Infant feeding practices within a large electronic medical record database

Abstract

BackgroundThe emerging adoption of the electronic medical record (EMR) in primary care enables clinicians and researchers to efficiently examine epidemiological trends in child health, including infant feeding practices.MethodsWe completed a population-based retrospective cohort study of 8815 singleton infants born at term in Ontario, Canada, April 2002 to March 2013. Newborn records were linked to the Electronic Medical Record Administrative data Linked Database (EMRALD™), which uses patient-level information from participating family practice EMRs across Ontario. We assessed exclusive breastfeeding patterns using an automated electronic search algorithm, with manual review of EMRs when the latter was not possible. We examined the rate of breastfeeding at visits corresponding to 2, 4 and 6 months of age, as well as sociodemographic factors associated with exclusive breastfeeding.ResultsOf the 8815 newborns, 1044 (11.8%) lacked breastfeeding information in their EMR. Rates of exclusive breastfeeding were 39.5% at 2 months, 32.4% at 4 months and 25.1% at 6 months. At age 6 months, exclusive breastfeeding rates were highest among mothers aged ≥40 vs. < 20 years (rate ratio [RR] 2.45, 95% confidence interval [CI] 1.62–3.68), urban vs. rural residence (RR 1.35, 95% CI 1.22–1.50), and highest vs. lowest income quintile (RR 1.18, 95% CI 1.02–1.36). Overall, immigrants had similar rates of exclusive breastfeeding as non-immigrants; yet, by age 6 months, among those residing in the lowest income quintile, immigrants were more likely to exclusively breastfeed than their non-immigrant counterparts (RR 1.43, 95% CI 1.12–1.83).ConclusionsWe efficiently determined rates and factors associated with exclusive breastfeeding using data from a large EMR database.Electronic supplementary materialThe online version of this article (10.1186/s12884-017-1633-9) contains supplementary material, which is available to authorized users.

Exclusive breastfeeding in hospital predicts longer breastfeeding duration in Canada: Implications for health equity

“…The Centers for Disease Control and Prevention reported that nearly 80% of American newborns initiated breastfeeding in 2013; however, only 27% were still breastfed at 12 months and <20% were exclusively breastfed for 6 months. 11 Systematic reviews and population-based studies have found that key social determinants of health, including maternal education, age, socioeconomic status or income, and ethnicity all influence breastfeeding initiation and duration. 10 A review of electronic medical records in the Canadian province of Ontario spanning the years 2002-2013 supports this observation, as the rate of exclusive breastfeeding at 6 months was 25%.…”

“…10 A review of electronic medical records in the Canadian province of Ontario spanning the years 2002-2013 supports this observation, as the rate of exclusive breastfeeding at 6 months was 25%. 11 Systematic reviews and population-based studies have found that key social determinants of health, including maternal education, age, socioeconomic status or income, and ethnicity all influence breastfeeding initiation and duration. [12][13][14][15][16][17] This is compounded by the observation that younger women and those with lower income or less education are more likely to be offered formula in hospitals.…”

Gastroschisis Following Treatment with High-Dose Methimazole in Pregnancy: A Case Report

“…This defect results from a failure of umbilical coelom formation, resulting in rupture and hole formation, most commonly on the right side of the umbilicus [ 9 ]. Gastroschisis occurs in 1 in 4000 births or 2–3 per 10,000 live births and is usually associated with young maternal age and a history of alcohol intake and tobacco consumption during pregnancy [ 9 , 10 ]. Congenital abnormalities due to ATDs (methimazole and propylthiouracil) are reported as percentages of live births with a history of exposure to ATD in the first trimester, making it difficult to compare the numbers.…”

Differences in growth of Canadian children compared to the WHO 2006 Child Growth Standards

“…For each eligible infant in EMRALD, we extracted data for their postnatal visits including date of the visit, age, current weight and length, and feeding practice. For each infant, we also examined each entry in their EMR chart up to age 750 days for any mention of present or past breast or formula feeding, using an algorithm that we developed to search structured and free text fields . Canadian family physicians commonly use the structured Rourke Baby Record system (http://www.rourkebabyrecord.ca) for routine child health surveillance – including growth and feeding – from birth to 5 years of age.…”

“…For each infant, we also examined each entry in their EMR chart up to age 750 days for any mention of present or past breast or formula feeding, using an algorithm that we developed to search structured and free text fields. 20 Canadian family physicians commonly use the structured Rourke Baby Record system (http://www.rourkebabyrecord.ca) for routine child health surveillanceincluding growth and feedingfrom birth to 5 years of age. For EMRs without a Rourke Baby Record, chart abstractors manually extracted information about the type and duration of infant feeding from free text fields.…”