Breastfeeding rates at an urban medical university after initiation of an educational program.ABSTRACT Background. Our objective was to improve breastfeeding initiation rates at an urban medical center. Methods. A breastfeeding educational program for health care providers was developed and implemented in 1995. The outcome variable of interest was the change in breastfeeding initiation rate during 2 periods, 1993-1994 and 1996 to 1999, stratified stratified /strat·i·fied/ (strat´i-fid) formed or arranged in layers. strat·i·fied adj. Arranged in the form of layers or strata. by weight (> 2,000, 1,500 to 2,000, and < 1,500 g). Results. The breastfeeding initiation rate in 1996 to 1999 for all mothers of newborns admitted to the hospital was 47.1% (4,107/8,724), compared with the 1993-1994 rate of 18.9% (816/4,315). During the second period, the breastfeeding rate among mothers of infants < 1,500 g was 60.8% (468/770), compared with 19.2% (56/293) during the earlier study period. Stratified by weight, the greatest improvement in rates of breastfeeding initiation and at discharge was seen with mothers of preterm infants. Conclusion. A breastfeeding educational program that interfaced with medical staff and mothers at an urban medical university was associated with increased rates of breastfeeding initiation. ********** BREASTFEEDING, vitally important to the health and well-being of infants throughout the world, is recognized as the optimal way to nourish nour·ish v. To provide with food or other substances necessary for sustaining life and growth. most newborns by the American Academy of Pediatrics The American Academy of Pediatrics ("AAP") is an organization of pediatricians, physicians trained to deal with the medical care of infants, children, and adolescents. Its motto is: "Dedicated to the Health of All Children. , (1) the American College of Obstetricians and Gynecologists The American College of Obstetricians and Gynecologists (ACOG) is a professional association of medical doctors specializing in obstetrics and gynecology in the United States. It has a membership of over 49,000[1] and represents 90 percent of U.S. , (2) and the World Health Organization. (3,4) Scientific evidence documents the nutritional and immunologic superiority of human milk for nourishing infants, as well as the positive psychosocial aspects of breastfeeding for mother and infant. (5-17) Human milk also has been shown to stimulate gastrointestinal growth and repair after injury. The incidence of feeding intolerance and necrotizing enterocolitis Necrotizing Enterocolitis Definition Necrotizing enterocolitis is a serious bacterial infection in the intestine, primarily of sick or premature newborn infants. is lower in preterm infants fed human milk. (9-13,16,17) In addition, breastfed full-term infants have less colic colic, intense pain caused by spasmodic contractions of one of the hollow organs, e.g., the stomach, intestine, gall bladder, ureter, or oviduct. The cause of colic is irritation and/or obstruction, and the irritant and/or obstruction may be a stone (as in the gall and feeding difficulties than formula-fed infants. Despite this evolving information, rates of breastfeeding initiation in the United States United States, officially United States of America, republic (2005 est. pop. 295,734,000), 3,539,227 sq mi (9,166,598 sq km), North America. The United States is the world's third largest country in population and the fourth largest country in area. remain near 60% nationally. Healthy People 2010, reissued by the US Department of Health and Human Services Noun 1. Department of Health and Human Services - the United States federal department that administers all federal programs dealing with health and welfare; created in 1979 Health and Human Services, HHS , reaffirms the Surgeon General's goals to increase the incidence of breastfeeding in the United States to 75% of infants at hospital discharge, and to increase the incidence of breastfeeding at the age of 6 months to 50%. (18) Although breastfeeding rates at the time of hospital discharge have shown a steady increase from 51.5% in 1990 to 62% in 1998, (19) they are still far from the national goal outlined by the Healthy People 2010 objectives. In 1994, the national breastfeeding rate was 56%. In the same year, the breastfeeding rate at the Medical University of South Carolina “MUSC” redirects here. For Abel Santa María airport in Santa Clara, Cuba (ICAO code MUSC), see Abel Santa María Airport. The Medical University of South Carolina (MUSC MUSC Medical University of South Carolina MUSC Maritime and Underwater Security Consultants MUSC Memphis Union Station Company ), an urban medical university in the Southeast, was 16.6% in the normal newborn nursery and 15.5% in the neonatal intensive care unit Noun 1. neonatal intensive care unit - an intensive care unit designed with special equipment to care for premature or seriously ill newborn NICU ICU, intensive care unit - a hospital unit staffed and equipped to provide intensive care , markedly below the national average. To address this problem, an educational program that targeted health care provider knowledge and attitudes about breastfeeding and the benefits of human milk was developed and implemented. It was hypothesized that providing an educational forum for health care staff about lactation lactation Production of milk by female mammals after giving birth. The milk is discharged by the mammary glands in the breasts. Hormones triggered by delivery of the placenta and by nursing stimulate milk production. and the benefits of breastfeeding would improve rates of breastfeeding initiation at our institution. METHODS Subjects All mothers and their newborns admitted to MUSC between January 1, 1993, to December 31, 1994, and January 1, 1996, to December 31, 1999, were included in the study. As part of an ongoing data collection system already in place, detailed clinical information about type of initial feeding (breastmilk, formula, or combination), type of feeding at discharge, and sociodemographic and birth characteristics were obtained from the Perinatal Data Center at MUSC. Educational Program A breastfeeding educational program for health care providers, including medical staff, house officers, and nursing staff was developed and implemented in 1995 (Table 1). Because of the global nature of the problem at our medical institution and the need to educate all health care professionals involved in the care of neonates and infants, this program was mandated for all staff rather than a select few, as would occur in a randomized ran·dom·ize