Lactation Support and Breastfeeding Duration in Jaundiced Infants: A Randomized Controlled Trial

<div><p>Objectives</p><p>Neonatal jaundice is the most common problem in full-term infants during the immediate post-natal period. We examined the effect of a lactation support intervention on breastfeeding duration in hospitalized jaundiced infants.</p><p>Study Design</p><p>We conducted a randomized controlled trial with a qualitative component involving mothers of hospitalized jaundiced breastfed infants <4 weeks of age. Mothers receiving the intervention met with an International Board-Certified Lactation Consultant in hospital and 1–3 times post discharge. Both groups received the standard care for jaundice. The primary outcome was exclusive breastfeeding at 3 months. To the exception of research assistants enrolling participants and completing qualitative interviews, all research staff, investigators and statisticians were blinded to group assignment. Qualitative interviews elicited feedback on breastfeeding experiences for both groups.</p><p>Results</p><p>99 participants were recruited, and 86 analyzed for primary outcome. There was no difference in exclusive breastfeeding at 3 months between groups (RR 0.84, 95% CI 0.56–1.24, p = 0.40) or in the secondary outcomes. 31 participants were included in the qualitative analysis. Participants in the intervention group described an increase in comfort and confidence levels with breastfeeding. Participants in the control group reported limited lactation support.</p><p>Conclusions</p><p>Our hospital-based lactation support program did not result in a higher proportion of mothers exclusively breastfeeding at 3 months compared to current hospital standard care. Qualitative feedback from the intervention group suggests that mothers’ confidence was increased, which is linked to breastfeeding duration. The decision to breastfeed is multifactorial and hospital-based lactation support may be only a small piece of the puzzle in hospitalized jaundiced infants. Further studies may be needed to fully elucidate the impact of an in-hospital lactation support program on successful breastfeeding for these infants.</p><p>Trial Registration</p><p>ClinicalTrials.gov NCT00966719 <a href="https://www.clinicaltrials.gov/ct2/show/NCT00966719?term=Lactation+Support+and+Breastfeeding+Duration+in+Jaundiced+Infants%3A+a+Randomized+Controlled+Trial&rank=1" target="_blank">https://www.clinicaltrials.gov/ct2/show/NCT00966719?term=Lactation+Support+and+Breastfeeding+Duration+in+Jaundiced+Infants%3A+a+Randomized+Controlled+Trial&rank=1</a></p></div

The relationship between the maternal gestational weight gain (GWG) and physical activity in offspring.

<p>(A) In all preschool-age boys (n = 56). (B) In preschool age boys born to mothers with pre-pregnancy body mass index (BMI) < 25 kg/m² (n = 42) (C) In preschool age boys born to mothers with pre-pregnancy BMI ≥ 25 kg/m² (n = 14) (D) In all preschool-age girls (n = 57). (E) In preschool-age girls born to mothers with pre-pregnancy BMI < 25 kg/m² (n = 35). (F) In preschool-age girls born to mothers with pre-pregnancy BMI ≥ 25 kg/m² (n = 22). Adjusted for maternal pre-pregnancy BMI (only all), gestational age at term, accelerometer weartime, andeconomic status.</p

CONSORT diagram.

<p>CONSORT diagram.</p

The relationship between the maternal gestational weight gain and TPA in preschool-age female offspring (counts⋅1000⁻¹/d) when stratified by maternal pre-pregnancy body mass index.

<p>The relationship between the maternal gestational weight gain and TPA in preschool-age female offspring (counts⋅1000⁻¹/d) when stratified by maternal pre-pregnancy body mass index.</p

Subject characteristics.

<p>Subject characteristics.</p

The association between the inadequate, adequate, and excessive gestational weight gain categories and TPA in offspring.

<p>(A) Preschool-age boys (n = 56). (B) Preschool-age girls (n = 57).</p

Comparison of proportions of mothers breastfeeding in study control group and community in general.

<p>^a Ottawa Public Health. Infant Care Survey 2005 [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0119624#pone.0119624.ref016" target="_blank">16</a>]</p><p>^bP values obtained through one-sample binomial tests</p><p>Comparison of proportions of mothers breastfeeding in study control group and community in general.</p

Demographic characteristics.

<p>Demographic characteristics.</p

Demographics and clinical characteristics of all participating mothers.

<p>^an = 97,</p><p>^bn = 98,</p><p>^cn = 45</p><p>Demographics and clinical characteristics of all participating mothers.</p

The relationship between the maternal gestational weight gain and preschool-age male offspring TPA (counts⋅1000⁻¹/d) stratified by maternal pre-pregnancy body mass index.

<p>The relationship between the maternal gestational weight gain and preschool-age male offspring TPA (counts⋅1000⁻¹/d) stratified by maternal pre-pregnancy body mass index.</p