Sunny G. Hallowell

The Relationship of Brain Development and Breastfeeding in the Late-Preterm Infant

Late-preterm infants (34 0/7-36 6/7 weeks gestation) are physiologically and developmentally immature at birth. The relationship between brain development and feeding is important since adequate oral intake is imperative to prevent feeding-related morbidity and mortality associated with being late preterm. One third of brain growth occurs in the last 6-8 weeks of gestation. The ontogeny of coordinated oral feeding appears to follow a chronological, predictable pattern in preterm neonates. This suggests that neurodevelopmental maturation, rather than experience or learned behavior, is largely responsible for feeding behaviors. The aim of this article is to provide a review of the literature that establishes the relationship between brain development and feeding in the late-preterm infant.

Characteristics of the NICU Work Environment Associated With Breastfeeding Support

PURPOSE: The provision of breastfeeding support in the neonatal intensive care unit (NICU) may assist a mother to develop a milk supply for the NICU infant. Human milk offers unique benefits and its provision unique challenges in this highly vulnerable population. The provision of breastfeeding support in this setting has not been studied in a large, multihospital study. We describe the frequency of breastfeeding support provided by nurses and examined relationships between NICU nursing characteristics, the availability of a lactation consultant (LC), and breastfeeding support. SUBJECTS AND DESIGN: This was a secondary analysis of 2008 survey data from 6060 registered nurses in 104 NICUs nationally. Nurse managers provided data on LCs. These NICUs were members of the Vermont Oxford Network, a voluntary quality and safety collaborative. METHODS: Nurses reported on the infants (n = 15,233) they cared for on their last shift, including whether breastfeeding support was provided to parents. Breastfeeding support was measured as a percentage of infants on the unit. The denominator was all infants assigned to all nurse respondents on that NICU. The numerator was the number of infants that nurses reported providing breastfeeding support. Nurses also completed the Practice Environment Scale of the Nursing Work Index (PES-NWI), a nationally endorsed nursing care performance measure. The NICU nursing characteristics include the percentages of nurses with a BSN or higher degree and with 5 or more years of NICU experience, an acuity-adjusted staffing ratio, and PES-NWI subscale scores. Lactation consultant availability was measured as any/none and in full-time equivalent positions per 10 beds. RESULTS: The parents of 14% of infants received breastfeeding support from the nurse. Half of the NICUs had an LC. Multiple regression analysis showed a significant relationship between 2 measures of nurse staffing and breastfeeding support. A 1 SD higher acuity-adjusted staffing ratio was associated with a 2% increase in infants provided breastfeeding support. A 1 SD higher score on the Staffing and Resource Adequacy PES-NWI subscale was associated with a 2% increase in infants provided breastfeeding support. There was no association between other NICU nursing characteristics or LCs and nurse-provided breastfeeding support. CONCLUSIONS: Nurses provide breastfeeding support around the clock. On a typical shift, about 1 in 7 NICU infants receives breastfeeding support from a nurse. Lactation consultants are not routinely available in NICUs, and their presence does not influence whether nurses provide breastfeeding support. Better nurse staffing fosters nurse provision of breastfeeding support.

Higher Quality of Care and Patient Safety Associated With Better NICU Work Environments.

The objective of this study was to investigate the associations between the neonatal intensive care unit (NICU) work environment, quality of care, safety, and patient outcomes. A secondary analysis was conducted of responses of 1247 NICU staff nurses in 171 hospitals to a large nurse survey. Better work environments were associated with lower odds of nurses reporting poor quality, safety, and outcomes. Improving the work environment may be a promising strategy to achieve safer settings for at-risk newborns.

