Breastfeeding Assessment Research Articles

Effect of oromotor stimulation on feeding performance and weight gain of preterm babies in selected hospital, Kolkata

Assessment of effect of oromotor stimulation on feeding performance and weight gain in selected hospitals, Kolkata. Introduction: According to WHO, every year about 15 million babies are born prematurely around the world. Almost 1 million children die each year due to complication of preterm birth (2013). In India, out of 27 million babies born every year (2010 data), 3.5 million babies are premature. Oral feeding difficulties are almost common in preterm neonates. Coordinated suck-swallow-breath pattern is not developed under 34 weeks of gestational age. So most of the preterm neonates are not able to have an independent feeding in that due time. Aims: 1. To assess the effect of oromotor stimulation in the interventional group. 2. To compare the effect of oromotor stimulation between interventional group and the control group. Design: Non probability purposive sampling technique was used to collect data from sixty preterm babies (30 in interventional group and 30 in control group) with the help of standardized IBFAT ( Infant Breast Feeding assessment tool) & weight checking proforma. Inter rater reliability for IBFAT (r = 0.92) & Weighing machine used for weight checking (r = 0.93) was done. Pretest posttest time series design was adopted. Demographic data (gestational age , birth weight , age of day of 1st intervention) was collected from each baby. Results: Results revealed the significant difference in pre and post interventional breast feeding performance and weight of preterm babies between day 1 and day 7 in the experimental group as computed ‘t’ value 30.91[ (df 29) =2.71, p Conclusion: Oromotor stimulation is effective in improving feeding performance and weight gain of preterm baby. Implication: In practice, oromotor stimulation can be practiced by nurse. The mothers of those preterm babies also can be taught this oromotor stimulation for practicing this method. In education, students may be provided with learning experiences in neonatal units and prac

Estimates of Preterm Infants' Breastfeeding Transfer Volumes Are Not Reliably Accurate

Adequate human milk nutrition is critical for infant growth and neurodevelopment; however, low milk transfer volumes are common when establishing preterm breastfeeding. Despite clinical assessments of milk transfer volumes at the breast being inaccurate, measurement of feed volume via test weighing is rarely carried out either routinely or in cases where infant weight gain is inadequate. To assess the accuracy of the Preterm Breastfeeding Assessment Tool (PBAT) in determining transfer volumes and examine factors associated with PBAT accuracy. Pre/postfeed weights were performed using electronic scales and PBAT scores recorded for 1186 breastfeeds in 60 preterm infants born less than 33/40 and 33 to 39/40 postmenstrual age. Measured milk intake volumes were converted to percent prescribed feed volume and compared with PBAT estimates of milk transfer. The PBAT is accurate in identifying when no milk is transferred at the breast but not in estimating transfer of half or the full prescribed volume (accuracy 26% and 47%, respectively). Wide ranges of transfer volumes (11-75 mL) were observed within and between infants, and for 20% of breastfeeds, no milk was transferred. Preterm Breastfeeding Assessment Tool accuracy decreased with each 1-week increase in birth gestation (odds ratio = 0.82; 95% confidence interval, 0.71-0.94; P = .004). When establishing breastfeeding, test weighing facilitates adequate nutrition by guiding appropriate complementary feeding. For mothers breastfeeding several times per day in preparation for discharge home, test weighing may offer a useful tool for developing maternal confidence in assessing milk transfer. Preterm Breastfeeding Assessment Tool is inaccurate in assessing preterm infants' milk transfer volumes when breastfeeding. While studies have typically focused on medically stable infants, test weighing offers a useful tool to examine breastfeeding efficacy and inform nutritional management of preterm infants with complications such as chronic lung and cardiac disease.

