The Academy of Breastfeeding Medicine 28 th Annual International Meeting Chicago, Illinois November 9–12, 2023
2023; Mary Ann Liebert, Inc.; Volume: 18; Issue: 10 Linguagem: Inglês
10.1089/bfm.2023.29253.abstracts
ISSN1556-8342
Tópico(s)Infant Development and Preterm Care
ResumoBreastfeeding MedicineVol. 18, No. 10 AbstractsFree AccessThe Academy of Breastfeeding Medicine 28th Annual International Meeting Chicago, Illinois November 9–12, 2023Published Online:17 Oct 2023https://doi.org/10.1089/bfm.2023.29253.abstractsAboutSectionsPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail Abstracts1. Barriers to breastfeeding on the paediatric ward: results from an explanatory sequential mixed methods studyLyndsey M. HookwaySwansea UniversityAbstract Category: ResearchBackground: Childhood illness is associated with additional difficulties and lower breastfeeding rates. There is a paucity of research within this sub‐population limiting our understanding of the barriers for families and professionals. An explanatory mixed‐methods study aimed to understand the challenges of breastfed children in the paediatric setting.Methods: Firstly, an online survey recruited paediatric healthcare professionals (n = 409), and questions explored attitudes to breastfeeding, training, barriers and ward culture. Secondly, a qualitative study of 30 mothers of children aged 2‐36 months with diverse conditions and backgrounds explored the challenges of breastfeeding sick children in paediatric wards/PICU. The two studies were triangulated, and the results help to understand the specific challenges in paediatrics, as well as enable recommendations for change.Results: Statistical analysis in Study 1 found that more extensive breastfeeding training was associated with higher lactation support skill scores and confidence supporting lactation challenges in sick children. Professionals identified stress, lack of support, and complex clinical scenarios as major barrier perceived barriers for parents. A thematic analysis undertaken for Study 2 generated seven themes, highlighting many previously unresearched breastfeeding challenges such as complex fluid needs, iatrogenic withdrawal, neurological irritability, and changes to breastfeeding behaviour during illness. Mothers described a lack of skilled lactation support on paediatric wards, insufficient resources, challenges around bedsharing, the impact of trauma on breastfeeding, and staff hostility. Mothers persevered because breastfeeding was immunologically meaningful, a parenting tool, and provided an important aspect of normality.Conclusions: There was substantial agreement between the professionals and parents in these studies, with both identifying a lack of skilled support particularly with more seriously unwell children. This research provides insight into what measures are perceived as supportive by mothers while also identifying barriers and areas for improvement. Skill deficits identified in the studies suggest that bespoke paediatric breastfeeding training based on identified clinical challenges is justified.2. Experience, skills and attitudes of multi‐disciplinary paediatric professionals supporting breastfed medically complex children in the UKLyndsey M. HookwaySwansea UniversityAbstract Category: Medical EducationBackground: Breastfeeding may be particularly beneficial for medically complex children. However, childhood illness is associated with additional challenges and lower breastfeeding rates. The Baby Friendly Initiative has been shown to improve health professional skills although the standards have not yet been adopted in paediatrics and most professionals defer to personal experience. There are no previous multidisciplinary studies of breastfeeding knowledge and attitudes in paediatrics, thus this survey was conducted to establish their confidence, barriers and skills supporting breastfeeding.Methods: The online survey recruited paediatric healthcare professionals from November 2020‐March 2021. Questions about attitudes to breastfeeding, training, credentials, barriers and ward culture were included with Likert scales and 409 professionals were included in the analysis.Results: A total of 245 paediatric nurses, 103 doctors, 45 allied health professionals and 16 health care assistants completed the survey. Most professionals had no breastfeeding training and felt that different skills are required in paediatrics to support more complex cases. Participants were asked about 13 clinical competencies and an aggregate skill score was calculated. Statistical analysis found that more extensive training was correlated with higher skill scores and greater confidence. There were many barriers to providing support including lack of knowledge, staff biases, poor awareness of how to transition back to breastfeeding after critical illness, the need to measure fluid balance, and relatively little awareness of support to refer to, especially among those with lower skill levels.Conclusions: This national sample of