Carrie-Ellen Briere

An integrative review of factors that influence breastfeeding duration for premature infants after NICU hospitalization.

OBJECTIVE To 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 SOURCES The 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 SELECTION Using 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 EXTRACTION Studies were reviewed for information related to factors associated with breastfeeding duration for high-risk mothers and preterm infants after NICU discharge home. DATA SYNTHESIS Studies 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. CONCLUSIONS Mothers 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.

State of the Science A Contemporary Review of Feeding Readiness in the Preterm Infant

Oral feeding readiness has been described by researchers in the neonatal intensive care unit, and research has continued on this topic for many years. The purpose of this narrative review is to identify research and practice guidelines related to oral feeding readiness in preterm infants that have occurred during the last decade. The introduction and mastery of oral feeding is a major developmental task for the preterm infant that is often a prerequisite for discharge from the neonatal intensive care unit. Having a better understanding of the evidence supporting the development of this skill will help the practicing nurse choose appropriate interventions and the researcher to develop trajectories of research that continue to increase our knowledge in this important practice area.

Establishing Breastfeeding with the Late Preterm Infant in the NICU

OBJECTIVE To describe challenges that late preterm infants (LPIs) face with breastfeeding and to provide an overview of current policy statements and practice guidelines that support breastfeeding for LPIs. In addition, we describe current breastfeeding research related to the LPI and combine this research with policies and practice guidelines to provide evidence-based recommendations to guide practice and future research in the NICU. DATA SOURCES Cumulative Index to Nursing and Allied Health Literature and PubMed databases. STUDY SELECTION Policies, guidelines, and research relevant to breastfeeding the LPI were selected if they were published between January 1, 2009 and March 1, 2014. All documents were published in English and related to breastfeeding management or breastfeeding outcomes for the LPI. DATA EXTRACTION Information from articles, policies, and guidelines were chosen for their relevance to breastfeeding the LPI. DATA SYNTHESIS Policy statements and practice guidelines were reviewed to provide an understanding of breastfeeding recommendations for the LPI. Additionally, recent research studies were reviewed and combined with the policy statements and practice guidelines to provide practice recommendations for NICU providers. CONCLUSIONS LPIs require a unique set of interventions for breastfeeding success; though they might be perceived as small, full-term infants, these infants often have greater challenges with breastfeeding than their term counterparts. Future research should be directed at identifying and testing specific strategies that will best support this at-risk population. Findings from this article are applicable for the LPI in the NICU as well as other care areas such as special care and transitional nurseries.

Direct-Breastfeeding Premature Infants in the Neonatal Intensive Care Unit

Background: The neonatal intensive care unit (NICU) presents challenges for breastfeeding, especially with feeding directly at the breast (direct-breastfeeding). Objectives: The objectives of this study were to describe the characteristics of direct-breastfeeding and identify factors that are associated with direct-breastfeeding in the NICU. Methods: A retrospective chart review of 88 infants born < 34 weeks gestational age whose mothers provided human milk was conducted. Analyses included chi-square and logistic regression models. Results: Of infants who received human milk at the time of their first oral feeding, 59% received their first oral feeding at breast and 33% of mothers had a specific breastfeeding goal. Mothers who breastfed ≥ 1 direct-breastfeed per day were more likely to have a breastfeeding goal (odds ratio [OR] = 11.13; 95% confidence interval [CI], 1.43-86.88) and be older (OR = 1.33; 95% CI, 1.03-1.72). Their infants had more days between the first breastfeed and introduction of a bottle (OR = 1.56; 95% CI, 1.11-2.17) and had shorter lengths of stay (OR = 0.9; 95% CI, 0.9-0.97). Mothers were more likely to provide direct-breastfeeding at discharge if they were non-Hispanic (OR = 0.05; 95% CI, < 0.01-0.60), were primiparous (OR = 0.06; 95% CI, 0.01-0.45), had a specific breastfeeding goal (OR = 13.79; 95% CI, 1.99-95.80), and their infant had a shorter length of stay (OR = 0.94; 95% CI, 0.90-0.98). Conclusion: Mothers should be supported to breastfeed before using bottles in the NICU. In addition, goal setting is important for prenatal care providers to discuss with all mothers early in pregnancy, especially those at high risk for premature delivery.