Human milk and breastfeeding: An intervention to mitigate toxic stress

The American Academy of Nursing has identified toxic stress in childhood as a health policy concern of high priority. Adult diseases (e.g., obesity, diabetes, hypertension and cardiovascular disease) should be viewed as developmental disorders that begin early in life that could be reduced with the alleviation of toxic stress in childhood. The provision of human milk/breastfeeding is an evidence-based intervention that may hold the greatest potential to mitigate the effects of toxic stress from the moment of birth. Assisting families to make an informed choice to initiate and continue breastfeeding from birth has the potential to address both the disparity in the quality of nutrition provided infants and the economic stress experienced by families who purchase formula. The Expert Panel on Breastfeeding endorses initiatives to improve the initiation, duration, and exclusivity of breastfeeding to mitigate the effects of toxic stress in this call to action for research to build the evidence to support these critical relationships.

Fostering Clinical Nurse Research in a Hospital Context.

Two components of the Magnet Recognition Program® are exemplary professional practice and the generation of new knowledge through research and clinical innovation. Within Magnet® institutions, exemplary professional practice is evidenced by collaboration. Hospitals and schools of nursing can develop collaborative relationships to promote a culture of inquiry in clinical care and generate research to advance nursing practice and nursing science. The authors describe a collaborative model between clinical nurses and an academic nursing research center that promotes involvement of clinical nurses in research.

The Use of Technologies to Support Human Milk & Breastfeeding

The application of lactation technologies is not limited to the NICU or the hospital setting. These technologies can be implemented within the home or hospital setting to promote the use of human milk and protect the breastfeeding relationship. Through the use of breast pumps, scales, and nipple shields, women can be supported to achieve their personal breastfeeding and lactation goals.

Strengthening Israel’s neonatal intensive care nursing workforce

Israel is experiencing a shortage of both physicians and nurses in a number of specialties, including neonatal intensive care. Inadequate hospital staffing and high patient demand contribute to the blurring of professional scope of practice boundaries between nurses and physicians. Striking similarities exist between the situation in Israel and the health services landscape in the United States more than three decades ago. This commentary explores changes related to nursing education, scope of practice legislation and hospital staffing learned through the U.S. experience that have the potential to inform health workforce changes in Israel through better nursing care.

Response to the Call to Action: A National Picture of Breastfeeding Support Provided in Neonatal Intensive Care

Paper Presentation Objective To measure the frequency of breastfeeding support by nurses and receipt of human milk by very low birth weight (VLBW) infants in the neonatal intensive care unit (NICU), which is not known and to determine if the numbers and qualifications of nurses, their professional practice environments, and the availability of lactation consultants increased the number of infants who received this care. Design Cross‐sectional, observational study. Setting One hundred four NICUs. Sample Participants included 6,060 nurse survey respondents, 15,233 infants who were card for by nurses on their last shifts worked, and 7,886 VLBW infants cared for in participating NICUs. Methods Secondary analysis was used to examine nurse survey data collected in 2008 from the parent study and infant hospitalization data from 104 NICUs in the Vermont Oxford Network (VON), an NICU quality collaborative. Analysis was conducted using bivariate and multiple general linear regression models. Results The majority (54%) were discharged on formula only. Few infants (6%) were discharged on exclusive human milk. The remaining infants (42%) received human milk mixed with fortifier or formula. Nurses reported providing breastfeeding support to one in five infants whose parents were present. Sixty percent of infants had parents present for part or the entire shift. Only half of the NICUs had a lactation consultant (51%). Significantly greater numbers of infants received breastfeeding support and human milk ( p Conclusion/Implications for Nursing Practice National health care agencies including the U.S. Surgeon General and American Academy of Pediatrics have described breastfeeding and human milk as the normative standard for infant feeding and nutrition. However, the country is falling far short of the Surgeon Generals recommendation for this high‐risk pediatric population. The findings suggest NICU nurses provide breastfeeding support around the clock, typically without a lactation consultant available. Our results demonstrate that nurses are essential to providing lactation care to NICU infants for whom the receipt of human milk is an issue of patient satisfaction, quality patient care, effectiveness, and survival.