Abstracts from
The Academy of Breastfeeding Medicine
16th Annual International Meeting
Miami, Florida
November 3–6, 2011

Background: The use of hindmilk rich completely expressed human milk increases the endogenous lipid content of human milk. This can improve the rate of weight gain of newborns and serve as a low-cost “fortifier” in resource-limited settings.

Objective: To study the effect of completely expressed hindmilk rich feeds vs. composite milk feedings in increasing the weight gain of preterm newborns.

Methods: Newborn infants between 28 to 32 weeks of gestational age with no significant medical issues except prematurity on expressed breastmilk feeds were randomized to hindmilk and composite milk feeding over a two week period. Rates of gain for weight, head circumference and length were compared between the two groups. Fat content of milk samples was analyzed using the crematocrit technique.

Results: Small-for-gestational age infants in the hindmilk group had a mean rate of weight gain of 15.62 ± 2.51 g/kg/d while their control group gained weight at the rate of 5.44 ± 1.99 g/kg/d. For appropriate-for-gestational age infants weight gain rates for the study and control group were 18.80 ± 3.20 and 8.02 ± 2.68 g/kg/d respectively. Similar rates for LGA infants were 21.56 ± 3.00 and 9.98 ± 2.98 g/kg/d. There were no significant differences in the rates of increase in length and head circumference between the two groups. Lipid content of hindmilk was 1.4 times that of composite milk.

Conclusions: Hindmilk feeds improve weight gain rates of preterm infants and can be a strategy to reduce length of stay in-hospital and improve newborn outcomes.

Funding Sources: Institute of Child Health Post-graduate Education Fund.

Background: NEC remains a common disease of infants weighing <1250 grams at birth. Preferential maternal milk feeds is a successful strategy to prevent NEC. However, maternal milk alone does not achieve optimal growth for these infants. A standard feeding guideline for infants <1250 grams implemented 2 years prior to the EHD did not yield any change in NEC. Currently, a human-derived liquid human milk fortifier (HHMF) is available, making EHD a possibility.

Objective: To confirm that EHD is effective for prevention of NEC in high risk infants.

Methods: Prospective cohort. Power of 80% with a 50% NEC reduction requires 244 patients. EHD differs from historical cohort in the fortification of breastmilk with HHMF (Prolacta ™) vs. standard HMF. EHD ended at 33-34 weeks gestation and >1500 grams. Data collected from 7/2010 - 3/2011. Statistical analysis was by Chi-Square.

Results: After 9 months, we have experience with 84 patients (34% of total). Total NEC rates declined to 4.8% from 16% (p=0.026, NNT=9). Surgical NEC rates have declined to 2.4% from 10% (p=0.35 NNT=13).

Conclusions: For infants <1250gm, EHD is an effective intervention, and may significantly reduce both total and surgical NEC.

Funding Sources: None.

Background: The standard of care at our institution has been to give the newborn bath at 2 to 4 hours of life. In May 2010, we began to delay the bath for at least 12 hours of life as standard of care for all eligible infants.

Objective: To determine if delaying the newborn bath correlated with a change in exclusive breastfeeding rates.

Methods: We compared exclusive breastfeeding rates 6 months before and after the start of the Delay the Bath Initiative. The medical record of every third eligible-to-breastfeed infant admitted to the newborn service during this 12-month period was reviewed. Infant feeding information was obtained from the 24-hour bedside flow sheet. Feeds for the entire hospital stay were tallied and each infant was categorized into one of 7 tiers by percentage of breastfeeds received (100%, 90-<100, 75-<90, 50-<75, 25-<50, 1-<25 and 0).

Results: We reviewed 718 infant charts. Infant (gestational age) and maternal characteristics (mode of birth, race, age, health insurance) were similar before and after delaying the bath. Exclusive breastfeeding rates increased from 31.4% (111/353) to 40% (146/365) (p=.02) during the time period studied.

Conclusions: We found that delaying the bath was associated with a statistically significant increase in exclusive breastfeeding rates. We hypothesize that this may be due to limiting stress during the critical period following delivery when the newborn's blood sugar normally nadirs and the infant is striving to maintain temperature regulation. Delaying the bath is a simple intervention that may support improved exclusive breastfeeding rates.

Funding Sources: Transforming Birth Fund of the New Hampshire Charitable Trust.

Background: Kenya has 2.46 million cases of HIVof which approximately 60,000 attributed to vertical transmission every year. There are no studies that have attempted to explore clinicians' knowledge on breastfeeding and HIV a vital component in prevention of maternal to child transmission.

Objective: To evaluate clinicians' knowledge on HIV and breastfeeding.

Methods: A cross-sectional survey to assess the knowledge of a group of health workers from all regions of Kenya. A questionnaire on HIV and breastfeeding was administered.

Results: There were 161 participants of whom 91 were female and 70 male. The mean age was 29 years. Nurses composed 106 (65.8%) and clinical officers 55 (34.2%) of the group. The responses were as follows; expressed breast milk from HIV positive mothers should be boiled before being given (49%), breast milk should be given regardless of availability of alternatives (78.3%), breast feeding should continue for at least 2 years after weaning (84.5%), exclusive breastfeeding increases chances of HIV transmission (74.5%) as compared to alternative feeding, breastfeeding is recommended for mothers who don't know their HIV status (66.5%). Additionally, 75.2% of the clinicians conceded that the risks of childhood illnesses and deaths superseded the risk of HIV transmission from breast milk if breastfeeding was not done. Moreover, 38% could not relate the contribution of mastitis to the increased risk of HIV transmission.

Conclusion: There are gaps concerning breastfeeding and HIV among this group of health workers. There is a need to educate these health workers on HIV and breastfeeding.

Background: Endocrine evaluation of breastfeeding problems is limited by lack of normative values in successfully breastfeeding women.

Objective: To determine normal ranges for cortisol, free T4, total T4 and prolactin in exclusively breastfeeding women.

Methods: Women planning to breastfeed were recruited in the 3rd trimester. Biomarkers were assessed before and after feeding at 2 and 8 weeks postpartum. We used descriptive statistics and paired t-tests to compare values at 2 and 8 weeks.

Results: Of 48 study participants, 30 were exclusively breastfeeding at visit 2 and 31 were exclusively breastfeeding at visit 3. Endocrine markers were lower at 8 weeks than at 2 weeks (paired t-test p≤01). We found a wide range of prolactin values among exclusively breastfeeding mothers at the 8 week visit (Prefeed: 9-184, Postfeed: 20-221ng/mL). The ranges for cortisol and free T4 at 8 weeks were lower than reference ranges for healthy adults (FT4: 0.67-1.22 vs. 0.8-1.7ng/dL, Cortisol: 4.1-14.1 vs. 5-25μg/dL.

Conclusions: Endocrine function changes during the first 8 weeks after birth. Establishing normal ranges may assist in endocrine evaluation of low milk supply.

Funding Sources: National Institute of Health and National Center for Research Resources UL1RR025747 (50KR20927).

Background: Smoking mothers are more than twice as likely to quit breastfeeding by ten weeks postpartum. Approximately 40% of women who smoke tobacco quit smoking during pregnancy, yet up to 85% relapse after delivery. Those who resume smoking often do so by eight weeks postpartum. The hospitalization of a newborn, while stressful, is an opportunity to emphasize the importance of breastfeeding and creating a smoke-free environment for babies. Supporting maternal-infant bonding may reduce maternal stress and motivate mothers to continue breastfeeding and remain smoke free.

Objective: To prolong breastfeeding duration during the first eight weeks postpartum and reduce postpartum smoking relapse in mothers who quit smoking just prior to or during pregnancy and have newborns admitted to the NICU.

Methods: This study was an IRB approved prospective randomized clinical trial. After informed consent, mothers of newborns admitted to the NICU were randomized to a control or intervention group. Both groups received routine breastfeeding support and weekly encouragement to remain smoke free. Mothers in the intervention group were also given enhanced support for maternal-infant bonding including information about newborn behaviors and encouraged to hold their babies skin-to-skin.

Results: More mothers were breastfeeding (86 vs. 21%, p<0.001) and smoke free (81 vs. 46%, p<0.001) in the intervention than in the control group at eight weeks postpartum.

Conclusions: Interventions to support mother-infant bonding during a newborn's hospitalization in the NICU are associated with prolonged duration of breastfeeding and reduced rates of smoking relapse during the first eight weeks postpartum.

Funding Sources: AAP Richmond Center, Flight Attendant Medical Research Institute and The March of Dimes (Inland Empire, CA) and Masimo, Corp.

Background: There is controversy about the mode of feeding babies with congenital heart disease (CHD) complicated by heart failure (HF).

Aim: To examine the effect of skin-to-skin care (SSC) during breastfeeding and artificial feeding on the vital signs of babies with CHD admitted to hospital with HF.

Subjects included 55 infants under one year with CHD and HF divided according to their mode of feeding into 19 exclusively breastfed, 21 formula fed and 15 controls. Their oxygen saturations (PO₂) and heart rate (HR) were monitored before and during a session of feeding, and after a period of SSC. The anxiety state of the mother was measured before and after SSC.

Results: Babies who were breastfeeding exhibited significantly higher levels of PO₂ at start of the feed than the formula fed ones and it continued to rise decreasing at about 8 minutes then rising again at the end of the feed. The PO₂ of formula fed did not rise during a feed and fell at 6 minutes. PO₂ and HR patterns improved with SSC in both groups but PO₂ remained statistically significantly higher in the breastfed. The anxiety state of mothers was high in both groups but severer grades were common among the formula fed.

Conclusion: Contrary to previous belief, formula feeding is not safer than breastfeeding. It is more stressful for babies with CHD and HF. SSC appears effective in stabilizing disturbed heamodynamics in these babies and is recommended as a means for improving their outcome irrespective of maternal anxiety.