professionals had both basic and more specialised knowledge gaps and training needs. Medically complex children encounter many barriers to optimal feeding ‐ including absence of paediatric lactation staff, and may have additional challenges such as re‐establishing oral feeding after ventilation or enteral/parenteral feeding. Skill deficits identified in this study indicate that existing training is insufficient, and bespoke paediatric breastfeeding training based on identified clinical challenges is justified.3. Disparities in Breastmilk Feeding Rates in Preterm Infants After Discharge from the Neonatal Intensive Care Unit (NICU)Nicole E. Larsen, Tricia J. Johnson, Paula Meier, Kayla J. Dobies, Mary C. Dyrland, Charlie B. Fischer, Aloka L. Patel, Suhagi KadakiaRush University Medical CenterAbstract Category: Human Milk CompositionBackground: There are limited data about post‐NICU discharge breastmilk feeding (BMF) rates in preterm (PT) infants, despite multiple initiatives to improve in‐hospital BMF rates.Methods: Retrospective study of PT infants (gestational age (GA) <37 weeks) discharged from the NICU that followed at an academic medical center clinic. Infant demographics and feeding at discharge were extracted from the medical record along with feeding history at newborn, 2, 4, 6, 9 and 12 months healthcare maintenance visits for PT infants born January 1‐ May 15, 2018, as part of a larger study. Exclusion criteria included: contraindication to BMF or insufficient feeding documentation.Results: Of 150 infants discharged during this time, 42 met eligibility criteria, with mean birth GA 33 ± 3 weeks (Table 1). At discharge, 62% were receiving any BM. At the newborn visit, 53% were receiving any BM (Figure 1), with 37% receiving exclusive BM. Receipt of any BM decreased over the first year. Racial/ethnic differences were observed, noticeably at the newborn visit with 100% of Non‐Hispanic White/Asian/Other infants receiving any BM versus 56% of Hispanic (H) infants and 37% of Non‐Hispanic Black (NHB) infants (Figure 2). Exclusive formula feeding rates for NHB infants increased 1.7‐fold from 46% to 78% over the first 2 months. Although H and NHB infants had similar rates of exclusive BMF, overall BMF rates were higher in H infants due to greater rates of combined feedings.Conclusions: BMF rates dwindled in the first year for all PT infants, with a sharp decline by 2 months. Disparities previously described during NICU hospitalization persist after discharge, with higher rates of exclusive formula feeding in NHB infants at all time points, highlighting opportunities for research to understand factors that result in the rapid decline in BMF and develop interventions to support continued BMF for former PT infants.4. Expressing milk while videoconferencing with the hospitalized premature infant, a randomized controlled trialAdrienne E. Hoyt‐Austin, Kristin Hoffman, Iesha T. Miller, Jennifer L. Rosenthal, Daniel J. Tancredi, Caroline J. Chantry, Mark Underwood, James Marcin, Kara Kuhn Riordon, Laura R. KairUniversity of California at DavisAbstract Category: ResearchBackground: Human milk is key to support optimal health outcomes for infants in the neonatal intensive care unit (NICU); however, expressing milk is impacted by separation and stress. We tested if visualizing one's infant while pumping through videoconferencing improves volume, efficiency, human milk nutritional content, and the pumping experience.Methods: In this randomized controlled trial with crossover design (NCT03957941), we enrolled mothers of hospitalized premature infants (<34 weeks), mothers pumped three consecutive times with and three consecutive times without videoconferencing of their infant, randomly assigning the two possible sequences. Milk volumes, start, and stop times were self‐recorded. Pumping experience was assessed with the Breastmilk Expression Personal Experience subscale (BMEE). Human milk was analyzed using the Miris HMA™. Data were analyzed in SAS using a panel data fixed effects model to estimate within‐person mean differences (MD).Results: Thirty‐eight women consented to the study; of those, 28 provided human milk data. There was no difference in volume or efficiency with or without videoconferencing. Mean BMEE subscale scores were higher with videoconferencing (MD 0.10, 95% CI 0.02‐0.18; p = 0.01). Women endorsed a better experience with videoconferencing, as it “is a reminder of why I pump” and “calms me to see baby at peace.” There were no crossover design effects for volume, efficiency, nor the BMEE; however, the nutritional content was affected by sequence order. Participants randomized to pump with videoconferencing first had milk samples with less fat, total solids and energy and more carbohydrates when videoconferencing.Conclusions: Videoconferencing with one's hospitalized premature infant was well received by participants and improved their pumping experience but was not associated with significant effects on human milk expression nor efficiency. The