Abstracts from The Academy of Breastfeeding Medicine 20th Annual International Meeting Los Angeles, California October 16–18, 2015

Abstract

Breastfeeding MedicineVol. 10, No. S1 AbstractsFree AccessAbstracts from The Academy of Breastfeeding Medicine 20th Annual International Meeting Los Angeles, California October 16–18, 2015Published Online:30 Sep 2015https://doi.org/10.1089/bfm.2015.29009.abstractsAboutSectionsPDF/EPUB ToolsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail Platform AbstractsMOTHER'S MILK MESSAGING (MMM): A PILOT STUDY OF AN APP TO SUPPORT BREASTFEEDING IN FIRST TIME MOTHERSBunik Maya1, Leiferman Jenn A2, Bryan Jessica R2, Furniss Anna3, Bull Sheana21University of Colorado, Aurora, Colorado, USA2University of Colorado, School of Public Health, Aurora, Colorado, USA3University of Colorado, School of Medicine, Aurora, Colorado, USACategory: OtherBackground: Use of social media to affect health behavior change is growing, but there is little evidence that this results in positive changes in behavior or health. We sought to explore benefits of using a mobile phone application (app) to effectively and conveniently support new mothers with breastfeeding (BF).Objective(s): 1) Solicit feedback from first time mothers on an app designed to support initiation and duration of BF; 2) Pilot test the feasibility of using this app to increase and maintain BF among a diverse sample; and 3) Obtain qualitative feedback from a subsample of participants.Materials/Methods: Formative and pilot research including online focus group discussions to generate reactions to a theory based app program with features and content designed to increase self-efficacy and social support for breastfeeding; beta-testing the app for usability, and pilot testing the app for three months with pre and post assessments of BF self-efficacy and behavior. Telephone interviews were conducted with 10 participants in the intervention group to document user experience.Results: Fourteen women participated in focus group discussions online. Consensus was that app would be useful/appreciated; most indicated they would read text messages and engage in other app features, including social support features. In the pilot n=60 were randomly assigned to the intervention (I) (n=23) or control (C) (n=37). At 3 months assessment 95% of those in the I were currently BF compared to 83% of C; 95% of those in the I were BF more than 80% of the time compared to 78% of C (NS). Mean increase in scores for BF self-efficacy was 7.1 for those in the I and 3.9 for those in the C (NS). Interviews revealed that mothers appreciated the private group social support page to communicate with others, often in the middle of the night and for information watched 2-minute videos of pediatrician's advice on BF topics.Conclusions: Data suggest important trends that show exposure to an app for first time mothers has potential to increase both self-efficacy and BF. Expanded research with a larger randomized controlled trial is warranted to establish the efficacy of using MMM to support exclusive breastingfeeding.SOUR MILK: IS LIPASE THE CULPRIT?Lawrence Ruth, Veazie Peter, Zhang Victoria, Dozier AnnUniversity of Rochester School of Medicine and Dentistry, Rochester, New York, USACategory: ResearchBackground: Some breast milk pumped and stored in the freezer has been found to turn sour. While the cause is unknown, excessive lipase has been considered. For some women, scalding the milk before freezing prevents this phenomenon. Lipoprotein lipase in human milk is not significantly affected by freezing and thawing (Neville et al). Does sour breast milk contain higher levels of lipase?Objective(s): To compare lipase concentrations and pH in sour milk and normal milk.Materials/Methods: Frozen samples of sour milk donated by 84 different certified donors, to a national milk bank were examined. Lipase and pH were measured in the University Enzymology Laboratory. Samples of normal milk from nine other mothers were also measured. Sour milk was determined by smell of thawed samples. All samples had been cultured by the milk bank and had normal flora.Results: Average lipase levels in sour milk samples were 793 units (S.D.=405) compared to the normal milk samples 1848 units (S.D.