Influência de fatores maternos no desempenho da amamentação

Objetivo: Investigar a relação entre os aspectos maternos (idade, escolaridade, tipo de parto e experiências anteriores com amamentação) e o desempenho da díade mãe-recém-nascido (RN) na amamentação, em uma maternidade pública. Métodos: Estudo diagnóstico analítico, realizado de novembro de 2016 a março de 2017, com 50 díades mães-RN, mediante aplicação do “Protocolo de Avaliação da Mamada”, proposto pela UNICEF. Os dados coletados foram tabulados e descritos por meio de frequências simples e percentuais. Para avaliar associação entre variáveis foi utilizado o teste Exato de Fisher, com nível de significância de 5%. Resultados: Na situação da amamentação, houve diferenças significativas entre idade materna e estado comportamental do RN; e experiências maternas anteriores com amamentação e o encerramento da mamada. Conclusão: A idade materna e as experiências anteriores com a amamentação são fatores que influenciaram o desempenho da mamada nesta população. A avaliação do desempenho da díade na amamentação permite a identificação de dificuldades, o que pode contribuir para o delineamento de condutas pelos profissionais de saúde, considerando as singularidades de cada díade.

Variations in Care for Breastfed Infants Admitted to US Children's Hospitals: A Multicenter Survey of Inpatient Providers.

Studies have revealed an association between hospitalization of breastfed infants and weaning posthospitalization. It is unknown what steps inpatient providers at children's hospitals are currently taking to support breastfeeding mothers of hospitalized infants, their comfort providing breastfeeding counseling, and what training they receive. We conducted a multicenter survey study of pediatric providers who care for infants hospitalized at 3 urban, tertiary-care children's hospitals over a 12-month period. A convenience sample of nurses, residents, and attending physicians agreed to participate. Participants completed a 24-question questionnaire addressing provider practices, comfort with breastfeeding counseling, and previous breastfeeding education. Data were summarized as medians (interquartile ranges) and frequencies (percentages). Kruskal-Wallis and χ2 tests were used to compare between provider types. A total of 361 out of 1097 (33%) eligible providers completed the survey: 133 (21%) nurses, 166 (45%) residents, and 62 (63%) attending physicians. Provider practices varied by provider type. We observed a general trend that providers do not routinely review breastfeeding techniques, directly observe feeds, or use standardized breastfeeding assessment tools. Residents and attending physicians were more likely than nurses to feel comfortable with breastfeeding counseling (P = .02). Residents were more likely than nurses and attending physicians to have received breastfeeding education in the last 3 years (P < .001). Practices, comfort, and previous education varied by provider type. There was a general pattern that providers do not routinely perform certain practices. Further studies are needed to determine if inpatient provider practices affect weaning posthospitalization and if inpatient quality improvement initiatives will help mothers continue breastfeeding posthospitalization.

Effects of prenatal individualized mixed management on breastfeeding and maternal health at three days postpartum: A randomized controlled trial

BackgroundPregnant women with antenatal depression are more prone to postpartum depression and failure in breastfeeding than women without antenatal depression. The purpose of this study was to evaluate the effectiveness of a prenatal individualized mixed management intervention on breastfeeding and maternal physical and psychological status at three days postpartum. MethodsThis randomized single-blind controlled trial was conducted from December 2017 to August 2018 with 182 primiparous women in Shanghai, China. Participants with Edinburgh Postnatal Depression Scale (EPDS) scores ≥9 were randomly allocated to the intervention group (n = 91) or control group (n = 91). The intervention group underwent a 4-session individualized mixed management intervention and the control group received usual care. Feeding patterns, Breastfeeding Self-Efficacy Scale (BSES), Infant Breastfeeding Assessment Scale (IBAS), and EPDS were used to measure the main outcomes. Two-tailed p-values of p < .05 were considered statistically significant. ResultsThe intervention group had significantly more effective breastfeeding behavior, better breastfeeding self-efficacy, more successful breastfeeding initiation, lower EPDS scores, more sleep time, and better appetite than the control group. ConclusionThe prenatal individualized mixed management intervention demonstrated significant short-term improvement in breastfeeding and maternal physical and psychological health at three days postpartum. Trial registrationChiCTR-IOR-17013761; December 7, 2017.

Is There Any Effect of Hyperbilirubinemia on Breastfeeding? If Any, at Which Level?

