Tube Feeding Practices and Transition to Breastfeeding Experiences of Mothers of Preterm Infants at a Kangaroo Mother Care Unit of a Tertiary Hospital in South Africa

To receive human milk, most preterm infants initially receive the mothers’ expressed milk through a nasogastric tube. However, breast milk feeding the preterm infant and making the transition to direct breast-feeding come with significant challenges. The study explored and described the experiences of mothers of preterm infants regarding initiation and expressing breast milk, tube feeding practices, and transition to breastfeeding during the infants’ stay in a kangaroo care unit (KMC) of an academic hospital in South Africa. Using a qualitative design, focus group interviews were conducted with 38 mothers of preterm infants after discharge from the neonatal intensive care unit (NICU). We analyzed transcripts following the 5 steps for qualitative thematic data analysis. Tube feeding and breastfeeding preterm infants was challenging and exhausting for the mothers. Many described their experiences of initiating expression and sustaining milk supply as negative. They had constant concerns about their ability to produce adequate milk volumes to feed their infants. They had immense dislike of expressing, which they described as physically exhausting, stressful, and painful. Those who had initiated breastfeeding were highly motivated to breastfeed their preterm infants. They described breastfeeding as a positive bonding experience that they derived pleasure from. The mothers’ dislike of expressing was overshadowed by their emotional obligation toward their preterm infants. Although the KMC unit promotes breastfeeding, mothers encountered problems and struggled to initiate expression and sustain milk production. Mothers of extreme and very preterm infants need support to continue with milk expression during the long NICU and KMC stay.

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Direct swallowing training and oral sensorimotor stimulation in preterm infants: a randomised controlled trial

Archives of Disease in Childhood - Fetal and Neonatal Edition ◽

10.1136/archdischild-2021-321945 ◽

2021 ◽

pp. fetalneonatal-2021-321945

Author(s):

Ju Sun Heo ◽

Ee-Kyung Kim ◽

Sae Yun Kim ◽

In Gyu Song ◽

Young Mi Yoon ◽

...

Keyword(s):

Randomised Controlled Trial ◽

Preterm Infants ◽

Neonatal Intensive Care ◽

Controlled Trial ◽

Tube Feeding ◽

Tertiary Hospital ◽

Oral Feeding ◽

Very Preterm Infants ◽

Very Preterm ◽

Randomised Controlled

ObjectiveTo evaluate the effects of direct swallowing training (DST) alone and combined with oral sensorimotor stimulation (OSMS) on oral feeding ability in very preterm infants.DesignBlinded, parallel group, randomised controlled trial (1:1:1).SettingNeonatal intensive care unit of a South Korean tertiary hospital.ParticipantsPreterm infants born at <32 weeks of gestation who achieved full tube feeding.InterventionsTwo sessions per day were provided according to the randomly assigned groups (control: two times per day sham intervention; DST: DST and sham interventions, each once a day; DST+OSMS: DST and OSMS interventions, each once a day).Primary outcomeTime from start to independent oral feeding (IOF).ResultsAnalyses were conducted in 186 participants based on modified intention-to-treat (63 control; 63 DST; 60 DST+OSMS). The mean time from start to IOF differed significantly between the control, DST and DST+OSMS groups (21.1, 17.2 and 14.8 days, respectively, p=0.02). Compared with non-intervention, DST+OSMS significantly shortened the time from start to IOF (effect size: −0.49; 95% CI: −0.86 to –0.14; p=0.02), whereas DST did not. The proportion of feeding volume taken during the initial 5 min, an index of infants’ actual feeding ability when fatigue is minimal, increased earlier in the DST+OSMS than in the DST.ConclusionsIn very preterm infants, DST+OSMS led to the accelerated attainment of IOF compared with non-intervention, whereas DST alone did not. The effect of DST+OSMS on oral feeding ability appeared earlier than that of DST alone.Trial registration numberClinicalTrials.gov Registry (NCT02508571).