=440). Using Wilcoxon Rank-Sum Test the distributions of lipase are significantly different (p≤0.0001). Average pH levels in sour milk were 6.5 (S.D.=0.26) compared with normal milk 6.9 (S.D.=0.34) (p-value=0.001).Conclusions: Findings are contrary to beliefs that high levels of lipase are associated with sour milk, and raise new questions about the role of lipase.THE IMPACT OF COLOSTRUM ORAL CARE IN SEPSIS RATES IN ELBW INFANTSMaxwell Abigael, Valdes-Greene Rhonda, Roeder Tina, Parvez BorianaMaria Fareri Children's Hospital Valhalla, New York, USACategory: Quality ImprovementBackground: Our NICU instituted a formal colostrum oral care policy in January 2015 and it has since become the standard of care in all eligible infants.Objective(s): To determine if colostrum oral care impacted the rates of sepsis in our ELBW infants.Materials/Methods: All ELBW infants who survived to 96 hours were included in our study. We compared sepsis rates in 2014 (prior to the institution of our colostrum oral care policy) in ELBW infants to sepsis rates in all ELBW infants admitted January 2015-May 2015. The medical records were reviewed for any positive blood cultures.Results: We reviewed charts of 31 ELBW infants and found a 45% reduction in nosocomial sepsis rates from 18% in 2014 to 10% during the time period studied (January–May 2015).Conclusions: Instituting a colostrum oral care policy in our NICU has had a direct impact on our rates of sepsis. We hypothesize this may be due to the study infants early exposure to immunoprotective factors in the breast milk that they otherwise would not be exposed to until enteral feeds have begun. Colostrum oral care is a simple strategy to decrease sepsis rates as well as increase overall breastfeeding rates in the NICU.UTILIZATION OF WEIGHT AT 24 HOURS OF LIFE AS REFERENCE FOR CALCULATION OF PERCENTAGE WEIGHT LOSS IN BREASTFEEDING INFANTS DELIVERED BY C-SECTION IN A BABY-FRIENDLY HOSPITALMcLaren Margaret1, Deng Xiaomeng2, Sandra Motta1, Marshall-Crim Mary31Connecticut Children's Medical Center, Hartford, Connecticut, USA2Trinity College, Hartford, Connecticut, USA3Hartford Hospital, Hartford, Connecticut, USACategory: ResearchBackground: Exclusive breastfeeding in the newborn nursery is strongly recommended for infant health. It is common practice to interpret a weight loss of ≥10% of birth weight as evidence of dehydration and to initiate supplements. Evidence is growing that transplacental transfer of intravenous fluids given to a mother during C-section may inflate the infant's birth weight. Studies suggest that the 24-hour weight is a preferred reference for weight loss calculation after the diuresis of this excess fluid. Hartford Hospital implemented the intervention of using 24-hour weight as opposed to birth weight as weight loss percentage calculation reference for infants whose mother received fluid during delivery.Objective(s): To evaluate the efficacy and safety of this clinical intervention to decrease supplementation.Materials/Methods: We performed a retrospective chart review of 667 healthy, term, appropriate for gestational age newborns, delivered by C-section to mothers planning to breastfeed. We performed independent sample t-tests to compare overall supplementation rate, maximum weight loss, length of stay, and maximum transcutaneous bilirubin between infants from two study periods: 12 months pre-intervention (n=404) and 12 months post-intervention (n=263).Results: Overall supplementation rate decreased from 43.6% to 27.4% due to the intervention; the decrease was especially dramatic among first-time mothers (51.9% to 31.0%). There was no increase in maximum percentage weight loss, length of stay, or maximum transcutaneous bilirubin level.Conclusions: Adopting the 24-hour infant weight as the routine reference for weight loss calculation was safe and effective in reducing supplementation and promotes exclusive breastfeeding.BREASTFEEDING PRACTICES AMONG PEDIATRIC CANCER SURVIVORS: AN INTERIM REPORTOgg Susan*, Klosky James, Ojha Rohit, Hudson Melissa, Chemaitilly Wassim, Srivastava Kumar, Carney Ginger, Cox Cheryl*Indicates presenting author.St. Jude Children's Research Hospital, Memphis, Tennessee, USABackground: Treatment of pediatric cancer has deleterious late effects