Ruth Lucas

Furthering our understanding of the needs of mothers who are pumping breast milk for infants in the NICU: an integrative review.

The purpose of this integrative review was to uncover information regarding emotional and other types of support required by mothers providing breast milk for infants in the neonatal intensive care unit (NICU). These high-risk infants are often unable to directly breastfeed and, thus, mothers need to pump their breast milk for weeks to months, which can be both a pleasing experience that increases satisfaction and infant involvement, while at the same time being an uncomfortable and tiring endeavor. Understanding this notion is important because pumping at least 8 times each day is central to increasing or maintaining breast milk production. Articles were gathered using PubMed and CINAHL databases. Forty-four sources were chosen for inclusion in this review. Search terms included “breastfeeding,” “pumping,” “neonatal intensive care unit,” “emotional support,” and “breast milk.” We identified that the emotional and practical support for NICU mothers is different from those of other breastfeeding mothers, especially around the development of early bonding behaviors. These mothers require significant ongoing emotional support from healthcare professionals and their partners and peers. Healthcare providers need to monitor breast milk production and provide educated encouragement that anticipates breastfeeding challenges, especially when the mother is pumping for an extended period of time while their infant is maturing in the NICU. Effective providers support may be best provided by selectively bundling interventions to support pumping initiation and transition to direct breastfeeding.

Establishing Breastfeeding with the Late Preterm Infant in the NICU

OBJECTIVEnTo 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.nnnDATA SOURCESnCumulative Index to Nursing and Allied Health Literature and PubMed databases.nnnSTUDY SELECTIONnPolicies, 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.nnnDATA EXTRACTIONnInformation from articles, policies, and guidelines were chosen for their relevance to breastfeeding the LPI.nnnDATA SYNTHESISnPolicy 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.nnnCONCLUSIONSnLPIs 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.

When is it safe to initiate breastfeeding for preterm infants

Background:Breast milk is the gold standard of nutrition for preterm infants. Yet, initiation of direct breastfeeding before 32 weeks postconceptional age (PCA) is not common practice in many neonatal intensive care units (NICUs). Our clinical question was, “In preterm infants, when is it safe to initiate breastfeeding in infants <32 weeks PCA receiving enteral feedings?” Search Strategy:A review of the literature was compiled between February 2013 and January 2015 by using the following databases: CINAHL, Cochrane Systematic Review, Scopus, and PubMed. Articles found were written in English and published after 1985. Key words were utilized during searches and references were hand checked. Results:Our review reveled that stable preterm infants maintain their physiological status during exposure to the breast as early as 27 to 28 weeks PCA. Several studies demonstrated infants during breastfeeding compared with bottle-feeding experienced minimal variation in oxygen saturation and heart rate during feeding. Some infants exposed to the breast before 30 weeks PCA were exclusively breastfeeding (direct breastfeeding and breast milk) at 32.8 weeks PCA. Skin-to-skin mother–infant contact is crucial to the successful transition to direct breastfeeding. Implications for Practice and Research:The transition from enteral feedings to direct, exclusive breastfeeding should involve frequent mother–infant skin-to-skin contact requiring support and guidance from the NICU staff. Future research should involve creating standard protocols within NICUs to facilitate breastfeeding transition and exploring barriers that may prevent the preterm infant from achieving direct, exclusive breastfeeding.

A Case Study of a Late Preterm Infant’s Transition to Full At-Breast Feedings at 4 Months of Age

Breast milk intake is recommended for late preterm infants. Many mothers provide expressed breast milk during hospitalization and anticipate transitioning their late preterm infant to full feedings at-breast after discharge. However, some infants take months to transition to full feedings at-breast. This article describes the case of a mother and her 35-week infant who transitioned to full feeding at-breast at 4 months after discharge. The clinical strategies to maintain maternal milk supply, use of hospital-grade scale, and importance of professional and community lactation support are discussed.

