Breastfeeding Assessment Score Research Articles

Predictors of Sustained Breastfeeding at 2 Months Among Early Term/Late Preterm Infants

Abstract Objectives To conduct secondary analyses to identify the independent effect of predictors of sustained breastfeeding at 2 months among early term/late preterm infants, and to specifically evaluate the associations between hospital-based practices and breastfeeding outcomes in this population. Methods Breastfeeding mothers (N = 125) who delivered an early term/late preterm infant (35 to 38 6/7 weeks gestation) were interviewed during their postpartum (pp) hospitalization. Medical records were reviewed to collect data on demographics, delivery characteristics and biomedical variables. Participants were contacted at 2 months pp to assess breastfeeding status. Bivariate analyses were conducted, and the significant bivariate predictors of breastfeeding at 2 months were entered into a logistic regression model to identify predictors of sustained breastfeeding at 2 months pp. Results At 2 months pp, 104 women (83.2%) were followed up, with 71.2% still breastfeeding. In bivariate analyses, significant predictors of sustained breastfeeding at 2 months pp included: skin-to-skin contact beyond the first 24 hours pp, higher breastfeeding self-efficacy score, breastfeeding assessment score >80% on day 1, no breast pump use after the first 24 hours during the pp hospital stay, no nipple shield use, primiparity, increased birthweight, singleton status, and no supplemental feedings given in the hospital. In the logistic regression analyses, the only significant predictors of sustained breastfeeding at 2 months were continued use of skin-to-skin contact beyond the first 24 hours (OR: 20.8; 95% confidence interval (CI) (3.19–133.6) and increasing birth weight (OR: 1.001, 95% CI (1.000–1.003). None of the hospital-based practices (use of breast pump, nipple shields, or nipple vs non-nipple supplemental feeding method) were associated with continued breastfeeding at 2 months. Conclusions Our findings suggest that continued use of skin-to-skin contact beyond the first 24 hours of life may be associated with extended breastfeeding duration among late preterm/early term infants. Future research is needed to evaluate the impact of variations in the timing and dose of extended skin-to-skin contact on breastfeeding duration of late preterm/early term infants. Funding Sources None.

Breast crawl at birth, effect on breastfeeding rate and infant growth in infants delivered at an urban tertiary care public hospital: A randomized controlled trial

IntroductionEstablishing successful breastfeeding within the first hour of infant’s life has been shown to have an inverse relationship with maternal breastfeeding difficulties and decreased neonatal mortality. Patients and MethodsWe compared the effect of immediate breast crawl with standard care on maternal perception of breastfeeding, mother infant bonding and maternal satisfaction at hospital discharge, breastfeeding rates, infant weights at 6 weeks and at 6 months. Eligible pregnant women after birth were randomized. In the breast crawl group, immediate skin to skin contact was practiced till 1 hour or till the infant had the first breast feeding. In the control group no skin to skin contact was practiced. Results200 mother infant dyads were enrolled in the study. Breast crawl was successful in 90% of the infants. No difference in breastfeeding rates was observed between the two groups at 6 weeks or at 6months age [94.8% (n= 97) vs. 95.7% (n=95), OR 0.99, 95% CI: 0.93-1.05 and 92.7% (n= 97) vs. 94.6% (n=93) OR 0.98 95% CI: 0.92-1.05]. The breastfeeding assessment score and maternal perception of breastfeeding and infant activity were significantly better in the crawl group (OR 10.2, 95% CI :5.12 -20). No difference in infant bonding scores was observed between the two groups. The mean weight at discharge was similar between the two groups. The mean infant weight at 6 months of age were significantly better in the crawl group [6767 ±843 grams vs. 6475 ±843 grams, p=0.018)]. ConclusionBreast crawl at birth improves the breastfeeding and maternal perception of breastfeeding at hospital discharge and the infant weights at 6 months of age. StrengthEducation and motivation of the mothers and labor room team, good breastfeeding rates in the control group are some of the unique features of this study. LimitationConsistent presence of the research assistant.

Breastfeeding Assessment Score: Systematic Review and Meta-analysis.

Previous studies have revealed conflicting results for the Breastfeeding Assessment Score (BAS) in predicting early breastfeeding cessation. Our objective was to externally validate the BAS and provide summary accuracy estimates for this clinical prediction model. We used the original data from a prospective cohort study. Additional studies were identified by searching electronic databases (Medline, Embase, Cumulative Index to Nursing and Allied Health Literature, and Cochrane) from 2002 to 2013 and contacting research groups that had derived or validated the BAS. Prospective cohort studies were eligible if the BAS was computed at baseline and mothers were followed up for breastfeeding cessation. Two physicians extracted relevant information and independently assessed the methodological quality for the included studies. In the external validation cohort, 22 of 424 mothers (5.2%) discontinued breastfeeding within 14 days of infant age. The BAS predicted early breastfeeding cessation with an area under the curve of 0.70 (95% confidence interval [CI]: 0.65 to 0.74) and inadequate calibration. When restricting the meta-analysis to 3169 mother-infant pairs enrolled in 4 higher-quality studies, a BAS value <8 predicted early cessation with 0.80 sensitivity (95% CI: 0.69 to 0.91) and 0.51 specificity (95% CI: 0.32 to 0.70) summary estimates. Substantial between-study heterogeneity limited the interpretation of summary accuracy estimates. The BAS predicts early breastfeeding cessation with moderate accuracy, although local recalibration is advised before implementation. Further study is warranted to determine whether the BAS can help pediatricians in identifying mother-infant pairs that may benefit from more extensive breastfeeding assessment and support.

