| Abstracts for ILCA's 2004
Research
Session |
Research Posters
Effect of NICU-based Peer Counselors on Breastfeeding Duration
among Premature Infants
Laura Beth Chamberlain, BA; Anne Merewood, MA, IBCLC; Barbara
L. Philipp, MD, IBCLC; Kirsten L. Malone, BA; John T. Cook,
PhD; Howard Bauchner, MD
Boston Medical Center, Boston, MA, USA
Abstract
Background: US breastfeeding rates among minorities and women
of low SES are low. Among premature infants, the benefits of
human milk are particularly crucial. Peer counseling programs
have been shown to increase breastfeeding duration among term
infants from underprivileged groups. Aim: To determine whether
peers impact breastfeeding duration in the Neonatal Intensive
Care Unit (NICU). Subjects: Postpartum mothers, with premature
singleton infants in the NICU, who intended to breastfeed.
Methods: Subjects were randomized to intervention (IG) or
control (CG) group. IG received breastfeeding peer support
within 72 hours of birth and weekly for 6 weeks. CG received
standard BMC NICU care. A research assistant blind to group
allocation assessed feeding status at 2, 4, 8, and 12 weeks.
Results: 38 mother/infant pairs were randomized to IG and 38
to CG. The groups were similar in important demographic and
social variables. In bivariate analyses of subgroup data, IG
mothers were significantly more likely than CG mothers to feed
any amount of breast milk at 4 (P=.01) and 8 (P=.03) weeks. At
4 weeks 97% of IG were feeding any amount of breast milk
compared with 77% of CG. In bivariate analyses of data pooled
from all contact points, IG mothers were significantly more
likely to offer breastmilk (P<.001). Moreover, in random
effects multi-level logistic regression models, IG mothers had
odds of breastfeeding 5.3 times as great as CG mothers at any
contact point. Conclusions: This study, the first of its kind
using an experimental design, indicates that NICU-based peer
counselors positively impact breastfeeding duration rates in
premature infants.
Breast Friends, A Comprehensive Breastfeeding Resource Guide
for King County, Washington: Does finding resources make a
difference in breastfeeding continuation rates?
Judy S. Norman, RN, BSN, MNc, MPHc, IBCLC; Kay Batt, BA, IBCLC;
Denise Stuart, BSN, IBCLC
University of Washington Hospital; La Leche League, King
County, WA; Valley Medical Center, Renton, WA, USA
Abstract
"Breast Friends," is a comprehensive guide of breastfeeding
resources in King County, Washington. Prior to its
publication, knowledge of public and private sources of
support in King County was scattered and often missed by both
lactating women and their health care providers. Access to
services and support during the early days post birth is
important in helping women successfully continue breastfeeding
for a longer period of time. To provide this type of
assistance to breastfeeding families within King County, a
volunteer team of lactation professionals belonging to the
South King County Breastfeeding Coalition canvassed community
resources and located all known available supportive services.
Resources and providers were included as "Breast Friends" if
their services were in accord with the WHO/UNICEF
International Code of Marketing of Breast-milk Substitutes.
"Breast Friends" exists as a 60 page booklet in English and
also has a Spanish section and is on the web at
www.breast-friends.org. This presentation describes a study of
potential users of the "Breast Friends" guide. Study
participants were 113 pregnant women enrolled in childbirth
classes at an urban medical center. They received "Breast
Friends" during their first class and completed pre- and
post-birth questionnaires about their intention to breastfeed,
anticipated sources of support for breastfeeding (pre-birth),
actual breastfeeding practices, actual sources of positive and
negative support, and their opinion of the "Breast Friends"
materials (post-birth). Results of this study suggest ways
that hospital and community-based services can play a strong
role in helping promote and sustain breastfeeding in the
newborn period.
Treating Postpartum Breast Edema with Areolar Compression
Voni J. Miller, RN. IBCLC; Janice Riordan, EdD, RN, IBCLC
NICU, Phoenix Children's Hospital, Phoenix, AZ, USA;
Education, Wichita State University, Wichita, KS, USA
Abstract
The case study describes an occurrence of gross edema in the
breast and areolar tissue of a mother in the first two days
postpartum that interfered with the early initiation of
breastfeeding. The mother developed severe generalized fluid
retention during labor and early post partum. Her breasts were
naturally large. The edema in her breasts made the areola and
nipple tissue firm and non-pliable. The mother successfully
latched her newborn onto her breast after being shown Areolar
Compression, a technique developed and named by the authors.