crossover design did impact macronutrient content, a finding that should inform the design of subsequent trials.5. Bridging the Provider Breastfeeding Knowledge Gap: A Novel Medical Student ElectiveNicole Feigenblum1, Rose St. Fleur2, Shelley Saber31Hackensack Meridian School of Medicine2Jersey Shore University Medical Center3Hackensack University Medical CenterAbstract Category: Medical EducationBackground: Breastfeeding education is recommended for all medical professionals and research demonstrates a strong desire to learn more about breastfeeding, but educational opportunities are insufficient. A lack of provider understanding and exposure leads to decreased breastfeeding rates in mothers during their postpartum hospital stay and beyond. PC‐05 of the Joint Commission evaluates hospitals exclusive breastfeeding rates, making it imperative to provide better education to both our providers and patients.Methods: A pilot two‐week Breastfeeding Medicine elective was offered to fourth year medical students beginning in May 2022. Participants completed a survey before and after the elective evaluating their knowledge and comfort with breastfeeding using a five point Likert scale. The goals of the elective included familiarizing students with breastfeeding physiology, pathology, and lactation management in both the inpatient and outpatient setting.Results: 80% of students who participated in the elective completed both the pre‐ and post‐elective surveys. Of those students, 75% stated that they had no prior breastfeeding education. Results demonstrated increases in knowledge of breastfeeding recommendations, management, and improvement in basic skills. Although students who enrolled in the elective planned to pursue different specialties, they all found the information important for future practice. All students stated that they would highly recommend this elective to other students.Conclusions: By exposing medical students to the field of Breastfeeding Medicine through this novel fourth year elective, we are able to help create a generation of providers with improved knowledge and skills, which can lead to improved rates of exclusive breastfeeding in the future.6. Antenatal breastfeeding education and how it impacts the success of breastfeeding initiation, exclusivity and continuationShereen Abd elghaniNo affiliationAbstract Category: ResearchBackground: Breastfeeding problems following delivery negatively impact breastfeeding period. Most of the breastfeeding mothers suffer postnantally the fear of inadequate milk, nipple scarring, congestion and insufficient evacuation of the breast, mastitis, breast abscess, and flattened nipples. Breast pain caused by nipple scarring, mastitis, and mother's concern about inadequate milk are the most frequent problems affecting almost 20–80% of women. Breastfeeding though an instinct however it is a skill that needs to be learned. The purpose of antenatal counseling is to help preganant mothers to better understand their surroundings and solve emotional and interpersonal problems. Antenantal breastfeeding counseling in which theoretical and clinical aspects of breastfeeding are introduced together, and breastfeeding skills are practiced that include the observation and assessment of breastfeeding, helping mothers to hold their infants appropriately, and clinical management of common breast problems such as injured nipples, congestion, mastitis, and apparently insufficient milk. We carried this study to compare the positive impact of anteanatal counseling and breastfeeding interventions on the success of breastfeeding initiation, exclusivity and continuation compared to mothers who did not recieve any antenatal breastfeeding education sessions.Methods: In this study we compared the positive impact of anteanatal counseling and breastfeeding interventions on the success of breastfeeding initiation, exclusivity and continuation compared to mothers who did not recieve any antenatal breastfeeding education sessions.Results: The results showed statistically significant difference between the two groups in terms of breastfeeding problems including nipple pain and scars, breast mastitis, and congestion in the first week and 1 month after delivery and also the rate of exlusive breastfeeding through 1st 6 moths.Conclusions: Antenatal breastffeding counselling sessions are crucial on its effect on the success rates of breastfeeeding, itsinitiation, exclusivity and continuation.7. Breast exercise preventing breast engorgement and improve breastfeeding outcomePayel Biswas SooInstitute of Human Sciences for HolisticAbstract Category: Clinical Practice/Lactation ManagementBackground: The World Health Organization also recommend exclusive breastfeeding for the first 6 months, with continued breastfeeding along with introducing complementary foods up to 2 years and beyond. But what we have observed fewer than half of infants under 6 months old are exclusively breastfed. Breastmilk is the ideal food for infants as it is safe, contains