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Breastfeeding the Preterm Infant

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Erica Wright

on 26 October 2012

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Transcript of Breastfeeding the Preterm Infant

Allison Applegate, Bethany Baker, Amber Cantrell, Rachel Davis, Will Elmore, Caroline England, Kerry Evans, Laura Johnson, Bianca Maselter, Mysti Motz, Emma Poland, and Erica Wright Breastfeeding
the
Preterm Infant The purpose of this presentation is.....
Physiology of the premature infant
Benefits of breastfeeding the premature infant
Critique of an article related to immunological components of breastfeeding Reasons and Beneficial Effects Summary Health Concerns
for the Preterm Infant in cardiorespiratory, metabolic, immunological, neurologic and motor development. 3 to 10 times at greater risk of infection
May have 1 or more episodes of sepsis due to loss of passive immunity inability to maintain temperature hyperbilirubinemia seizures more likely to develop respiratory distress syndrome immunological dysfunction late preterm may be delayed Benefits
of Breastfeeding the
Preterm Infant Respiratory Neurology Enhanced GI maturation
Protection against diarrhea Gastrointestinal Immunology “Better psychomotor, neurological, circulatory, and cognitive outcomes"
Accelerated myelination
Improved fine motor skills and high adaptability and communication Breast milk contains cytokines and immunoglobulins
Decrease in chance of death due to
acute respiratory infection Colostrum and Human Milk Critique Cristina Castellote, Rosario Casillas, Carolina Ramirez-Santana, Francisco J. Perez-Cano, Margarida Castell, M. Gloris Moretones, M. Carmen Lopez-Sabater, and Angels Franch Premature Delivery Influences the Immunological Composition of Colostrum and Transitional and Mature Human Milk To see the immunization benefits from breastfeeding preterm and very preterm infants due to the lack of research regarding this content. Purpose of Study •42 total participants:
22 delivered at term
10 delivered prematurely
10 delivered very prematurely Sample Size Quantitative experimental study of term, preterm, and very preterm.
Milk samples were collected for colostrum, transitional, and mature milk. (Castellote et al., 2011)
The Kurskal-Wallis unpaired test was performed and the significant effect of gestational age was then analyzed by the Mann-Whitney U test (Castellote et al., 2011) Methods Used in Study Results Agree or Disagree? Implications for Practice Identified by author:
• The research authors stated that the “small sample size, especially due to high inter-individual variability” and “the collection of only hind milk and the partial breast emptying may have resulted in an under- or overestimation of the immune factor content in milk samples.” (Castellote et al., 2011) Limitations of Study Identified by author:
•The research authors stated that further studies are needed to ensure that immunological factor concentrations are representative of the whole breast-emptying period and also of a larger population. Recommendations for
Future Study Impact of the study on practice Call to action This presentation covers... (Radtke, 2011) (Murray & McKinney, 2010) (Arifeen, 2001) (Radtke, 2011) (Radtke, 2011) (Oddy & Robinson, 2011) (Lamberti, 2011) (Radtke, 2011) (Chirico, 2008)
(M'Rabet, 2008) Journal of Nutrition, vol. 141, p. 1181-1187 Breast milk presents the ability to “collaborate in the immune defense and development of preterm” infants. (Castellote et al., 2011) Encourage your patient to breastfeed to promote... Identified by us:
a limited ethnic group
limited geographical area
samples were limited to only hind milk
small participant sample size Identified by us:
We need to see a diversification of subjects at different gestational ages (term, preterm, and very preterm), a more diverse selection of ethnic groups, and a larger participant sample size. Reduced incidence of infection and necrotizing enterocolitis, a GI disorder
Enhanced neurodevelopment
Decreased number of hospital readmissions (Aggett et al., 2006).
Interventions that promote breastfeeding for premature infants can improve outcomes and weight gain (Ahmed & Sands, 2010). The impact this study will have on us as nursing students will be tremendous for future practice.

By the end of this presentation we should have learned how human milk is necessary for the preterm infant’s survival and maturation of growth and development.

We must use this information to educate our patient’s and not just encourage. We must be knowledgeable of what we preach and this critique provides this information to us. Educate your patients:
on why human milk is vital to a preterm’s survival
how to implement and encourage this practice Interventions Kangaroo care
In-home intake measurements
Lactation support
Ask for help
Follow up consults
Peer counseling
Weight monitoring Ahmed, A. H., & Sands, L. P. (2010). Effect of pre- and postdischarge interventions on
breastfeeding outcomes and weight gain among premature infants. JOGNN, 39. 53-63.