involving the endocrine system, potentially negatively affecting breastfeeding. Breastfeeding practices among survivors are not well-characterized.Objective(s): Describe breastfeeding initiation/duration among survivors; explore impact of specific cancer therapies, and endocrine-related diagnoses on breastfeeding.Materials/Methods: This cross-sectional survey is nested in the St. Jude Lifetime Cohort Study. Survivors aged >18 years who completed therapy at St. Jude Children's Research Hospital, survived >10 years, and reported a live birth were eligible for the study (n=724). The survey incorporates questions from the national Infant Feeding Practices Survey with modification for relevance to our population. Breastfeeding initiation (breastfeeding for any duration) and duration (continued breastfeeding for at least 6 months) are based on self-report pertaining to the survivor's first live birth following completion of cancer-directed therapy. We will estimate the proportion and 95% confidence interval (CI) of breastfeeding initiation/duration and explore associations between cancer therapies, diagnoses, and breastfeeding outcomes.Results: To date, 334 survivors have returned questionnaires. Our interim analysis included 189 survivors (88% White; 40% ≥Bachelor's degree). Median age at birth of the first child following completion of cancer-directed therapy was 25 years (interquartile range=21–28). Breastfeeding was initiated by 64% (95% CI: 57%–71%) of survivors in this interim sample (vs. 79% of the general population), and 26% (95% CI: 20%–33%) breastfed for at least 6 months (vs. 49% of the general population). Survivors indicated that the reasons for stopping breastfeeding were difficulties initiating 34% (vs. 20.9% of the general population) and “not enough milk” 53% (vs. 45.5% of the general population).Conclusions: Our interim results suggest less breastfeeding initiation/duration among survivors than the general population, but data collection completes in August 2015.EVIDENCED BASED (BABY FRIENDLY) CLINICAL INTERVENTIONS AND TERM NEW BORN WEIGHT LOSS: A RETROSPECTIVE COMPARISONProcaccini DianeCapital Health, Pennington, New Jersey, USABackground: It has been generally accepted that all newborns lose weight in the first few days of life. Seven to ten percent weight loss in newborns has long been accepted as “normal” and continues to be described as such by professional organizations such as the American Academy of Pediatrics. More weight loss than “normal” may indicate poor feeding and often requires medical intervention such as supplementation, or even hospitalization. A weight loss of ≥10% is considered the point at which intervention is required (Mulder, Johnson, and Baker 2010). The “Baby Friendly Hospital Initiative” represents ten evidence-based practices that include exclusive breastfeeding and support mother and baby remaining together twenty-four hours a day (Baby-Friendly, 2012). Baby Friendly practices support the biological norm in humans. However, there are only 251 Baby Friendly Facilities out of more than 3,400 birth facilities in the United States. So the question remains, “What is “normal” newborn weight loss if the 7 to 10 percent weight loss average in infants is based on hospital practices that include separation, use of pacifiers and formula supplementation?”Objective(s): To determine if Baby Friendly practices decrease amount of weight loss in the first 3 days of life.Materials/Methods: 400 newborn infant weights in the first 3 days were compared one full year prior to Baby Friendly Designation and one full year after Baby Friendly designation. Sub categories were Breatfeeding, Breast and Formula Feeding, and Formula Feeding Only (1000 entrees before and after are being entered at this time).Results: Mean percent weight loss decreased for Day 0 to 2 for all three categories of infants after the initiation of Baby Friendly practices. There was a significant decrease in percent weight loss for Day 0 to 2 in Breast Fed (p=.033) after the initiation of Baby Friendly practices. A preliminary analysis indicates that Baby Friendly practices decreases percent weight loss in infants for Day 0 to 2, regardless of feeding type, with the most significant impact seen in BF infants. (Will recalculate