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The effect of smell and taste of milk during tube feeding of preterm infants (the Taste trial): a protocol for a randomised controlled trial

BMJ Open ◽

10.1136/bmjopen-2018-027805 ◽

2019 ◽

Vol 9 (7) ◽

pp. e027805 ◽

Cited By ~ 1

Author(s):

Friederike Beker ◽

Judith Macey ◽

Helen Liley ◽

Ian Hughes ◽

Peter G Davis ◽

...

Keyword(s):

Preterm Infants ◽

Neonatal Intensive Care ◽

Late Onset ◽

Controlled Trial ◽

Tube Feeding ◽

Growth Failure ◽

Neurodevelopmental Outcomes ◽

Very Preterm Infants ◽

Reference Number ◽

Discharge From Hospital

IntroductionSmell and taste of milk are not generally considered when tube feeding preterm infants. Preterm infants have rapid growth, particularly of the brain, and high caloric needs. Enteral feeding is often poorly tolerated which may lead to growth failure and long-term neurodevelopmental impairment. Smell and taste are strong stimulators of digestion and metabolism. We hypothesise that regular smell and taste during tube feeding will improve weight z-scores of very preterm infants at discharge from hospital.Methods and analysisTaste is a randomised, unblinded two-centre trial. Infants born at <29 weeks’ gestation and/or <1250 g at birth and admitted to a participating neonatal intensive care unit are eligible. Randomisation occurs before infants receive two hourly feeds for 24 hours. Infants are randomised to either smell and taste of milk with each tube feed or tube feeding without the provision of smell and taste. The primary outcome is weight z-score at discharge. Secondary outcomes include: days to full enteral feeds, duration of parenteral nutrition, rate of late-onset sepsis, post menstrual age at removal of nasogastric tube and at discharge from hospital, anthropometric data and neurodevelopmental outcomes at 2 years of corrected age.Ethics and disseminationHuman Research Ethics Committees of Mater Misericordiae (trial reference number: HREC/16/MHS/112) and the Royal Women’s Hospital (trial reference number: 17/21) last approved the trial protocol (version 4.2; Date: 18 December 2018) and recruitment commenced in May 2017 and November 2017, respectively. The trial results will be published in a peer-reviewed journal and will be presented at national and international conferences.Trial registration numberACTRN12617000583347.

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Short-term Pasteurization of Breast Milk to Prevent Postnatal Cytomegalovirus Transmission in Very Preterm Infants

Clinical Infectious Diseases ◽

10.1093/cid/ciy945 ◽

2018 ◽

Vol 69 (3) ◽

pp. 438-444 ◽

Cited By ~ 9

Author(s):

Sascha Bapistella ◽

Klaus Hamprecht ◽

Wolfgang Thomas ◽

Christian P Speer ◽

Klaus Dietz ◽

...

Keyword(s):

Breast Milk ◽

Preterm Infants ◽

Neonatal Intensive Care ◽

Severe Illness ◽

Short Term ◽

Very Preterm Infants ◽

Very Preterm ◽

Cox Proportional Hazard ◽

Level 3 ◽

Historical Controls

Abstract Background Postnatally acquired cytomegalovirus (pCMV) infection through breast milk (BM) may cause severe illness and even death, yet BM is advantageous for preterm infants. Therefore, effective methods to prevent CMV transmission are needed. Methods To assess the effectiveness of short-term pasteurization (62°C for 5 seconds) in preventing CMV transmission via BM in preterm infants. Design: Prospective interventional bicentric cohort study with infant enrollment between 6/2010 and 1/2012. A cohort from the Tuebingen neonatal intensive care unit (NICU) from 1995–1998 served as historical controls. Differences in CMV transmission were compared with reference to the cumulative time at risk for CMV transmission. Setting: Two German level-3 NICUs. Eighty-seven preterm infants of 69 CMV immunoglobulin G-positive mothers with birth weight <1500 g or gestational age <32 weeks and 83 historical controls were included. Intervention: BM samples were short-term pasteurized from postnatal day 4 to discharge. Primary endpoint: CMV status at discharge, evaluated by polymerase chain reaction and short-term microculture from urine. Results Two of 87 (2.3%) study infants had a pCMV transmission. This compared to 17 of 83 (20.5%) controls. Total time under risk for infection was 9.6 years vs 10.0 years in controls, yielding an incidence of 0.21/year (95% confidence interval [CI], 0.03 to 0.75/year) vs 1.70/year (95% CI, 0.99 to 2.72/year), respectively. The risk ratio controls vs study infants was 8.3 (95% CI, 2.4 to 52.4) according to Cox proportional hazard model (P = .0003). Conclusions Short-term pasteurization significantly reduces the incidence of pCMV infection through BM in the NICU. Clinical Trials Registration NCT01178905.

