI toolkit, designed for and provided to all sites, included an educational curriculum and tools to use for staff and parent education. Local teams implemented safe sleep education using the tools as plan-do-study-act cycles. After each cycle, audits assessing maternal report of nursing education on safe sleep and inpatient infant sleep position and environment were performed. RESULTS: The QI interventions lasted a median of 160 days (range, 101–273). Mothers reported receiving information on 4 primary safe sleep topics 72% to 95% of the time (a 24%–57% increase over the baseline). Additionally, 93% of infants were observed in a supine sleep position, and 88% of infants were observed in a safe sleep environment (a 24% and 33% increase over baseline, respectively). These rates were sustained up to 12 months later. CONCLUSIONS: Implementation of a multisite QI intervention for safe sleep parenting education and role modeling led to increased knowledge of and compliance with safe sleep practices during postpartum hospitalization.

Current Scope of Practice for Newborn Care in Non-Intensive Hospital Settings

The scope of practice for newborn care in nonintensive hospital settings is ever changing, with obstetric care advances, shorter length of stay (LOS), and increased family-centered care.[1][1] In response to the US Surgeon General’s call to support breastfeeding and Baby Friendly USA, more infants

Prevalence of Baby Bottle Versus Breastfeeding Graphics on Products in National Chain Stores

OBJECTIVE This study surveyed the prevalence of bottle versus breastfeeding graphic images on products marketed for pregnant mothers and young children available for purchase in national chain stores. STUDY DESIGN AND METHODS This was a product survey/content analysis. Eighteen national chain stores located in a 10-mile radius of Charlottesville, VA were visited. In total, 2,670 individual items in 11 categories of baby shower and baby gift merchandise (shower invitations, greeting cards, gift wrap, shower decorations, baby dolls, baby books, infant clothing, bibs, nursery decorations, baby blankets, and disposable diapers) were assessed. The main outcome measures were prevalences of baby bottle and breastfeeding graphic images. RESULTS Baby bottle images were found on products in eight of the 11 categories of items surveyed. Thirty-five percent of baby dolls were marketed with a baby bottle. The prevalence of bottle images on items in all other categories, however, was low. Of the 2,670 items surveyed, none contained a breastfeeding image. CONCLUSIONS The low prevalence of baby bottle images on commonly purchased baby gift and baby shower items is encouraging. However, the absence of breastfeeding images and the relatively high prevalence of baby dolls marketed with a baby bottle demonstrate that breastfeeding is not portrayed as the physiologic norm on these products. Product designers should explore ways to promote breastfeeding, consumers should make informed choices in product selection, and advocacy groups should promote guidelines for these products.

Mobile Health (mHealth) Interventions to Promote Safe Sleep

JOGNN 2018; Vol. 47, Supplem Results Groups were equivalent, with a mean age of 30 years; in addition, most participants were White, married, planned to breastfeed, and had a spontaneous vaginal delivery. The postintervention versus preintervention group had a statistically significant increase in the proportion of mothers agreeing with the statement, “Nurses helped me prepare for breastfeeding” (94% vs. 81%, p 1⁄4 .03). Seventy-five percent of mothers from both groups were comfortable during breastfeeding. Significantly fewer babies in the

BAP: Testing of a Breastfeeding History Questionnaire to Identify Mothers at Risk for Postpartum Formula Supplementation

Background: The objective of this study was to test a breastfeeding history questionnaire to predict inhospital formula supplementation. Methods: A breastfeeding questionnaire named BAP, an abbreviation based on three questions, was conceptualized and implemented in clinical practice. Primary outcome was formula supplementation during the postpartum hospital stay. Results: Multiparous women with BAP scores of 1 or less were over four times more likely to use formula during the postpartum hospital stay than women with BAP scores of 2 or greater (RR = 4.35, 95% CI [2.47, 7.65]; p < .001). Additionally, multiparous mothers with BAP scores of 1 or less were more likely to use formula than primiparous mothers (RR = 1.93, 95% CI [1.47, 2.52]; p < .001). The adjusted odds of formula use were eight times greater for women with the lower BAP score (aOR 8.04, 95% CI [3.10, 20.86]; p < .001). Conclusions: The BAP tool can be used to identify multiparous women most at risk for early formula use, thereby allowing targeted referral to breastfeeding support services.

Serratia marcescens Colonization Causing Pink Breast Milk and Pink Diapers: A Case Report and Literature Review

INTRODUCTION Serratia marcescens is an opportunistic pathogen and common cause of infectious outbreaks in pediatric units, leading to both significant morbidity and mortality in immunocompromised hosts. Environmental and some clinical strains may produce a characteristic red pigment, prodigiosin. Colonization can hence turn breast milk and fecally-soiled diapers pink, which can lead otherwise unaffected patients to present to their physicians and also interrupt breastfeeding. No clear guidance exists regarding the outpatient management of breastfeeding mothers and infants colonized with S. marcescens. METHODS Our aim was to understand the significance of pigment-producing S. marcescens colonization of breast milk and stools in healthy infants in the community setting. We describe the case of a healthy 9-week-old infant presenting with pink soiled diapers secondary to S. marcescens colonization and systematically review previously reported cases of infants diagnosed with pink diapers or milk published in PubMed between 1958 and 2017. RESULTS Six publications describing seven additional mother-infant cases were selected for inclusion. In all, 8 mother-infant groups of colonization were reviewed, involving 10 infants (there were 2 sets of twins). Good clinical outcomes were reported in all cases regardless of whether antibiotic treatment was prescribed. CONCLUSION Providers evaluating mother-infant dyads with S. marcescens colonization causing pink milk or pink infant soiled diapers should assess for manifestations of systemic infection. In the absence of evidence of clinical infection, expectant management is appropriate and continued breastfeeding can be supported.