after all entries are in but data already appears very similar to first 400).Conclusions: Friendly Practices decrease initial newborn weight loss.PROLACTIN LEVEL AND BREAST MILK VOLUME AMONG MOTHERS OF LOW BIRTH WEIGHT INFANTS ADMITTED TO LEVEL II NEONATAL INTENSIVE CARE UNIT WHO UNDERWENT KANGAROO MOTHER CARERaguindin Peter Francis1, Uy Ma. Esterlita1, Dumalag Jessica Ann21University of the Philippines Manila, Manila, National Capital Region, Philippines2Philippine General Hospital, Manila, National Capital Region, PhilippinesBackground: Kangaroo Mother Care (KMC) has been proven by several studies to promote breastfeeding. But much of the studies focused on the success of exclusive breastfeeding, and less on its lactogenic effects.Objective(s): To determine if KMC is associated with higher maternal serum prolactin levels and increased milk volume than standard care for low birth weight babies.Materials/Methods: This is a randomized-controlled, open-label trial conducted in a nursery of a tertiary government hospital. Admitted infants weighing <2000 g together with medically stable mothers and no contraindication for breastfeeding were simultaneously enrolled. Mother-infant dyads were randomly-allocated to KMC and routine newborn care. Primary outcome measures were maternal serum prolactin levels and expressed milk volume on day 3 and day 7 postpartum.Results: Fifty mother-infant dyads, equally allocated to two arms, had similar baseline characteristics. Mean serum prolactin levels on third day post-partum were 5244.0 (±2702.1) mIU/L and 4129.2 (±2485.3) mIU/L on KMC and control group respectively (p=0.070). Serum levels at seventh day post-partum were also elevated for KMC compared to control (4968.8±2425.8 mIU/mL vs 3705.4±2731.4 mL; p=0.063). Subsequently, amount of expressed breast milk on experimental groups is increased for both third (29.6±27.8 vs 16.3±26.1 mL; p=0.043) and seventh (72.4±62.3 vs 47.3±43.8 mL; p=0.002) day post-partum compared to control.Conclusions: Kangaroo mother care may have its lactogenic effects by increasing maternal serum prolactin levels.Poster AbstractsPOSTNATAL BREASTFEEDING EDUCATION TO PROMOTE EXCLUSIVE BREASTFEEDING AMONG JORDANIAN MOTHERS: QUASI-EXPERIMENTAL STUDYAbuidhail JamilaFaculty of Nursing - Hashemite University, Zarqa, JordanBackground: The duration of exclusive breastfeeding (EBF) is declining in most countries of the region and in Jordan as well. This leads to an early introduction of mixed breast and bottle feeding and complementary food. Most postnatal education focuses on knowledge of breastfeeding rather than skills of breastfeeding process.Objective(s): To measure the effectiveness of postnatal breastfeeding education among Jordanian mothers in three major governorates Amman, Irbid and Zarqa.Materials/Methods: A quasi-experimental, nonequivalent control group before–after design was used. The sample was 224 postpartum healthy mothers who were in the postpartum wards at the main governmental hospitals. Data was collected using LATCH assessment tool. The breastfeeding education material that was used during the postnatal educational classes at hospitals has been prepared after review of the literature. It consists of a brief introduction about breast problems and breastfeeding, normal caring process of the breast, how to deal with sore nipples, and the proper positions of breastfeeding and latch on technique which prevent nipple and breast problems.Results: There was a significant difference in LATCH score of posttest between postpartum mothers who were given the education material about skills of breastfeeding process (mean=9.3) and the postpartum mothers who were not given the education material (mean=8.7, p=0.004).Conclusions: Postnatal breastfeeding education classes are effective for the promotion and implementation of breastfeeding process and in decreasing the incidence of breast problems.THE EFFECT OF HOME VISITATION EDUCATIONAL PROGRAM ON THE NUTRITION PATTERN AND EXCLUSIVE BREASTFEEDING IN NEWBORNSAmiri Parastoo1, Milani Hourieh Shamshiri21Iranian Research Center on Healthy Aging, University of Medical Sciences, Sabzevar, Khorasan Razavi, Iran2Dept. of Health & Social Medicine, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, IranBackground: In spite of the worldwide emphasis on exclusive breastfeeding during the first six months of birth, many mothers stop breastfeeding. Postpartum care at home, as an interventional method, may influence the duration of exclusive breastfeeding.Objective(s): The aim of this study was to assess the impact of a home visit educational intervention on the nutrition pattern and duration of exclusive breastfeeding in newborn infants.Materials/Methods: A clinical trial was conducted with 276 mothers who had delivered in Shahid Beheshti University hospitals. 