Barbara L. Philipp

Vitamin D Deficiency in a Healthy Group of Mothers and Newborn Infants

Plasma 25-hydroxyvitamin D was measured in 40 healthy, mostly Black, mother-infant pairs. Although a majority of mothers received a daily prenatal multivitamin, vitamin D deficiency (<30 nmol/L), was found in 50% of mothers and 65% of their newborn infants, with a positive correlation between maternal and infant plasma 25-hydroxyvitamin D concentrations. Maternal vitamin D deficiency may represent an important risk factor for the development of rickets in children.

Breastfeeding Rates in US Baby-Friendly Hospitals: Results of a National Survey

Objectives. The objectives of this study were to analyze all available breastfeeding data from US Baby-Friendly hospitals in 2001 to determine whether breastfeeding rates at Baby-Friendly designated hospitals differed from average US national, regional, and state rates in the same year and to determine prime barriers to implementation of the Baby-Friendly Hospital Initiative. Methods. In 2001, 32 US hospitals had Baby-Friendly designation. Using a cross-sectional design with focused interviews, this study surveyed all 29 hospitals that retained that designation in 2003. Demographic data, breastfeeding rates, and information on barriers to becoming Baby-Friendly were also collected. Simple linear regression was used to assess factors associated with breastfeeding initiation. Results. Twenty-eight of 29 hospitals provided breastfeeding initiation rates: 2 from birth certificate data and 26 from the medical record. Sixteen provided in-hospital, exclusive breastfeeding rates. The mean breastfeeding initiation rate for the 28 Baby-Friendly hospitals in 2001 was 83.8%, compared with a US breastfeeding initiation rate of 69.5% in 2001. The mean rate of exclusive breastfeeding during the hospital stay (16 of 29 hospitals) was 78.4%, compared with a national mean of 46.3%. In simple linear regression analysis, breastfeeding rates were not associated with number of births per institution or with the proportion of black or low-income patients. Of the Ten Steps to Successful Breastfeeding the 3 described as most difficult to meet were Steps 6, 2, and 7. The reason cited for the problem with meeting Step 6 was the requirement that the hospital pay for infant formula. Conclusion. Baby-Friendly designated hospitals in the United States have elevated rates of breastfeeding initiation and exclusivity. Elevated rates persist regardless of demographic factors that are traditionally linked with low breastfeeding rates.

The baby-friendly hospital initiative increases breastfeeding rates in a US neonatal intensive care unit.

This study evaluated the impact of a Baby-Friendly designation on breastfeeding rates in a US neonatal intensive care unit (NICU). The medical records of all surviving infants directly admitted to the Boston Medical Centers level III, 15-bed NICU in 1995 (before Baby-Friendly policies were implemented) and 1999 (when Baby-Friendly status was granted) were reviewed. Infants receiving any breast milk by any means during the first week of enteral feeds were considered to have initiated breastfeeding. Maternal and infant demographics for 1995 and 1999 were comparable. The NICU breastfeeding initiation rate increased from 34.6% (1995) to 74.4% (1999) (P <.001). Among 2-week-old infants, the proportion receiving any breast milk rose from 27.9% (1995) to 65.9% (1999) (P <.001), and the proportion receiving breast milk exclusively rose from 9.3% (1995) to 39% (1999) (P = .002). The implementation of Baby-Friendly policies leading to a Baby-Friendly designation was associated with increased breastfeeding initiation and duration rates. J Hum Lact. 19(2):166-171.

Prevalence of bacteriuria in febrile children.

To determine the risk of urinary tract infections in acutely ill febrile children younger than 5 years of age we obtained a urine culture from 664 children presenting to our walk-in clinic with an acute febrile episode. Only 11 children (1.7%) had significant bacteriuria. This figure is similar to the number of children who would be expected to have asymptomatic bacteriuria. These results suggest that pediatricians are not missing the diagnosis of urinary tract infection in febrile children.

Breastfeeding rates among mothers of infants with neonatal abstinence syndrome.