Areolar Compression reduces nipple and areola edema by using
gentle positive pressure on the areola. The baby continued to
successfully latch onto the breast after Areolar Compression
was used and taught to the mother. Recognizing and knowing how
to assist a mother with postpartum areolar edema, the nurse or
lactation consultant may enable earlier successful
breastfeeding for women with this condition.
Breast Reduction Surgery and Breastfeeding
Sue Hermann, RN, IBCLC, PNC©
Sunnybrook and Women's College Health Sciences Centre,
Toronto, ON, Canada
Abstract
Background: Women have breast reduction surgery for a number
of reasons including decreased self image and discomfort from
large breast size. It is not uncommon for women to have this
surgery in their childbearing years before they are able to
realize the impact this surgery may have on how they can feed
their infants. Breast reduction surgery has been observed to
negatively affect milk supply in lactating women. Aim: The aim
of this study was to describe the outcomes of women who
experienced breast reduction surgery and were breastsfeeding.
Participants: Records comprising part of the breastfeeding
clinic database were reviewed for the last 3 ˝ years, to
identify women with a history of breast reduction surgery
being followed for their care at the breastfeeding clinic.
Data was collected including age of mothers at the clinic
visit, approximate age of mothers at the time of surgery, if
mothers were able to exclusively breastfeed their infants or
if supplementation was required, and the details of their
breastfeeding plan. Methods: Data was collected
retrospectively after the mother's visits to the breastfeeding
clinic including, age of mother, parity, previous
breastfeeding experience, milk supply and breastfeeding plan.
Results: Results will be presented at the conference.
Breastfeeding Patterns in a Predominantly Hispanic WIC
Population
Zulma O. Vargas, MPH, RD, IBCLC; J. Sue Myers, PHD, APN, RN
Department of Human Services, Arlington County, Alexandria,
VA; Massachusetts General Hospital Institutes of Health,
Charlestown, MA, USA
Abstract
A nine-year longitudinal retrospective descriptive survey was
completed to evaluate breastfeeding patterns in a largely
Hispanic group of low income mothers (n= 982) , living in the
U.S. and receiving Women Infant and Children (WIC) services.
Each mother received on-going support from a bilingual peer
counselor by occasional home visits, regular phone calls or
contacts at the WIC Baby Clinic or hospital outpatient clinic.
Typical reasons for cessation of breast feeding from less than
1 month to over 6 months were: 1) "I don't have enough milk";
2) baby not interested; 3) mom returns to work or school.
Mothers who breast fed for less than one month constituted
20.6% of the study population in 1993, compared to 8.6% in
2001. During the same time, 49.2% of mothers breast fed for
six months or longer in 1993 and increased to 59.5% in the
year 2001. These study results are further noteworthy because
Hispanic women (Mexican, Mexican American, Puerto Rican)
traditionally have shown low rates of initiation and duration
of breastfeeding, yet the study population of Hispanic women
(mostly Central and South American) had a comparatively high
rate of breastfeeding initiation and duration, which was
evident at the beginning of the study and significantly
increased in 2001, when the survey period was completed. These
findings suggest that the Hispanic community is quite diverse
and breastfeeding rates found in one group are not necessarily
a reflection of the breastfeeding rates of another.