92 mothers were the interventional group and 184 mothers were the control group. The intervention group received a home visit. After 60 days the rate of exclusive breastfeeding was comparedResults: On sixtieth day, exclusive breastfeeding was higher in the intervention group (84/8%) compared to the control group (64/7%). The results indicated a significant difference between the two groups regarding nutrition pattern (P<0.001).Conclusions: The home visit educational program was effective in increasing exclusive breastfeeding in newborn infants in this study. Considering the importance of continuation of care and the positive effects of breastfeeding, healthcare providers are recommended to incorporate home visit educational plan into their programs so as to promote the newborns' health.GROWTH PATTERN OF EXCLUSIVELY BREASTFED LOW BIRTH WEIGHT BABIES UP TO SIX MONTHS OF CORRECTED GESTATIONAL AGEHonnali Bannajji Mallikarjuna.Associate Professor, Bengaluru, Karnataka, IndiaBackground: Gestational age and nutritional status at birth are important determinants of growth pattern in infants. Children who are preterm and have low birth weight are at higher risk of growth deficits in infancy and throughout childhood. Nutritional interventions designed to optimize the growth of low birth weight babies in the neonatal period could reduce the prevalence of growth deficits in later life. Numerous studies have indicated that the pattern of growth during infancy is influenced by feeding mode.Objective(s): To study the growth pattern of exclusively breastfed low birth weight babies up to six months of corrected gestational age.Materials/Methods: Low birth weight (1501–2500 g) babies born over a period of 2 years were enrolled. Anthropometric measurements (weight, length and head circumference) were recorded at birth, 15 days and monthly until six months of corrected gestational age.Results: Total 252 low birth weight babies completed follow up of which 162 babies were exclusively breastfed until the completion of 6 months of corrected gestational age. Among these babies, 102 were term low birth weight and 60 were preterm babies with mean gestational age of 35 weeks. Mean birth weight of term low birth weight babies was 2294 grams and that of preterm babies was 2104 grams. All babies showed better growth in the first 3 months compared to later months in all parameters. Term low birth weight babies showed significantly and consistently more growth than preterm babies. The weight and head circumference of both term low birth weight and preterm babies was comparable to Agarwal charts by 6 months of age for both sexes. However, the length was lower than the Agarwal charts but was parallel to Agarwal charts until 6 months of corrected gestational age.Conclusions: Low birth weight babies can grow optimally on exclusive breastfeeding alone until 6 months of corrected gestational age with appropriate breastfeeding counseling and support to the mothers and family members.CESAREAN ANESTHESIA AND EARLY BREASTFEEDING SUCCESSCalvo Jacqueline1, Joyner Andrea21UConn Health Center, Farmington, Connecticut, USA2The Hospital of Central Connecticut, New Britain, Connecticut, USABackground: The effects of labor medications on breastfeeding have been identified as an area requiring further study. Nationwide, the majority of cesarean sections are performed with one of four forms of anesthetic: spinal, combined spinal-epidural, epidural and general anesthesia.Objective(s): To determine if general anesthesia at time of cesarean leads to decreased short-term breastfeeding success.Materials/Methods: A retrospective cohort study was performed to evaluate all primary unplanned cesarean sections from May 2012-February 