BACKGROUND Woman who struggle with drug addiction during pregnancy are perhaps the most vulnerable of new mothers. The opioid substitution medications methadone and buprenorphine are both compatible with breastfeeding. The objective of this study is to determine breastfeeding rates among opioid-dependent women giving birth in a Baby-Friendly Hospital. METHODS We performed a retrospective chart review of all infants born at Boston Medical Center (Boston, MA) between July 2003 and January 2009 with a diagnosis of neonatal abstinence syndrome. Feeding information was obtained, as well as baseline medical information about the mother-infant pairs. Breastfeeding eligibility was determined by a negative urine toxicology screen on admission, no illicit drug use in the third trimester, and a negative human immunodeficiency virus status. RESULTS Two hundred seventy-six mother-infant pairs were identified. Forty percent of the mothers carried one or more psychiatric diagnoses; 24% were taking two or more psychiatric medications. Sixty-eight percent of the mothers were eligible to breastfeed; of those, 24% breastfed to some extent during their infants hospitalization. Sixty-percent of those who initiated stopped breastfeeding after an average of 5.88 days (SD 6.51). CONCLUSIONS Breastfeeding rates among opioid-dependent women were low, with three-quarters of those eligible electing not to breastfeed. Of the minority of women who did choose to breastfeed, more than half stopped within 1 week.

The relationship between maternal opioid agonists and psychiatric medications on length of hospitalization for neonatal abstinence syndrome.

Objective:To examine the relationship between maternal opioid agonists, methadone, or buprenorphine (BPH), and concurrent psychiatric medication use on length of hospitalization (LOS) among infants with neonatal abstinence syndrome (NAS). Methods:We reviewed the charts of infants born at Boston Medical Center between 2003 and 2009 with a diagnosis of NAS whose mothers were prescribed methadone or BPH for opiate addiction. Univariate and multivariate linear regression analyses were used to examine associations between maternal opioid substitution concurrent with psychiatric medication use and infant LOS. We also tested whether exposure to BPH was associated with a shorter hospitalization. Results:A total of 273 mother-infant pairs were identified. The average LOS for all infants was 22.9 days (SD: 10.9). In bivariate analyses, maternal use of any psychiatric medication was associated with a longer infant LOS (P < 0.005). Compared with those prescribed methadone alone (n = 158), those also taking benzodiazepines (n  = 56) had a 5.88-day longer LOS (95% confidence interval [CI]: 2.15–9.60, P = 0.002). Infants of mothers taking methadone plus an selective serotonin re-uptake inhibitor (n = 51) had a longer LOS (&bgr; = 4.47, 95% CI: 1.15–7.79) compared to methadone alone; results remained significant in an initial multivariate model, however the effect was attenuated when additional psychiatric medication use was added to the model. Compared with those exposed to methadone, those exposed to BPH (n = 22) had a significantly shorter LOS (ß = −7.35, CI: −0.18 to −14.52, P = 0.04). Conclusions:Maternal use of prescribed methadone and benzodiazepines, compared to methadone alone, increased LOS for infants with NAS by 6 days. Maternal use of BPH was associated with a shorter LOS.

Becoming Baby-Friendly: overcoming the issue of accepting free formula.

Although, in the current financial climate, paying for formula is a difficult step for US hospitals, demystifying the process helps. Actual formula costs may be lower than perceived costs because agreements with formula companies may list unnecessary or unused products and services. Fair market value is difficult to define, but by contacting other hospitals with Baby-Friendly status, those costs can be determined. While we do not recommend that other institutions forge ahead on the track to Baby-Friendly designation without considering the formula issue, we would encourage them to apply for the certificate of intent and begin work, even if it is not immediately clear how the hospital will pay for formula. Each of the Ten Steps takes the hospital along an important course, is never wasted effort, and increases the number of breastfeeding mothers (thereby reducing formula costs). Demonstrating a willingness to invest time and energy for the benefit of patients and the institution as a whole is valuable when requesting support for formula payment. Hospital administrators, who may make the final decision regarding formula payment, will be more willing to listen to breastfeeding advocates if they have already accomplished significant goals within the institution and have collected supporting data. The authors conclude that although for BMC not accepting free formula was the most difficult barrier to overcome on the path to Baby-Friendly designation, it was not insurmountable, and we hope other institutions will be helped by learning how we dealt with this problem.