antibodies which help to protect against many diseases, it helps in brain development. it's good for the mothers and environment. Though breastfeeding is natural and normal but most of the mothers have initial challenges. Many a times breastfeeding is painful. Due to breast engorgement many mothers delay breastfeeding and results in delaying breastfeeding and not reaching optimal exclusive breastfeeding for 6 months. Breast engorgement is swelling, tightness, and an increase in size of the breasts. It usually occurs in the early days of breastfeeding but may occur late as well. Moderately severe breast engorgement results in hard, full, tense, warm and tender breasts with throbbing and aching pain.Methods: In my practice I teach mothers to identify engorgement or lump inside the breast and armpits from pregnancy. They are taught to self‐examine and do different exercise and massage techniques along with lymphatic drainage. Constant encouragement that they can do it, to boost their morale, to make them more empowered and confident help them to overcome these challenges of breastfeeding.Results: From past 17 + years of practice and teaching thousands of mums have helped to get rid of engorgement, pain , lump and prevent absess formation make them happy and comfortable in feeding.Conclusions: If we can help mothers from antenatal period then there will be less crying mothers and more happy babies and families. They will reach 6months of exclusive breastfeeding and continue till 2 years and beyond.8. Cultural Influence on Mothers' Knowledge and Attitudes Regarding Donor Human Milk in the Palestinian Territories and IsraelLawrence Noble1, Anita Noble21Icahn School of Medicine at Mount Sinai2Hadassah Medical Organization & Hebrew UAbstract Category: ResearchBackground: When mother's milk is unavailable, donor human milk (DHM) is recommended to provide the infant with human milk. Mothers' knowledge and attitudes regarding DHM have not been previously evaluated in the Palestinian Territories or Israel. This study aimed to examine mothers' knowledge and attitudes regarding DHM.Methods: A prospective, descriptive study using snowball sampling. Mothers were recruited through social media using an online questionnaire. Chi‐square, t‐test, and logistic regression analyses were used. Power analysis was performed, and IRB approval was received.Results: Eighty mothers participated in the study; 27 (34%) were Muslim, 24 (32%) Christian, and 27 (34%) Jewish. Thirty‐three (41%) were from the Palestinian Territories and 47 (59%) from Israel. 39% would donate to a HMB, and 56% to a friend or relative. Only 29% would receive HM from a HMB, and 33% from a friend or relative. 9% of Muslim mothers reported that milk banks were safe or trustworthy compared to 29% of Christians and 70% of Jewish (p < 0.001). 13% percent of Muslim mothers stated DHM was permissible compared to 71% of Christians and 96% of Jewish (p < 0.001). Muslim mothers were 17.5 times more likely (OR = 17.5, CI 4.3‐71.4) and Christian mothers 4.9 times more likely (OR = 4.9, CI 1.451‐16.552) to prefer formula as a better option than Jewish mothers. Muslim mothers were 59 times less likely (OR = 0.017, CI = 0.003‐0.101) and Christian mothers eight times less likely (OR = 0.130, CI = 0.024‐0.687) to donate human milk to a friend or relative than Jewish mothers. These results were significant after correcting for multiple factors, including education, socioeconomics, and language.Conclusions: Mothers in the Palestinian Territories and Israel have low knowledge and negative attitude regarding DHM and HMBs. Mothers' knowledge and attitudes were significantly correlated to their religion. We speculate that culturally appropriate information regarding the benefits of DHM could improve knowledge and attitudes toward DHM in this population.9. Flange Fitting to Optimize Breast Milk Removal and Comfort for Pumping Parents: A Pilot StudyLisa A. Anders1, Jeanette P. Mesite Frem21University of North Carolina‐Greensboro2Babies in CommonAbstract Category: ResearchBackground: In the United States, most parents that feed human milk wish or need to use a breast pump at some point during their infants' first year. Parents have complained of supply concerns, pain, and time consumption related to pumping which could undermine their ability or desire to continue. It has long been asserted that proper fit of the flange, also known as the breast shield, contributes to the efficiency and comfort of pumping. The common standard is to follow pump manufacturers' suggestions of measuring the base of the nipple and adding up to 9mm, depending on brand. Some providers see in practice that a size closest to exact nipple tip diameter as ideal. It is unclear which flange fit guidance is optimal. The purpose of this study is to examine differences in comfort and milk removal using a standard fit compared to a smaller fit.Methods: A quantitative one‐group, matched pairs design is being utilized to examine differences in pumping