Arifeen, S., Black, R. E., Antelman, G., Baqui, A., Caulfield, L., & Becker, S. (2001). Exclusive
breastfeeding reduces acute respiratory infection and diarrhea deaths among infants in dhaka slums. Pediatrics, 108(4).

Breast-feeding positions [photograph]. (2007) Retrieved October 25, 2012 from:
http://www.summitmedicalgroup. com/library/womens_health/post/

BreastFeeding350 [photograph]. (2010). Retrieved October 17, 2012, from:
http://health.ucsd.edu/women/child/newborn/nicu/spin/Pages/default.aspx

Castellote, C., Casillas, R., Ramirez-Santan, C., Perez-Cano, F. J., Castell, M., Moretones, M.
G., Lopez-Sabater, M. C, & France, A. (2011). Premature delivery influences the immunological composition
of colostrums and transitional and mature human milk. The Journal of Nutrition. 1181-1187.

CDC. Racial and ethical differences in breastfeeding initiation and duration, by statenationalimmunization
survey, United States, 2004-2008. (2010, March 26). Retrieved from http://www.cdc.gov/.

Chirico, G., Marsollo, R., Cortinovis, S., Fonte, C., & Gasparoni, A. (2008). Antiinfective properties of human milk.
The Journal of Nutrition. 1801S – 1806S.

Fotalia [photograph]. (2011). Retrieved October 17, 2012, from: http://kellymom.com/ages/newborn/newborn-
concerns/preemie-links/

Hardon, D.C., Baker, D., Hodges, J.S., & Hicks, N. (1996) Ratings of evidence for practice guidelines.
Journal of Clinical Epidemiology. Retrieved from http://onsopcontent.ons.org/toolkits/evidence/Process/levels.shtml

Kangaroo-care [photograph]. (2010). Retrieved Ovtober 17, 2012, from :
http://www.growingyourbaby.com/2010/04/03/kangaroo-care-can-cut-pretern-infant-death-rates-in-half/

Lamberti, L. M., Walker, C. L. F., Noiman, A., Victoria, C., & Black, R. E. (2011).
Breastfeeding and the risk for diarrhea morbidity and mortality. BMC Public Health 2011, 11(Suppl 3). References M’Rabet, L., Vos, A. P., Boehm, G., & Garssen, J. (2008). Breast-feeding and its role in early
development of the immune system in infants : Consequences for health later in life. The
Journal of Nutrition, 138. 1782s-1790s.

Murray, S. S., & McKinney, E. S. (2010). Foundations of Maternal-Newborn and Women's Health Nursing (5th ed.).
Maryland Heights, MO: Saunders Elsevier.

Oddy, W. H., Robinson, M., Kendall, G. E., Li, J., Zubrick, S. R., & Stanley, F. J. (2011). Breastfeeding and early
childhood development: A prospective cohort study. Acta Paediatrica, 100. 992-999.

Oddy, W. H., & Rosales, F. (2010). A systematic review of the importance of milk TGF-B on
immunological outcomes in the infant and young child. Pediatr Allergy Immunol 2010, 21. 47-59.

Petryk, A., Harris, S. R., & Jongbloed, L. (2007). Breastfeeding and neurodevelopment. Infants & Young Children,
20(2). 120-134.

Radtke, J. V.(2011). The paradox of breastfeeding-associated morbidity among late preterm infants.
JOGNN, 40. 9-24. Fotalia [photograph]. (2011). Retrieved October 17, 2012, from: http://kellymom.com/ages/newborn/newborn-concerns/preemie-links/ breastDFeeding350 [photograph]. (2010). Retrieved October 17, 2012, from: http://health.ucsd.edu/women/child/newborn/nicu/spin/Pages/default.aspx kangaroo-care [photograph]. (2010). Retrieved Ovtober 17, 2012, from : http://www.growingyourbaby.com/2010/04/03/kangaroo-care-can-cut-pretern-infant-death-rates-in-half/ TRCHtubefeeding [photograph]. (2011). Retrieved October 17, 2012, from: http://www.hciproject.org/node/3698 preterm [photograph]. (2010). Retrieved October 17, 2012, from: http://bliss-breastfeeding.blogspot.com/2010/01/exclusive-human-milk-diet-benefits-nicu.html Levels of Evidence (Hardon et al., 1996) RelayHealth. (2007). Breast-feeding positions.
Retrieved from http://www.summitmedicalgroup. com/library/womens_health/post/ TRCHtubefeeding [photograph]. (2011). Retrieved October 17, 2012, from:
http://www.hciproject.org/node/3698
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