2015 and evaluated short term breastfeeding success through analysis of daily mean LATCH scores and exclusive breastfeeding at discharge. Information was obtained from our hospital electronic medical record.Results: We reviewed 257 mother-infant dyads. Mothers were grouped into general (n=21) vs regional (n=236) anesthesia. Mothers receiving general anesthesia were more likely to have NRFHT listed as an indication and less likely to have failure to progress as an indication. They also had significantly shorter labor lengths and their infants were more likely to require NICU admission. Other maternal and infant characteristics were not significantly different (age, race, parity, gestational age, APGARs, birth weight, gender). No significant difference was noted between groups in LATCH scores (p=0.309) or in exclusive breastfeeding at discharge (p=0.545).Conclusions: There was no significant difference in either of our outcome measures between general and regional anesthesia. A likely contributor to our result was our low numbers in the general anesthesia group. Prior to presentation, we hope to expand this study to a larger cohort to allow for adequate power to discover any occult clinically relevant difference.BREASTMILK VITAMIN B12 CONCENTRATIONS ARE INADEQUATE, BUT ARE NOT ASSOCIATED WITH REPORTED RECENT ANIMAL SOURCE FOOD OR VITAMIN B12 INTAKE AMONG LACTATING WOMEN IN RURAL KENYAChantry Caroline1, Williams Anne2, Young Sera3, Null Clair4, Stewart Christine21University of California Davis Medical Center, Sacramento, California, USA2Program in International and Community Nutrition, University of California Davis, Davis, California, USA3Division of Nutritional Sciences, Cornell University, Ithaca, New York, USA4International Policy Research and Evaluation, Mathematica, Princeton, New Jersey, USABackground: Breast milk vitamin B12 concentration varies with maternal diet, and may be inadequate in regions where animal source food (ASF) consumption is infrequent.Objective(s): To estimate adequacy of vitamin B12 in breast milk and examine its associations with household hunger (HH), recent ASF and vitamin B12 intake.Materials/Methods: From June to November 2014, 300 women 1–6 mo postpartum sampled from an ongoing trial assessing a water, sanitation, hygiene (WSH) and nutrition interventions in Kenya hand-expressed breast milk 1-minute into a feed, following 90-minutes of observed non-breastfeeding. HH over the past month was measured with the household hunger scale, food intake in the last week was measured using a food frequency questionnaire (FFQ), and B12 intake was estimated using a 24-hour dietary recall. An ASF score was based on frequency of 10 items on the FFQ (range 0–70). Breast milk B12 concentration was measured using a competitive protein-binding assay.Results: Mean (SD) maternal age was 26.0 (5.5) years. Median (Q1, Q3) B12 intake was 0.6 (0,2.8) μg/d and 71.8% consumed <2.4 μg/d, the estimated average requirement (EAR) during lactation. Breast milk concentration was 113.0 (60.5,199.2) pmol/L; 92.7% had concentrations <362 pmol/L, the estimated adequate level. HH prevalence was 27%, and the ASF score ranged from 0 to 30. Although HH, recent ASF and B12 intakes were not associated with breast milk B12 concentrations, maternal age was negatively associated with log B12 concentrations [adjusted beta-coefficient (95% CI) -0.01 (-0.03, -0.00)].Conclusions: Most women consumed less than the EAR of vitamin B12 for lactating women and had breastmilk B12 concentrations currently considered inadequate.EARLY BREAST MILK INTENSITY OF PRETERM INFANTS PREDICTS INTENSITY IN THE NICU BUT NOT AFTER DISCHARGECourchia Benjamin1, Noble Lawrence2, Rhee David21Icahn School of Medicine at Mount Sinai/Elmhurst Hospital Center, Rego Park, New York, USA2Elmhurst Hospital Center/ Icahn School of Medicine, Elmhurst, New York, USABackground: Breast milk (BM) in preterm infants has been shown to decrease rates of necrotizing enterocolitis, infection-related morbidities and re-hospitalization rates. Early pumping of milk has been shown to increase long term breastfeeding success, but the relationship is not clear.Objective(s): The aim of this study is to compare the BM intensity in preterm infants in the first week of life with long