SYNOPSIS Best practices that translate the evidence for high dose HM feeding for preterm infants during the NICU hospitalization have been described in multiple studies but their implementation has been compromised largely due to economic and ideologic concerns. Although the rates of “any” HM feeding have increased over the last decade, efforts to help mothers maintain human milk provision through to NICU discharge have remained problematic throughout the world. Special emphasis should be placed on prioritizing the early lactation period of coming to volume so that mothers have sufficient HM volume to achieve their personal HM feeding goals. Finally, donor HM does not provide the same risk reduction as own mothers’ HM for multiple morbidities in preterm infants, providing needed evidence for channeling of limited resources into NICU programs that promote the use of mothers’ own HM.

The effectiveness of the breastfeeding peer counselor role is thought to be embedded in the relationship between new and experienced mothers. In this study, new mothers of very low birth weight infants emphasized that one of the most important aspects of their relationship with the breastfeeding peer counselors is the peer or shared experience of how difficult it can be to provide milk and breastfeed while coping with the emotional stress of having an infant in the neonatal intensive care unit. This study provides evidence for the promotion and facilitation of lactation for mothers of neonatal intensive care unit infants through the use of breastfeeding peer counselors who are peers by virtue of the shared experience of providing milk for an infant hospitalized in the neonatal intensive care unit.

Objective To compare the trajectories and determine the predictors of maternal distress, defined as a continuous spectrum of symptomatology and elevated symptomatology, of depression, anxiety and perinatal-specific post-traumatic stress (PPTS), in mothers of very low birth weight (VLBW) infants throughout the neonatal intensive care unit (NICU) hospitalization. Method 69 mothers completed psychological questionnaires within the first month of their infant’s NICU hospitalization and again two weeks prior to NICU discharge. Multiple regression models determined maternal psychological, reproductive, sociodemographic, and infant medical predictors of maternal distress. Results PPTS remained stable throughout the NICU hospitalization while other aspects of distress declined. Previous psychological history and infant medical variables predicted higher PPTS but no other aspects of distress. Reproductive variables predicted anxiety and PPTS; history of fetal loss initially predicted lower PPTS, but throughout hospitalization primipara status emerged as a predictor of higher anxiety and PPTS. Sociodemographic variables predicated initial, but not later, depressive distress. Conclusion Psychological screening is important in the NICU. The PPTS profile suggests it may require distinct treatment. Primiparas should be targeted for intervention.

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Aim To examine associations between maternal NICU visitation rates, maternal psychological distress (“distress”), and preterm infant outcome post-NICU discharge in a contemporary cohort of very low birth weight (VLBW) infants. Methods This was a prospective study of 69 mothers and their VLBW infants. Distress was assessed 1 month post-birth, 2 weeks prior to NICU discharge and after NICU discharge at 4 months corrected age [CA]. Maternal NICU visitation rates were calculated for the first 2 weeks and 1 month post-birth as well as for the entire NICU hospitalization. Regression analyses adjusted for the impact of 1. maternal and infant characteristics and distress on maternal visitation rates and 2. the impact of visitation on long-term maternal distress, and rates of infant clinic attendance and rehospitalization. Results Greater number of children in the home, maternal exposure to a greater number of potentially traumatic events prior to childbirth, and lower maternal anxiety consistently predicted lower visitation rate. Lower maternal visitation rate predicted higher maternal depression scores at infants’ 4 month CA visit. Maternal NICU visitation rate did not predict post-NICU discharge infant clinic attendance or rehospitalization. Conclusion Distress is an important predictor of visitation. In turn, visitation is associated with long-term maternal distress.