Objectives: We wanted to investigate whether hyperbilirubinemia (significant or physiological) has an effect on breastfeeding, milk intake, infant's wakefulness, and if any, which level of bilirubin affects breastfeeding. Materials and Methods: Healthy, term, and breastfed babies with significant hyperbilirubinemia who required phototherapy were included in the study (group 1, n = 71). In the neonatal outpatient clinic, a control group was formed from babies with physiological jaundice (group 2, n = 90). All infants were monitored during breastfeeding and breastfeeding was evaluated with breastfeeding assessment tools (IBFAT and LATCH) and milk intake was assessed by test scale. The same examinations were repeated after phototherapy when normal bilirubin levels were reached. Results: Milk intake, Infant Breastfeeding Assessment Tool (IBFAT) (IBFAT total score [IBFATT], IBFAT first item score [IBFAT1], IBFAT sixth item score [IBFAT6]), and LATCH scores were significantly lower in group 1 than the control group (p = 0.001). In group 1, the amount of milk intake, IBFAT and LATCH scores after phototherapy increased significantly compared to prephototherapy values (p = 0.001). Looking at the correlation matrix in the whole study group (groups 1 and 2) there were moderate but very significant negative correlations between bilirubin and milk intake (r = 0.32, p = 0.001), IBFATT (r = 0.47, p = 0.001), IBFAT1 (r = 0.57, p = 0.001), IBFAT6 (r = 0.65, p = 0.001), and LATCH scores (r = 0.49, p = 0.001). In the receiving operating characteristics analysis, the cutoff bilirubin value was found to be 12 mg/dL. Conclusion: Hyperbilirubinemia may have a negative effect on breastfeeding and milk intake. It appears that bilirubin levels above 12, including in babies with physiological jaundice, adversely affect breastfeeding.

Longer duration of kangaroo care improves neurobehavioral performance and feeding in preterm infants: a randomized controlled trial.

To investigate the effect of kangaroo care (KC) and its duration on neurobehavioral performance, stress response, breastfeeding success, and vital signs in premature infants. One hundred and twenty premature infants were randomized to receive either KC for 60 min daily, KC for 120 min daily or conventional care (controls) for at least 7 days. Salivary cortisol was measured before and after the first KC session and then after 7 days. Temperature, respiration rate, heart rate, and oxygen saturation were recorded, before and after KC. Neonates were evaluated by the Neonatal Intensive Care Unit Network Neurobehavioral Scale (NNNS). Both KC groups demonstrated higher scores for attention, arousal, regulation, nonoptimal reflexes, and quality of movements and lower scores for handling, excitability, and lethargy, compared to controls (p < 0.05). Both KC groups had higher infant breastfeeding assessment tool score and reached full enteral feeds faster than controls (p < 0.05). After the first KC session, improvement in O2 saturation and temperature was observed in KC 120-min group compared with the KC 60-min group (p < 0.05). Salivary cortisol decreased in both KC groups compared with controls after 7 days (p < 0.05). Preterm neonates who receive KC for long durations reach full enteral feeds faster, have better breastfeeding success, neurobehavioral performance, thermal control, and tissue oxygenation.

Decreased consumption of common weaning foods is associated with poor linear growth among HIV-exposed infants participating in the Kigali antiretroviral and breastfeeding assessment for the elimination of HIV (Kabeho) study.

The World Health Organization recommends that complementary foods that are adequate, safe, and appropriate be introduced to infants at age 6 months. Using an innovative modeling technique, we examine patterns of nutrient intake in HIV-exposed and uninfected (HEU) infants and establish their relationship with growth. Single-day dietary recalls and anthropometrics were collected every two to 3 months from 543 infants living in Kigali, Rwanda, and attending clinics for the prevention of mother-to-child HIV transmission. A common weaning food index (CWFI) was calculated in grams and nutrient density for infants to reflect the extent to which the infants consumed the weaning foods typical of this population at ages 6 to 10, 11 to 15, and 16 to 20 months. Regressions among the CWFI, length-for-age z-scores (LAZ), and weight-for-length z-scores (WLZ) were conducted to estimate the relationship between the dietary patterns and growth. Mean absolute intake of zinc and calcium from complementary foods was insufficient. Increasing CWFI was related to increasing cow milk consumption. The density CWFI showed a decrease in the density of iron and folate as infants consume more of the weaning foods typical of this population. Density CWFI, breastfeeding, and caloric intake act on early LAZ and WLZ and interact with one another. Among breastfed infants, those who consume little of the common weaning foods and have a high caloric intake develop deficits in LAZ and have an elevated WLZ. A diet that is more dominated by the typical weaning foods of this population may support a healthy growth pattern.

