Breastfeeding rates at discharge: don’t blame the fortifier! A national survey of practice and comparison with NNAP data

Stiles, Samantha L.; Rooy, Laura de

doi:10.1136/archdischild-2018-314991

Cited by 4 publications

(11 citation statements)

References 2 publications

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“…The results show that all respondents used BMF routinely in preterm infants, which is higher than previously reported in 2012, when only 69% of UK and Irish neonatal units used BMF as part of standard practice ( 16 ) . There was no disparity in the use of BMF between levels of neonatal unit, in contrast to a previous finding that BMF was used more commonly in level 2 versus level 3 neonatal units ( 15 ) . Most neonatal units (77.5%) had guidelines on the use of BMF, which is greater than the 49% previously identified ( 15 ) .…”

Section: Discussioncontrasting

confidence: 97%

“…There was no disparity in the use of BMF between levels of neonatal unit, in contrast to a previous finding that BMF was used more commonly in level 2 versus level 3 neonatal units ( 15 ) . Most neonatal units (77.5%) had guidelines on the use of BMF, which is greater than the 49% previously identified ( 15 ) . Overall, the present study has demonstrated a positive change in dietetic practice.…”

Section: Discussioncontrasting

confidence: 97%

“…The majority of respondents (85%, n = 34) routinely monitored serum biochemistry when preterm infants were receiving BMF in hospital. Almost all dietitians used standard fortification methods, with only 12.5% ( n = 5) using targeted and adjusted fortification of breast milk, possibly because most neonatal units do not have access to breast milk analysers ( 15 ) . Standard fortification remains the most widely used fortification method; however, this does not address the issue of protein undernutrition in very low birthweight infants ( 1 ) .…”

Section: Discussionmentioning

confidence: 99%

“…There are currently no national guidelines on when to initiate or discontinue BMF, or what dose should be given per day, potentially leading to inconsistent practices across different neonatal units. A recent UK survey of neonatology healthcare professionals illustrated a number of widely held beliefs regarding the use of BMF, some of which are not supported by current evidence ( 15 ) . Similarly, an international survey of neonatologists also demonstrated marked variability in neonatal feeding practices, including the use of BMF ( 16 ) .…”

Section: Introductionmentioning

confidence: 99%

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The use of Breast Milk Fortifier in Preterm Infants by paediatric dietitians in the UK

Jupe

Maslin

2020

J Human Nutrition Diet

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Background Breast milk is the feed of choice for premature infants, although its nutritional composition is not always sufficient to meet their raised nutritional requirements. The addition of a multi‐nutrient breast milk fortifier (BMF) to breastmilk is recommended; however, international guidelines on the use of BMF are inconsistent. The present study aimed to explore the use of BMF in preterm infants by paediatric dietitians in the UK. Methods A questionnaire was designed and sent to members of the British Dietetic Association neonatal specialist group (n = 100) using a secure online platform. Descriptive statistics were calculated. Results Forty dietitians completed the survey, all of whom used BMF. Local hospital BMF guidelines were available to 77.5% (n = 31). The most commonly used criteria for commencing BMF were: tolerating a feed volume of 150 mL kg−1 day−1 (72.5%, n = 29), a gestational age <34 weeks (67.5%, n = 27) and a birth weight <1500 g (60%, n = 24). The primary contraindication for the use of BMF was necrotising enterocolitis (NEC). The majority of respondents used standard fortification, with individualised fortification available to only 12.5% (n = 5). The most common indicators for discontinuing BMF were on discharge home (67.5%, n = 27), satisfactory growth (65%, n = 26) or feeding directly from the breast (62.5%, n = 25). Conclusions Although BMF is used more proactively in UK neonatal units than previously, variation in practice remains. Individualised fortification is very uncommon and caution remains regarding risk of NEC. The development of national guidelines on the use of BMF would help to standardise nutritional care in neonatal units.

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Section: Discussioncontrasting

confidence: 97%

Section: Discussioncontrasting

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The use of Breast Milk Fortifier in Preterm Infants by paediatric dietitians in the UK

Jupe

Maslin

2020

J Human Nutrition Diet

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“…Therefore, during their stay in the NNU, a commercially available BMF specifically designed to enhance the nutritional content of breast milk, by providing additional protein and micronutrients, including calcium and phosphorus,9 is usually added to MBM. A recent survey of practice surrounding the use of BMF during NNU stay suggested it could potentially protect breast feeding on discharge 10…”

Section: Introductionmentioning

confidence: 99%

Home use of breast milk fortifier to promote postdischarge growth and breast feeding in preterm infants: a quality improvement project

et al. 2018

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To improve the postdischarge growth of exclusively breastfed preterm infants, born weighing ≤1.8 kg, by using breast milk fortifier (BMF) supplements postdischarge until 48 weeks’ gestational age. A quality improvement (QI) project involving plan–do–study–act (PDSA) cycles. A tertiary surgical neonatal unit. Preterm infants weighing ≤1.8 kg at birth. We completed four PDSA cycles to develop and improve an electronic patient information sheet to promote the use BMF beyond discharge. Safety, feasibility and attitudes of parents to home BMF were assessed using questionnaires. A retrospective audit (July 2015–September 2017) was completed investigating the effects of home BMF on growth up to 1 year of age. Change in SD scores for weight for age, length for age and head circumference of age at various time points compared with those at birth were calculated. Compared with baseline measurements (infants born October 2012–November 2013), the QI project resulted in improved growth (measured as the change in SD score from birth, cSDS) at discharge for weight (cSDS −0.7), head circumference (cSDS 0.4) and length (cSDS-0.8), and at 1 year for weight (cSDS 0.9) and length (cSDS 0.8). Home BMF appeared to be safe, and parents found its use acceptable. QI methods facilitated the successful integration of BMF into routine clinical care after discharge, improving the growth trajectory of exclusively breastfed preterm infants discharged home, as well as supporting breast feeding in this vulnerable population group.

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Solely human milk diets for preterm infants

Taylor

2019

Seminars in Perinatology

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Breastfeeding rates at discharge: don’t blame the fortifier! A national survey of practice and comparison with NNAP data

Cited by 4 publications

References 2 publications

The use of Breast Milk Fortifier in Preterm Infants by paediatric dietitians in the UK

The use of Breast Milk Fortifier in Preterm Infants by paediatric dietitians in the UK

Home use of breast milk fortifier to promote postdischarge growth and breast feeding in preterm infants: a quality improvement project

Solely human milk diets for preterm infants

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