time(min), milk yield(g), and comfort (Likert scale) with a target sample of at least 45 participants who are exclusively feeding human milk to their infant between 1‐ and 6‐months of age. They are being fitted for standard fit flanges and smaller, closer‐to‐nipple‐size fit flanges and asked to pump for 1‐week with each, being randomized to the ordering of flanges.Results: This study is ongoing with results TBD. Recruitment and data collection are projected to continue through August, followed by data analysis to be completed by the end of September.Conclusions: This study will provide empirical evidence of differences in comfort, milk yield and milk removal efficiency between these flange fits. The findings will inform education for lactation providers so they can tailor support for pumping parents. More research will be needed to examine long‐term differences and outcomes related to flange fit.10. Evidence‐Based Implementation of Pasteurized Donor Human Milk (PDHM) for Medically Indicated Supplementation in Well Newborns in the University of Virginia (UVA) Mother/Baby UnitKatie ZechaUVA HealthAbstract Category: Program Development and FinancingBackground: Self‐identified unit need for availability of PDHM to newborns when medically indicated. Unit guidelines created, and implementation delayed due to staffing shortages and no organizational lead. Intervention of an evidence‐based implementation following the Iowa Implementation for Stability Framework. Proposing strategy that is divided into four distinct phases: (1) creating awareness and interest, (2) building knowledge and commitment, (3) promoting action and adoption, and (4) pursuing integration and sustainability of use (Cullen et al., 2022).Methods: Methods were specific to each phase. Phase one (creating awareness) was completed with announcements, staff meetings, and written materials posted. Phase two (building knowledge) began with a gap analysis in the form of a staff pre‐survey. Staff education via in‐services, distributing resource materials, and educational posters will fulfill phase two. Phase three (promoting action) involves rolling out availability of donor milk, providing clinician reminders, utilizing interprofessional discussions and family input, and creation of patient education pamphlets. The fourth phase (sustainability) aims to evaluate the efficacy of the intervention and make necessary changes to promote long‐term use.Results: In early April 2023 our data analysis will be completed comparing pre and post survey clinician knowledge base using percentage statistics.Conclusions: A successful implementation of this project would positively affect the knowledge and clinical skills of staff members. This implementation will allow for a smooth integration of new guidelines among staff, in turn improving outcomes for both babies and families. Project implementation will be timely and efficient, avoiding the likelihood of having to re‐work the protocols by using a stepwise approach.11. The role of lactation Education in Glycemic Control to Babies of Primi MothersMostafa Kotb Ab. ElmalaKing Khalid HospitalAbstract Category: ResearchBackground: The majority of the primi mothers have no enough experience with baby feeding which can lead to unpredictable degrees of hypoglycemia and or dehydration in their babies. We aimed to evaluate the importance of lactation education for primi mothers.Methods: This Hospital review was done for babies to primi mothers before and after starting the lactation education (which started on September 2017). We divided them into 2 groups:A‐ Babies to mothers before starting lactation education service over 12 months from September 2016 to August 2017 (n = 109).B‐ Babies to mothers after starting lactation education service over 18 months from September 2017 to February 2019 (n = 265).Only healthy primi mothers with no medical background have been selected. All of them have almost the same social & educational levels. Comparison has been done among their babies, provided all babies have an uneventful birth history with birth weight >3 kilograms, based on: serial blood glucose levels in the first 48 hours of life. (we kept the definition of Normal blood glucose levels >2.6 mmol/l). the lactation education services are run for mothers in the third trimester on 2 weekly bases till one week after the delivery time.Results: Good glycemic control was noted in 50 babies out of 109 (45.8 %) in the first group (Before starting lactation education). Good glycemic control was noted in 212 babies out of 265 (80 %) in the second group (who adhered to education services). For the non‐adhered 53 mothers (20%) their babies developed hypoglycemia & 12 of them required bolus dextrose injection and then maintenance intravenous fluids (IVF) with more observational time.Conclusions: Lactation Education for primi mothers has a great role in good glycemic control of their babies, which is easy to apply in each medical institute as well as in the community.12. General