The development and evaluation of a picture tongue assessment tool for tongue-tie in breastfed babies (TABBY)

BackgroundThe presence of a tongue-tie (ankyloglossia) in an infant may lead to breastfeeding difficulties, but debate continues about which babies should be treated with frenotomy. The Bristol Tongue Assessment Tool (BTAT), a clear and simple evaluation of the severity of tongue-tie, is being used worldwide and translated into different languages. We aimed to produce a simple picture version of the BTAT to aid and enhance consistent assessment of infants with tongue-tie.MethodsThe Tongue-tie and Breastfed Babies (TABBY) assessment tool was developed from the BTAT by a graphic designer, with iterative discussion with four practicing NHS midwives. The TABBY tool consists of 12 images demonstrating appearance of the infant tongue, its attachment to the gum and the limits of tongue mobility. The TABBY tool is scored from 0 to a maximum of 8.Two initial audits of the TABBY were undertaken at a large maternity unit in a secondary care NHS Trust, in Bristol UK from 2017 to 2019. TABBY was evaluated by five midwives on 262 babies with tongue-ties and experiencing breastfeeding difficulties who were referred for assessment to a tongue-tie assessment clinic using both BTAT and TABBY. Each pair of scores was recorded by one midwife at a time. A further training audit with 37 babies involved different assessors using BTAT and TABBY on each baby.ResultsAll midwives found the TABBY easy to use, and both audits showed 97.7% agreement between the scores. We suggest that a score of 8 indicates normal tongue function; 6 or 7 is considered as borderline and 5 or below suggests an impairment of tongue function. Selection of infants for frenotomy required an additional breastfeeding assessment, but all infants with a score of 4 or less in the audits had a frenotomy, following parental consent.ConclusionsThe TABBY Assessment Tool is a simple addition to the assessment of tongue-tie in infants and can provide an objective score of tongue-tie severity. Together with a structured breastfeeding assessment it can inform selection of infants for frenotomy. It can be used by clinical staff following a short training and will facilitate translation into other languages.

A review of breastfeeding assessment tools

Breastfeeding, as the optimal feeding pattern, ensures the physical, neurological and psychological growth and development of infants. Professional evaluation of breastfeeding with assessment tools facilitates identifying critical influencing factors and providing specific guidance and health education. This review summarized the breastfeeding assessment tools at home and abroad to provide reference for clinical practice and research. Key words: Breast feeding; Psychiatric status rating scales

Comparison of the breastfeeding outcomes and self-efficacy in the early postpartum period of women who had given birth by cesarean under general or spinal anesthesia

Objectives This study was conducted to compare the breastfeeding outcomes and self-efficacy in the early postpartum period of women who had given birth by cesarean under general (GA) or spinal anesthesia (SA). Methods This descriptive study was conducted with 190 women who had given birth under GA and SA at a training and research hospital. The data of the study were collected with the “Data Collection Form”, “LATCH Breastfeeding Assessment Tool” and the “Breastfeeding Self-Efficacy Scale- Short Form (BSES-SF)”. Results The time to first breastfeeding of the newborns was 78.71 ± 126.9 min and 23.7% of the women breastfed within 30 min. Those who gave birth under SA breastfed their newborn infants statistically significantly earlier (p < .05). However, there was no statistical difference between women giving birth by cesarean under GA and SA and their score medians from the LATCH or the BSES-SF (p > .05). Conclusion The percentage of women breastfeeding their infants within the first half hour and the self-efficacy and success rate was higher among women who gave birth under SA than those who had cesarean under GA. However, breastfeeding behaviors were not at the desired level in either group. Health care professionals should therefore support women who undergo a cesarean and especially those who give birth under GA to increase their breastfeeding success and self-efficacy.