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Implementing an education program for nurse-midwives focused on early essential care for breast milk expression among mothers of preterm infants

10.21203/rs.3.rs-136755/v1 ◽

2020 ◽

Author(s):

Rie Tanaka ◽

Shigeko Horiuchi

Keyword(s):

Breast Milk ◽

Preterm Infants ◽

Educational Program ◽

Neonatal Intensive Care ◽

Medical Center ◽

Breast Milk Expression ◽

Breast Milk Production ◽

Appropriate Care ◽

Mothers Of Preterm Infants ◽

Nurse Midwives

Abstract BackgroundAlthough breastfeeding guidelines for infants admitted to the neonatal intensive care unit (NICU) have been introduced in Japan, these guidelines have not been reflected in practice. To improve this situation, it is important for nurses and nurse-midwives to acquire knowledge of appropriate care. This study examined changes in the knowledge of appropriate care of nurse-midwives after implementing an educational program focused on early essential care for breast milk expression among mothers of preterm infants. MethodsThis before-after study using a single group enrolled 36 nurse-midwives in one perinatal medical center. The educational program content included nurses’ roles in early essential care for milk expression and the necessary care to promoting breast milk production among mothers of preterm infants. The nurse-midwives' knowledge and attitude on care were investigated three months before (pre-1), just before (pre-2), just after (post-1), and three months after (post-2) the program. The nurse-midwives’ care implementation was investigated at pre-1, pre-2, and post-2. During this time, 11 mothers (before: 7, after: 4) reported the status of milk expression for 10 days after birth. ResultsThe mean knowledge scores of the nurse-midwives at post-1 and post-2 were significantly higher than that at pre-2 (post-1: p < 0.001, post-2: p < 0.001). The attitude on care scores at post-1 and post-2 were significantly higher than that at pre-2 (post-1: p < 0.001, post-2: p = 0.010). The care implementation score at post-2 was significantly higher than that at pre-2 in eight items (e.g., Q7 Explain about the effect of initiating milk expression early and assist mothers in it). However, the educational program did not cause any changes in the mothers’ initiation and frequency of milk expression, and breast milk volume after birth. ConclusionsThe significant increases in the knowledge, attitude on care, and care implementation scores of the nurse-midwives suggest the beneficial effects of the educational program. Further detailed examination of the effects of the program on nurses and nurse-midwives, and identification of methods to reduce barriers to the practice of best evidence in the clinical setting are warranted to improve mothers’ status of milk expression.

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The Effect of Individualized Developmental Care Practices in Preterm Infants

Complementary Medicine Research ◽

10.1159/000504357 ◽

2019 ◽

Vol 27 (2) ◽

pp. 97-104

Author(s):

Dilek Küçük Alemdar ◽

Sevil İnal

Keyword(s):

