Copyright 2015 Maureen Shogan. Not to be reproduced without permission in writing from above.

Transcription

1 Nourishing the Neonate Phoenix, AZ 10/8/15 Meeting 2016 TJC Perinatal Core Measure for Exclusive Breastfeeding Perinatal Core Measure PC 05 ANY Percentage of US children breastfeed Exclusive Neonatal Clinical Nurse Specialist Spokane, WA CDC breastfeeding data national immunization survey 2014 Percent of Breastfed children who were supplemented with formula Any and Exclusive Breastfeeding children born in US 2011 CDC breastfeeding data national immunization survey 2014 Nurse= Hospital Nurse Joint Commission Definition of Exclusive Breast Milk Feeding A newborn receiving only breast milk and no other liquids or solids except for drops or syrups consisting of vitamins, minerals or medicines Includes expressed mother s milk as well as donor human milk, both of which may be fed to the infant by means other than suckling at the breast. Advice to Moms. Eisenberg, et al (8/2015) Pediatrics. 20% received no advice from their MD on breast feeding

2 Nourishing the Neonate Phoenix, AZ 10/8/15 Changes to JC PC 05 June PC 05. Maternal medical conditions are no longer excluded. Will remove burden Women who do not want to excl breast feed will alter data PC 05 achievable target for hospitals. Retirement PC 05a Capturing data on mothers preference. has been challenging. Hospital concentrating on data collection Performance on PC 05 TJC June 2015 AAP.org 4/2012 Breastfeeding and the use of Human Milk in Healthy Term infants Begin skin to skin immediately after delivery until first feeding (v) Begin skin to skin at C Section birth Facilitate proper Positioning Promote rooming in Help moms see early feeding cues Educate Partner with WIC Skin to Skin at natural C Section increases exclusive breast feeding Kendall Tackett, et al (2015) Clinical Lactation 6(3) J Smith,a F Plaat,b NM Fiska,c (2008) BJOG

3 Nourishing the Neonate Phoenix, AZ 10/8/15 Breastfeeding increases when mom and baby skin to skin at C Section Skin to Skin at C section Better LATCH scores Less formula Consider utilization of natural C Section drapes Protocol Development Supportive Hospital Practices to Promote Exclusive Breast Feeding Facilitate Proper Positioning Frequent breast feeding Promote rooming in Educate: Br Milk Production and let down Hung, KJ & Berg, O (2011) MCN 14 Breastfeeding and the use of Human Milk in Healthy Term infants DELAY initial separation Delay routines Delay Vitamin K administration until 6 hours of birth Breastfeeding and the use of Human Milk in Healthy Term infants In Hospital Give no supplements Avoid routine pacifier use in the immediate post partum period Pacifier Use Quandary No association that pacifier use reduces length of breast feeding Cochrane Review n= 1302 Healthy FT Jenk et al 1021 moms randomized. No differences in breastfeeding prevalence Pacifier Use Quandary Use when indicated for medical purpose (sucrose binky/dummie for pain relief) Oregon Health Sciences University Unlimited pacifier use Exclusive Breastfeeding Pacifier restriction EBF Supplemented with formula Mom s perception Theory lack of non nutritive suck consolation Kair et al (2013). Pacifier restriction and EBF, Pediatrics, 131: e1101

4 Nourishing the Neonate Phoenix, AZ 10/8/15 Breastfeeding and the use of Human Milk in Healthy Term infants In Hospital Ensure 8 12 feedings at the breast Ensure formal Begin oral Vitamin D drops (400IU) at discharge Promote rest Fatigue as a challenge to breast feeding promotion AVOID offering formula as a means to increase maternal rest Consider and Recommend Prepare moms for fatigue post partum Side lying Parents ability to soothe infant crying Hospital enforced Quiet Time Web based education resources at discharge Heinig, MJ (2010). JHL 26(3) Supportive Hospital Practices to Promote Exclusive Breast Feeding Use TJC brochures What you need to know about Breast feeding campaign Active Follow up after discharge Connect families to support Breastfeeding and the use of Human Milk in Healthy Term infants Followup Former AAP statement: All breast fed infants should be seen by a pediatrician at 3 5 days of age or hours of discharge. (2012) Current AAP Statement: For newborns discharged before 48 hours after delivery, an appointment should be made for the infant to be examined by a health care practitioner within 48 hours of discharge. (AAP, 2015) Weight loss no more than % from birth No further weight loss Hydration Observe feeding Avoid introducing pacifier until Benitz, WE. (2015) AAP Policy Statement: Hospital stay for healthy term newborn infants, Pediatrics. May Breastfeeding and the use of Human Milk in Healthy Term infants Breast feed exclusively for about 6months Introduce complimentary foods rich in Fe and other micronutrients at about 6 months Ongoing Support for breastfeeding mothers (Cochrane Review, 2012) 52 Studies, 56,451 couplets, 21 countries Support Reassurance and praise Information Opportunity to discuss mother s questions OFFER support to increase duration Healthcare settings provide training to support moms Face to Face support Negative: Support that is only offered when women SEEK help Women should be offered ongoing visits on a scheduled basis