term BM intensity from prospectively collected data.Materials/Methods: We studied 30 consecutively born preterm infants, with no medical contraindications to receiving BM, born at <32 weeks of gestation or weighing <1500 g at birth. We excluded infants who died or were transferred. Their BM intensity, i.e. the percent of BM as a fraction of the total enteral feedings, was prospectively recorded during each feed from admission to discharge by our nursing staff and by physicians at outpatient visits after discharge. As donor BM was not available in the NICU, the main determinate of BM intensity was the amount of BM pumped by the mother. A power analysis was performed and data was analyzed using t-tests, ANOVA, linear regressions and Pearson correlation coefficients.Results: A significant difference in BM intensity was noted before and after the initiation of full feeds (28% vs 40%; p=0.015). Furthermore, BM intensity during the first week of life was predictive of the BM intensity before and after the initiation of full feeds and for the overall hospital stay (p<0.001, p=0.028 and p=0.001 respectively), but not at 1 and 3 months post discharge (p=0.771 and p=0.450 respectively). Furthermore, a significant drop in BM intensity was noted after discharge, from 34.2% to 33.1% and 15.3% at one and three months post discharge respectively (p=0.043). These results were adjusted for gestational age and birth weight.Conclusions: Our data confirms that successfully breastfeeding a VLBW infant in the NICU requires an early start in the first week of life, but this relationship is not true after discharge.IMPACT OF STATE LEGISLATION ON HOSPITAL BREASTFEEDING SUPPORT IN NEW YORKDennison Barbara1, Nguyen Trang1, Xu Changning2, Fan Wei1, Jurkowski Janine21New York State Department of Health, Albany, New York, USA2School of Public Health, Rensselaer, New York, USABackground: In 2009, NY passed a Breastfeeding Mothers' Bill of Rights (Public Health Law §2505-a) and, the State Health Commissioner, under Public Health Law §2803-j, began public reporting hospital-specific breastfeeding measures.Objective(s): The purpose of this study is to evaluate the impact of two state mandates, both implemented in 2010, on NY hospitals providing maternity care. Specifically, whether the Breastfeeding Mothers' Bill of Rights and the mandate for public reporting of hospital-specific breastfeeding rates affected hospital staff awareness, attitudes, or promotion of breastfeeding, maternity care practices or breastfeeding policies were tested.Materials/Methods: In both 2009 and 2011, written hospital breastfeeding policies were collected and evaluated using a 28-item tool, and hospital surveys, reporting maternity care practices, hospital culture and staff attitudes around breastfeeding promotion, were conducted. Changes in written policies and implementation of maternity care practices, and the extent to which these changes were related to staff awareness, hospital culture, or breastfeeding promotion were determined.Results: Between 2009 and 2011, the number of components included in the hospital policies, maternity practices implemented, and lactation staff all increased (all p<0.001). Greater awareness by hospital administrators of breastfeeding rates was associated with more emphasis on promoting breastfeeding (p<0.02). Hospitals reporting much more emphasis on promoting breastfeeding or reporting large changes in organizational culture had greater increases in the number of components included in their policies and in the recommended maternity care practices implemented (all p<0.05).Conclusions: These findings suggest that state mandates requiring breastfeeding support in hospitals and public reporting of breastfeeding rates led to increased emphasis and promotion of breastfeeding, improvement in hospital policies and maternity care practices. Further research could assess longer term impact on maternal and infant health outcomes.BREASTFEEDING SUCCESS AND BREAST ANATOMY IN OBESE WOMENGal Dana1, Leff Michelle2, Boies Eyla2, LaCoursiere D. Yvette31Department of Pediatrics, University of California San Francisco, California, USA2Department of Pediatrics, University of California San Diego, California, USA3Department of Reproductive Medicine, Univer