Evaluating sucking maturation using two pressure thresholds

BACKGROUNDnThe Medoff-Cooper Nutritive Sucking Apparatus (M-CNSA) has been used to objectively measure sucking maturation in preterm infants. The M-CNSA is able to accurately detect sucking pressures less than 20mmHg, however lower pressure thresholds have not previously been used in research.nnnAIMSnTo determine if differences are observed in the number of sucks and maturation in the number of sucks over time when the minimum pressure threshold used to detect a suck is 7mmHg compared to 20mmHg using the M-CNSA.nnnSTUDY DESIGNnDescriptive.nnnSUBJECTSnA convenience sample of 171 healthy premature infants born between 29 and 34weeks gestational period who were part of a larger randomized controlled study.nnnOUTCOME MEASURESnThe number of sucks detected during weekly five-minute oral feeding observations using 7mmHg and 20mmHg.nnnRESULTSnSignificantly more sucks were detected using the 7mmHg vs 20mmHg threshold at all time points. At both pressure thresholds, the mean number of sucks detected during the five minute feeding observation increased over time. The difference in the number of sucks detected at 7 and 20mmHg did not change over time (p=0.50).nnnCONCLUSIONSnUsing the lower threshold of 7mmHg compared to 20mmHg resulted in more sucks detected while consistently measuring improvement in sucking over time. Detection of more sucks and sucks at a lower pressure threshold allows clinicians and researchers to more accurately assess oral feeding skills among premature infants.

Effect of Maternal Body Mass Index on Infant Breastfeeding Behaviors and Exclusive Direct Breastfeeding

OBJECTIVEnTo describe the effect of maternal body mass index (BMI) on infant breastfeeding behaviors (poor, steady, vigorous) and the transition of the mother-infant dyad to exclusive, direct breastfeeding during the first month of life.nnnDESIGNnLongitudinal descriptive investigation.nnnSETTINGnTertiary-level southeastern medical center and follow-up telephone calls.nnnPARTICIPANTSnOne hundred sixteen healthy, racially diverse, breastfeeding mother-infant dyads (77 full-term and 39 late-preterm infants).nnnMAIN OUTCOME MEASURE(S)nBreastfeeding outcomes were classified as exclusive direct or partially breastfed. The effect of maternal BMI was compared to results from weekly mothers reports of infant breastfeeding behaviors.nnnRESULTSnSignificant breastfeeding differences were observed based on maternal BMI and infant gestational age. Mothers with BMIs greater than 25 who described their infants as a vigorous breastfeeders were less likely to exclusively direct breastfeed (p < .002). Only 40% of mother-infant dyads had exclusive direct breastfeeding at any time point or gestational age with no significant increase at any time point after discharge. The BMIs of the woman made no difference in exclusive direct breastfeeding full-term infants compared to late-preterm infants.nnnCONCLUSIONnMaternal BMI had limited negative influence on exclusive direct breastfeeding during the first 4 weeks after discharge. Mothers should be educated that many infants need 3 to 4 weeks after discharge to learn how to breastfeed, infant feeding demands change during this time, and this time is important to the infants neurologic and overall development.

In Focus CNE Post TestEffect of Maternal Body Mass Index on Infant Breastfeeding Behaviors and Exclusive Direct Breastfeeding

Objective: To describe the effect of maternal body mass index (BMI) on infant breastfeeding behaviors (poor, steady, vigorous) and the transition of the mother-infant dyad to exclusive, direct breastfeeding during the first month of life. Design: Longitudinal descriptive investigation. Setting: Tertiary-level southeastern medical center and follow-up telephone calls. Participants: One hundred sixteen healthy, racially diverse, breastfeeding mother-infant dyads (77 full-term and 39 late-preterm infants). Main Outcome Measure(s): Breastfeeding outcomes were classified as exclusive direct or partially breastfed. The effect of maternal BMI was compared to results from weekly mother’s reports of infant breastfeeding behaviors. Results: Significant breastfeeding differences were observed based on maternal BMI and infant gestational age. Mothers with BMIs greater than 25 who described their infants as a vigorous breastfeeders were less likely to exclusively direct breastfeed (p < .002). Only 40% of mother-infant dyads had exclusive direct breastfeeding at any time point or gestational age with no significant increase at any time point after discharge. The BMIs of the woman made no difference in exclusive direct breastfeeding full-term infants compared to late-preterm infants.