Funding Sources: Self funded by the candidate student for fulfillment of the requirements of Master degree in Pediatrics.

Background: A 9.0-magnitude earthquake occurred on 11 March in Japan at 15:46:23 GMT, hitting the northeast coast of Honshu, Japan. Multiple disasters occurred including fires, aftershocks and damage to nuclear power plants. Based on official Japanese government figures (7 June), 15,382 people are confirmed dead, 5,364 injured and 8,191 missing. There are now 93,270 evacuees. JALC started supportive activities on 11 March.

Objective and Methods: Many reports are published about breastfeeding-support in emergencies. But we have never experienced such ‘complicated’ disaster with earthquakes, tsunamis and nuclear accidents.

We summarize JALC's activities for the breastfeeding support in this disaster mainly conducted by Advocacy Committee in JALC, which is composed with mainly medical doctors and ABM members.

Results: JALC announced 7 statements and collaborated with other breastfeeding-support organizations of including the Japan Committee for UNICEF. Several medical academic societies posted statements sent from JALC on their websites as reference documents. Several FM broadcast and TV stations broadcasted information of JALC to local inhabitants.

Conclusions: The myth that the artificial milk was safe collapsed in the developed country such as Japan. Though the information that indicated the safety of breastfeeding at the time of a disaster was easily accepted, the assertion to be said not to receive liquid milk donated from foreign countries was hard to be understood not only by general public but journalists. The problem about nuclear accidents is now going on.

Funding Sources: None.

Background: Breastfeeding can present challenges for the healthiest of mother-baby dyads. Additional feeding challenges may arise when the infant has Down Syndrome (DS).

Objective: To learn about breastfeeding experiences, perceptions, barriers and needs from mothers of children with DS.

Methods: We conducted an online survey via the websites of three different DS organizations. Mothers who were from the US, >18 years, and able to read English were eligible to participate. The survey contained a mixture of 56 quantitative and open-ended questions.

Results: Most of the 98 respondents were white (95%), well-educated (94%), and had an annual household income of ≥$50,000 (87%). Breastfeeding rates were 84% (initiation), 56% (6 months), and 42% (12 months). Previous breastfeeding experience, perception of breastfeeding normality, birth order, and days spent in the hospital influenced breastfeeding success; congenital medical conditions, surgery, poor infant health, and belief in infant capability did not. 31% of respondents reported substantial difficulty with breastfeeding. Most of the time (70%), the diagnosis of DS either did not change or increased the mother's motivation to breastfeed. Only 5% reported that a medical professional provided information about breastfeeding an infant with DS, and, when information was provided, it was often inconsistent.

Conclusions: Medical professionals should play a primary role in educating and supporting mothers who are breastfeeding infants with DS. The message should be that the diagnosis need not change their plans to breastfeed because it is achievable. Because the process may be challenging, these families need accurate information and ongoing support.

Funding Sources: Brandeis University Graduate School of Arts and Sciences Master's Research Grant.

Background: The effect of latitude on vitamin D status of fully lactating mothers and their infants is unknown.

Objective: Measure vitamin D status in lactating women and their infants at one-month as part of vitamin D RCT conducted at MUSC (latitude 32^°N) and UofR (latitude 43.1^°N).

Methods: Baseline total circulating 25(OH)D concentration as the indicator of vitamin D status was measured by RIA (Diasorin, Inc., Stillwater, MN) in 334 fully lactating women and their infants enrolled at 1-month postpartum as part of an ongoing RCT conducted at MUSC and UofR. Maternal sociodemographics also were collected. Data analyzed by t-test, X² and ANOVA.

Results: There were 99 African American, 138 Caucasian and 97 Hispanic pairs, 190 from MUSC and 144 from UofR. [see Table 1] The sites differed by race/ethnicity and insurance status but not by maternal age or other sociodemographics. African American and Hispanic women living in Charleston had lower mean maternal 25(OH)D than women in Rochester with the reverse found in Caucasian women. Infant mean 25(OH)D was significantly lower at MUSC compared to UofR overall and among African American and Hispanic infants. Seasonality accounted for some of the variance only in the infants.

Conclusions: The higher latitude was found to adversely affect vitamin D status only in lactating Caucasian women; African American and Hispanic women living in Rochester compared to Charleston had improved vitamin D status. Breastfeeding infant vitamin D status mirrored maternal status by latitude. Conclusions about vitamin D status based on latitude alone may be faulty.

Funding Sources: NIH/NICHD #R01 HD47511; NCRR UL1RR029882; Children's Hospital Fund, MUSC; Division of Neonatology, MUSC.

Background: Kangaroo mother care (KMC) has been accepted as a safe and effective method in caring for low birth weight infants (LBWI). However, the adoption of this method by many countries of the Eastern Mediterranean region (EMR) is still low.

Objective: To identify the barriers to the implementation of KMC in neonatal intensive care units (NICUs) in two countries in the EMR; one with low affluence: Egypt, and one with high affluence: Kingdom of Saudi Arabia (KSA).

Methods: This is a cross-sectional study including 90 major hospitals with NICUs, 60 in Egypt and 30 in KSA. The knowledge, attitude and practice (KAP) toward KMC of 560 NICU staff and hospital administrators was assessed through quantitative and qualitative methods of analysis.

Results: Overall acceptance rate was high at 79%. It was higher among doctors and nurses (80% and 86% respectively) as compared to only 63% for hospital administrative staff. Barriers and suggested solutions focused on space and awareness about the value and safety of KMC in Egypt and on cultural issues and training in KSA.

Conclusions: Resistance to implementation of KMC continues to prevail in over-medicalized health care systems. This originates mainly from the administrative staff irrespective of the degree of affluence in a country. Producing training and advocacy material targeting the latter staff is recommended. A training module for administrators based on current evidence, cost effectiveness, compliance with quality in health care and patient satisfaction may prove useful for this region.

Funding Sources: Self funded by the candidate student (Dr. Nesreen) for fulfillment of the requirements of Master degree in Pediatrics.

Abstract Withdrawn

Background: Little information is available with regards to breastfeeding mothers especially once they are discharged from the hospital. To improve rates of breastfeeding, information on beliefs and practices that influence this outcome is needed.

Objective: To determine the breastfeeding knowledge, attitude and practices of low income mothers who delivered at Perpetual Hospital.

Methods: This is a cross sectional-analytical study using a semi-structured interview. Mothers who completed the prenatal, Iowa Infant Feeding Assessment Scale (IIFAS) and postpartum questionnaires were included in this study. Responses from IIFAS were graded using a five-point Likert rating system. Univariate analysis using crude odds ratio was utilized to determine the association of demographic and breastfeeding knowledge, attitudes and practices. Non-parametric Kruskal WallisANOVAand median test were utilized to compare the ranked mean responses across three or more categories. All tests of significance were performed at .05 alpha level of significance using MEDCALC as biostatistical software.

Results: The IIFAS was able to distinguish three breastfeeding intentions (breastfeeding, formula and mixed feeding) and eventual outcome. The breastfeeding initiation in our study was very high (100%) however only 51% were exclusively breastfeeding at 1–2 weeks. Social support was significantly associated with breastfeeding continuation postpartum. The intention to breastfeed, early initiation ( μ 1 hour) and high IIFAS scores were significantly associated with the actual practice.

Conclusions: This study provides evidence for the reliability of IIFAS. It identified mothers who have higher tendency to breastfeed. This survey tool could prove useful in targeting mothers and provide intervention prior to delivery.

Background: The purpose of this study, that analyzed the existing Feeding Your Infant (FYI) dataset, was to examine the impact of Baby-Friendly (BF) Hospital designation, employment, parity, and other social-ecological factors on lactation status at three months postpartum in upstate New York.

Objective: The dataset was analyzed using an adapted version of the Bronfenbrenner Social-Ecological Systems Framework.

Methods: A convenience sample of 842 breastfeeding mothers was surveyed at baseline between two sites - one a BF designated hospital, and one a community-based hospital with a mature breastfeeding program. T-tests, Chi square,multiple correspondence analyses, and multiple logistic regression analyses were performed

Results: Of the 515 mothers who returned the three month survey, 409 (79.4%) were still breastfeeding. Maternal age of 31 to 35 years, women with 16 or more years of education, and married women, were statistically more likely to be breastfeeding. Mothers who expected a maternity leave > 3 months, who had a prior live birth, and who associated breastfeeding with “convenience” were more likely to be breastfeeding. Mother's race, parity status, perception of having a “sleepy baby,” experience with engorgement and/or sore/bleeding nipples, and a mother's delivery site, were not statistically significant. Predictors of breastfeeding status were insufficient milk, perception of “too much time,” and mothers' educational level.

Conclusion: In light of “The 2011 U.S. Surgeon General's Call to Action to Support Breastfeeding,” and the growing interest in The Ten Steps to Successful Breastfeeding and the WHO/UNICEF BF Hospital Initiative, these findings have important implications for education, practice, policy, and future research.

Funding Sources: None.

Abstract Withdrawn

Background: In-hospital formula supplementation (H-formula) of breastfed infants is associated with shorter breastfeeding duration. Causality is unclear.

Objective: To evaluate among mothers intending to exclusively breastfeed: a) reasons for H-formula; and b) if H-formula shortens breastfeeding duration after adjusting for strength of breastfeeding intentions.

Methods: Data were collected prospectively on primiparas' reported prenatal breastfeeding intentions; daily reasons for H-formula (multiple reasons allowed; coded into 8 themes) and breastfeeding practices to 60 days. We used Chi-square tests to compare reasons for H-formula (first 72 h) by Infant Feeding Intention (IFI) score and logistic regression to examine if H-formula increases risk of early breastfeeding cessation after adjusting for IFI.