Conducting a Randomized Clinical Trial (RCT) with an
Underserved Population of Mothers with Very Low Birthweight (VLBW;
<1500g) Infants
Judy E. Motykowski, RN, BSN; Paula P. Meier, RN, DNSc, FAAN;
Janet L. Engstrom, RN, PhD, CNM; Joyce L. Zuleger, RN, BSN
Women and Children's Nursing, Rush University Medical Center,
Chicago, IL; Rush University Medical Center, Chicago, IL;
Maternal-Child Nursing, University of Illinois at Chicago,
Chicago, IL, USA
Abstract
In the US, African American and low-income (LI; SSI,
WIC-eligible) women are significantly less likely to initiate
and sustain breastfeeding than are Caucasian and more affluent
women. This health discrepancy has special implications for
mothers of VLBW infants, who are 3 times more likely to be
African American and twice as likely to be LI. Although
several studies have focused on improving lactation outcomes
for mothers of VLBW infants, no previous RCTs have included a
representative sample of these women as research subjects. The
purpose of this presentation is to describe the conduct of a
RCT in which the sample demographics reflect women who deliver
VLBW infants--rather than those who typically choose to
breastfeed. In this RCT, which compared the comfort and
effectivness of 3 milk expression patterns using the Symphony
breast pump (Medela, Inc.), mothers: 1) maintained detailed
milk volume records for the right and left breasts separately
for several weeks; 2) collected 1-ml milk samples separately
from the right and left breasts before and after each pumping
for a 24-hour baseline period; and 3) used the Symphony breast
pump in the NICU at the same time for 6 out of 9 days, while
the investigator measured outcome variables.Of the 35 women
who completed this demanding protocol, 46% did not plan to
provide milk for their VLBW infants at the time of delivery,
but changed their decision and consented to the RCT within 48
hours post-birth. Of the mothers, 40%, 40%, and 20%,
respectively, were African American, Caucasian, and
Latina/other, and 48.6% were LI. There were no missing data
points for the 35 mothers, a combined testatment to the
women's protocol compliance and investigator strategies. Our
presentation will focus on the types of investigator supports,
followup, and study incentives that are necessary for
conducting research with an underserved population.
The Relationship between Type of First Oral Feeding (Breast vs
Bottle), and Pre and Post Discharge Breastfeeding among
infants in a Neonatal Intensive Care
Chris Elinor Auer, BSN, IBCLC; Jamison Fargo, MA; Jean
Steichen, MD
Lactation, Univeristy Hospital, Inc., Cincinnati, OH;
Univeristy of Cincinnati, Cincinnati, OH; Pediatrics,
Univeristy Hospital, Inc., Cincinnati, OH, USA
Abstract
Purpose: To determine whether there is a predictive
relationship between initial oral feeding, pre-discharge
breastfeeding status, and post-discharge breastfeeding status.
Design: Cohort study.
Sample: 181 infants admitted into a level three NICU. Main
Outcome Variable: Quality Assurance data was collected on
whether the first oral feeding was initiated by breast or
bottle and if the baby was breastfeeding prior to discharge or
after discharge. Information on gestational age, birth weight,
and insurance was collected as well. Methods: Regression
analysis was used to analyze the impact of first feeding and
pre-discharge breastfeeding on post-discharge breastfeeding
status. Results: When the breast was offered first, infants
were nearly 3 times more likely to still be breastfeeding in
the week before discharge (p < .02). If infants were
breastfeeding in the week prior to discharge, they were over
18 times more likely to still be breastfeeding in the first
week home (p < .0001). Conclusion: Staff may impact
breastfeeding duration by making every effort to protect the
first oral feeding at the breast and promote frequent
breastfeeding prior to discharge.
Comparison of Full Enteral Feeding and Weight Gain Between
Breast Milk Feeding and Combined Feeding (breast milk feeding
plus premature formula milk) in Premature Infants
Park sun ja, head nurse
Nursery, Asan medical center, Seoul, Democratic People's
Republic of Korea
Abstract
While the advantages of breast milk feeding are well
documented, the efficiancy of human milk in high risk
premature infants who cannot suck directly from the breast has
been studied to a limited extent. One of the important
benefits of breast milk feeding in premature infants is the
smaller residual volume than formula milk. therefore breast
milk feeding is the tolerence premature's food.
