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The Use of Human Milk and Breastfeeding in the Neonatal Intensive Care Unit: Position Statement 3065

Spatz, Diane L. PhD, RN-BC, FAAN; Edwards, Taryn M. MSN, CRNP, NNP-BC

doi: 10.1097/ANC.0000000000000313
NANN Position Statement
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Diane L. Spatz, PhD, RN-BC, FAAN, is Professor of Perinatal Nursing at the University of Pennsylvania's School of Nursing and Nurse Researcher and Director of the Lactation Program at The Children's Hospital of Philadelphia (CHOP) and the CHOP Mother's Milk Bank. Taryn M. Edwards, MSN, CRNP, NNP-BC, is a neonatal nurse practitioner for General, Thoracic, and Fetal Surgery at CHOP.

Correspondence: Diane L. Spatz, PhD, RN-BC, FAAN, University of Pennsylvania, Philadelphia, PA (spatz@nursing.upenn.edu).

The authors declare no conflicts of interest.

In the third edition of The Use of Human Milk and Breastfeeding in the Neonatal Intensive Care Unit, NANN recommends that all infants should be exclusively breastfed for the first 6 months of life with continued breastfeeding for 1 year or more. Data from the Centers for Disease Control and Prevention's 2014 Breastfeeding Report Card1 reveal that only 18.8% of infants are exclusively breastfed for the first 6 months of life, which is far below the Healthy People 2020 goal of 60.6%.1

This revised position statement includes the following recommendations for increasing breastfeeding rates: (1) prenatal lactation intervention should focus on education so that families can make informed decisions,2 (2) milk supply should be maintained through the use of a hospital-grade electric pump and daily ongoing assessment of maternal milk volume to ensure that mothers come to full milk volume and sustain milk production,3 (3) oral care with human milk should be used to promote immunological defense as well as positive oral experiences for the infant,2 (4) human milk management, prioritization of fresh milk, and optimizing human milk feedings including the use of donor milk as a bridge to mother's own milk,4 and (5) vulnerable infants should be transitioned to at-breast feedings as soon as possible prior to discharge and an electronic scale should be used to measure pre- and postweights to determine milk transfer.2

Recent research by Hallowell and colleagues5 demonstrated that only 49% of neonatal intensive care units had lactation consultants employed in the neonatal intensive care unit and nurses only reported providing breastfeeding support 13% (median) of the time during their prior shift. All neonatal nurses should possess evidence-based knowledge regarding the science of human milk, lactation, and breastfeeding. As the professional voice of neonatal nurses, NANN recommends that nurses integrate lactation support and care into their daily routines to ensure that vulnerable infants receive human milk through discharge and beyond.

The full NANN position statement can be accessed at http://www.nann.org/uploads/files/Use__of_Human_Milk_FINAL.pdf.

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References

1. Centers for Disease Control and Prevention. Breastfeeding report card. www.cdc.gov/breastfeeding/data/reportcard.htm. Published 2014. Accessed April 10, 2015.
2. Spatz DL. Innovations in the provision of human milk and breastfeeding for infants requiring intensive care. J Obstet Gynecol Neonatal Nurs. 2011;41(1):138–143. doi:10.1111/j.1552-6909.2011.01315.x.
3. Froh EB, Hallowell S, Spatz DL. The use of technologies to support human milk & breastfeeding. J Pediatr Nurs. 2015;30(3):521–523. doi:10.1016/j.pedn.2015.01.023.
4. Edwards TM, Spatz DL. Making the case for using donor human milk in vulnerable infants. Adv Neonatal Care. 2012;12(5):1–7.
5. Hallowell SG, Spatz DL, Hanlon AL, Rogowski JA, Lake ET. Characteristics of the NICU work environment associated with breastfeeding support. Adv Neonatal Care. 2014;14(4):290–300.
© 2016 by The National Association of Neonatal Nurses