Brown, Kimberly C, MD

Lenhart, C, PhD

Rajan, Preethi

English

Lehigh Valley Health Network: LVHN Scholarly Works

Lehigh Valley Health NetworkLVHN Scholarly WorksUSF-LVHN SELECTStarting off on the Right Food: The Role ofLactation Support in Breastfeeding Initiation andContinuationPreethi RajanUSF MCOM-LVHN Campus, Preethi.Rajan@lvhn.orgC Lenhart PhDKimberly C. Brown MDLehigh Valley Health Network, Kimberly.Brown@lvhn.orgFollow this and additional works at: https://scholarlyworks.lvhn.org/select-programPart of the Medical Education CommonsThis Poster is brought to you for free and open access by LVHN Scholarly Works. It has been accepted for inclusion in LVHN Scholarly Works by anauthorized administrator. For more information, please contact LibraryServices@lvhn.org.Published In/Presented AtRajan, P. Lenhart, C. Brown, K. (2019, March). Starting off on the Right Food: The Role of Lactation Support in Breastfeeding Initiationand Continuation. Poster Presented at: 2019 SELECT Capstone Posters and Presentations Day. Kasych Family Pavilon, Lehigh ValleyHealth Network, Allentown, PA© 2018 Lehigh Valley Health NetworkLehigh Valley Health Network, Allentown, PennsylvaniaStarting off on the Right Food: The Role of Lactation Supportin Breastfeeding Initiation and Continuation REFERENCESRajan, P., Lenhart, C., PhD, Brown, K., M.D. 1. Infant and Young Child Feeding: Model Chapter for Medical Students and Allied Health Professionals. World Health Organization, 2003. http://www.who.int/maternal_child_adolescent/documents/9789241597494/en/2. Carling, Stacy J., et al. "Breastfeeding duration and weight gain trajectory in infancy." Pediatrics 135.1 (2015): 111-119. doi: 10.1542/peds.2014-1392. Epub 2014 Dec 13. Li, Ruowei, et al. "Why Mothers Stop Breastfeeding: Mothers’ 9 Self-reported Reasons for Stopping During the First Year." Pediatrics122.Supplement 2 (2008): S69-S76. doi: 10.1542/peds.2008-1315i4. Chantry CJ, Dewey KG, Peerson JM, Wagner EA, Nommsen-Rivers LA. In-Hospital Formula Use Increases Early Breastfeeding Cessation Among First-Time Mothers Intending to Exclusively Breastfeed. The Journal of pediatrics. 2014;164(6):1339-45.e5. doi:10.1016/j.jpeds.2013.12.035.5. World Health Organization. “Guideline: protecting, promoting, and supporting breastfeeding in facilities providing maternity and newborn services. “ (2017).  Accessed January 29, 2019.6. Bonuck K, Stuebe A, Barnett J, Labbok MH, Fletcher J, Bernstein PS. Effect of Primary Care Intervention on Breastfeeding Duration and Intensity. American Journal of Public Health. 2014;104(Suppl 1):S119-S127. doi:10.2105/AJPH.2013.301360. 7. Bonuck, K. A. (2005). Randomized, Controlled Trial of a Prenatal and Postnatal Lactation Consultant Intervention on Duration and Intensity of Breastfeeding up to 12 Months. Pediatrics, 116(6), 1413-1426. doi:10.1542/peds.2005-0435Problem Statement• WHO – exclusive breastfeeding until 6 months of age [1]• Breastfeeding Benefits [2]– Decreased morbidity and mortality of infectious diseases in childhood – Moderating early infant weight gain future obesity • Early Termination of Breastfeeding – lactation and nutritional concerns [3], In-hospital formula feeding[4]• LVHN- Baby-Friendly Hospital [5]• Role of Lactation Consultant in Prenatal and Postnatal Setting [6, 7]This study investigated the relationship between duration of breastfeeding and encounters with the lactation consultant in both the nursery and the clinic. 