Supporting Public Health Nurses with Breastfeeding Interventions for Late Preterm Infants

Abstract

Late preterm infants often experience feeding difficulty post discharge from hospital. While breast milk is especially important for late preterm infants, they have lower exclusive breastfeeding rates than full term infants. This is because mothers of late preterm infants often do not receive sufficient amount of breastfeeding support in the postpartum period. Furthermore, in the Canadian context, guidelines do not exist for health care providers to use to assist them in providing breastfeeding support for mother's of late preterm infant in the community setting. We used a modified Delphi approach to begin to fill this gap. We present information relating to physiological development in systems, its significance to feeding, and potential interventions for public health nurses. This information will assist PHNs in their clinical reasoning and decision-making when supporting mothers and their LPIs to exclusively breastfeed in the community. Keywords IntroductionLate preterm infants (LPIs), born between 34 0/7 weeks and 36 6/7 weeks gestational age, comprise approximately 75% of all preterm births [1][2][3]. While the average rate of preterm birth in Canada is 7.9%, Alberta (2015Alberta ( -2016 has the highest rate of preterm birth (8.6%) among the provinces, with Calgary averaging 8.9% [4]. Historically, various health care providers have managed the care of LPIs similar to that of term infants because of their comparatively large size and seemingly mature appearance [3,5,6]. The Canadian Paediatric Society (CPS) supports the early discharge of LPIs if it is safe to do so, as early discharge promotes infant feeding [2]. However, when compared with full term infants, LPIs are at higher risk of experiencing feeding difficulties, which may, in turn, result in excessive weight loss, hypoglycemia, hyperbilirubinemia, and the associated neurologic sequelae [7][8][9][10][11][12][13]. Because these medical issues may persist after discharge from hospital, LPIs have a higher rate of emergency room visits and hospital readmission within the first two weeks of life for issues related to feeding, including jaundice and dehydration [14][15][16][17].While LPIs may benefit significantly from breastmilk, they have lower exclusive breastfeeding rates due to mothers receiving inadequate breastfeeding support after birth [18]. Kair and colleagues [19] found that mothers receive inadequate breastfeeding support post discharge. Dosani and colleagues [20] found that not only did mothers have various difficulties with breastfeeding, public health nurses (PHNs) also found it challenging to guide mothers in breastfeeding and provide anticipatory guidance. There are many reasons for this, including limited training received in undergraduate programs [21]. In addition, there are limited guidelines, models of care, and evidence informed standards of community care for LPIs. PHNs in Alberta therefore must adapt guidelines for term infants to care for LPIs in the community setting, where follow up of the mother infant dyad is provided...

Breastfeeding self‐efficacy predicts breastmilk feeding in preterm infants at discharge from the neonatal intensive care unit

“…Dosani and Currie (2017) highlighted that there are many unique breastfeeding challenges with late preterm infants and reinforced that breastfeeding support is crucial to ensure success. Further, Gerhardsson et al (2018) found that length of hospital stay was inversely correlated with BSE in mothers of late preterm infants.…”