Direct-breastfeeding in the neonatal intensive care unit and breastfeeding duration for premature infants

AIM To explore the relationship between direct-breastfeeding in the neonatal intensive care unit (NICU) and breastfeeding duration after discharge. BACKGROUND Initiating and maintaining breastmilk feeding is an important goal that begins in the NICU. Little is known about direct-breastfeeding in the NICU and its relation to breastfeeding duration. METHODS Chart review of 46 infants (<32weeks gestational age or <1500 grams) whose mothers provided breastmilk. RESULTS One month after discharge, mothers still providing breastmilk were more likely to have provided ≥1 direct-breastfeed per day in the NICU (21.16, CI: 3.13-143.25, p<0.01) and had prior breastfeeding experience (OR: 9.16, CI: 1.02-82.34, p<0.05). At 4months, mothers still providing breastmilk were more likely to have provided ≥1 direct-breastfeed per day in the NICU (OR: 12.80, CI: 1.39-118.32, p<0.05). CONCLUSIONS Direct-breastfeeding in the NICU may play an essential role in preparing mothers for breastfeeding after discharge, thus potentially impacting breastfeeding duration.

Breastfed or bottle-fed: who goes home sooner?

A literature search was conducted to answer the clinical question, “Do premature infants who breastfeed have different oral feeding outcomes compared with those who receive bottles?” The CINAHL, PubMed, and PsycInfo databases were queried for articles published in the past 10 years that reported original research available in English. Two studies specifically addressed a comparison between infants who received exclusive direct breastfeeding, mixed direct breast and bottle, and/or exclusive bottle-feeding. Additional studies were included that addressed oral feeding outcomes specific to either direct breastfeeding (n = 2) or those that grouped bottle and breastfeeding together (n = 3). The findings from these studies indicate that the statement that bottle-feeding leads to sooner discharge is not based in evidence. Although more data are needed to fully understand the differences between direct breastfeeding and bottle-feeding, neonatal intensive care unit staff should be aware of the message they send to breastfeeding families when they encourage the use of bottles over direct breastfeeding.

Breast Milk Stem Cells: Current Science and Implications for Preterm Infants

Background:The benefits of breast milk are well described, yet the mechanistic details related to how breast milk protects against acute and chronic diseases and optimizes neurodevelopment remain largely unknown. Recently, breast milk was found to contain stem cells that are thought to be involved in infant development. Purpose:The purpose of this review was to synthesize all available research involving the characterization of breast milk stem cells to provide a basis of understanding for what is known and what still needs further exploration. Methods/Search Strategy:The literature search was conducted between August and October 2015 using the CINAHL, PubMed, and reference list searching. Nine studies addressed characterization of human breast milk stem cells. Findings/Results:Five research teams in 4 countries have published studies on breast milk stem cells. Current research has focused on characterizing stem cells in full-term breast milk. The amount, phenotype, and expression of breast milk stem cells are known to vary between mothers, and they have been able to differentiate into all 3 germ layers (expressing pluripotent characteristics). Implications for Practice:There is much to learn about breast milk stem cells. Given the potential impact of this research, healthcare professionals should be aware of their presence and ongoing research to determine benefits for infants. Implications for Research:Extensive research is needed to further characterize stem cells in breast milk (full-term and preterm), throughout the stages of lactation, and most importantly, their role in the health of infants, and potential for use in regenerative therapies.

Quality Improvement Initiative to Prevent Admission Hypothermia in Very-Low-Birth-Weight Newborns

Objective To decrease rates of admission hypothermia (<36 °C) in very‐low‐birth‐weight (VLBW) newborns (<1,500 g). Design Quality improvement initiative. Setting/Local Problem Urban, Level IV NICU with 32 patient beds. The number of VLBW newborns admitted with temperatures less than 36 °C was greater than in comparable NICUs in the Vermont Oxford Network. Participants Neonates born in 2016 who weighed less than 1,500 g at birth. Intervention/Measurements Based on the literature and the needs of our unit, our team decided to focus efforts on equipment (chemical mattresses and polyurethane‐lined hats for newborns who weighed <1,000 g and polyurethane‐lined hats for newborns who weighed <1,500 g), staff education/awareness, and temperature documentation and workflow. Axillary temperature measurements for all neonates who weighed less than 1,500 g were tracked on admission. Results The processes involved in this quality improvement initiative were successfully implemented, and use of new equipment began January 1, 2016. In 2016, only 9.6% (n = 7) of VLBW newborns were admitted with temperatures less than 36 °C, compared with 20.2% (n = 19) in 2015 and 32.4% (n = 24) in 2014 (p = .003). Overall, the mean admission temperature for neonates who weighed less than 1,500 g rose from 36.2 °C in 2014 to 36.6 °C in 2016 (p = .001). Conclusion We reduced the number of VLBW neonates admitted with temperatures less than 36 °C and increased overall admission temperatures for neonates who weighed less than 1,500 g with the addition of polyurethane‐lined hats and chemical mattresses.