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.

Decreased consumption of common weaning foods is associated with poor linear growth among HIV-exposed infants participating in the Kigali antiretroviral and breastfeeding assessment for the elimination of HIV (Kabeho) study

Decreased consumption of common weaning foods is associated with poor linear growth among HIV-exposed infants participating in the Kigali antiretroviral and breastfeeding assessment for the elimination of HIV (Kabeho) study

Effect of follow-up home-based oromotor stimulation on breastfeeding performance in preterm low-birth-weight infants: A randomized control trial

BACKGROUND: In preterm neonates, feeding problems are recognized as a challenging issue. Immaturity of the oromotor system, inability to generate a suck-swallow-breath pattern, and poor motor development are few factors contributing to feeding difficulties. Oromotor stimulation is one of the various techniques used to enhance breastfeeding in infants which is frequently given in hospitals. However, the effect of oromotor stimulation is given as a home-based program has not been studied. OBJECTIVE: The objective of this study was to evaluate the effect of home-based oromotor stimulation on weight, sucking frequency, duration of transition from spoon-feeding to breastfeeding, and Latch breastfeeding assessment in preterm low-birth-weight infants. MATERIALS AND METHODS: A randomized control trial was done on 40 preterm low-birth-weight infants where they were divided equally into intervention and control groups. Weight, Latch scores, and sucking frequency were noted at baseline. Routine Newborn Intensive Care Unit (NICU) care was given to infants in the control group whereas oromotor stimulation was given for 21 days as a home-based program to the intervention group. The outcome measures were evaluated on the 7th and the 21st day. RESULTS: Oromotor stimulation improved the sucking frequency, Latch scores, and hastened the transition from spoon-feeding to breastfeeding as compared to the controlled group (P 0.05). CONCLUSION: The present study concludes that home-based oromotor stimulation program is effective in improving sucking frequency, Latch scores, and duration of transition from spoon-feeding to breastfeeding in preterm low-birth-weight infants, although no significant changes were seen in the rate of weight gain between the groups. Oromotor stimulation should be added along with routine NICU care for preterm low-birth-weight infants to improve the breastfeeding performance.

The use of breastfeeding assessment tools to predict the excess weight loss risk in newborns

Aim: Postnatal weight loss is a major issue of concern to pediatricians. We aimed to determine whether the LATCH tool, Infant Breastfeeding Assessment Tool (IBFAT) and the Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF) are useful in predicting postnatal excess weight loss. Material and Method: One hundred fifty one mother infant dyads’ breastfeeding sessions were monitored and scored simultaneously by using the LATCH and IBFAT assessment tools during the postnatal first feeding and at 12, 24 and 48 hours. Maternal confidence in breastfeeding was assessed using BSES-SF at the same breastfeeding sessions. Infants were followed until they reached their birth weights after discharge. Comparisons were made between infants with ≥10% weight loss and infants with <10% weight loss during following. Results: IBFAT, LATCH and BSES-SF scores were significantly higher in infants with <10% weight loss than those with ≥10% weight loss (p<0.05). According to ROC analysis including all tools’ scores, AUC values were close to 0.70. These results indicate that these assessment tools can be used to predict the risk of excessive weight loss of the newborns. Conclusions: Mother/infant dyads that achieve higher scores in these tests can be discharged earlier, avoiding unnecessary hospitalization.