Results: Of 407 infants, 189 (46%) infants received H-Formula (41% vs. 54%, high vs. low IFI, respectively, p=0.008). Reasons were: 18%, milk supply concern; 16%, signs of inadequate intake; 14%, difficulty with latching/suckling; 9%, maternal-infant separation; 6%, convenience; 4%, breast or nipple pain; 3%, unwell mother; and 1%, medication concern. Overall, 33% vs. 10% stopped breastfeeding before 60 days, H-Formula vs. no H-Formula groups: RR=3.1, p<0.0001. Adjusted RR=2.8 (adjusted for IFI), p<0.0001. Risk of breastfeeding cessation was greatest if reason for H-Formula was breast/nipple pain (RR=4.5), latch/suckling difficulty (RR=4.2), or convenience (RR=4.0) (vs. no H-Formula group, all p<0.0001).

Conclusions: H-formula supplementation significantly increases risk of early breastfeeding cessation, even after adjusting for breastfeeding intentions. Acceptable alternatives to supplementation should be sought, particularly with painful breastfeeding, infant breastfeeding difficulties, or maternal inconvenience. Methods to mitigate adverse outcomes associated with unavoidable H-formula should be identified.

Funding Sources: MCHB Grant R40MC04294, K. Dewey PI; NIH 1R21HD063275-01A01, L. Nommsen-Rivers PI.

Background: Exclusive Breastfeeding (EBF) for 6 months is challenging in Thailand. The strengthening of the Baby-Friendly Hospital Initiative (BFHI) could be a key strategy to overcome the factors affecting the EBF rate.

Objective: To determine the associated factors of EBF practices and related infant health outcomes in Thailand Baby-Friendly Hospitals.

Methods: A Cohort Study of 3,964 mother-infant dyad discharged from 11 BFHI hospitals was conducted during April 2009 to February 2011.The perinatal data, infant feeding practices, maternal knowledge, attitude and practices and infant health status from birth to 24 months were analyzed.

Results: The mean EBF rate was 46.7%. The 7/11 hospitals achieved the higher EBF rate than the national targeted rate of 30%, one of those achieved the highest rate of 70.5%. Maternal occupation, income, comprehensive breastfeeding knowledge and skill and continuous support after discharging from hospitals were the most common outcome determinants. The upper respiratory tract infection and the diarrhea rate was high during 9–24 months among the group of infants who were both breastfed and formula-fed during the first 6 months of life. The rate of diarrhea was significantly reduced at 24 month old infants by the increased duration of EBF during the first 6 months of life.

Conclusions: The strengthening of the BFHI especially the 10^th step was the recommended strategy for the sustainability of EBF. The infant infection, especially diarrhea, was prevented by EBF for 6 months.

Funding Sources: Thai Health Foundation.

Background: Exclusive breastfeeding is an important metric in hospital quality measures. The 10 steps of the Baby-Friendly Hospital Initiative are known to be predictive of immediate and long term breastfeeding success.

Objective: To describe progress towards a “Baby-Friendly Hospital” in an Academic Medical Center.

Methods: A multidisciplinary task force, BFIT (Breastfeeding Improvement Task Force), was assembled with the short term goal of improving exclusive breastfeeding rates at hospital discharge. BFIT chose three of ten Baby-Friendly Steps – breastfeeding within the first hour, exclusive breastfeeding, and having a written breastfeeding policy. Much improvement was made over the first year. Increased transitioning (from 87% to 97%), allowed improvement in “breastfeeding in the first hour”. Exclusive breastfeeding was encouraged through educating health care providers and parents. A written breastfeeding and supplementation policy was written and implemented. An electronic medical record was incorporated that allowed accurate tracking of many breastfeeding metrics.

Results: Over a 12 month period, implementation of 3 of the 10 Baby-Friendly Hospital steps occurred. The EMR enabled accurate tracking of any breastfeeding, exclusive breastfeeding and percentage of babies who successfully transitioned. Monthly reports are part of the Hospital Scorecards. Exclusive breastfeeding rates went from 30% to 42% over a one year period. Any breastfeeding increased from 74–85%.

Conclusions: The organization of a multidisciplinary task force is effective in moving towards “Baby-Friendly” in Medical Centers. Having an accurate way to track breastfeeding data will allow hospitals moving toward “Baby-Friendly Status” to document improvement over time.

Funding Sources: None.

Background: Breastfeeding statistics are an important metric in hospital quality measures. Current national breastfeeding reported data is predominately based on parental or nursing report and is inaccurate.

Objective: To describe an EMR allowing accurate breastfeeding tracking in an academic medical center.

Methods: In October 2009, an EMR was created for newborn and maternal care at the University of Kentucky. Many important breastfeeding metrics were added over the next 16 months to allow collection of comprehensive and accurate breastfeeding data. Examples of reportable data include timing of all feedings, whether the baby transitioned and if not, why, and cc's of formula supplementation. Percentage of women who do any breastfeeding and exclusive breastfeeding is reported. Exclusivity is measured by breast milk-fed term infants as a proportion of all term infants. Our EMR excludes babies with contraindications to breastfeeding. Exclusivity by ethnicity, age and type of insurance is tracked and reported. To improve physician compliance, many of the fields are mandatory.

Results: As a result of a nursery EMR, accurate monthly breastfeeding metrics are collected and reported. This data can be used to direct changes in patient care that can result in improved breastfeeding practices.

Conclusions: National breastfeeding data currently is collected by parent or nursing report. Using an EMR to ensure accurate reporting is the first step in monitoring and improving breastfeeding rates. Data can document success or failure of small cycles of change in breastfeeding management. Ideally a standardized EMR across institutions would allow true measurements of change across institutions.

Funding Sources: None.

Background: Nurses play a pivotal role in collaborating and implementing the Baby-Friendly Hospital Initiative policy. Despite the vital role of nurses in promotion and support of breastfeeding, there are few studies regarding the knowledge and activities in breastfeeding promotion.

Objective: To evaluate the knowledge, attitude and practices of nurses employed in Department of Obstetrics and Gynecology - Philippine General Hospital.

Methods: This descriptive study had for subjects 62 nurses. The questionnaire included 20 questions on attitudes to and knowledge of breastfeeding, and five multiple-choice questions on breastfeeding management.

Results: The participants have a positive attitude towards breastfeeding. 93.5% of subjects knew that breastmilk is enough to satisfy babies for six months. 82.3% of them recognized the benefit of breastfeeding on mother's health. The common reason for terminating exclusive breastfeeding is resumption of work after a maternity leave. The subjects have inadequate understanding in recognizing symptoms and managing the common breastfeeding problems. A few of the nurses who have attended the lactation management training still have inadequate understanding on the facts on breastmilk and management of breastfeeding problems.

Conclusions: The nurses of the Department of Obstetrics and Gynecology-Philippine General Hospital understand and accept that breastfeeding is an important aspect of primary care. Additional training programs are required to increase optimal breastfeeding knowledge and improve practice.

Funding Sources: None.

Background: When encouraging mothers to breastfeed, it is critical to understand how socioeconomic status can impact a woman's breastfeeding experience. When healthcare providers do not understand the impact of socioeconomic status on breastfeeding, segments of our population are excluded and barriers are not broken, but cemented.

Objective: The purpose of this study is to compare the impact of socioeconomic status on mothers' breastfeeding experience.

Methods: Surveys were offered to mothers at a clinic serving low-income patients. The data from 77 completed surveys were analyzed using EpiInfo version 3.5.1 and then were compared to prior survey results from more affluent mothers in the same geographic area.

Results: Of those surveyed, 50% planned to breastfeed for 12 months and only 1.8% met this goal (versus 50% of the more affluent planning this goal, and 50% falling short), 38.9% reported their physician frequently encouraged them to breastfeed (versus 28.2% of the more affluent), and 32.4% reported that breastfeeding was not common among family and friends (versus 10% of the more affluent).

Conclusions: Socioeconomic status clearly is an important factor contributing to mothers not meeting their own goals for breastfeeding duration. But regardless of socioeconomic status, breastfeeding mothers need more support from their physicians to attain breastfeeding success.

Funding Sources: None.

Background: Many families who are unable to provide breastmilk for their babies look for and accept breastmilk from other lactating women. There is no research evaluating the attitudes of health professionals regarding milk sharing and wet nursing.

Objective: This survey evaluates the knowledge, experience and attitudes of wet nursing and milk sharing among health professionals who are experienced in the field of breastfeeding.

Methods: The survey was sent via email to health professionals who participated in listserves regarding breastfeeding. Survey questions asked for demographic and medical specialty information, and assessed the health professionals' knowledge, experience and attitudes regarding wet-nursing and milk sharing.

Results: 410 respondents finished the survey; 30% physicians, 16% nurses, 26% lactation consultants, 7% La Leche League leaders, 5% midwifes, and 16% other. Ninety percent of all respondents agreed that women should share unpasteurized milk or wet nurse a term healthy infant. 75% of all respondents agreed that the donors should be screened like blood donors, and 25% agreed that the donors don't need such screening. The respondents' 2 highest ranked issues in ensuring safety of shared unpasteurized milk were 1)Donors are screened via interview and blood work in the same way that blood donors are screened and 2) Instructions are given to donors on safe expression and milk storage/handling techniques.

Conclusions: Health professionals who are knowledgeable about breastfeeding overwhelmingly support wet nursing and sharing of unpasteurized human milk. Donors should be screened and should be instructed on safe milk handling and storage techniques.

Funding Sources: None.

Background: Author's previous study on breastfeeding dyads demonstrates that nursing facilitates the development of intricate interactions, contributing to sensitive mothering styles and healthy psychological growth. Systems theory indicates that interchanges in dyads affect the family and vice versa.

Objective: To broaden earlier research and investigate the reverberating impact of nursing on the family system.

