Breast Milk Stem Cells: Current Science and Implications for Preterm Infants

Background: The benefits of breast milk are well described, yet the mechanistic details related to how breast milk protects against acute and chronic diseases and optimizes neurodevelopment remain largely unknown. Recently, breast milk was found to contain stem cells that are thought to be involved in infant development. Purpose: The purpose of this review was to synthesize all available research involving the characterization of breast milk stem cells to provide a basis of understanding for what is known and what still needs further exploration. Methods/Search Strategy: The literature search was conducted between August and October 2015 using the CINAHL, PubMed, and reference list searching. Nine studies addressed characterization of human breast milk stem cells. Findings/Results: Five research teams in 4 countries have published studies on breast milk stem cells. Current research has focused on characterizing stem cells in full-term breast milk. The amount, phenotype, and expression of breast milk stem cells are known to vary between mothers, and they have been able to differentiate into all 3 germ layers (expressing pluripotent characteristics). Implications for Practice: There is much to learn about breast milk stem cells. Given the potential impact of this research, healthcare professionals should be aware of their presence and ongoing research to determine benefits for infants. Implications for Research: Extensive research is needed to further characterize stem cells in breast milk (full-term and preterm), throughout the stages of lactation, and most importantly, their role in the health of infants, and potential for use in regenerative therapies

Direct-Breastfeeding in the Neonatal Intensive Care Unit and Breastfeeding Duration for Premature Infants

Aim To explore the relationship between direct-breastfeeding in the neonatal intensive care unit (NICU) and breastfeeding duration after discharge. Background Initiating and maintaining breastmilk feeding is an important goal that begins in the NICU. Little is known about direct-breastfeeding in the NICU and its relation to breastfeeding duration. Methods Chart review of 46 infants (\u3c 32 weeks gestational age or \u3c 1500 grams) whose mothers provided breastmilk. Results One month after discharge, mothers still providing breastmilk were more likely to have provided ≥ 1 direct-breastfeed per day in the NICU (21.16, CI: 3.13–143.25, p \u3c 0.01) and had prior breastfeeding experience (OR: 9.16, CI: 1.02–82.34, p \u3c 0.05). At 4 months, mothers still providing breastmilk were more likely to have provided ≥ 1 direct-breastfeed per day in the NICU (OR: 12.80, CI: 1.39–118.32, p \u3c 0.05). Conclusions Direct-breastfeeding in the NICU may play an essential role in preparing mothers for breastfeeding after discharge, thus potentially impacting breastfeeding duration

Current Practice of Neonatal Resuscitation Documentation in North America: A Multi-Center Retrospective Chart Review

Background To determine the comprehensiveness of neonatal resuscitation documentation and to determine the association of various patient, provider and institutional factors with completeness of neonatal documentation. Methods Multi-center retrospective chart review of a sequential sample of very low birth weight infants born in 2013. The description of resuscitation in each infant’s record was evaluated for the presence of 29 Resuscitation Data Items and assigned a Number of items documented per record. Covariates associated with this Assessment were identified. Results Charts of 263 infants were reviewed. The mean gestational age was 28.4 weeks, and the mean birth weight 1050 g. Of the infants, 69 % were singletons, and 74 % were delivered by Cesarean section. A mean of 13.2 (SD 3.5) of the 29 Resuscitation Data Items were registered for each birth. Items most frequently present were; review of obstetric history (98 %), Apgar scores (96 %), oxygen use (77 %), suctioning (71 %), and stimulation (62 %). In our model adjusted for measured covariates, the institution was significantly associated with documentation. Conclusions Neonatal resuscitation documentation is not standardized and has significant variation. Variation in documentation was mostly dependent on institutional factors, not infant or provider characteristics. Understanding this variation may lead to efforts to standardize documentation of neonatal resuscitation

Initiation of Oral Feeding, and Protection and Promotion of Breastfeeding with Premature Infants in the Neonatal Intensive Care Unit

Care is provided in the Neonatal Intensive Care Unit (NICU) for infants who are born premature (prior to 37 weeks gestational age) and those requiring advanced nursing and medical care. Breastmilk is the best nutrition for infants and breastfeeding the premature infant in the NICU is often challenging. This dissertation provides an overview of oral feeding initiation in the premature infant with special consideration on the importance of breastmilk and breastfeeding. Within this dissertation are two literature reviews; one that evaluates current practice in oral feeding initiation and one that examines factors that impact breastfeeding after NICU discharge. Each review provides essential information on the state of oral feeding and how factors can impact breastfeeding success. The final research chapter is an original study that explored the impact of direct-breastfeeding in the NICU with breastfeeding and health outcomes after discharge. When combined, these three chapters create a greater understanding of feeding the premature infant in the NICU and the importance of direct-breastfeeding in this high-risk population. The information within this dissertation will help NICU providers to understand oral feeding the premature infant, to anticipate potential barriers to breastfeeding, and to acknowledge the role of direct-breastfeeding on the ultimate goal of continued breastfeeding. The overarching purpose of this dissertation is to discover the evidence behind oral feeding initiation in premature infants while analyzing factors that affect breastfeeding duration after NICU discharge

Caregiving factors affecting breastfeeding duration within a neonatal intensive care unit.