Exploring the mother's perception of latching difficulty in the first days after birth: An interview study in an Italian hospital

Objectivesto explore Italian mothers' perception of latching difficulty in the first days postpartum. Latching difficulty is the only qualitative item included in the Breastfeeding Assessment Score (BAS) that has proven to be a valid instrument to identify women at risk of early breast-feeding cessation. Design and settinga phenomenologic–hermeneutic study was conducted at the Mangiagalli Clinic, Milan, Italy. Participantsfifteen women who received a BAS <8 (indicating an early breast-feeding cessation risk) were interviewed before discharge, and later by phone, for member checking. Findingssix main themes emerged from the interviews: (1) Breast feeding can be difficult due to both the mother and newborn, and encountered problems are mainly physical. (2) Women have developed different strategies to overcome latching difficulties. (3) Early breast feeding, even if difficult, is mostly related to positive feelings. (4) Breast-feeding sustains the child–mother relationship. (5) Mothers have already developed constructive theories about human colostrum, breast milk and artificial milk. (6) Receiving integrated health-care support and education is fundamental to overcome early breast-feeding problems. Conclusionsthe interviews suggest that although mothers experience difficulties during early breast feeding, positive feelings seem to prevail over the negative ones, and mothers have already developed strategies to overcome their latching problems. Receiving support is fundamental, but this must be consistent among health-care professionals. Implications for practicewhen evaluating the BAS item ‘latching difficulty’, midwives should consider that difficulties are primarily related to physical problems. Furthermore, to sustain lactation, mothers should be helped to elicit their experience of early breast feeding, as it can be extremely satisfying, even when difficulties in latching the babies occur.

Breastfeeding: validation of a reduced Breastfeeding Assessment Score in a group of Italian women

To assess the accuracy of a reduced Breastfeeding Assessment Score in a group of Italian women; the reduced Breastfeeding Assessment Score considers only five of the eight original Breastfeeding Assessment Score items studied, those not indicating a pathology. The World Health Organization recommends exclusive breastfeeding for the first 6 months of life because of its many benefits. A prognostic approach that identifies mothers at increased risk of early breastfeeding cessation is needed to provide preventive support. The Breastfeeding Assessment Score is useful to this approach. This is a descriptive, prospective study. This study involves two Italian hospitals. We included healthy Italian mothers who gave birth from 7 July 2008-15 January 2009. The exclusion criteria on the convenience sample were: non-Italian nationality, birth under 36 weeks and twin birth. The authors calculated a reduced Breastfeeding Assessment Score ('reduced' because the original eight items studied by Hall, were reduced to five) 48 hours after birth. After 4 weeks a structured follow-up telephone interview was carried out: the primary outcome was breastfeeding cessation. We recruited 386 women, with six lost during follow-up. Out of 380 women, 127 (33·4%) stopped breastfeeding. With a cut off point of 8, the reduced Breastfeeding Assessment Score sensitivity was 52·0%, which increased to 77·9% by using a cut-off point of 9. We also calculated a modified Breastfeeding Assessment Score with different age categories, which is adequate based on the Italian situation: in this case sensitivity was 70·1%. This study suggests that a reduced Breastfeeding Assessment Score with a different cut-off point or modified with a different age classification is useful in identifying Italian mothers who will discontinue breastfeeding, as in both cases sensitivity does increase. Italian midwives could use this modified Breastfeeding Assessment Score to identify mothers at increased risk of early breastfeeding cessation.

CD‐ROM‐based program for breastfeeding mothers

The vast majority of breastfeeding mothers in Western countries have routine access to multimedia and Internet resources at home. The aim of this study was to assess the effectiveness of a CD-ROM-based intervention in increasing the rates of breastfeeding. We conducted a pre- and post-intervention study involving four control and four intervention maternity units in France. All breastfeeding mothers in intervention units were given a CD-ROM-based program addressing various breastfeeding topics. The primary outcome was any breastfeeding at 4 weeks assessed by follow-up telephone interview. The secondary outcomes included breastfeeding duration, breastfeeding difficulties after discharge and satisfaction with the breastfeeding experience. The rates of any breastfeeding at 4 weeks varied from 88.6% (209/236) to 87.9% (211/240) and from 86.0% (222/258) to 88.0% (228/259) for mothers enrolled in intervention and control maternity units, respectively (P for interaction=0.54). The hazard of breastfeeding discontinuation for mothers enrolled in intervention units did not vary significantly across study periods after adjusting for education level, epidural anaesthesia, breastfeeding assessment score and return to work (P for interaction=0.18). The rates of breastfeeding at 4 weeks remained unchanged when restricting the analysis to the mothers who actually received (87.8% [173/197]) or used [88.2% (105/119)] the CD-ROM during the post-intervention period. No significant differences were found in secondary outcomes between the two study groups. A CD-ROM-based intervention for breastfeeding mothers provides no additional benefit to usual post-natal care. Further study is needed to assess the effectiveness of multimedia packages as part of more intensive multifaceted interventions.

