BackgroundThe supply of breast milk to preterm infants tends to occur at a lower rate than that recorded among term infants. We aimed to investigate the facilitators of and barriers to breastfeeding during hospital stay according to the experiences of mothers that gave birth to premature infants requiring admission to neonatal intensive care unit.MethodsA cross-sectional questionnaire survey was conducted. Mothers who had delivered a newborn with a gestational age ≤33 weeks requiring intensive care, entered the study. Basic subjects’ characteristics and infant feeding practices were also recorded.ResultsA total of 64 mothers were enrolled, leading to a total of 81 infants. At discharge, any breastfeeding was recorded in 66% of infants, with 27% of those infants being exclusively breastfed. Any infant was exclusively fed directly at the breast. Most mothers experienced adequate support during their infant’s hospitalization and reported satisfaction with breastfeeding. Almost all mothers felt that feeding their infant human milk was beneficial for the infant’s health. Thirty percent of the mothers reported that they had experienced some obstacles to breastfeeding. Specifically, infants born to mothers who experienced difficulties in pumping breast milk (OR = 4.6; CI 1.5–13.9) or in providing an adequate amount of milk to the infant (OR = 3.57; CI 1.1–11.5) were at higher risk of being fed with formula at discharge.ConclusionsOn the basis of the present results, health care professionals should target their efforts to optimize breastfeeding support for mothers of premature infants admitted to level III care, especially by improving breast milk production and endorsing direct breastfeeding.
BackgroundLate preterm infants account for the majority of preterm births. They are at an increased risk of neonatal mortality and morbidity and are less likely to initiate breastfeeding and to be exclusively breastfed at discharge compared to infants born at term. The aim of this study was to identify the facilitators and barriers to breastfeeding during hospital stays according to the experiences of mothers of late preterm infants.MethodsWe conducted a cross-sectional questionnaire survey. Mothers who intended to breastfeed and had given birth to a newborn admitted to level I and II care, with a gestational age of 34 0/7 to 36 6/7 weeks, were enrolled. Sociodemographic data, neonatal variables, mode of feeding and feeding status at discharge were also collected.ResultsA total of 92 mothers who had given birth to 121 infants were enrolled. At discharge, any human milk was fed to 94 % of infants, with exclusively human milk being fed in 43 % of cases; exclusively formula was fed to 6 % of infants. In the multivariate analysis, having expressed breast milk was independently associated with an increased risk of being fed with either any human milk or formula only (OR = 2.73, 95 % CI 1.05–7.1, p = 0.039), whereas being encouraged to practice kangaroo mother care tended to have a protective effect (OR = 0.46, 95 % CI 0.2–1.06, p = 0.07).ConclusionsBased on the present findings, health care professionals should strive to fully implement breastfeeding support for mothers of late preterm infants who intend to breastfeed, in particular optimizing breast milk expression and promoting kangaroo mother care. Further studies are needed to gain further insight into the complex interplay of the factors that modulate breastfeeding outcome in late preterm infants.
Introduction: There is paucity of data within the Italian context regarding moral distress in intensive pediatric settings. The aim of the present study was to assess the frequency, intensity, and level of moral distress experienced by nurses working in a sample of pediatric intensive care units (PICUs). Materials and Methods: A cross-sectional questionnaire survey was conducted in eight PICUs from five northern Italian regions in a convenience sample of 136 nurses. Moral distress was evaluated using the modified Italian version of the Moral Distress Scale Neonatal–Pediatric Version (MDSNPV). Each item was scored in terms of frequency and intensity on a five-point Likert scale, ranging from 0 to 4. The total frequency and intensity scores for all the 21 clinical items were comprised between 0 and 84. For each item, the level of moral distress was derived by multiplying the frequency score by the intensity score and quantified with a score ranging from 0 to 16. The total score of the moral distress level for the 21 items ranged from 0 to 336. Results: The mean total scores for the frequency, intensity and level of moral distress were 24.1 ± 10.4, 36.2 ± 18.6, and 57.7 ± 37.1, respectively. The clinical situations identified as the major causes of moral distress among nurses in the present study involved end-of-life care and resuscitation. At multivariate logistic regression analysis, number of deaths occurring in PICUs, having children and intention to leave work due to moral distress resulted to be independently associated with a higher total moral distress level. Conclusions: The results of the present study contribute to the understanding of moral distress experience in acute pediatric care settings, including the clinical situations associated with a higher moral distress level, and highlight the importance of sharing thoughts, feelings and information within the multidisciplinary health care professional team for effective shared decision making, particularly in situations involving end-of-life care and resuscitation.
The present study provides further insight into the moral distress experienced by nurses working in Italian NICUs.
Limited data are available on complementary feeding in preterm infants, who show increased nutritional needs and are at risk of altered postnatal growth. The aim of this study was to investigate the timing and content of complementary feeding in a cohort of late preterm infants. We conducted a prospective, observational study, including mothers who had given birth to infants admitted to level I or II of care with a gestational age between 34 and 36 weeks. Mothers were contacted at 3, 6 and 12 months after delivery by phone calls and were asked about their infant’s mode of feeding and the timing and schedule of the introduction of different solid foods types. A total of 49 mothers and 57 infants completed the study. The mean postnatal age of the introduction of complementary foods was 5.7 ± 0.7 months. Low energy and/or low protein-dense foods were first introduced in most infants. Fruit as the first type of complementary food in the infant’s diet was associated with a 1.6-month advance in initiating complementary feeding. The present findings provide further insight into complementary feeding practices in late preterm infants and underline the need for specific recommendations addressing this vulnerable population.
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