Copyright Rush Mothers' Milk Club, All rights reserved. 1

Transcription

1 Paula P. Meier, RN, PhD, FAAN Director for Clinical Research and Lactation Neonatal Intensive Care And Professor of Women, Children and Family Nursing And Professor of Pediatrics Rush University Medical Center President, International Society For Research in Human Milk and Lactation NIH: Health Outcomes and Cost of Human Milk Feedings for VLBW Infants ( ). AHRQ: Accelerating Comparative Effectiveness Research for Premature Infants ( ). Medela, Inc. Increasing Effectiveness, Efficiency, Comfort and Convenience of Milk Removal for Breast Pump-Dependent Mothers with Premature Infants Anne and Kenneth Griffin Foundation Rossman Family Foundation Rush Women s Board Translate evidence about lactation and human milk into best clinical practices Do you have a protocol as to how often you schedule a consult with NICU moms? What is your written policy about how soon after birth mothers are seen by a lactation consultant? How do you manage nurses who do not do breasts? Conduct clinical research focused on removing barriers to lactation and human milk feedings in the NICU Empower parents through sharing the science about lactation and human milk Human Milk should be managed as scientifically as any other therapy Evidence: Not pro or con breastfeeding HM use competes for other therapies on an even playing field Available online ahead of publication Technologies that improve the availability and use of HM should be evidence-based not ideologically driven All rights reserved. 1

2 Provide 75% of all lactation care in the NICU 5 are now IBCLC BPCs are in the NICU and available to assist families 7 days a week and from 7A-9:30 PM Health Outcomes and Cost of Human Milk Feedings for VLBW Infants Prospective cohort study 430 VLBW Infants enrolled Feb, 2008-Jan, 2013 Variables Included: Dose and Exposure Period of HM Feedings Health Outcomes Enteral feed intolerance Late onset sepsis Necrotizing enterocolitis Chronic lung disease Retinopathy of prematurity Periventricular leukomalacia Growth velocity (wt, length, HC) Cost of NICU Care Maternal and Institutional Costs of Providing HM NIH grant: NRO10009, 2007, Meier, PI Health Outcomes and Cost of Human Milk Feedings for VLBW Infants 95% of eligible infants were enrolled 98% received some HM from the mother (HM - Ever) Days 1-14: Median Cumulative HM-PCT = 100% 76.8% received exclusive HM Days 1-28: Median Cumulative HM-PCT = 98% 59.7% received exclusive HM NICU hospitalization: Average HM-DD = 61 ml/kg/d Average HM-PCT = 48.6% Age: 27.2 ± 6.5 Education: 13.2 ± 2.8 Pre-pregnancy BMI: 28.7 ± 7.5 Black: 30.1 Hispanic: 27.7 Caucasian: 26.7 Cesarean delivery: 65% Major morbidity: Hypertension: 31.3% Diabetes: 8.3% Mental Health Dx: 17.1% Bigger, HR, et al. J Perinatology, Advance Online February, 2014 doi: /jp /30/14 All rights reserved. 2

3 Approximately 40% of mothers do not plan to provide milk at the time of entering the hospital to give birth Excerpt from In Your Hands, Rush Mothers Milk Club, 2011 Does this unequivocal message from the NICU staff make mothers feel pressured or coerced? Excerpt from In Your Hands, Rush Mothers Milk Club, 2011 JOGNN 33: , Excerpt from In Your Hands, Rush Mothers Milk Club, 2011 Excerpt from In Your Hands, Rush Mothers Milk Club, 2011 All rights reserved. 3

4 Excerpt from In Our Hands, Rush Mothers Milk Club, 2011 Insert from Your Milk is a Medicine for Your Baby Clarifies HOW decisions are made about medications in NICU Clarifies factors that influence amount of medication that reaches infant s blood stream Informs parents about references for compatibility of medications with breastfeeding Clarifies that the NICU staff-- not the prescribing MD-- should decide about suitability of milk for feeding Indicates that NICU staff will consult with prescribing MD at parents request Clarifies that mothers will make good milk even if their diet is not ideal. Clarifies that a good diet helps to protect their own body stores, but nature protects the baby by making good milk. Informs parents that milk changes taste and smell depending upon diet, and encourages them not to avoid cultural foods. Emphasizes that foods rich in DHA result in higher concentrations in the milk. Discourages weight-loss diets, but emphasizes that lactation brings natural weight-loss advantage. Start of the Day: Review status of all newly admitted infants and their families with the charge nurse or nurse lactation specialist Excerpt from In Our Hands, Rush Mothers Milk Club, 2011 All rights reserved. 4

5 Each NICU-based refrigerator and freezer is checked, organized, cleaned and made ready for the upcoming shift of nurses The BPCs check that enough of the right milk is in the NICU for the infant s upcoming 24-hour feedings, and that all milk is properly labeled and in the correct infant bin Extra milk is moved out of the NICU and carefully stored in our industrial freezers that are temperature-controlled. Initial Visits to New Mothers Take about 1 Hour Each BPC Maintains a Photo Album of Her or His NICU Baby from Birth through Current Age Discussion focuses on impact of human milk on the infant s outcome BPCs assist with the first pumping session for all new NICU mothers Teaching Correct Labeling of Milk Storage Containers Proper use of the pump is taught Breast shield sizing is done Pump hygiene is reviewed Pump rental is organized All rights reserved. 5

6 Correct Cleansing of Breast Pump Equipment is Demonstrated for Each Family Mothers perceived the BPCs as knowledgeable, competent and sensitive Preferred speaking to the BPCs than anyone else during the maternity hospital stay Valued the BPCs sitting with them during the first milk expression, explaining and validating sensations and techniques BPCs were an integral part of the NICU team Would not want to work in a NICU without the BPCs Learned from the BPCs Valued the support that families received from the BPCs Conceptualization, Implementation and Evaluation of NICU BPC role Job description and scope of practice Recruitment and orientation of BPCs Payment considerations Summary of evaluation research All rights reserved. 6

7 Weekly Mothers Milk Club Luncheons Provide a Forum to Share the Science about Human Milk and Lactation Excerpt from Lunch with the Rush Mothers Milk Club, Rush Mothers Milk Club, 2011 Excerpt from Lunch with the Rush Mothers Milk Club, Rush Mothers Milk Club, 2011 Excerpt from Lunch with the Rush Mothers Milk Club, Rush Mothers Milk Club, 2011 Mothers had faith that their milk would mitigate the impact of prematurity in highly specific ways Realistic that milk would not cure the complication, but would help protect from other complications, or lessen the impact of the complication Mothers described the ritual of pumping in a manner similar to the ritual of attending church Every 3 hours I have to pump. I don t care what it is I m doing, I have to pump for him. It s just like church for me. I won t miss any of church. I won t miss any of pumping. Faith served as a motivator to initiate and maintain pumping, even if mothers did not want to feed at breast and/or disliked the actual process of pumping All rights reserved. 7

8 Sub-study of maternal distress that enrolled 69 NIH cohort mothers, of which 23 participated in qualitative interviews between 2-4 weeks post-birth Peer support was ranked as the #1 factor for development of the maternal role in the NICU At home nobody understands. Here it less stressful. Getting to see that other people have been in the same situation has been so positive. Interaction with someone who has been through a similar situation gives you some validation of your feelings being OK Rossman et al, In press, JOGNN Beverly Rossman All rights reserved. 8