Breast Milk ◽

Preterm Infants ◽

Neonatal Intensive Care ◽

Controlled Trial ◽

Oral Feeding ◽

Control Group ◽

Developmental Care ◽

Significant Difference ◽

Care Practices ◽

Maternal Voice

Background: Preterm infants are vulnerable humans requiring much care and attention. They may be exposed to irregular noise, light, and odor in the neonatal intensive care unit for a period of several weeks or months. This study was carried out to determine the effect of individualized developmental care on physiological parameters, growth, and transition to oral feeding in preterm infants. Methods: The study was a randomized controlled trial. The sample comprised premature infants meeting the inclusion criteria. They were randomly assigned to four groups: the maternal voice group, the breast milk odor (BMO) group, the incubator cover (IC) group, and the control group. Results: No statistically significant difference was found between the groups in terms of weight, height, and head circumference at time of discharge. Mean SO2 values were statistically higher in the IC group than the other groups; however, the heart rate and respiratory rate were not statistically different in a significant sense between the groups. The briefest duration of transition to total oral feeding was seen in the BMO group. Conclusion: Individualized developmental care practices based on the results of these interventions are likely to support the care of preterm infants. Breast milk odor may ease the transition to breastfeeding.

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A prospective cohort study on lactation status and breastfeeding challenges in mothers giving birth to preterm infants

International Breastfeeding Journal ◽

10.1186/s13006-021-00447-4 ◽

2022 ◽

Vol 17 (1) ◽

Author(s):

Dingding Dong ◽

Xifang Ru ◽

Xiaofang Huang ◽

Tian Sang ◽

Shan Li ◽

...

Keyword(s):

Logistic Regression ◽

Preterm Infants ◽

Multivariate Logistic Regression Analysis ◽

Tertiary Hospital ◽

Post Discharge ◽

Milk Output ◽

Early Postpartum ◽

Milk Volume ◽

Mothers Of Preterm Infants ◽

Mother’S Own Milk

Abstract Background Mothers of preterm infants face many challenges in breastfeeding, especially regarding lactation. This study aimed to investigate the lactation status and challenges in breastfeeding faced by preterm infants’ mothers. Methods We approached 124 mothers who gave birth to preterm infants between 26 May and 31 October 2018 in a tertiary hospital in China. Lactation status and challenges in breastfeeding on day 7 postpartum, at discharge of infants, 2 weeks post-discharge, and 3 months of corrected age were collected using questionnaires. The area under the receiver operating characteristic (ROC) curve for expressed milk volume on day 7 postpartum for predicting expressed milk volume ≥ 300 mL/d at discharge was calculated. Logistic regression analyses were performed to identify factors associated with delayed lactogenesis II onset and continuation of breastfeeding at 3 months of corrected age. Results Seventy mothers were enrolled, and 51.4% had delayed lactogenesis II. Multivariate logistic regression analysis revealed that older maternal age (aOR = 1.19; 95% CI: 1.01, 1.40) and first live birth (aOR = 4.81; 95% CI 1.43, 16.18) were significant independent predictors of delayed lactogenesis II. Mothers with delayed lactogenesis II had significantly lower expressed milk volume (day 7 postpartum: 160.0 mL vs. 300.0 mL, U = 328.50, p = 0.001; at discharge: 425.0 mL vs. 612.5 mL, U = 372.00, p = 0.005), with a lower proportion of exclusive breastfeeding in their infants (at discharge: 33.3% vs. 69.8%, χ2 = 12.39, df = 1, p < 0.001; 3 months of corrected age: 17.8% vs. 52.8%, χ2 = 11.03, df = 1, p = 0.001). The ROC showed that expressed milk volume > 190 mL/d on day 7 postpartum significantly predicted expressed milk volume ≥ 300 mL/d at discharge. Insufficient human milk was the main reason for breastfeeding discontinuation at 3 months of corrected age. Twins were less likely to continue breastfeeding at 3 months of corrected age (aOR = 0.27; 95% CI 0.09, 0.86). In singleton infants, mother’s own milk ≥50% of total milk uptake at 2 weeks post-discharge (aOR = 32.66; 95% CI 3.00, 355.25) was an independent predictor of continuous breastfeeding at 3 months of corrected age. Feeding complications in infants, poor breastfeeding technique, and low milk output are the main challenges in breastfeeding. Conclusion Interventions to improve early postpartum lactation and breastfeeding techniques may increase breastfeeding adoption in mothers of preterm infants.

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