A multifaceted programme to reduce the rate of tongue-tie release surgery in newborn infants: Observational study

ObjectivesA programme was introduced in Canterbury, New Zealand to evaluate the diagnosis and treatment of frenulum releases in newborn infants with suspected tongue-tie (ankyloglossia). The primary goals were to support breastfeeding and ensure that unnecessary surgery was avoided. MethodsLocal healthcare professionals reached consensus on a pathway for improving management of infants with tongue-tie and breast-feeding difficulties. This embedded an expert breast-feeding review and assessment of lingual function using a validated method, the Bristol Tongue-tie Assessment Tool (BTAT). Infants with breastfeeding problems related to tongue-tie had a frenotomy at a hospital outpatient clinic. An education programme was developed to support introduction of the new clinical pathway and included seminars and online information for healthcare professionals and the general public. ResultsFrenotomy intervention rate reduced markedly from 11.3% in 2015 to 3.5% by mid-2017. Feeding methods were not different before or after surgery between infants who received a frenotomy and those who did not. Initially, the BTAT threshold for frenotomy was set at ≤5, however the final clinical pathway combined a breastfeeding assessment and a BTAT threshold of ≤4. The education programs assisted with the changes in practice, while increased use of the clinician guidance and public health information websites confirmed growing awareness of tongue-tie and community breastfeeding support. ConclusionsEstablishing consistent multidisciplinary assessment of tongue-tie in infants with feeding difficulties led to a marked reduction in frenotomy intervention rate. 23% of the frenotomy group in the 2016 audit showed a significant improvement in the ability to breastfeed, but overall there was no difference in the feeding pattern of infants who either received or were declined a frenotomy. The development of a supportive education programme and availability of online information about tongue-tie for health professionals and consumers contributed to successful uptake of the new clinical pathway.

Lactation Assessment Tools: A Qualitative Analysis of Registered Nurses' Perceptions of Tool Limitations and Suggested Improvements.

Background Several lactation assessment tools are available for in-hospital assessment of breastfeeding dyads, and their components vary widely. To date, no research has evaluated the perceptions of registered nurses (RNs) regarding the limitations and future improvements of these tools. Research Aim The aim was to describe RNs' perceptions of the limitations of currently used lactation assessment tools and how these tools could be enhanced. Methods Focus groups ( n = 7) were conducted with RNs ( N = 28) whose current responsibilities included in-hospital breastfeeding assessment. Recruitment occurred from April through July 2015 at regional and international lactation conferences. Focus groups were audiotaped and transcribed verbatim. Two lactation researchers analyzed the transcripts to identify emerging themes and subthemes. Results RNs identified three key limitations of the tools included being too subjective and time-consuming, difficulty in assessing audible swallows, and missing the big picture (e.g., overemphasizing numbers, being a snapshot in time). Suggested improvements focused on maternal characteristics (evolving breasts and nipples, holding it together, "got milk?," risk factors, embracing the role), infant characteristics (day of life, latch/suck/swallow, baby's "driving the bus," risk factors for supplemental feeding), their interaction (two to tango, positioning, better qualitative descriptors), and tool organization (formatting and multiple versions). Conclusions RNs suggested novel components for consideration when developing future lactation assessment scales, including removing audible swallowing, adding mother/infant interactions, infant output, and expressible colostrum, and developing criteria specific to infant age. Future research should translate these suggestions into evidence-based indicators and evaluate the resulting proposed tools for reliability and validity.

Effect of an innovative community-based care model, the Monarch Centre, on postpartum length of stay: an interrupted time-series study.

Reduction in postpartum length of stay has been advocated within a context of reducing health care system costs and maintaining quality of care. We assessed trends in postpartum length of stay for vaginal and cesarean deliveries at an academic hospital, The Ottawa Hospital, before and after the implementation in 2014 of a novel community-based postpartum outpatient clinic, the Monarch Centre. The Monarch Centre model of postpartum care consists of prebooked appointments at the postpartum clinic, scheduled within 48 hours of hospital discharge. Clients receive maternal assessment including mood screening and care, neonatal care, laboratory testing including infant total serum bilirubin level, and breast-feeding assessment and support. Family physicians, lactation consultants and registered nurses are available for consultation at the appointment, and there is coordination with institutional care, community partners and primary care providers. We used interrupted time-series regression models to assess trends in postpartum length of stay at The Ottawa Hospital between January 2012 and December 2016. There were 16 023 deliveries with 16 515 babies born over the study period. The mean postpartum length of stay was 46 hours (66 h for cesarean deliveries and 37 h for vaginal deliveries). Eighteen months after implementation of the centre, the average length of stay following a cesarean birth had decreased by 20 hours, a relative reduction of 27% (95% confidence interval [CI] 9.5 to 30.4); for vaginal deliveries, length of stay was reduced by 6 hours, a relative reduction of 18% (95% CI 5.2 to 31.1), and by 12 hours among typical cases (relative reduction 28%, 95% CI 19.2 to 36.6). There was a decrease in the proportion of women with a length of stay exceeding 48 hours after centre implementation. An increase in the rate of 30-day readmission from 1.1% to 1.9% was observed among babies. A strong association was found between implementation of a community-based multidisciplinary postpartum clinic and declines in postpartum length of stay. This alternative model of postpartum care is safe, has the potential for reducing provider costs and should be considered for further implementation at provincial and national levels.

