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Neonatal Intensive Care Unit-Specific Lactation Support and Mother's Own Breast Milk Availability for Very Low Birth-Weight Infants

Mercado, Kathryn DNP, APRN, NNP-BC; Vittner, Dorothy PhD, RN, CHPE; Drabant, Bradlee MD; McGrath, Jacqueline PhD, RN, FNAP, FAAN

Section Editor(s): Parker, Leslie

doi: 10.1097/ANC.0000000000000684
Human Milk Science: Special Series
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Background: Mother's own milk (MOM) is the preferred nutrition for premature infants, particularly for the very low birth-weight (VLBW) cohort. Benefits are well documented; yet, numerous barriers exist for provision of MOM in the neonatal intensive care unit (NICU). Lactation consultants (LCs) can optimize breastfeeding support for NICU mothers; however, understanding of the impact of NICU-dedicated LCs is limited.

Purpose: Evaluate the effectiveness of NICU-dedicated LCs in improving breastfeeding outcomes and MOM provision in VLBW infants.

Methods: A retrospective chart review of 167 VLBW infants comparing breastfeeding outcomes between 2 NICUs, one with NICU-dedicated LCs (hospital A; n = 48) and one without (hospital B; n = 119). Primary outcome measures included feeding percentages of MOM received by infants at 3 intervals, throughout hospitalization, and number of direct breastfeeding events. Secondary outcome measures included number of days to first enteral feed, days to reach full feeds, days of nil per os, days on total parenteral nutrition, and length of stay.

Findings: Neonatal intensive care unit–specific lactation support increased the number of direct breastfeeding events on day of discharge (P = .048). No statistical significance was found at each of the 3 time intervals, or throughout hospitalization (week 1: P = .18; midpoint: P = .40; discharge: P = .16; total hospitalization: P = .19). No statistical significance was demonstrated in secondary outcome measures (days to first enteral feed: P = .22; days to full feeds: P = .25; nil per os days: P = .27; total parenteral nutrition days: P = .34; length of stay: P = .01). Length of stay not found to be significant after correcting for confounding variables.

Implication for Practice: Increased direct breastfeeding events on day of discharge with exposure to NICU-dedicated LCs in the VLBW population.

Implication for Research: Prospective studies regarding NICU-specific lactation support with larger samples are warranted.

University of Connecticut, School of Nursing, Storrs (Dr Mercado); Pediatrix Medical Group, Affiliate of Mednax, Las Vegas, Nevada (Drs Mercado and Drabant); WakeMed Health & Hospitals, Raleigh, North Carolina (Dr Vittner); and University of Texas Health Science Center San Antonio, School of Nursing (Dr McGrath).

Correspondence: Kathryn Mercado, DNP, APRN, NNP-BC, Pediatrix Medical Group, Affiliate of Mednax, 653 N Town Center Dr Ste 112, Las Vegas, NV 89144 (Kathrynmercadonp@gmail.com or kathryn_mercado@uconn.edu).

This study was conducted at the University of Connecticut, Storrs and the Valley Health System, Las Vegas, Nevada.

The authors declare no conflicts of interest.

Dr. McGrath, who is a Co-Editor for Advances in Neonatal Care and the coauthor and mentor to the primary author, was not involved in the editorial review or decision to publish this article. The entire process from submission, referee assignment, and editorial decisions was handled by other members of the editorial team for the journal.

© 2019 by The National Association of Neonatal Nurses