Abstract Background: Increasingly, evidence supports oral feeding of very-low-birth-weight (VLBW) preterm infants exclusively at breast or with breastmilk. Despite known breastmilk benefits, outcomes related to exclusive breastmilk provision are poor. Identifying factors that promote breastmilk provision is critical. Purpose: Breastfeeding practices of mothers of VLBW infants admitted to neonatal intensive care unit (NICU) were explored to identify factors associated with mode of feeding at discharge. Method: This retrospective study replicates previous work. Subjects were VLBW preterm infants consecutively admitted during a 24-month period. Primary outcomes included receiving any breastmilk at discharge. Infant variables included gestational age (GA), post-menstrual age (PMA) of first direct breastfeeding, and co-morbid conditions. Maternal variables included age and ethnicity. Nursing practices variables included first direct-to-breast feeding, number of times to breast daily and total direct-to-breast feeding encounters 24 hours prior to discharge. Results: 96 VLBW infants (28.7 ± 2.8 weeks GA) met inclusion criteria. Of these, 48% received breastmilk at discharge. Controlling for significant effect of length of stay, infants receiving first oral feed at breast were more likely discharged home receiving breastmilk (adj OR 8.7, 95% CI 2.9-32.3, p\u3c0.0001). There was both an independent effect of first oral feed at breast, and an interaction where infants of non-married women also benefited from the first oral feed at breast. Implications: Significant associations were found between first oral feeding at breast and infant receiving any breastmilk at discharge. Targeting VLBW infants to receive first oral feeding at breast may yield the best outcome even among sickest and smallest infants

Caregiving factors affecting breastfeeding duration within a neonatal intensive care unit.

Abstract Background: Increasingly, evidence supports oral feeding of very-low-birth-weight (VLBW) preterm infants exclusively at breast or with breastmilk. Despite known breastmilk benefits, outcomes related to exclusive breastmilk provision are poor. Identifying factors that promote breastmilk provision is critical. Purpose: Breastfeeding practices of mothers of VLBW infants admitted to neonatal intensive care unit (NICU) were explored to identify factors associated with mode of feeding at discharge. Method: This retrospective study replicates previous work. Subjects were VLBW preterm infants consecutively admitted during a 24-month period. Primary outcomes included receiving any breastmilk at discharge. Infant variables included gestational age (GA), post-menstrual age (PMA) of first direct breastfeeding, and co-morbid conditions. Maternal variables included age and ethnicity. Nursing practices variables included first direct-to-breast feeding, number of times to breast daily and total direct-to-breast feeding encounters 24 hours prior to discharge. Results: 96 VLBW infants (28.7 ± 2.8 weeks GA) met inclusion criteria. Of these, 48% received breastmilk at discharge. Controlling for significant effect of length of stay, infants receiving first oral feed at breast were more likely discharged home receiving breastmilk (adj OR 8.7, 95% CI 2.9-32.3, p\u3c0.0001). There was both an independent effect of first oral feed at breast, and an interaction where infants of non-married women also benefited from the first oral feed at breast. Implications: Significant associations were found between first oral feeding at breast and infant receiving any breastmilk at discharge. Targeting VLBW infants to receive first oral feeding at breast may yield the best outcome even among sickest and smallest infants

Current Practice of Neonatal Resuscitation Documentation in North America: A Multi-Center Retrospective Chart Review

Background To determine the comprehensiveness of neonatal resuscitation documentation and to determine the association of various patient, provider and institutional factors with completeness of neonatal documentation. Methods Multi-center retrospective chart review of a sequential sample of very low birth weight infants born in 2013. The description of resuscitation in each infant’s record was evaluated for the presence of 29 Resuscitation Data Items and assigned a Number of items documented per record. Covariates associated with this Assessment were identified. Results Charts of 263 infants were reviewed. The mean gestational age was 28.4 weeks, and the mean birth weight 1050 g. Of the infants, 69 % were singletons, and 74 % were delivered by Cesarean section. A mean of 13.2 (SD 3.5) of the 29 Resuscitation Data Items were registered for each birth. Items most frequently present were; review of obstetric history (98 %), Apgar scores (96 %), oxygen use (77 %), suctioning (71 %), and stimulation (62 %). In our model adjusted for measured covariates, the institution was significantly associated with documentation. Conclusions Neonatal resuscitation documentation is not standardized and has significant variation. Variation in documentation was mostly dependent on institutional factors, not infant or provider characteristics. Understanding this variation may lead to efforts to standardize documentation of neonatal resuscitation