Abstract
BackgroundBreastmilk is the ideal nutrition for preterm infants. Yet, breastmilk feeding rates among preterm infants are substantially lower than those of full-term infants. Barriers incurred through hospital care practices as well as the physical environment of the neonatal intensive care unit (NICU) can result in physical and emotional separation of infants from their parents, posing a substantial risk to establishing and maintaining breastfeeding. Additionally, current practitioner-focused care provision in the NICU can result in decreased breastfeeding self-efficacy (BSE), which is predictive of breastfeeding rates in mothers of preterm infants at 6 weeks postpartum.MethodsFamily Integrated Care (FICare) integrates and supports parents to actively participate in the care of their infant while in the NICU. Nested within the broader FICare trial, we will conduct an explanatory sequential mixed methods study to investigate if FICare improves maternal BSE and rates of breastmilk feeding in moderate and late preterm infants at discharge from the NICU. In phase 1, we will calculate the mean difference between admission and discharge BSE scores for the intervention group. Mothers who score in the top and bottom 20th percentile of change scores will be invited to participate in a semi-structured telephone interview exploring maternal experiences with infant feeding in the NICU. We will conduct inductive thematic analysis to identify and describe the facilitators and barriers of FICare on maternal feeding experiences. Once data saturation is achieved and themes have been established, phase 2 will revisit the quantitative data to determine whether FICare was impactful on BSE and breastmilk feeding rates. Findings from the qualitative and quantitative phases will be integrated to determine how infant feeding experiences on FICare units work to improve or detract from maternal BSE and rates of breastmilk feeding.DiscussionFICare may help to improve maternal BSE and rates of breastmilk feeding in moderate and late preterm infants. Improved breastmilk feeding outcomes can have a substantial impact on overall infant health, developmental outcomes, and maternal-infant bonding and will help to improve long-term health outcomes for moderate and late preterm infants.Trial registration(NCT02879799). Registered May 27, 2016 protocol version June 9, 2016 Version 2.
Highlights
Breastmilk is the ideal nutrition for preterm infants
Mothers are relegated to the role of supplementary care provider or observer [18], which may limit time spent with their infant(s) and educational opportunities [19]
Integrating mothers into the care of their infants in the neonatal intensive care unit (NICU) may improve maternal breastfeeding self-efficacy and increase rates of breastmilk feeding at discharge
Summary
Breastmilk is the ideal nutrition for preterm infants. Yet, breastmilk feeding rates among preterm infants are substantially lower than those of full-term infants. Barriers incurred through hospital care practices as well as the physical environment of the neonatal intensive care unit (NICU) can result in physical and emotional separation of infants from their parents, posing a substantial risk to establishing and maintaining breastfeeding. Not as medically complex as their early preterm (born prior to 32 weeks GA) counterparts, moderate and late preterm infants are at risk for several health and developmental issues [6], and often require level II neonatal intensive care [7]. The physical environment of the neonatal intensive care unit (NICU), and practices that physically and emotionally separate infants from their mothers, pose a risk to establishing and maintaining breastmilk feeding [15]. Traditional models of care decrease parenting and breastfeeding self-efficacy, potentially contributing to lower breastmilk feeding rates [15]. Integrating mothers into the care of their infants in the NICU may improve maternal breastfeeding self-efficacy and increase rates of breastmilk feeding at discharge
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