Methods: Observations, interviews, audio and videotape of families actively involved in physiological breastfeeding in natural settings over time and interviews with carefully selected key informants were organized into case studies and categories and analyzed.

Results: Families engaging in physiological breastfeeding patterns display unique behaviors and interactions associated with evolving and reverberating themes related to breastfeeding. Themes facilitate interaction based on infant and child cues. Parents' attuned responses to cues for nursing and proximity evolve into an overall sensitive parenting and family style extending beyond nursing and early childhood. The circulation of themes associated with the development of sensitivity through nursing is influenced by complementary parenting task allocation, open communication and tutoring. Unresolved couple discord and closed communication interfere with these processes and is expressed through distancing, the use of artificial pacifiers, and naming nursing as feeding.

Conclusions: The study concludes that interaction in the nursing sub-system affects and is influenced by overall systemic interchanges, and facilitates the development of parental and family sensitivity extending beyond nursing. The conclusions have important implications for child outcome, including for children in families with multiple risk factors, due to the importance of parental sensitivity for healthy socio-emotional development.

Funding Sources: None.

The author has published the findings in a book and receives intermittent royalties.

Epstein-Gilboa, K. (2009). Interaction and relationships in breastfeeding families: Implications for Practice.

Amarillo TX: Hale Publishing.

Background: Wiessinger's (1996) original work demonstrates the negative implications of using artificial feeding as the term of reference versus the facilitative factors of referring to nursing as normal for breastfeeding behaviors.

Objective: To investigate and enhance language associated with breastfeeding in clinical discourse and education.

Methods: Data were collected from the abstract author's study on breastfeeding families, observations of interaction, assessment of narrative, language and images in the media, and lay and professional literature. Analysis was facilitated by the application of psychological concepts.

Results: Clinical discourse and educational material is abundant with examples of language interfering with maintenance of physiological breastfeeding patterns. Examples include referring to breastfeeding as superlative and beneficial, naming nursing as food and a feeding choice, discussing breastfeeding frequency and amount, using patriarchal and hierarchal terms including management and compliance, negating the encompassing nature of nursing, and commending breastfeeding initiation while implying that nursing beyond infancy and associated proximity behaviors are abnormal. Personal experience and the false believe in one's ability to induce guilt impair optimal language use and clinical interaction.

Conclusions: Enhanced language use in clinical practice requires an acknowledgement of bias and the capacity to use concepts implying that physiologically based nursing patterns are the norm. Guiding principles include framing nursing as an encompassing and normal developmental task associated with infancy and early childhood that includes proximity behaviors. Discourse is enhanced and the obligation to facilitate informed decision making is fulfilled when practitioners inform clients about the risks of veering from normal nursing patterns.

Funding Sources: None.

Background: Exclusive breastfeeding through 3 months is a Healthy People 2020 goal, yet most U.S. infants who initiate breastfeeding receive formula before 3 months.

Objective: To examine the effect of birth weight on exclusive breastfeeding at 3 months.

Methods: We analyzed data from a randomized trial of probiotics for healthy infants to determine the effect of birth weight and other predictors available at birth on any breastfeeding and exclusive breastfeeding through 3 months. We used backward stepwise logistic regression to examine the effect of maternal age, education, feeding plan, delivery method and parity and infant birth weight and gestational age on the outcomes of any and exclusive breastfeeding through 3 months.

Results: Among 162 infants, we found that birth weight was strongly associated with exclusive breastfeeding through 3 months (OR 5.85 (2.18, 15.7) per kg birth weight), adjusting for maternal education and feeding plan. However, birth weight was not associated with any breastfeeding at 3 months when adjusting for the same predictors. The area under the receiver-operator curve was 0.82 for the exclusive-breastfeeding model and 0.87 for the any breastfeeding model; no other predictors reached significance when added to either model.

Conclusions: Smaller newborns were much more likely to receive formula before 3 months in this study population. It is possible that some mothers of smaller babies mistakenly believe that formula is needed to promote growth. Educating mothers of smaller babies about normal newborn weight patterns might reduce unnecessary formula use.

Funding Sources: NIH/NHLBI ROI HL080074 (Cabana and McKean) and NICHD K23 HD059818-01 (Flaherman).

Background: The past characterizations of breastfeeding as being only “at the breast” feeding may no longer be applicable in the United States as mothers now frequently express their milk.

Objective: Our goal was to better understand breast milk feeding behaviors of healthy mothers and infants, specifically focusing on breast milk expression.

Methods: We conducted a retrospective cohort study with women who visited the Cincinnati Children's Breastfeeding Medicine Clinic and asked them about their breast milk production and their infants' breast milk consumption.

Results: All 40 respondents reported putting their baby to the breast within the first day of life. All 40 mothers expressed their milk at some point and all 40 infants were fed expressed milk. One infant was fed another mother's milk for 30 days longer than he received his own mother's milk. 95% of the infants received both “at the breast” and “expressed breast milk” feedings concurrently. At times when infants received breast milk only “at the breast,” mothers also produced milk by milk expression. At the beginning and end of the mother's lactation cycle, infants were fed milk that had been expressed days to weeks previously. There were 14 different patterns of maternal milk production and 16 different patterns of milk consumption by infants during the first six months.

Conclusion: The use of breast pumps has made measuring “breastfeeding” and defining maternal and infant “breastfeeding” behaviors much more complex. Thus, it is now necessary to update how we measure and define “breastfeeding.”

Funding Sources: NIH K23ES014691 (SRG).

Background: Exclusive breastfeeding rates at birth are low in Los Angeles County (33%) and very low in the community served by Children's Hospital Los Angeles (CHLA) and Hollywood Presbyterian Medical Center (HPMC) (∼13%).

Objective: To increase exclusive breastfeeding rates in the community served by CHLA, HPMC, and affiliate clinics, and impact approximately 10,000 infants a year.

Methods: LATCH NOW (Lactation, Advocacy, and Teaching at CHLA, HPMC, and Network of WICs) is as an ongoing evidence-based project. Informal key stakeholder interviews were used to identify inpatient and outpatient barriers to breastfeeding. A multi-institution, collaborative coalition addresses these barriers. Consultation is provided to HPMC toward achieving Baby-Friendly designation. Tailored breastfeeding curricula for nurses and staff were modeled after the Baby-Friendly Hospital Initiative. Reimbursable breastfeeding classes for community parents were modeled after the California Perinatal Services Program.

Results: In two years LATCH NOW has collaborated with numerous stakeholders and decision-makers; moved CHLA and HPMC toward Baby-Friendly practice, including increased awareness and lactation staffing; and designed free and reimbursable curricula for hospitals and families, respectively. Institutional buy-in is very high. Policy and practice have measurably improved. Partners now include the LA County Department of Public Health and hospitals throughout LA. A county-wide provider educational campaign is being planned.

Conclusions: LATCH NOW has transformed breastfeeding culture at influential institutions in the community through collaboration. Improvements in exclusive breastfeeding rates are highly anticipated. To the authors' knowledge, this is a unique initiative that comprehensively and simultaneously addresses many barriers to breastfeeding.

Funding Sources: First 5 Los Angeles Baby-Friendly Hospital Project grant (March, 2010), American Academy of Pediatrics Community Access To Child Health grant (October, 2010), American Academy of Pediatrics California Chapter 2 Resident Research Award (June, 2011), Children's Hospital Los Angeles Gary F. Krieger, M.D. Pediatric Advocacy Award (June, 2011).

Background: There is very little data on adoptive breastfeeding (ABF), especially in special needs' and/or older infants' adoptions. “ABF” and similar terms fail to identify parental designation (adoptive, foster, or kinship), dyad's primary goals (nutrition and/or attachment), and child's condition (developmental, emotional, sensory and/or physical).

Objective: To review the available information, define the ABF process, and determine the feasibility of further investigations.

Methods: Medical literature was accessed by using the database searches with key words 'adoption', 'breastfeeding', 'lactation'. Data from the general Internet searches as well as archives of adoption-related and breastfeeding-related discussion groups was collected and evaluated.

Results: Studies were limited to case reports with mostly either single or few dyads of newborn or young infant adoption. Failure to initiate or sustain ABF (partial or exclusive) was frequently attributed to intrinsic maternal factors (higher education, lack of motivation, etc) only. Breastfeeding-related Internet sources had similar attitudes. Adoption-related groups were more open about failures and complications and usually had reservations towards ABF. Very few authors were objectively addressing unusual demands of special needs children, international adoptions, and/or older adoptions.

Conclusions: ABF is a desirable and realistically achievable goal. ABF should be viewed as a continuum of attachment and development promoting interventions ranging from encouraging holding and skin-to skin contact to the pinnacle of partial or exclusive breastfeeding. We suggest the term “adaptive nursing” to define the very special needs of that very unique dyad. Further research is essential and requires cooperation of adoption and breastfeeding specialists.

Funding Sources: None.

Background: Despite a large body of literature advocating benefits to mother and child, breastfeeding rates have been slow to increase. One barrier to successful breastfeeding is lack of access to lactation support.

Objective: Develop a physician-led breastfeeding clinic that provides increased access to lactation support services.

Methods: A team of two pediatricians, one ob/gyn physician, and one RN/IBCLC (International Board Certified Lactation Consultant) staffed the clinic which operated 8 hr/wk within an academic health center that provides pediatric and ob/gyn services as well as medical student and resident education.

Each mother/infant pair was seen by both a physician and lactation consultant. While physicians addressed breastfeeding issues in the context of related medical problems, lactation consultants provided the majority of counseling which proved to optimize use of physician time. The patients were billed for physician and/or RN services rendered based on standard billing guidelines.

Results: During the first 9 months of operations, clinic visits of 359 mother/baby pairs defined the study population. Retrospective analysis revealed that insurance reimbursement rates for these appointments were equivalent to that of a typical medical visit to the clinic. The net revenue covered expenses of the program including physician and IBCLC salaries, consistent with a viable financial model.