Practitioner (GP) views on infant feeding support provision during the early pandemicSamantha RM. RossNational Health ServiceAbstract Category: Quality Improvement AdvocacyBackground: Breastfeeding has important maternal and infant health benefits but relies on promotion and support to improve falling rates, and General Practitioners (GPs) are considered to have a role in providing support. During the early months of the pandemic there was an observed reduction in referrals from primary care made to a Scottish infant feeding service. Given the limited evidence on established GP views on the essence of their role and data on activity, a survey was designed to examine this further.Methods: An 18‐point survey was created using Webropol (with quantitative questions on demographics and qualitative questions on GP views on support) and was distributed to 177 GP practices in NHS Greater Glasgow and Clyde. 58 GPs responded to the survey. The GP response rate was low at 5% so limited statistical comparisons; however, rich qualitative data allowed review using reflexive thematic analysis to generate themes related to GP views on provision of support.Results: Results showed that breastfeeding training was seen as important, particularly by GPs with previous paediatric training experience. GPs also wanted more consistent information on infant feeding and nutrition, and better resourcing of local services to support breastfeeding. There were mixed views on the use of remote consultation which was an emerging technology in use at this time.Conclusions: GPs who responded to the survey were supportive of breastfeeding in general but would like resources and training to support the delivery of this service. Considering GP views when designing support services would enable improved care pathways for breastfeeding women and may help to address inequalities in access to breastfeeding support.13. The Effect of a Donor Milk Program on Exclusive Breastfeeding RatesMelanie Kaufer, Kristen A. Giordano, Shelley Saber, Donna Lacorazza, Christine MooreHackensack University Medical CenterAbstract Category: Quality Improvement AdvocacyBackground: Many interventions have been proposed to increase the exclusive breastfeeding rates in full term healthy infants. Pasteurized donor human milk for this population can serve as a bridge to breastfeeding when there is a delay in the establishment of a mother's own milk supply or an identified need for supplementation. A previous study has shown that the use of donor human breast milk in the well baby nursery for infants who require supplementation has been associated with higher rates of exclusive breastfeeding at hospital discharge as compared with hospitals that do not use it (77% vs. 56%). The purpose of this study is to evaluate the effect of the implementation of a pasteurized donor human milk program on the exclusive breastfeeding rates for healthy full term infants at hospital discharge at our institution.Methods: Data was collected from the PC‐05 measure included population for exclusive breastfeeding rates abstracted from the electronic medical record over a 60 day period from December 18, 2022 ‐ February 18, 2023.Results: Our baseline PC‐05 data showed an monthly exclusive breastfeeding rate of 47%. Sixty days after the initiation of the pilot program, there was an increase in monthly exclusive breastfeeding rates to 69%. During this pilot period, 66 infants received donor breastmilk, compared to 0 prior to the introduction of the donor milk program for healthy term infants in the newborn nursery.Conclusions: Introduction of a pasteurized human donor milk program increased our institution's exclusive breastfeeding rates at the time of hospital discharge by 22% over the 60 day pilot program. A human donor milk program can be one strategy to improve exclusive breastfeeding rates in the immediate postpartum period.14. Neurological, Growth, and Health Outcomes up to 6 Years of Age in Moderately Preterm Children who Received Exclusive vs. Fortified Human MilkJenny Ericson1, Dirk DW. Wackernagel2, Fredrik Sven Einar Ahlsson3, Emilija E. Wilson41Dalarna University2Meinz University3Uppsala University4Karolinska InstitutetAbstract Category: ResearchBackground: Moderately premature infants (32‐36 weeks of gestation) have an increased risk of poorer neurological development and metabolic health compared to full‐term infants. Optimal nutrition could hypothetically reduce this difference. The aim of this study was to investigate neurodevelopment, growth, and health up to six years of age in children born moderately preterm who received either exclusive breast milk or fortified breast milk and/or formula during neonatal hospitalization.Methods: This longitudinal cohort study of 142 children who had previously participated in a randomized controlled trial of parental breastfeeding support. Data were collected via questionnaires until the child was six years old. The questionnaires contained
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