Improved exclusive breastfeeding rates in preterm infants after a neonatal nurse training program focusing on six breastfeeding-supportive clinical practices

Abstract

Background Early breast milk expression, prolonged skin-to-skin contact, rooming-in, use of test-weighing and minimizing use of pacifiers are positively associated with exclusive breastfeeding of preterm infants, whereas use of nipple shields is negatively associated. Aim To test whether a training program for neonatal nurses with a focus on these six breastfeeding-supportive clinical practices affects the rate of preterm infants exclusively breastfed at discharge to home, the postmenstrual age at establishment of exclusive breastfeeding, and maternal self-reported use of the practice in the neonatal intensive care unit, the. Methods A quasi-experimental multi-centre intervention study from 2016–2019 including a control group of 420 preterm mother-infant dyads, an intervention with a training program for neonatal nurses and implementation of weekly breastfeeding meetings for neonatal nurses, and an intervention group of 494 preterm mother-infant dyads. Results Significantly more preterm infants in the intervention group were exclusively breastfed at discharge to home (66.6%) than in the control group (58.1%) p = 0.008. There was no significant difference in postmenstrual age at establishment of exclusive breastfeeding between control and intervention group (37.5 vs.37.8 weeks, p = 0.073). Compared to the control group the number of infants continuing daily skin-to-skin contact after incubator care increased (83.2% vs. 88.3%, p = 0.035), infants using a nipple shield decreased (61.8% vs. 54.2%, p = 0.029), and the number of mothers initiating breast milk expression before six hours post-partum increased (32.6% vs. 42.4%, p = 0.007). There was a significant correlation between percentage of neonatal nurses participating in the breastfeeding training program and changes in exclusive breastfeeding rates (Pearson Correlation 0.638, p = 0.047). Conclusion Exclusive breastfeeding rates in preterm infants and maternal self-reported use of breastfeeding-supportive practices increased by training neonatal nurses in the six clinical practices. It is important to include all nurses in the breastfeeding training program to ensure positive effect on exclusive breastfeeding rates.

Positive breastfeeding experiences and facilitators in mothers of preterm and low birthweight infants: a meta-ethnographic review

“…Mothers from the included studies also described that staff needed to have specific knowledge in the breastfeeding behaviours of preterm infants and possess skills and knowledge in breastfeeding preterm terms [ 64 ]. As nurses in neonatal units provide support for breastfeeding during every shift [ 65 ], it is important to include all nurses in breastfeeding training programs to ameliorate the support provided to mothers and infants [ 66 ]. Unlike mothers of term infants, mothers of preterm/LBW infants have a much longer hospital stay with more staff encounters, which places a larger responsibility on staffs’ communication skills [ 67 ] and to ensure continuity and meaningful relationships [ 68 ].…”

Supporting Premature Infants’ Oral Feeding in the NICU—A Qualitative Study of Nurses’ Perspectives

“…There are programs that provide such training for parents and/or healthcare professionals, such as the Neonatal Behavioral Assessment Scale [ 29 ], the Neonatal Individualized Developmental Care and Assessment Program [ 5 ] and the Early Collaborative Intervention [ 30 ]. However, education and experience are also important [ 11 ], especially when it comes to feeding cues and not least listening to the parents and empowering them to trust their own parental skills and competences.…”

“…One major task for nurses in the NICU involves ensuring that infants receive adequate nutrition and supporting the provision of human milk [ 1 ]. If the parents’ desire is to breastfeed, the nurses should support that long and complex process and encourage early skin-to-skin contact and breastmilk expression [ 9 , 10 , 11 ]. According to WHO and UNICEF’s tens steps for successful breastfeeding, mothers should be supported to initiate and maintain breastfeeding, manage common difficulties and recognize and respond to their infants’ cues for feeding [ 9 ].…”

“…This increases the risk of parents feeling unsupported, which in turn may jeopardize the breastmilk production and further decrease breastfeeding rates for preterm infants. Several studies can be found on barriers and facilitators for successful breastfeeding [ 11 , 17 , 18 , 19 , 20 ], but studies exploring nurses’ experiences of supporting parents with the oral feeding process of their preterm infant in the FC NICU are scarce. It is important to consider nurses’ intentions and views of supporting families in this vulnerable situation.…”

Breastfeeding and the Influence of the Breast Milk Microbiota on Infant Health

“…The delay in colonization is especially marked for the anaerobic flora (Bifidobacterium and Bacteroides) while the aerobic flora (Enterobacteriaceae, Enterococci, Staphylococci) colonizes the premature baby fairly quickly [92][93][94][95][96][97][98][99][100][101][102]. This delay in implantation may be due to the fact that these children are more frequently born by cesarean section, are quickly separated from their mothers and placed in a highly aseptic intensive care environment and often subjected to broadspectrum antibiotic therapy [89].…”