Infant feeding practices within a large electronic medical record database

Emily Bartsch,Joel G Ray,Jacqueline Young,Alison L Park,Karen Tu

doi:10.1186/s12884-017-1633-9

Abstract

BackgroundThe emerging adoption of the electronic medical record (EMR) in primary care enables clinicians and researchers to efficiently examine epidemiological trends in child health, including infant feeding practices.MethodsWe completed a population-based retrospective cohort study of 8815 singleton infants born at term in Ontario, Canada, April 2002 to March 2013. Newborn records were linked to the Electronic Medical Record Administrative data Linked Database (EMRALD™), which uses patient-level information from participating family practice EMRs across Ontario. We assessed exclusive breastfeeding patterns using an automated electronic search algorithm, with manual review of EMRs when the latter was not possible. We examined the rate of breastfeeding at visits corresponding to 2, 4 and 6 months of age, as well as sociodemographic factors associated with exclusive breastfeeding.ResultsOf the 8815 newborns, 1044 (11.8%) lacked breastfeeding information in their EMR. Rates of exclusive breastfeeding were 39.5% at 2 months, 32.4% at 4 months and 25.1% at 6 months. At age 6 months, exclusive breastfeeding rates were highest among mothers aged ≥40 vs. < 20 years (rate ratio [RR] 2.45, 95% confidence interval [CI] 1.62–3.68), urban vs. rural residence (RR 1.35, 95% CI 1.22–1.50), and highest vs. lowest income quintile (RR 1.18, 95% CI 1.02–1.36). Overall, immigrants had similar rates of exclusive breastfeeding as non-immigrants; yet, by age 6 months, among those residing in the lowest income quintile, immigrants were more likely to exclusively breastfeed than their non-immigrant counterparts (RR 1.43, 95% CI 1.12–1.83).ConclusionsWe efficiently determined rates and factors associated with exclusive breastfeeding using data from a large EMR database.

Highlights

The emerging adoption of the electronic medical record (EMR) in primary care enables clinicians and researchers to efficiently examine epidemiological trends in child health, including infant feeding practices
Maternal-newborn pairs were identified from the Institute for Clinical Evaluative Sciences (ICES) MOMBABY dataset, which links the inpatient records of delivering mothers and their newborns in the Canadian Institute for Health Information (CIHI) Discharge Abstract Database (DAD), housed at ICES
Like the Canadian Community Health Survey (CCHS), our current study found that the rate of exclusive breastfeeding at 6 months was 25%

Summary

Introduction

The emerging adoption of the electronic medical record (EMR) in primary care enables clinicians and researchers to efficiently examine epidemiological trends in child health, including infant feeding practices. Consequent recommendations from the World Health Organization (WHO) [5] and the Canadian Paediatric Society [6], according to the 2009 Maternity Experiences Survey (MES), only 14% of Canadian infants are exclusively breastfed at 6 months [7]. The 2009 Canadian Community Health Survey (CCHS) reported rates of Preterm infants are less likely to be breastfed [9, 10]. Infants of immigrant women to Canada – who comprise 35% of all births in Ontario [11] – may not have significantly different rates of breastfeeding than those of Canadian-born women [12]. The WHO reports that return to work is the largest barrier to breastfeeding [13]

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Discussion

Conclusion