Breastfeeding Information in Pediatric Textbooks Needs Improvement

The objective of this study is to determine if breastfeeding information in general pediatric textbooks used in the United States is accurate and up-to-date. Seven pediatric textbooks published between 1999 and 2002 were reviewed. Three reviewers examined breastfeeding content in each text independently. Using a standardized scoring sheet, each book was evaluated for inclusion of 15 basic breastfeeding criteria. Of the 15 criteria scored, the mean number present in each textbook was 11. The mean number of criteria that were correct was 7.6 (3.4 for incorrect or inconsistent criteria). The mean number of criteria omitted was 4. For each of the texts, the number of correct responses divided by the number of criteria present was 7/11 (64%), 11/14 (79%), 5/11 (45%), 9/11 (82%), 11/13 (85%), 8/9 (89%), and 2/8 (25%). Thus, breastfeeding information in these texts, when not omitted, is highly variable and at times inaccurate and inconsistent.

10 Years after Baby-Friendly Designation Breastfeeding Rates Continue to Increase in a US Neonatal Intensive Care Unit

Background: Mothers of preterm and sick infants admitted to the neonatal intensive care unit (NICU) often encounter more difficulties with breastfeeding than mothers of healthy term newborns. The extent to which Baby-Friendly designation is associated with breastfeeding rates for NICU infants over time is unknown. Objective: This study aimed to determine the rate of breastfeeding initiation and continuation in a US, inner-city, level 3 NICU 10 years after Baby-Friendly designation. Methods: We compared the rate of breastfeeding initiation and continuation among breastfeeding-eligible mothers with infants admitted to the Boston Medical Center NICU in 1999 and 2009, using chi-square tests. Results: Breastfeeding initiation increased from 74% in 1999 to 85% in 2009 (P = .04). Any breast milk at 2 weeks of age increased from 66% to 80% (P = .05), and exclusive breastfeeding at 2 weeks remained stable between 1999 and 2009. Breastfeeding initiation increased from 68% to 86% among black mothers from 1999 to 2009 (P = .01). Conclusion: Improvement in breastfeeding initiation and any breastfeeding at 2 weeks of age continued 10 years after Baby-Friendly designation among mothers with NICU infants in a US, inner-city, level 3 NICU.

Hospital Education in Lactation Practices (Project HELP): Does Clinician Education Affect Breastfeeding Initiation and Exclusivity in the Hospital?

BACKGROUND A womans decision to breastfeed may be influenced by her health care practitioners, but breastfeeding knowledge among clinicians is often lacking. Project HELP (Hospital Education in Lactation Practices) was an intensive education program designed to increase breastfeeding knowledge among health care practitioners. The purpose of this study was to determine whether educating practitioners affected breastfeeding initiation and exclusivity rates at hospitals with low breastfeeding rates. METHODS Between March 31, 2005, and April 24, 2006, we taught courses at four Massachusetts hospitals with low breastfeeding rates. Each course consisted of three, 4-hour teaching sessions and was offered nine times. The training, taught by public health professionals, perinatal clinicians, and peer counselors, covered a broad range of breastfeeding-related topics, from managing hyperbilirubinemia to providing culturally competent care. Medical records of infants born before and after the intervention were reviewed to determine demographics and infant feeding patterns. RESULTS Combining data from all hospitals, breastfeeding initiation increased postintervention from 58.5 to 64.7 percent (p = 0.02). An overall increase in exclusive breastfeeding rates was not statistically significant. In multivariate logistic regression for all hospitals combined, infants born postintervention were significantly more likely to initiate breastfeeding than infants born preintervention (adjusted OR 1.32, 95% CI 1.03-1.69). CONCLUSIONS Intensive breastfeeding education for health care practitioners can increase breastfeeding initiation rates.