Conclusions: Physician-led breastfeeding clinics are a financially viable model for providing enhanced breastfeeding support services. Additional benefits of such a program housed within an academic medical center include enhanced breastfeeding education for medical students and residents as well as a platform for clinical breastfeeding research.

Funding Sources: None.

Background: Breastfeeding's many benefits may be lost with poor initial breastfeeding competence and loss to follow-up post-discharge. Weight loss may be an early predictor. We determined that early (in hospital) intervention would be beneficial for this population and needed to identify contributors in order to intervene.

Objective: To describe factors influencing weight loss in healthy, term, breastfeeding newborns.

Methods: This descriptive correlation study, using data from 200 retrospectively charts audits of mother-infant dyads who delivered in early 2009. Descriptive statistics describe infant (sex, gestational age, number of breast feeding attempts) and maternal characteristics (gravity, parity, and type of delivery, epidural use, hospital length of stay, lactation consultation or depression). Hierarchical multiple regression techniques determined contribution of infant and maternal characteristics to percent of weight loss.

Results: Babies born by cesarean lost more weight than those delivered vaginally (6.7% versus 4.2%). There was no difference in weight loss by gender, epidural use, or prenatal maternal depression.

Conclusions: Cesarean Delivery is now a priority for lactation consultation at this institution. It was noted that newborns and mothers were separated from time of delivery to recovery completion, losing the critical period for skin to skin (STS) benefits and initial breastfeeding opportunity afforded to vaginal delivery mother-newborn dyads. Early intervention of skin to skin and low early intervention protocols were instituted to motivate greater efforts during the critical periods and solidify breastfeeding competence/confidence prior to discharge. Test of change shows 94% lactation consultation and 90% of all (77.3% CD) deliveries placed STS and breastfed within 30 min of delivery.

Funding Sources: Beta Psi Chapter of Sigma Theta Tau clinical Scholarship/Research Grant.

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Background: Improved VLBWI growth is associated with improved neurodevelopment. Protein intake is an important factor for growth, and HM has low protein density. HM supplementation products exist but may remain inadequate and therefore some institutions promote PF over HM to optimize growth. In 2009, one institution developed quality improvement initiative (QII) to improve VLBWI growth while promoting HM as optimal VLBWI intake.

Objective: Determine QII effect on VLBWI growth/body composition (BC) while not promoting PF over HM.

Methods: VLBWI born pre-QII (9/2007–10/2009) and post-QII (12/2009–3/2011) were consented for BC measurement by air displacement plethysmography (ADP) (COSMED USA, Inc.) at term age (TA). QII included goal >3.5 g/kg/day protein intake and daily discussion of nutrition/growth. BC and growth parameters were followed from birth to TA. Growth parameter percentiles per Fenton. Growth rates from birth to TA. Comparisons by t-test and regression. Significance p<0.05.

Results: 116 infants (65 pre-QII/51 post-QII; 64% black; 40% male). All received HM instead of PF until 32 weeks post-menstrual age (PMA). 55% received predominately HM past 32 weeks PMA. Mean birth weight, birth PMA, PMA at ADP were 1050g, 29 weeks, 36 weeks pre-QII and 1125g, 29 weeks, 40 weeks post-QII. Controlling for PMA, length gain rate (0.97 cm/week pre- and post-QII) and % fat (13% vs. 17%, respectively) at TA were not significantly different. Weight gain rate significantly improved post-QII (19.9 vs. 25.7 g/day, respectively). Fenton weight percentile significantly improved when controlling for PMA (6% tile vs. 23.9% tile, respectively).

Conclusions: Preterm infant growth was significantly improved while maintaining and promoting HM feeds.

Funding Sources: COSMED USA, Inc (formerly Life Measurements, Inc) and the MUSC Division of Neonatology.

Background: Although over 75% of New Hampshire mothers initiate breastfeeding, many find it difficult to do so exclusively and for recommended breastfeeding durations.

Objective: We conducted a needs assessment of maternity-care practices based on the Ten Steps to Successful Breastfeeding at all 21 birthing hospitals in New Hampshire.

Methods: Each birthing unit's nurse manager gave permission to conduct the assessment. All 21 hospitals completed the survey. Data were collected via in-person (13 hospitals) or phone interview (1) or via on-line (5) or paper (2) questionnaire. We used descriptive statistics to analyze the study data.

Results: Hospitals reported 84–2195 deliveries per annum. All hospitals indicated familiarity with the Ten Steps and the provision of prompt skin-to-skin contact and breastfeeding assistance in the first hour postpartum [Step 4]. The majority (81%) encouraged rooming-in [Step 7]. Hospitals performed less favorably on Step 2 with only 2 (14%) meeting education requirements for physicians and 12 (57%) for nursing staff. Nine hospitals (43%) did not inform pregnant women of the benefits and management of breastfeeding [Step 3]. Free or low-cost formula was present in 16 hospitals (75%), and non-medical use of formula occurred in 19 hospitals (91%) [Step 6].

Conclusions: While widely recognized, the Ten Steps to Successful Breastfeeding are not well implemented in New Hampshire birthing hospitals particularly with regard to prenatal and provider breastfeeding education, and non-medical use of formula in breastfed newborns.

Funding Sources: None.

Background: Abnormal sublingual tissue in tongue-tie (TT) restricts tongue movement and causes breastfeeding difficulties. It occurs in 3–10% of newborns, with a male-to-female ratio (M:F) of 1.5–2:1. Two forms of TT are recognized: 1) thin anterior webs (AnTT) and 2) thick fibrous posterior tissue (PoTT). Only 20 cases of PoTT have been reported. Thus, this entity is not well described.

Objective: Compare sex distribution in infants with PoTT to infants with AnTT.

Methods: Eight members of the International Association of Tongue-tie Professionals contributed consecutive case series of infants with TT. All used the Coryllos system for classification: Types 1–4, along the spectrum of anterior to posterior. For analysis, types 1&2 were considered AnTT and types 3&4 were considered PoTT. The association between anterior/posterior and sex was evaluated using logistic regression with a robust variance estimator.

Results: 1096 infants were included. The table shows sex distribution by type of TT.

The difference between AnTT and PoTT was significant, P<0.001. The odds ratio for being male with AnTT vs. PoTT was 1.85 (95% confidence interval 1.49, 2.30).

Conclusions: This finding raises important questions: (1) Are AnTT and PoTT on the same spectrum? The embryologic derivation of AnTT is known. Posterior tissue may have a different origin. (2) Is the mechanism of tongue dysfunction the same for all types? (3) Does frenotomy for PoTT result in the same improvements as reported for AnTT? Further investigation is needed.

Funding Sources: None.

Background: In 2008, the DC Breastfeeding Coalition (DCBFC) evaluated Washington, DC birthing facilities for their support of breastfeeding. We hypothesized that collaboration between hospitals could improve breastfeeding support city-wide.

Methods: The PLQCC was established by the DCBFC in October 2010 and meets quarterly. The initial PLQCC meeting was attended by representatives from every facility in the District (7 general hospitals, 1 children's hospital and one free-standing birthing facility). We reviewed The Joint Commission's Perinatal Care Core Measure Set, specifically focusing on the exclusive breastfeeding measure. Subsequent meetings have included thorough discussions of practical implementation of each of the Ten Steps to Successful Breastfeeding.

Results: Of the 28 respondents to the online evaluation surveys, 90% indicated that the information shared during the meetings was helpful in improving their breastfeeding support services and 100% indicated that they would continue to attend future meetings. Participants' interest for future topics include: (1) ideas to optimize mother-baby nursing care that promotes breastfeeding, (2) identifying post-discharge breastfeeding support services (3) assistance with improving workplace support and (4) collaborating with research.

Conclusions: The PLQCC has been a well-accepted model for collaboration between hospitals to enhance breastfeeding support in the District.

Funding Sources: Center for Perinatal Advocacy at Providence Hospital.

Background: Despite the significant health and financial benefits of breastfeeding, there is a substantial gap between professional recommendations and personal practices among physician-mothers in the United States.

Objective: To understand the typical barriers to breastfeeding for physician-mothers in Rhode Island and systematically coordinate ongoing efforts to overcome these common obstacles.

Methods: This project was comprised of a comprehensive literature review of the barriers and support for physician-mothers at the federal and local levels in conjunction with a formal, regional needs assessment of physician-mothers.

Results: Historically, physicians-mothers lack time and space to express milk in a private, convenient, and healthy manner. In addition to federal legislation to promote breastfeeding, two well-established Rhode Island resources actively advocating on behalf of physician-mothers are: 1) MomDocFamily (MDF), a RI-based multi-specialty group of physicians and medical students who are mothers and 2) the Rhode Island Breastfeeding Coalition (RIBC), made up of community organizations that aim to support local businesses in the breastfeeding promotion by distributing the Department of Health and Human Services' Business Case for Breastfeeding Toolkit and through mini-grants for employers to start or enhance their lactation programs. MDF and RIBC have collaborated on two mini-grants, are working with the state's only medical school and two university-affiliated hospitals to establish four new lactation rooms, and have compiled and distributed a list of existing lactation accommodations for medical students and physicians in Rhode Island hospitals.

Conclusions: Systematic collaborative advocacy efforts in support of breastfeeding among physician-mothers in Rhode Island can serve as a national model.

Funding Sources: None.

Background: Rates of breastfeeding among African-Americans have long been found to be lower than those for Whites/Latinas. Although low socioeconomic status among African-Americans has often been cited as a factor, other factors may play a role, including that of the health care provider (HCP).

Objective: To examine the role that the HCP may play by expressing strong support for breastfeeding and how that support might influence the selection of infant feeding method (IFM) among college-educated African-American women, a subgroup not often studied in this area.

