Exclusive breastfeeding at the point of discharge of high-risk newborns at a Neonatal Intensive Care Unit and the factors associated with this practice

Abstract

Este trabalho é parte da Dissertação de Mestrado defendida por Paula G. Bicalho-Mancini junto ao Curso de Mestrado em Enfermagem, UFMG.Artigo submetido em 19.12.03, aceito em 03.03.04. AbstractObjective: To study the rate of exclusive breastfeeding at the moment of hospital discharge of newborns admitted to a neonatal Intensive Care Unit and to analyze potential risk factors.Methods: Four hundred and ninety-five medical records were studied, pertaining to neonates born between 1998 and 1999, admitted to a neonatal intensive care unit, before and after the implementation of the Baby Friendly Hospital Initiative policies. Babies born during the Baby Friendly Hospital Initiative transition period and outside the Maternity ward were excluded from the study, as were children or mothers who were transferred from the institution, abandoned children and also mothers unfit to breastfeed. Risk factors for non-exclusive breast-feeding at discharge were studied. Odds ratio and 95% confidence intervals were calculated using multivariate logistic regression. Results:The exclusive breastfeeding rate increased from 36% at discharge (before the Baby Friendly Hospital Initiative) to 54.7% (after BFHI). The independent risk factors associated with non-exclusive breastfeeding were the use of enteral feeding (OR = 3.01), ante-natal consultations < 6 (OR = 2.75), relactation use (OR = 2.66), birth weight < 2,500 g (OR = 2.64) and being born during the period before Baby Friendly policies were implemented (OR = 2.75)Conclusion: This research shows the potential efficiency of adopting Baby-Friendly policies to increase the chance of successful breastfeeding at the point of discharge for high-risk newborns. ResumoObjetivo: Avaliar as taxas e o padrão de aleitamento materno dos recém-nascidos internados em berçário de alto risco no momento de sua alta hospitalar e analisar os potenciais fatores que interferem na prática do aleitamento materno exclusivo.Métodos: Foram estudados prontuários médicos de 495 recém-nascidos internados no berçário de alto risco da Maternidade Odete Valadares, Minas Gerais, antes e após receber o título de Hospital Amigo da Criança. Foram excluídos os nascidos fora da maternidade e durante o período de transição, crianças ou mães que foram a óbito ou transferidas da instituição e crianças abandonadas e/ou de mães com contra-indicação para amamentar. Foram calculadas razões de chance (odds ratio, OR) e intervalos de confiança de 95% a partir de análises bivariadas e multivariadas utilizando a técnica da regressão logística.Resultados: A taxa de aleitamento materno exclusivo na alta passou de 36% no período anterior para 54,6% no período posterior à implementação da Iniciativa Hospital Amigo da Criança. Os fatores de risco independentemente associados com ausência de aleitamento exclusivo foram: uso da dieta por sonda (OR = 3,01), número de consultas pré-natais menor que seis (OR = 2,21), uso de translactação (OR = 2,66), peso ao nascer < 2.500 g (OR = 2,64) e internação em período anterior ao recebimento do títu...

How to achieve long-term breast-feeding: factors associated with early discontinuation

“…Low birth weight of premature infants might have contributed to this result as well. Although there are studies that report no significant association between birth weight and breast-feeding duration (28,29) , the present study together with some others reveal that low birth weight has a negative impact on duration of breast-feeding (5,8,20,30) .…”

Adolescent Parenting in the Neonatal Intensive Care Unit

“…Likewise, Espy and Senn [30] reported that preterm NICU infants who breast-feed consistently were more likely to have older mothers. Conversely, Bicalho-Mancini and Velásquez-Meléndez [57] found no significant difference in the prevalence of exclusive breastfeeding at NICU discharge between adolescent and older mothers. Although the studies by Lessen and Crivelli-Kovach [32], Purdy et al [25], and Espy and Senn [30] were completed in the United States, the study by BicalhoMancini and Velásquez-Meléndez [57] was completed in Brazil.…”

“…There were also notable methodological issues in these studies. For example, retrospective data collection methods of telephone survey [32] and chart review [57,58] might have led to recall and reviewer biases respectively.…”

Factors associated with infants receiving their mother's own breast milk on discharge from hospital in a unit where pasteurised donor human milk is available

“…Many factors have the potential to influence whether a mother successfully breastfeeds their very preterm infant. Factors associated with a greater proportion of preterm babies successfully breastfeeding include older maternal age [20][21][22] ; early initiation of breastfeeding 23 ; higher parity 21,[24][25][26] ; higher socio-economic and educational status 20,21,24,27 ; marital status as married 28 ; and a range of practices including skin-to-skin post delivery, 29 implementation of the Baby Friendly Hospital Initiative, [30][31][32] maternal breastfeeding education, bedside nursing and lactation practitioners support, 21,22,29,[33][34][35][36][37][38] the practice of kangaroo mother care, 32,39-41 the use of pacifiers and lullabies 42 and the practice of pre-feed oral stimulation. 43 Conversely, factors associated with a smaller proportion of preterm babies successfully breastfeeding include prematurity and low birthweight, 20,21,25,32,[44][45][46] prolonged length of hospital stay, 20,21,25,26,44,45 multiple pregnancy, 20 chronic neonatal lung dis...…”