Evaluation of a Breastfeeding Assessment Score in a Diverse Population

A previous study performed in a predominately suburban population developed a breastfeeding assessment score (BAS) that was designed to predict, prior to hospital discharge, those mothers who would discontinue breastfeeding within the first 10 days of age. The purpose of the present study was to assess the BAS in a more diverse population. Patients were solicited from 3 urban hospitals serving patients primarily supported by public funding. Results of the present study with 1182 mother-infant pairs confirmed that 5 variables scored on a 0-2 scale (maternal age, previous breastfeeding experience, latching difficulty, breastfeeding interval, number bottles) remained highly significant for predicting discontinuation of breastfeeding. The data also demonstrate that the BAS is inversely related to the risk of cessation of breastfeeding at 7 to 10 days of age. Those at an early risk of cessation of breastfeeding, identified by the BAS, may benefit from early identification and a lactation consultation.

Breastfeeding outcomes for mothers with and without home access to e‐technologies

To estimate the percentage of breastfeeding mothers with home access to e-technologies and to compare breastfeeding outcomes for mothers with and without access to e-technologies. We conducted a prospective observational study of 550 breastfeeding mothers discharged from nine maternity units in France. Overall, 435 mothers (79%; 95% confidence interval [95% CI], 75-82) had home access to e-technologies. Mothers with access to e-technologies were less likely to be unemployed (6% vs. 15%, p = 0.004), to smoke during pregnancy (8% vs. 16%, p = 0.03), to have a breastfeeding assessment score <8 (39% vs. 59%, p < 0.001) and to use a pacifier (23% vs. 41%, p < 0.001). Although mothers with access to e-technologies had a longer median breastfeeding duration than those without home access to e-technologies (19 vs. 16 weeks, p = 0.02), adjusted hazard ratios for breastfeeding discontinuation (0.85; 95% CI, 0.60-1.21), overall satisfaction rates (73% vs. 67%, p = 0.19) and breastfeeding difficulties after discharge (58% vs. 61%, p = 0.60) were not different for the two groups. A vast majority of breastfeeding mothers have home access to e-technologies in France. However, access to e-technologies was not independently associated with better breastfeeding outcomes in this study.

Intérêt du Breastfeeding Assessment Score pour la prédiction du sevrage précoce de l'allaitement maternel en France

Background The Breastfeeding Assessment Score (BAS) was derived to help identify mothers at increased risk of early weaning in United States. Data are currently lacking on the accuracy of the BAS for French mother-infant pairs. Objective To assess the accuracy of the BAS in a French validation cohort. Methods We used the original data from a prospective cohort study of 488 mothers who were breastfeeding at discharge in 9 maternity wards in 2005. The outcome measures were assessed using structured follow-up telephone interviews at 4 and 26 weeks. Results The weaning rate was 3% at 14 days of infant age. The corresponding area under ROC curve was 0.73 [0.60–0.85] and was comparable to that observed in the derivation cohort (0.75). For a cut point of 8 recommended by the authors of the BAS, 43% of mother-infant pairs were categorized at high risk and the weaning rate in this subgroup was 5%. The mother-infant pairs with a score lower than 8 had a shorter median breastfeeding duration (18 versus 20 weeks, P = 0.02), were more likely to report breastfeeding difficulties after discharge (63% versus 53%, P = 0.03), and were less likely to be “very satisfied” with breastfeeding experience (66% versus 77%, P = 0.007). Conclusion The intrinsic properties of the BAS are robust. However, its use would be of limited interest in France because of the relatively low rate of early weaning. Randomized trials are needed before recommending routine use of BAS-based breastfeeding support intervention.

A breast-feeding assessment score to evaluate the risk for cessation of breast-feeding by 7 to 10 days of age

Objectives: To develop a succinct and comprehensive breast-feeding assessment score (BAS) to accurately identify infants at risk for early cessation of breast-feeding before initial hospital discharge. Study design: Mothers who intended to breast-feed their infants were solicited from 9 suburban hospitals. Two detailed data forms covering 107 items were completed before hospital discharge. A third form was completed at 7 to 10 days of age after telephone contact with the mother. Results: Cessation of breast-feeding occurred in 113 of 1075 infants (10.5%). A multiple logistic regression analysis revealed 8 variables that were significant (P <.05) in predicting breast feeding cessation. A BAS was developed based on the odds ratios and relative risks of breast-feeding cessation for these 8 variables. Conclusions: The BAS was easily and quickly performed before hospital discharge for near term and term infants, which accurately predicted the risk of breast-feeding cessation within 7 to 10 days of age in the population studied. (J Pediatr 2002;141:659-64)