Methods: 85 African-American women were recruited through the alumni association of Spelman College and through local chapters of Delta Sigma Theta sorority. They were asked to complete a survey questionnaire through Survey Monkey regarding their infant-feeding choices.

Results: More than ½ of the women reported that their HCP expressed strong support for breastfeeding. These providers were also more likely to discuss the benefits and disadvantages of each method (88.1% vs. 39.5%) and to have the discussion early in pregnancy (25.0% vs. 12.1%). Women whose providers expressed strong support were more likely to initiate breastfeeding (72.1% vs. 57.1%) and to not discontinue breastfeeding until at least month 4 or later (80.6% vs. 43.8%). These women were also less likely to see breastfeeding complications as a barrier (37.5% vs. 65.2%) or to report that medical issues (e.g., C-section, maternal/infant complications) played an important role in their selection of an IFM.

Conclusions: The findings of this study support the importance of HCPs expressing strong support for breastfeeding in contributing to improving rates of breastfeeding among African-American women.

Funding Sources: None.

Background: The literature shows that curricula incorporating simulated clinical scenarios increase resident confidence in counseling breastfeeding mothers. Therefore, we designed and implemented a breastfeeding OSCE using live breastfeeding dyads and standardized-patient and expert evaluators.

Objective: To compare and contrast the qualitative content of feedback from standardized patients (SP) and expert lactation consultants (LC) in a pediatric resident breastfeeding OSCE encounter.

Methods: Second year pediatric residents (N=10) completed a three station breastfeeding OSCE exercise. SP's were asked to provide written comments about performance and give immediate verbal feedback to residents. The OSCE encounters were videotaped and later viewed by LC's who were instructed to provide written comments on “strengths” and “to work on.” After an iterative process to develop codes for data interpretation, we employed a thematic analysis to describe, compare, and contrast feedback given by SP's and LC's.

Results: Five themes emerged: History, Physical exam, Education/Plan, Support, and Interactive style. SP feedback was more general, positive and more likely to concentrate on resident style. LC comments concentrated on evidence based feedback/advice and relevance to presenting problem. Neither SP nor LCs commented on residents' assessments of the latch.

Conclusions: Five themes emerged: History, Physical exam, Education/Plan, Support, and Interactive style. SP feedback was more general, positive and more likely to concentrate on resident style. LC comments concentrated on evidence based feedback/advice and relevance to presenting problem. Neither SPs nor LCs commented on resident's assessment of the latch.

Funding Sources: Child Health Discovery Institute.

Background: Breastfeeding has extensive benefits for mothers, babies, and society. We suspected that rates of both initiation and duration of breastfeeding at The Brooklyn Hospital Center (TBHC) are far below national standards.

Objective: 1: Assess breastfeeding initiation, exclusive breastfeeding, and duration of breastfeeding. 2: Define barriers to breastfeeding.

Methods: We surveyed 95 healthy mothers of healthy newborns at TBHC within 48 hours of birth. Data collected included mother's age, race, education, WIC eligibility, father's involvement, breastfeeding education, and age of newborn at initiation of breastfeeding. Follow up phone surveys were done at 1, 3, and 6 months.

Results: Eighty-six percent of mothers received breastfeeding education. Breastfeeding was initiated by 81% (9% exclusively). At 1, 3, and 6 months, 67, 40, and 19%, respectively, were breastfeeding (follow up for 63/95 mothers). One baby continued breastfeeding exclusively at 1 and 3 months. Reasons for not breastfeeding were: baby not latching, mother on medication, returning to work/school. Fifty percent did not give a reason.

Conclusions: We were pleased with our breastfeeding initiation rate, but found exclusive breastfeeding and continuation rates low. Our study population was primarily low-income non-Hispanic black, known to have the lowest breastfeeding rates. We hypothesize that insufficient breastfeeding education during prenatal visits, rapid separation of mother and baby in the delivery room, infrequent rooming-in, and inadequate breast feeding support explain our results. In further study, we plan to focus QI and research efforts to address these factors and are committed to improving breastfeeding rates at TBHC.

Funding Sources: None.

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Background: Many women experience breastfeeding problems in a non-supportive setting. Breastfeeding clinics can have an important role in helping these women to overcome breastfeeding difficulties.

Objective: The purpose of this study was to describe the variables associated with breastfeeding problems in a group of Puerto Rican mothers who attend a breastfeeding clinic.

Methods: An exploratory, cross-sectional design was used. 141 medical records were examined to gather data related to maternal, perinatal, feeding practices, family and nutritional history. Data analysis was done by descriptive and inferential statistics, and cross tables.

Results: The median time of gestation was 38 weeks (SD=3.27). 28.9% of the participants reported having had medical problems during their pregnancy and 23.0% at the time of the labor. 66.7% used anesthesia during labor [45.5%-spinal and 9.8% epidural]. 51.5% delivered by C-section. At the time of evaluation 35.5% of the participants were breastfeeding. 25.9% had started to breastfeed immediately after birth; median time for breastfeeding initiation was 7.5 hours [SD=249.4]. 86% of the participants reported having been separated from their babies for over 2 hours, and 45.1% breastfed less than 8 times during their first 24 hours in the hospital. Participants reported the following problems: difficulty to latch to the breast [45.5%], sleepy baby [45.0%], pain in the nipples [40.5%], insufficient milk production [24.2%], preference for one particular breast [26.7%], and other problems [15.4%]. It was observed that those having C-sections had shorter mean breastfeeding time than those having vaginal births [106 vs. 221 days respectively; p>0.05].

Conclusions: Hospital practices appear to hinder successful breastfeeding in the studied group.

Funding Sources: None.

Background: Abdominal pregnancy is a rare condition with significant risk of maternal and fetal morbidity and mortality. Due to the vascular involvement, the placenta is often left in situ. Prior reports have neglected to discuss the implications of leaving the placenta in situ on breastfeeding and lactation.

Objective: To present a case of failure of lactogenesis II following the successful delivery of an advanced abdominal pregnancy in which the placenta was left in situ.

Methods: Case report and review of literature.

Results: A 39-year-old African American G1P0 was diagnosed at 25 4/7 weeks gestation with an intra-abdominal pregnancy. A viable male infant was delivered by cesarean section at 28 1/7 weeks. Due to the hypervascularity of the placenta, the placenta was left in situ and embolization and arteriography were performed. Following delivery, the patient initiated breast pumping on day one postpartum while in the ICU. On day two she produced several drops of colostrum and by day six she had produced only one drop of breast milk. The patient reported breast changes during pregnancy, but never experienced any breast changes notable for lactogenesis II.

Conclusions: This report of an advanced abdominal pregnancy in which the placenta was left in situ due to the significant risk of maternal hemorrhage provides further evidence to the effects of the placenta on lactation. It is important to discuss with patients in whom treatment options include leaving the placenta in situ the potential for delayed or failure of lactation.

Funding Sources: None.

Background: In 2010, a group of pediatricians and family doctors at Boston Medical Center began to perform frenotomies for infants with tongue-tie and breastfeeding difficulties. Although frenotomy is a simple procedure, it is not commonly taught outside of otolaryngology residency. In response to the need for basic instruction in frenotomy and for a centralized, easily accessible repository of information on this topic, a website was created that offers two videos, a PowerPoint presentation, frequently asked questions, references, and a self-assessment tool.

Objective: To analyze national and international interest in tongue-tie and frenotomy as measured by visits to an instructional website.

Methods: The website, www.tonguetieclipit.com, launched in January 2011. Analysis was performed to evaluate website traffic during the first 6 months.

Results: From January to June 2011, the site received a total of 732 unique visitors who viewed 7305 pages. 52% of key phrases entered to reach the website included a variant of “tongue tie clip.” The website averaged 122 unique visitors/month, 1.57 visits/visitor, and 6.34 pages/visit. Hits came from 29 countries. 79% of page views were from the United States. Countries with 100 or more page views included Great Britain, Canada, Australia, France, and Japan. The most visited pages included the home page, the videos, how to use the website and the PowerPoint. Visitors included physicians, non-MD clinicians, and lactation consultants.

Conclusions: Activity on www.tonguetieclipit.com indicates significant national and international interest in the area of tongue-tie and frenotomy, suggesting the need for a formalized certification process for this procedure.

Funding Sources: None.

Background: High plasma lamotrigine levels can be measured in breastfed infants whose mothers take lamotrigine. There is no data on the use of lamotrigine when breastfeeding a premature neonate. Since lamotrigine is eliminated by glucuronidation, an immature metabolic pathway in neonates, an accumulation of the medication is anticipated in premature neonates.

Objective: Report lamotrigine blood levels in premature neonates and evaluate side effects.

Methods: This is a descriptive study on the use of lamotrigine during breastfeeding. All women on lamotrigine that delivered a live newborn in a five year period at CHU Ste-Justine were included. Data were collected in medical files.

Results: There were twenty term newborns and five preterm newborns in our population. Fifty percent of the term newborns and all the premature babies were breastfed. Plasma levels were monitored in three of the premature newborns. Lamotrigine was not detectable in the infant of a mother on a daily dosage of 200 mg for epilepsy and no adverse effects were noted. Lamotrigine was within therapeutic range in the premature twins of a mother on polytherapy for bipolar disorder including lamotrigine 200 mg daily. With the exception of transient elevation of liver enzymes, no side effects were reported. No levels were drawn in the two other premature infants but no adverse effects were seen.

Conclusions: Breastfeeding is possible when taking lamotrigine, with a follow-up of side effects and plasma levels if necessary. When breastfeeding an early preterm neonate, lamotrigine plasma levels should always be measured in the baby.

Funding Sources: None.

Background: DGGE has enhanced identification of bacterial DNA in stool and offers opportunity for investigation of microbial presence in human milk. Evidence regarding successful amplification of HM microbial DNA is limited.