5 Nourishing the Neonate Phoenix, AZ 10/8/15 Breastfeeding and the use of Human Milk in the preterm Benefits of Breast feeding All Preterm infants should receive human milk Costs of NEC/Surgical NEC Human milk for the preterm < 1500 grams at birth should be fortified Mothers will receive training on manual and mechanical methods of milk expression Breastfeeding and the use of Human Milk in the preterm NICUs will have evidence based protocols NICUs should prevent No data to support routines Pasteurized donor milk Contraindications for Breastfeeding (AAP) Mom is HIV positive Untreated TB Once treated for weeks, may breast feed Untreated brucellosis May not breast feed, but breast milk may be used Varicella H1N1 flu mom and baby separated until mother is afebrile, but may use breast milk Active herpes simplex on the breast Untreated TB Formula supplementation potentials Buying milk on the internet Delayed lactogenesis Increases risk of maternal engorgement Alters neonatal bowel flora Exposes and sensitizes newborn Interfere with immune system development

6 Nourishing the Neonate Phoenix, AZ 10/8/15 breast milk contained bacteria (n=101) CMV positive What viral agents are in the milk? What substances has the mom been ingesting? Would you go to the internet if your child needed a?? Discourage ANY acquisition of unpasteurized breast milk via the internet Keim et al, Pediatrics, 132:e1227 e1235. Breast Milk Sold on line 102 samples purchased in the intranet DNA extracted from 200 ml of each sample Assessed for human or bovine DNA Bovine DNA content Buyer beware Keim, SA, et al, 2015) Pediatrics, 135 (5), Workplaces that support Breast feeding moms For every $1 that a work site invests in to assist moms to pump, refrigerate, and for hand washing 3 is returned (USBC, 2013) Pt Protection and Affordable Care Act passed by US Congress 2010, workplace must provide reasonable break time and private non bathroom area for breast feeding mothers to express milk Business Case for Breast feeding US Dept Health and Human Services (2011) USBC 2013 AWHONN. (2015). Breastfeeding: AWHONN Position Statement, JOGNN, 44, (1), Benitz, WE. (2015) AAP Policy Statement: Hospital stay for healthy term newborn infants, Pediatrics. May Eidelman, A.I. & Schanler, R.J. (2012). Breastfeeding and the use of human milk. Pediatrics, 129: e PM: Eisenbert, SR et al (2015). Maternal report of advice received for infant care, Pediatrics, 136 (2), e Kair, LR, Kenron, D Etheredge, K, Jafffe, AC & Phillipi, CA. (2013). Pacifier restriction and exclusive breastfeeding, Pediatrics, 131 (4) e Keim, SA, Kulkami, MM, McNamara, K Geraghty, S, Bilock, RM Ronau, R, Hogan, JS & Kwiek, JJ (2015). Cow s milk contamination of human milk purchased via the internet, Pediatrics, 135 (5) Keim, S.A., Hogan, J.S., McNamara, K.A., Gudimetla, V., Dillon, C.E., Kwiek, J.J. & Geraghty, S. R. (2013). Microbial contamination of human milk purchased via the internet. Pediatrics, 132:e1227 e1235. Kendall Tackett, K., Cong,Z. and Hale, T. (2015). Birth interventions related to lower rates of exclusive breastfeeding and increased risk of postpartum depression in a large sample. Clinical Lactation 6(3) Miller, C. W. (2012). Marijuana use and breastfeeding, Clinical Lactation, 3: Sachs, H. C. and Committee on Drugs. (2013). The transfer of drugs and therapeutics into human breast milk: An update on selected topics, Pediatrics, 132, e 796 e809. Specifications Manual for Joint Commission national Quality Measure (v12015a). Reason for Not Exclusively Feeding Breast Milk Discharges (1Q15) though (3Q15). The Joint Commission Perspectives (2015). Changes to Breast Milk feeding performance measures PC 05a and PC 05 June. US Breastfeeding Committee (2013). Breastfeeding saves dollars and makes sense. Good 34 for families, employers and the economy. WA, DC: USBC