A Pilot Study of a Culturally Grounded Breastfeeding Intervention for Pregnant, Low-Income African American Women.

Increasing breastfeeding rates among low-income African American women may work toward the achievement of health equity. The dynamic breastfeeding assessment process (D-BAP) is a community-grounded, equity-focused intervention designed to increase prenatal breastfeeding self-efficacy. Research aim: The aims of the pilot study were (a) to determine the effect of the D-BAP on breastfeeding self-efficacy among pregnant, low-income African American women, (b) to examine the findings among women with no previous breastfeeding experience, and (c) to compare the findings between women with prior breastfeeding experience and those without it. A pre/post, paired-samples design was utilized. Convenience sampling was used to recruit pregnant, low-income African American women ( N = 25). Participants completed the Breastfeeding Self-Efficacy Scale-Short Form prior to and following the D-BAP. The Wilcoxon signed rank test indicated that participation in the D-BAP had a statistically significant influence on breastfeeding self-efficacy ( z = -2.01, p = .04). Among a subsample of participants with no previous breastfeeding experience ( n = 12), completion of the D-BAP resulted in a statistically significant increase in breastfeeding self-efficacy ( z = -2.36, p = .02). There was no statistically significant difference between those with prior breastfeeding experience and those without it. Breastfeeding among low-income African American women is a health equity issue for which culturally responsive, effective breastfeeding interventions are needed. This research demonstrates an association between completion of the D-BAP and an increase in prenatal breastfeeding self-efficacy.

Defining Tip-Frenulum Length for Ankyloglossia and Its Impact on Breastfeeding: A Prospective Cohort Study.

The purpose of this study was to investigate the normal lingual frenulum anatomy in newborns and to evaluate tip-frenulum distance as an objective diagnostic tool for identifying newborns at risk for anterior and posterior tongue tie and breastfeeding difficulty. The distance from the tongue tip to the insertion of the lingual frenulum was measured in a group of 100 healthy newborns to establish normative data. The presence of a visible or palpable cord was noted. Inter-rater reliability was assessed. Breastfeeding surveys including a maternal pain scale and Infant Breastfeeding Assessment Tool (IBFAT) were administered on days of life 2 and 14 to determine whether these findings predict breastfeeding difficulty. Mean tip-frenulum length was 9.07 mm. Intraclass correlation coefficient between observers for tip-frenulum length was 0.82. A visible cord was identified in 21 subjects (21%). A palpable cord was identified in 59 subjects (59%). Unweighted κ coefficients for inter-rater reliability of visible and palpable cords were 0.91 and 0.47, respectively. Visible cord and shorter tip-frenulum distance were independently predictive of higher maternal pain scores. A positive correlation was identified between tip-frenulum length and IBFAT scores for mothers with two or more previous breastfed children. Tongue tip-frenulum length correlated with maternal nipple pain, and was useful as an objective tool for identifying newborns at risk for ankyloglossia. Maternal breastfeeding experience appears to be an important factor in the link between tongue anatomy and breastfeeding difficulty. The presence of a palpable cord was variable across examiners, and should be interpreted with caution when evaluating newborns for posterior tongue tie.