Upcoming important dates, next steps for the Milk Initiative...
(This email goes out to the key contact person from each team in the collaborative. Please share relevant information with your team members or others at your hospital.)
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Notes from Marty...
| | |  A couple of very interesting recent articles for your review.
We have heard from a number of centers in EHM Well focused on promoting skin to skin practices after cesarean deliveries. The first reference (click here) describes the experience of a small urban medical center serving a large proportion of indigent mothers. The hospital is Baby Friendly and seriously committed to prompting skin to skin time after cesarean. The article does not describe statistical analysis of its results but does report a significant increase in breastfeeding rates amongst cesarean section mothers with skin to skin time in the OR or within 90 minutes after birth. Any formula in the OR group was 33% versus 43% for skin to skin by 90 minutes and 74$ for those with no skin to skin by 90 minutes. While the statistical analysis is lacking, the article is notable for its description of a compendium of references related to skin to skin time as a support for breastfeeding. It also describes in detail the application of quality science in their effort to support this practice. While focused on well newborns and mothers undergoing Cesarean delivery, there is much for all of us to review in this article.
The second reference (click here) reports on the impact of direct breastfeeding in the NICU. The authors reviewed the impact of putting preterm infants directly has on establishing and sustaining breastfeeding at discharge. Specifically examined were , the number of times the mother put the infant to breast, the gestational age of the first direct breast-feeding, whether the first oral feeding was at the breast, the duration of breast milk feedings and whether breast milk feedings continued until NICU discharge. While this is an intial foray into a fascintaing area of research, this study demonstrates a link between direct breast-feeding behaviors in the NICU and success with provision of milk at discharge.
A question for the EHM teams that are sampling, how many babies do you intend to sample per month and how do you pick them?
Keep up the great work!
-Marty
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Notes from Miriam Labbok, MD, MPH, FACPM, IBCLC, FABM
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|  Dear Friends:
By now, I hope you are seeing improvements in your breastfeeding initiation and exclusivity rates. In other work we are doing, we find that unnecessary supplementation can be the major factor in defeating a mother's intention to breastfeed. Unfortunately, the most common reasons for supplementation are not always medically indicated, e.g., weight loss. Babies are often over hydrated by maternal IVs, and need to pee out some of that excess, and will not become dehydrated if they do not need to feed in the first hours. Standing orders to formula feed based on hour of life can be harmful, not helpful.
A recent study found a significant positive relationship between maternal IV fluids from admission to birth, and in the final 2 hours before birth, and newborn weight loss in grams at 60 hours. Neonatal output at 24 hours was also correlated to the IV fluids given 2 hours before birth. On Day 1, there was a positive relationship between output and grams of weight loss. It appears neonates experience diuresis in the first 24 hours with a related weight loss. This study re-confirms this IV-associated overhydration and its impact on the infant's weight loss, and offers a protocol for assessing the impact in your setting, if you would like.
So, how are you doing on documenting all supplemental feedings by type of supplement, mode of feeding, and amount? Falling back on freely available formula, rather than supporting the mom to successfully breastfeeding, is poor practice; it is not the best for health or for patient satisfaction in the long run. If we are to succeed with supporting moms to breastfeed, every single hospital staff member who comes in contact with the mom must be able to provide basic breastfeeding support. How are your trainings coming along? Does every mom now learn feeding and satiety cues? Hand expression?
If you need any help with any of the above, please let Keith know.
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Upcoming Webinars
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|  HM NICU: Tuesday, September 13th, 2:00 - 3:00 (note that due to popular demand the regular date has been changed from the 2nd Monday of the month to the 2nd Tuesday of the month)
HM Well Baby: Wednesday, September 28th, 2:00 - 3:00
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| Contact |
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Keith M. Cochran
PQCNC Debrouillard
keith_cochran@unc.edu
919.966.8182
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