400 Women and Infants Enrolled in the Primary Care Obesity Intervention Study Between July 2016-July 2017280 Women and Infants Active at 6 Months 30% of Original Cohort Lost to Follow Up247 Women and Infants Eligible For Inclusion in Breastfeeding StudyInclusion: Born at LVHN – for access to medical record regarding lactation consultation after delivery  Full-Term Infant (Born 37w of gestation) – for feeding and growing issues related to preterm delivery Exclusion Born at Outside Hospital Born Between 34-37 weeks gestation In alignment with the WHO guidelines regarding infant nutrition and the Baby-Friendly designation, lactation counseling should function as a routine part of postnatal care both in the clinic and nursery, as demonstrated by a small sample size of mother-infant dyads in this study. Further work should be pursued to elucidate its role in a larger sample size and in the prenatal setting. There was a statistically significant difference in rate of initiation of breastfeeding in the control group versus the intervention group. No difference existed at 6 months. The control and intervention groups were well-balanced, with the exception of the demographic characteristic of  African-American race. There was a significant difference in the mean duration of breastfeeding within the control groups when analyzed for differences in exposure to lactation counseling (F(2, 114) = 3.36, p=0.04). A significant difference in rates of breastfeeding was found between control mothers seen in the nursery when compared to those seen in the nursery and clinic (p=0.03).• Role of Lactation Support on Breastfeeding – Nursery and Clinic • Limitations – Loss to Follow Up, Sample Size, Standard but not Routine Care • Further Work – Prenatal Counseling, Measurement of Baby-Friendly Initiatives, Larger Sample Size with Routine Counseling• SELECT Principles – Primary Care InterventionTable 1: Baseline Characteristics of  Active Study ParticipantsControl (n=127) Intervention (n=120)Maternal DemographicsWhite 20.3% (26) 23.3% (28)Black/African American* 7.1% (9) 15.8% (19)Hispanic 74.0% (94) 63.3% (76)Age 25.6 yrs (5.0 yrs) 25.9 yrs (5.4 yrs)Completed high school or less 55.9% (71) 50.0%(60)Employed Full time Pre-baby 45.7% (58) 43.8% (53)Employed Full Time Post-Baby 3% (4) 1.7% (2)Overall health is excellent/very good 57.4% (73) 58.3% (70)First Time Breastfeeding 41.4%(53) 44.2% (53)Household DemographicsParents co-parenting in single household 78.7% (100) 75.6% (90) Child’s parents married to each other 28.3% (36) 26.9% (32) WIC participants 81.0% (102) 75.0% (90)Household income ≤ $20,000 44.1% (52) 39.5% (45)Experienced food insecurity 40.9% (40) 33.6% (40) Infant Birth StatisticsWeeks of  gestation at birth 39.4 (1.1w) 39.5 (1.1w)Vaginal delivery 74.0% (94) 75.0% (75)*P<0.05 Table 2: Participation in Breastfeeding (from survey responses)Proportion of Moms breastfeeding at each time point:Among Intervention GroupAmong Control Group Chi^2/t P % (N) % (N)Ever breastfed this baby 79.2% (95) 89.0% (113) 4.47<0.05*At 6 months 21.0% (25) 18.9% (24) 0.005 0.95Table 3: ANOVA Comparisons of Duration of BreastfeedingTukey’s HSD Group n Mean (weeks)           SD Not Seen Nursery OnlyInterventionA) Not Seen by Lactation 12 11.29 9.05B) Seen in Nursery Only69 11.01 9.18C) Seen in Nursery and Clinic11 11.09 7.76ControlA) Not Seen by Lactation 11 9.27 8.82B) Seen in Nursery Only93 9.43 8 0.9C) Seen in Nursery and Clinic11 15.96 8.27 0.13 0.03*TotalA) Not Seen by Lactation 23 10.33 9B) Seen in Nursery Only162 10.1 8.56C) Seen in Nursery and Clinic22 13.63 8.56Background Results DiscussionMethodsConclusions

Starting off on the Right Food: The Role of Lactation Support in Breastfeeding Initiation and Continuation

https://scholarlyworks.lvhn.org/cgi/viewcontent.cgi?article=1273&context=select-program

Starting off on the Right Food: The Role of Lactation Support in Breastfeeding Initiation and Continuation

Abstract

Similar works

Full text

Available Versions

Lehigh Valley Health Network: LVHN Scholarly Works