Helping Mothers Identify and Estimate Milk Transfer After Breastfeeding Their Preterm Infant Danette Zanatta¹, BSN, Sylvia Martin¹, RN, Mandy Smith¹, RN & Suzanne Campbell², PhD, RN, IBCLC ¹Vancouver Coastal Health & ²UBC School of Nursing Introduction
Results
Breast milk provides many specific benefits to infants who are born preterm. When breastfeeding is established in a Neonatal Intensive Care Unit (NICU) setting, mothers rely on nursing observations, test weights and daily weights to determine if their preterm infant is getting enough milk. Often a ‘top up’ of milk is given by nasogastric route or by bottle after breastfeeding since parents and nurses are unsure how much milk the baby transferred while breastfeeding. After discharge, these comforts are removed and a mother begins the often stressful task of attempting to quantify the amount of milk her baby received when breastfeeding. During this transition, preterm infant growth and nutrition, maternal confidence, and the important act of breastfeeding is put at risk.
Discussion Practice
Maternal Estimate Accuracy Chart Demonstrates the difference in maternal estimates of intake and actual intake. Ranges from 0 (exactly accurate) to 45mls more/less than actual intake. Mean trend line shows an overall improvement in maternal accuracy.
By increasing maternal accuracy and confidence, the NICU team can foster a safe and empowering discharge. This study has highlighted some areas that the NICU team can focus on. High breastfeeding rates after discharge have reinforced the importance of breastfeeding promotion in the NICU. It has also provided the RNs with the knowledge that high rates are possible. This study has exposed nursing staff in the NICU to the appropriate methods of test weighing. Test weights in the NICU can help prevent over/under top up after breastfeeding. Research We recommend a larger study to examine trend lines with the use of more statistical data. Investigation into other possible variables affecting maternal confidence and accuracy.
Purpose
Comparing and contrasting NICU’s that test weigh versus NICU’s that do not. Maternal Confidence Rating
To examine the effects of formal teaching of clinical indicators of milk transfer and test weights on a mothers’ ability to accurately estimate her preterm infant’s intake while breastfeeding
Shows individual confidence rated over the course of the study.
To examine mothers’ confidence levels related to their ability to estimate the amount of milk their baby received accurately
Focuses on the mother’s confidence in her abilities to accurately estimate milk intake.
To examine breastfeeding plans and actual breastfeeding rates after discharge
Mean trend line shows an increase in confidence of about 2 points when mothers self-rated on a 0 to 5 rating scale beginning with pre study and ending at 1 month post discharge.
Methods
Knowledge Translation Present findings to members of the healthcare team through staff meetings and interdisciplinary rounds. Written presentation through applicable disciplines such as Neonatal and La Leche League.
References Callen, J., & Pinelli, J. (2005). A review of the literature examining the benefits and challenges, incidence and duration, and barriers to breastfeeding in preterm infants. Advances In Neonatal Care: Official Journal Of The National Association Of Neonatal Nurses, 5(2), 72-88. Kim, J. H., & Froh, E. B. (2012). What Nurses Need To Know Regarding Nutritional and Immunobiological Properties of Human Milk. JOGNN:
A longitudinal, prospective, single subject experimental design was used.
Journal Of Obstetric, Gynecologic & Neonatal Nursing, 41(1), 122-137.
Informed consent was obtained from a convenience sample of 10 mothers in which both her, and her preterm infant met the inclusion criteria. Control was established by performing 3 blind test weights where the mother estimated her infant’s intake after breastfeeding each time. Intervention consisted of a formal one-to-one teaching. Post-intervention test weights were done 3 more times, revealing the actual weight after the mother had estimated. Short questionnaires were given before control testing, after intervention teaching, at discharge and at 1 month post discharge to assess support, levels of confidence and levels of knowledge. Statistical evaluation analysis was done to assess for improving accuracy of mother’s estimates and confidence levels.
Meier, P.P., Engstrom, J.L., Fleming, B.A., Streeter, P.L., & Lawrence, P. (1996). Estimating milk intake of hospitalized preterm infants who breastfeed. Journal Of Human Lactation: Official Journal Of International Lactation Consultant Association, 12(1), 21-26.
Breastfeeding Plans vs Rates Compares breastfeeding plan at discharge with actual rates of breastfeeding at discharge and 1 month post discharge.
Rodriguez, N., Miracle, D., & Meier, P. (2005). Sharing the science on human milk feedings with mothers of very-low-birth-weight infants. JOGNN: Journal Of Obstetric, Gynecologic & Neonatal Nursing, 34(1), 109-119 Walker, M. (2008). Breastfeeding the late preterm infant. Journal Of Obstetric, Gynecologic, And Neonatal Nursing: JOGNN / NAACOG, 37(6), 692701.
Each mother met or exceeded their planned number of breastfeeds in a day at 1 month post discharge.
Contact For more information please contact Danette Zanatta : danette.zanatta@vch.ca
What is a test weight?
Acknowledgements
A measurement used to assess the amount of milk transferred to an infant during breastfeeding The infant is weighed in the exact conditions before and after the breastfeed Weight gained in grams = intake in milliliters
Our team would like to thank • The VCH Research Challenge competition and the BC Nursing Research Initiative (through Michael Smith Foundation for Health Research) for funding this study. •The NICU RNs for their support and participation. •Masoud Yousefi¹ and Leanne Currie² for statistical support.