The purpose of this study was to identify the effects of
breast milk feeding and combined feeding for feeding tolerance
and weight gains from initial feeding to full enteral feeding
in premature infants. The subjects study inclueded premature
infants admitted to an neonatal intensive care unit from March
2003 to December 2003 in A hospital in Seoul. Who were fed
breast milk only (n=26) or combined feeding group(30). The
subjects of this study were premature infants from gestational
age (34-37weeks, birth weight from 1800gm to 2500gm) informed
conserts were obtained all parents whose babies were enrolled
in the study. The datas regarding the days to full enteral
feeding, the number of feeding skips, weight gain were
gathered by medical records and analyzed through t-test, X2
test, Pearson's correlation with SPSS-PC win version 10.0. The
results of this study were as follows:
1. Breast milk feeding group required shorter time to reach
full enteral feeding than mixed combined feeding group
(p=.004)
2. Breast milk feeding group had fewer number of until full
feeding skips than combined feeding group (p=.004)
3. Breast milk feeding group and combined feeding group had
gained the same weight.
In conclusion, breast milk fed premature infants had fewer
days to full enteral feeding compared with combined feeding
premature infants. and effort should spend to enhancing breast
milk feeding especially among premature infants.
Breast is Best...According to Whom?
Julie Sittlington, MA(Hons) MSc; Barbara Stewart-Knox, PhD;
Marion Wright, PhD
1Northern Ireland Centre for Diet and Health, University of
Ulster, Coleraine, Northern Ireland; School of Health
Sciences, University of Ulster, Coleraine, Northern Ireland,
United Kingdom
Abstract
Northern Ireland is reputed to have one of the lowest
breast-feeding rates in Europe, with a breast-feeding
initiation rate of 54 % in the year 2000, falling to 37% seven
days post-natal. The aim of this research has been to explore
the perceived reasons why mothers choose to feed artificially
rather than breast-feed and why breast-feeding mothers change
to formula within weeks after birth.
Expectant mothers (n=28) were recruited during the third
trimester of pregnancy from five ante-natal clinics situated
throughout Northern Ireland. The mothers were then contacted
and interviewed (3-8 weeks post-natally) at home, using a
qualitative approach. The interviews were taped, transcribed
and thematically content analysed. Despite an initial desire
to breast-feed amongst the women ante-natally, post-natally
the mothers identified a number of key issues which deterred
them from breast-feeding and which negatively influenced the
duration of breast-feeding. These included disgust at the idea
of breast-feeding, fear of social isolation, a rejection of a
close attachment/bond between mother and child and the view
that a mother has executed her physical role already
throughout the pregnancy and labour. Issues which negatively
influenced the duration of breast-feeding included lack of
understanding and support from friends and family, lack of
support and advice from midwives and health visitors, lack of
education regarding how to breast-feed and lack of public
facilities to breast-feed. Fear of the baby becoming
under-nourished, social rejection and a lack of freedom were
associated with both the initial decision to feed artificially
and early cessation of breast-feeding. An understanding of the
reasons why women choose to formula feed or to cease
breast-feeding at a very early stage should provide the scope
to develop new interventions to encourage uptake and improve
duration of breast-feeding.
Implementation of a Web Survey for the Study of Recurrent
Plugged Ducts in Lactating Women
Suzanne H. Campbell, Ph.D., APRN, IBCLC; Christina M. Smillie,
MD, IBCLC, FAAP
School of Nursing, Fairfield University, Fairfield, CT;
Breastfeeding Resources, Stratford, CT, USA
Abstract
Background: Anecdotal evidence suggests that the diagnosis of
hyperlactation is frequently associated with both maternal
nipple infections and recurrent plugged ducts, greatly
complicating clinical management, but these anecdotal findings
and their implications have not been well studied or
described. Building upon our pilot study looking at plugged
ducts, in this study we will use a web-based survey to expand
our data collection to examine the risk factors, physical
symptoms, and treatments of all three of these diagnoses, as
well as the interrelationships between these three conditions.
Study Design: Retrospective, survey & chart review. Setting: A
private medical breastfeeding practice in Fairfield County,
Connecticut (USA) that currently sees an average of 600-700
new mother-baby dyads per year. Research Questions: In women
experiencing hyperlactation, plugged ducts, and nipple
infections, what treatments make a significant difference in
breastfeeding outcomes and satisfaction (including resolution
of the diagnoses, development of other complications, duration
of breastfeeding, and breastfeeding self-efficacy)? Do certain
physical symptoms, associated risk factors, and treatments
predict the development or resolution of the three diagnoses?