Objective: To achieve bacterial DNA isolation from preterm MM and DHM and evaluate the bacterial diversity between these groups.

Materials/Methods: HM samples fed to 8 preterm infants <30 weeks were collected prospectively on day of life 21, and stored at −80°C until such time as DNA was extracted. 4 MM and 4 DHM samples, as well as a term HM control (C) sample were analyzed. DNA was extracted using the Qiamp DNA Stool Mini Kit according to the manufacturer's instructions (Qiagen). This assay contains a specific adsorption resin and optimized buffer for complete removal of PCR inhibitors from samples with high concentrations of PCR inhibitors. Microbes comprising the microbiome of the breast milk samples were determined through amplification by PCR and subsequent characterization using DGGE. In DGGE, isolated bacteria are separated based on nucleotide differences. Intensity and migration differences of bands allows for comparison between samples.

Results: DNA was isolated from all samples. Median (range) (ng/μL) DNA of MM 5.3 (2.53–7), DHM 5 (4.2–5.37). DNA concentration in control HM: 7.97. DGGE (see figure) demonstrates the success of bacterial DNA isolation in human milk and allows for intra- and inter-group comparison.

Conclusions: We demonstrated successful bacterial DNA isolation from HM. Success of this technique allows further study of the role of the HM microbiome in preterm infant health.

Funding Sources: South Carolina Clinical & Translational Research (SCTR) Institute, with an academic home at the Medical University of South Carolina, NIH/NCRR Grant number UL1 RR029882 and the Medical University of South Carolina Department of Pediatrics, Division of Neonatology.

Background: The risk of anemia among exclusively breastfed infants varies widely in the literature, both positively and negatively.

Objective: To compare the incidence of anemia between infants who were exclusively breastfed (EBF) for 6 months and those who were not.

Methods: A cross-sectional survey by face to face interview with care-givers was conducted for the prevalence of anemia, looking at hematocrit and other red cell indices among 6-month-old infants visiting the well-child clinic at two Bangkok hospitals.

Results: 63 infants were included: 24 (38%) EBF; and 39 (62%) non-EBF. Mean hematocrits in the EBF and non-EBF groups were 34.5+1.7 and 35.1+2.3% respectively. The prevalence of anemia in the EBF group was 4.2%, and in the non-EBF group, 12.8%. Although the findings were not statistically significant, the red blood cell indices for the one anemic infant in EBF group were not compatible with a diagnosis of iron deficiency, whereas 4 of the 5 anemic infants in the non-EBF group had indices compatible with iron deficiency. Growth parameters were comparable between the two groups.

Conclusions: This study did not show statistical differences between the hematocrits or other red blood cell indices of EBF and non-EBF infants, but the prevalence of anemia was higher among those who were not exclusively breastfed for 6 months. No iron deficiency anemia was identified in the EBF group, whereas indices suggesting iron deficiency were seen in over 10% of those not EBF. Our study supports the advocacy of exclusive breastfeeding for six months.

Funding support: QSNICH research fund.

Background: Breastfeeding rates at most urban Midwestern hospitals fall short of WHO 2010 goals, with the rate at St. John Hospital and Medical Center being less than 60% at initiation, 15% at 6 months, and <10% at one year despite a robust inpatient lactation support service. The early discontinuation rate has been attributed to delay in management of problems which arise after hospital discharge.

Objective: Our objective was to identify attributes of post-discharge services that make them approachable and desirable to the breastfeeding mother.

Methods: Data were collected by chart review and telephone survey. Study group consisted of 186 couplets seen at the physician-led outpatient breastfeeding clinic for any difficulty experienced. Control group consisted of mothers who were breastfeeding at discharge who did not access the clinic.

Results: In the study group, 43% reported their decision to utilize the breastfeeding clinic was influenced by physician presence and 50%, by insurance billing policies. 90% of those in study group reported they breastfed longer because of the clinic, and 97.5% reported it contributed to their meeting their breastfeeding goal. Mothers in the control group who had discontinued breastfeeding at the time of survey reported that utilization of the clinic could have contributed to prolonged breastfeeding (p=0.043).

Conclusion: Women who utilize a physician-led accessible breastfeeding clinic were able to prolong their breastfeeding experience and meet or exceed their breastfeeding goals. Physician involvement and insurance coverage were the most positive attributes of the clinic.

Funding Sources: None.

Background: There is significant evidence that autistic disorders are the result of the interaction of the autism genes and the infant's social environment. Animal research and neuro-imaging studies have demonstrated that exclusive breastfeeding and bonding increase the production of oxytocin and its receptors in the brain. Oxytocinergic neurons may have the physiological capability to alter gene expression and therefore prevent autism.

Objective: To investigate the association between feeding methods, exclusive breastfeeding, breast-milk or formula feeding on the prevalence of autism diagnosis. We postulate that exclusive breastfeeding and bonding will reduce the prevalence of autism.

Methods: A random, confidential and anonymous parent's survey was conducted from our pediatric practice to ascertain the association of a parent's reported autism diagnosis with the duration and exclusivity of breastfeeding, breast milk or formula feeding.

Results: One hundred and forty five parents responded to the survey. Sixty children had autism diagnosis. Twelve of the sixty children were formula-fed. Twenty six were exclusively breast-fed from less than two months to greater than two years and had autism diagnosis. Twenty two were fed breast-milk, via a bottle, from less than two months to greater than two years. The survey results indicate that exclusive breastfeeding longer than nine months was associated with significant reduction in autism diagnosis (odds ratio 9.56 and confidence interval 2.42, 37.7).

Conclusions: This study demonstrates an association between exclusive breastfeeding and decline in autism diagnosis. The results validate the hypothesis that oxytocin has a major and central role on the brain plasticity and prevention of autism.

Funding Sources: None.

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Background: Preterm and sick infants in developing countries benefit most from exclusive feedings of their own mothers' milk. However, collecting mothers' milk in suitable volumes to support growth in infants unable to directly breastfeed is challenging worldwide, frequently leading to difficulty providing enough milk to support the nutritional needs of their infants.

Objective: To compare breastmilk volume using three breastmilk expression techniques. One hundred sixty-one Ugandan mothers whose infants were too ill or premature to directly breastfeed used one of three methods for breast milk expression: double electric breast pump, single manual breast pump, or hand expression.

Methods: Study design was quasi-experimental. Mothers were assigned at delivery to one of three breast milk expression groups, using non-probability sampling. Maternal milk volume (MMV) was measured for seven days postpartum. Data were analyzed using a one-way ANOVA and Tukey HSD test.

Results: MMV per total time was evaluated among groups using a one-way ANOVA (p<0.002). MMVs in milliliters/day averaged over the 7-day pumping period were: Group 1=647mL±310; Group 2=520mL±298; Group 3=434 mL±291. The Tukey revealed significant differences in MMV (p<0.01) between mothers using the electric breast pump and those using hand expression.

Conclusions: The findings reveal greater MMV with electric breast pump use for support of infant growth than with hand expression for those mothers unable to express adequate milk volumes with hand expression alone. This data has important implications for providing exclusive own mothers' milk feedings for vulnerable ill or premature infants in developing countries.

Funding Sources: Medela (McHenry, IL) provided the Lactina^® electic breast pump with double collection kits, the Medela Harmony™ single non-electric manual breast pumps and funding for the study nurses' time.

Background: Early childhood caries (ECC) is an infectious disease linked to oral streptococcus mutans, genetics, cariogenic foods, inadequate oral hygiene, and bottle-feeding. The role of extended breastfeeding and co-sleeping is controversial. No published reports describe the subsequent dental history of children with ECC who continued breastfeeding and co-sleeping after diagnosis.

Objective: To describe the experiences of four mothers—a dentist, a pediatrician, a psychiatrist, and a videographer—who declined dental advice to wean and stop co-sleeping after ECC was diagnosed.

Methods: Current and previous cases were identified by serendipity. Each mother was queried about risk factors; parental and sibling dental histories; co-sleeping, breastfeeding, dietary, and oral hygiene practices before and after the diagnosis; initial presentation; the dental professional's diagnoses and recommendations; parental reactions, responses and compliance with these recommendations, and dental outcome.

Results: Five children of four mothers are described, from China, Israel, and the US. Dietary and hygiene risk factors varied considerably at diagnosis. Seven caries-free siblings co-slept and breastfed at night. Against their dentists' advice, all four mothers continued co-sleeping and ad lib nighttime breastfeeding for at least 6 months to several years after diagnosis. Three accepted recommended dental procedures, became vigilant about cariogenic foods, and instituted rigorous daytime dental hygiene practices. The caries in these three children halted, with no further sequelae. One family declined recommended procedures, tolerating superficial abscesses; both affected children, now 13 and 18, have healthy permanent teeth.

Conclusions: Breastfeeding co-sleeping children with ECC may not need to wean; further research is needed.

Funding Sources: None.

Background: We wanted to create breastfeeding educational opportunities that were effective, easy and diverse.

Objective: To create a network of educated community pediatricians, nurses, lactation consultants, and other health care providers in Virginia to promote breastfeeding education, outreach, and advocacy.

Methods: A web-based educational module (www.breastfeedingtraining.org) was created through collaboration between Virginia Department of Health and University of Virginia. After receiving a grant from the AAP Section on Breastfeeding, a conference was held to educate community pediatricians about breastfeeding; now progressing into an annual event. A Virginia Breastfeeding Advocates List-serve was created to keep health care providers, who have a special interest in breastfeeding, informed of various educational, outreach, and advocacy opportunities.

Results: To date, 10,503 people have accessed the www.breastfeedingtraining.org site. 4316 physicians and 6187 non-physicians have used this site representing 23 countries. This training-site qualifies for Baby-Friendly Hospital Initiative staff-training. After the inaugural conference, over 94% of participants responded that they would make changes in their current practice related to breastfeeding. The Virginia Breastfeeding Advocates List-serve mobilized breastfeeding providers throughout the state for Breastfeeding Advocacy Day to help lobby for the Breastfeeding Promotion Act. Parts of the bill targeting breastfeeding in the workplace have been included in the 2010 Affordable Care Act.

Conclusions: Collaboration on many levels has resulted in various successful education opportunities throughout Virginia and across the world.

Funding Sources: VDH; UVA; Virginia Chapter-AAP, AAP-Section on Breastfeeding.

Background: Institution-developed process-improvement bundle (PIB) to optimize mothers' milk (MM) to newborns with specific concentration on preterm infants and racial disparity.

Objective: Determine effect of PIB on rates of MM in-hospital and hospital discharge (HD).

Methods: PIB instituted 7/2009. Pre-PIB 1/2007–6/2009. Post-PIB 7/2009–3/2011. Following IRB-approval, single university tertiary-care hospital, perinatal database queried to identify infants receiving in-hospital and HD MM. Subgroup analyses for black and very low birth weight (VLBW) infants. Analysis Chi-squared and logistic regression (LR). Significance=p<0.05.

Results: 7,175 Pre-PIB and 4,534 Post-PIB infants. In-hospital MM and HD MM rates were 66.9% and 60.6% Pre-PIB and 70.9% and 62.7% Post-PIB, respectively. By LR, odds ratio (95% confidence interval) (controlling for birth weight, race, inborn, delivery mode, maternal preeclampsia, diabetes, and obesity) of in-hospital MM Post-PIB were 1.2 (1.1–1.3) and of HD MM were 1.1 (1–1.2) times Pre-PIB. For black infants, in-hospital MM and HD MM 47.9% and 37.9% Pre-PIB and 55.3% and 44% Post-PIB, respectively. When controlling for above-mentioned factors (except race), odds of in-hospital MM Post-PIB were 1.3 (1.2–1.5) and HD MM were 1.3 (1.1–1.4) times Pre-PIB. For VLBW infants, in-hospital MM and HD MM were 72.3% and 44.5% Pre-PIB and 79.3% and 45.6% Post-PIB, respectively. Controlling for above-mentioned factors, odds of in-hospital MM Post-PIB were 1.5 (1.1–2.0) times Pre-PIB and HD MM not significantly different.

Conclusions: Multidisciplinary lactation PIB was significantly associated with increased MM to all infants and especially black infants throughout hospitalization. The PIB was significantly associated with increased in-hospital MM but not HD MM for VLBW infants.

Funding Sources: MUSC Division of Neonatology and Perinatal Services.

Background: Queen Sirikit National Institute of Child Health (QSNICH) is the tertiary care hospital for Thailand's children. Almost all personnel (95 %) are women. Before 2006 there was no system to support exclusive breastfeeding (ECBF) for hospital personnel.

Objective: To implement and monitor an exclusive breastfeeding support program for the hospital personnel v.

Methods: Lactation clinic leads the program by: inviting pregnant mothers to join a mother support group at least once before and after delivery, visiting within 3 days after delivery, breastfeeding gift set given by administrative team, convenient channel to access lactation clinic either by call or drop in. Day care support and two 30 minute breaks to breastfeed were allowed. Questionnaire on breastfeeding duration and the infant health situation at 4 and 6 months were included.

Results: From 2006–2010, 69 mothers participated in this program. The remainder of the mothers did not participate because their children were cared for by out of town relatives once they returned to work. For 2006 to 2010 the exclusive breastfeeding rate at six months was 52% (12/23 births), 53% (8/22), 63% (14/22), 66% (10/15) and 69% (11/16) respectively. Factors associated with breastfeeding at 6 months include attendance at breastfeeding support group before delivery, lactation clinic team support during delivery and postpartum period and also the adequate milk production at discharge from the hospital.

Conclusions: A program to support exclusive breastfeeding for hospital personnel increases the rate of breastfeeding at 6 months.

Abstract Withdrawn

Background: Few clinical trials with domperidone have been conducted, and those involving mothers of critically ill neonates are scarce.

Objective: Measure effectiveness and safety of domperidone as a galactagogue in mothers of preterm and critically ill infants admitted to NICU.

Methods: Retrospective review of 14-day pumping records of mothers of critically ill neonates without history of arrhythmia or chronic hypertension prescribed domperidone for low milk supply who met criteria (pumping ≥six times/day; increased frequency of pumping for >72 hrs, kangarooing infant, non-nutritive suckling at breast, hand expression to fully empty breasts after pumping, and pumping at bedside). If milk supply <200 at 7 days or <350 mL/day @ 14 days postpartum despite above interventions, domperidone (20 mg tid) was prescribed. Adverse events were recorded. Baseline and 14-day breastmilk volume were analyzed by t-test (p<0.05).

Results: 14 women with neonates in NICU prescribed domperidone (2010–2011) were studied. Mean gestational age at delivery was 26.3 weeks (range 23 6/7 to 32 3/7). Mean baseline milk volume increased from 196.6±160 to 410±174 mL on day 14. Milk volume increased by 47.9% between two time periods (p<0.0001; Figure 1 below). Three (*) had baseline milk production above criteria. There were no recorded adverse events.

Conclusions: Domperidone therapy was associated with consistent improvement in daily pumping volumes at 14-days in mothers of critically ill neonates. Large RCT studies involving NICU mothers are needed to explore the safety and effectiveness of domperidone compared to placebo.

Funding Sources: Division of Neonatology, MUSC; Medical University Hospital Authority, MUSC.

Background: The Tennessee Initiative for Perinatal Quality Care (TIPQC) is a statewide quality improvement collaborative that elected to develop a project to address Tennessee's low breastfeeding rates.

Objective: The project aim is to improve the health of infants and mothers in Tennessee by systematically promoting breastfeeding at prenatal care visits.

Methods: A toolkit of evidence-based practices was developed by an interdisciplinary project development team after review of published tools from the AAP, ACOG, ABM, and elsewhere. Inclusion of a practice was based on evidence of effectiveness and consensus/approval by the team and pilot centers. The project pilot was launched in four TN practices in spring 2011.

Results: Participating practices will first establish a primary improvement team of relevant stakeholders. The toolkit includes a menu of “potentially better practices” (PBPs) that may be implemented individually, or as a bundle. Success of this project relies on use of rapid Plan-Do-Study-Act (PDSA) cycles. Web-based data-entry through REDCap will allow practices to access on-demand run-charts for their project data and comparisons to project-wide aggregate data. The fractions of mothers exclusively feeding breastmilk, feeding both breastmilk and formula, and feeding exclusively formula at the first post-partum visit at 4–8 weeks post-delivery will be determined. Local audits will be used to evaluate reliability of implementation of potentially better practices.

Conclusions: This project may serve as a model for how quality improvement methodologies may be combined with use of distance-learning and web-based data entry and reporting to facilitate implementation of potentially better practices to increase breastfeeding rates.

Funding Sources: Funded under an agreement with the state of Tennessee.

Background: Mothers of VLBW NICU infants are often dependent on breast pumps for establishing milk production.

Objective: We sought to evaluate milk production with a multi-user pump having many of the features of larger, more expensive pumps, but with a compressible silicone flange.

Methods: This single-site, 24-month prospective trial of pj's comfort^® electric breast pump used a convenience sample of NICU mothers of infants ≤31 weeks and <1,500 g birth weight who met the same inclusion and exclusion criteria of a similar study (Hill et al, 2005). Mothers were asked to complete a pumping log for 15 days. Maternal demographic and infant hospital data were collected.

Results: Of the 50 mothers entered into the study, 35 submitted complete pumping logs (CPL), 5 incomplete pumping logs, and 10 no logs (4 infants died). Of the mothers with a CPL, the average time to the 1^st pumping was 9.5 hrs after delivery, the mean number of pumpings was 7.4/day, and mean minutes pumping was 118/day. Milk volume was correlated with prior breastfeeding experience (p=0.037). 83% of the mothers achieved ≥350 mL/d, 66%≥500 mL/d and 29%≥700 mL/d, volumes comparable with Hill et al., 2005 and other published reports. 74% of the mothers were providing breastmilk at the time of discharge.

Conclusions: The pj's comfort^® multi-user pump is a viable alternative to larger, more expensive pumps for establishing an adequate milk supply in mothers of VLBW infants in the NICU. Further study with a larger, more diverse sample is planned.

Funding Sources: Pumps donated by Limerick, Inc.

Background: Human milk has been rediscovered as one of the key factors in improving infant outcomes, and is now the standard of care in the NICU. However, establishing and maintaining a mother's milk supply for her NICU infant can be extremely difficult. Although most of our NICU mothers started milk production, there was a significant and unacceptable attrition to the time of discharge.

Objective: Our objective is to describe the development and function of the Neonatal Nutrition Task Force (NNTF) and report 3 years of quality improvement data. We will suggest methods of nutritional and breastmilk assessment in the NICU.

Methods: NNTF members collected weekly data on breastmilk use in the NICU, monthly data on timing and type of first feeding and breast before bottle feeding, and quarterly data on any breastmilk at discharge (VON). Failure mode analysis was used to review charts of VLBW infants not discharged on any human milk. Monthly, then every other month, NNTF meetings reviewed data and planned strategies to improve breastmilk outcomes. The NNTF created and updated policies and procedures to support breastfeeding and pumping mothers.

Results: Nutritional data collection has been “built in” to normal NICU functions. Our baseline breastmilk parameters were better than average. However, despite sustained attention, using multiple evidence-based approaches, we have been unable to significantly improve our breastmilk outcomes for VLBW infants.

Conclusions: Reevaluation of our approaches is needed. There may be an irreducible nadir of no breastmilk at discharge based on our specific NICU population.

Funding Sources: None.