Results: Descriptive statistics will be used to describe the
sample and the research question will be tested by T-tests
comparing individuals on breastfeeding outcome criteria by
diagnosis. Logistic regression will be used to predict the
risk of developing one or more diagnoses given physical
symptoms and associated risk factors. Prediction of the
development of other clinical problems including mastitis and
breast abscess will be attempted given treatment effectiveness
and diagnosis resolution as described by the client.
Lowest Global Breast-feeding Rates in Northern Ireland -
Exploring misconceptions?
Julie Sittlington, MA(Hons) MSc; Barbara Stewart-Knox, PhD;
Marion Wright, PhD
Northern Ireland Centre for Diet and Health, University of
Ulster, Coleraine, Northern Ireland; School of Health
Sciences, University of Ulster, Coleraine, Northern Ireland,
United Kingdom
Abstract
Northern Ireland has one of the lowest rates of breast-feeding
initiation world-wide.
The objectives of this research have been to compare the
infant feeding attitudes of expectant mothers with those of
their primary source of support and to establish to what
extent individual attitudes during early pregnancy are
predictive of chosen infant feeding methods at time of
discharge from hospital. A sample of expectant women (n=200)
were recruited from ante-natal booking clinics (~ gestational
age 8-12 weeks). Each participant and their primary source of
social support completed a demographic questionnaire and the
self-administered Iowa Infant Feeding Attitude Scale (IIFAS).
The IIFAS consists of 17 attitude questions, half of which are
favourable to breast-feeding and the remaining favourable to
artificial feeding. At booking, 43% of participants intended
to breast-feed, 33% intended to feed artificially and the
remainder were unsure. At discharge from hospital (n=192),
38.5% of mothers were exclusively breast-feeding and 59.9%
were exclusively formula feeding. A total of 16 out of the 17
attitude questions distinguished between individuals in terms
of feeding intention. The exception producing agreement
between feeding intention groups was 'women should not
breast-feed in public places' (p=0.074). There was general
agreement in the infant feeding attitudes between expectant
mothers and their primary source of support for all except
three statements. Whereas expectant mothers assumed that
'fathers would feel excluded if they breast-fed' (p=0.01),
responses from their support indicated that this assumption
was unfounded. There was also disagreement between mothers and
their support that 'formula is as healthy for an infant as
breast milk' (p=<0.05) and that 'mothers who formula feed miss
one of the great joys of motherhood' (p=0.005). This tool may
be useful to identify women in Northern Ireland who are likely
to be receptive to breast-feeding targeting interventions.
Molecular epidemiology of Staphylococcus aureus transmission
of lactation mastitis
Midori Kawada, RN, CNM, PhD; Chieko Sugishita, RN, PhD
Faculty of Nursing, Fukuoka Prefectual University, Tagawa-shi,
Japan
Abstract
Aims and Objectives: To find evidence of Staphylococcus aureus
transmission of lactation mastitis using bacteriological
methods and pulsed-field gel electrophoresis.
Methods: The patients with clinical signs of lactation
mastitis in the study were selected from outpatients who gave
birth at a hospital. If the mother saw a hospital midwife with
her infant, we also conducted the study on the infant. The
samples were collected for investigation: swabs of the
mothers' nipples, the breast milk and the infant's nares and
oral cavities.
Results: The study included eight mothers and seven of their
infants. Methicillin-resistant Staphylococcus aureus (MRSA)
was isolated from two mother-infant pairs. The two mothers did
not have the MRSA strains during pregnancy. MRSA was isolated
from the eye discharge of one of the 3-day-old infants in the
hospital nursery. Methicillin-sensitive Staphylococcus aureus
(MSSA) was isolated from one mother-infant pair, two mothers
and one infant. DNA fragment patterns of the S. aureus were
indistinguishable within each mother-infant pair. DNA fragment
patterns of MSSA from two mothers who had a relatively low
likelihood of coming into direct contact with one another
while in the hospital were closely related.
Conclusion: These results may suggest that MRSA or MSSA was
transmitted from the hospital staff, medical appliances or a
third outside source to mothers or infants in transmission
routes of lactation mastitis. |
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