tr.v. ran·dom·ized, ran·dom·iz·ing, ran·dom·iz·es To make random in arrangement, especially in order to control the variables in an experiment. trial of education efficacy. Emphasis was placed on the important differences between breastmilk and formula. The learning forum included (1) a yearly didactic conference given to all pediatric pediatric /pe·di·at·ric/ (pe?de-at´rik) pertaining to the health of children. pe·di·at·ric adj. Of or relating to pediatrics. residents, (2) a twice yearly seminar on breastfeeding for pediatric, obstetric ob·stet·ric or ob·stet·ri·cal adj. Of or relating to the profession of obstetrics or the care of women during and after pregnancy. obstetrical, obstetric pertaining to or emanating from obstetrics. , and nursery staff overseen by faculty, and (3) teaching bedside rounds with a physician knowledgeable about breastfeeding. Within the division of neonatology neonatology /neo·na·tol·o·gy/ (ne?o-na-tol´ah-je) the diagnosis and treatment of disorders of the newborn. ne·o·na·tol·o·gy n. , clinical case conferences and journal club meetings to review recent research about human lactation and breast milk were held to facilitate physician e ducation. Patient education consisted of both prenatal and postnatal postnatal /post·na·tal/ (-na´t'l) occurring after birth, with reference to the newborn. post·na·tal adj. Of or occurring after birth, especially in the period immediately after birth. educational interventions by on-site hospital staff (Table 1). Prenatal education consisted of classes offered through each local hospital and the medical center, with at least one session devoted to breastfeeding. During that session, the differences about breastmilk and formula, health implications for the neonate neonate /neo·nate/ (ne´o-nat) newborn infant. ne·o·nate n. A neonatal infant. neonate a newborn animal. and infant, discussion of the mechanics of breastfeeding, and how to optimize breastfeeding success were reviewed. These educational sessions did not require the hiring of additional staff by the hospital, but rather, used on-site personnel already engaged routinely in patient education (nursing, house staff, nutritionists, and attending physicians). Other parent breastfeeding educational opportunities consisted of consultation with an attending neonatologist or fellow before all high-risk deliveries. The consultation included discussion about neonatal nutrition and the benefits of human milk, particularly for those recovering from illness and for the preterm preterm /pre·term/ (-term´) before completion of the full term; said of pregnancy or of an infant. pre·term adj. population. (5) After delivery, there was active discussion with mothers about breastfeeding, and mothers were openly encouraged to consider initiation of breastfeeding. Data Collection Data were collected from the records of all newborn infants admitted to MUSC during the periods January 1, 1993, through December 31, 1994 (n = 4,315) and January 1, 1996, through December 31, 1999 (n = 8,724). The outcome of interest was the difference in the rates of breastfeeding initiation during the two study periods. Breastfeeding was defined as either exclusive breastfeeding or combination breastfeeding with formula supplementation at the time of feeding initiation during the first 24-hour period that feedings had been initiated. The type of feeding that the infant was receiving at the time of discharge also was recorded. Further information was collected on type of feeding stratified by birth weight. The birth weight category was stratified as <1,500 g (very low birth weight), 1,500 to 2,000 g (low birth weight), and >2,000 g. Data Analysis Data entered prospectively into the MUSC Perinatal Database were analyzed by a computerized statistical program (SAS-6.11). (20) The outcome measure was the change in the rate of breastfeeding initiation for all MUSC newborns during the two study periods. The rate of breastfeeding was further stratified by birth weight. The data were analyzed by chi-square test chi-square test: see statistics. . Significance was set at P <.05. RESULTS During the two study periods, yearly admissions of mothers whose infants were admitted to the university hospital were similar (Table 2). The racial distribution of the patient population in the study cohort was as follows: 66% African American African American Multiculture A person having origins in any of the black racial groups of Africa. See Race. , 27% white, 2% Hispanic, and 1 % Asian. This distribution remained stable during the two study periods. Insurance status during the two study periods was stable and consisted of Medicaid (70%), private! commercial insurance (26%), and self-pay (4%). Rates of inadequate or no prenatal care prenatal care, n the health care provided the mother and fetus before childbirth. were constant during the study periods (9.6% vs 8.9%). Prenatal class attendance by patients was low during both study periods (<10%). During 1993-1994, the overall breastfeeding initiation rate for mothers whose newborns were admitted to MUSC was 18.9% (n = 816/ 4,315). In contrast, the breastfeeding initiation rate for mothers whose newborns were admitted to MUSC between 1996 and 1999 was 47.1% (n = 4,107/8,724) (P <.0001). When analyzed by weight class (Figure), rates of breastfeeding initiation were significantly lower for all weight groups in 1993-1994 than in the 1996 to 1999 study period (P <.0001). During the second study period, rates of breastfeeding were inversely related to birth weight: 45.1 [+ or -] 3.1% in the >2,000 g group 54.0 [+ or -] 4.3% in the 1,500 to 2,000 g group, and 60.8 [+ or -] 4.9% in the <1,500 g group (P <.01). During the two study periods, significant differences in rates of breastfeeding to the time of discharge were found between the groups. During study period 1 (1993-1994), at the time of discharge, 15.5% of mothers whose infants weighed <1,500 g and 18.4% of those whose infants weighed 1,500 to 2,000 g continued to provide breastmilk for their infants. During study period 2, 55% in the <1,500 g group and 83.5% in the 1,500 to 2,499 g group were still breastfeeding at time of discharge (P <.001). Given the short average length of stay (<2 days) for the >2,000 g group, the rates of breastfeeding initiation and continued breastfeeding at discharge were similar. DISCUSSION Implementation of an educational program at an urban medical center that interfaced with medical and nursing staff and mothers in an inner-city medical university was associated with higher rates of breastfeeding initiation and continued breastfeeding at discharge during the two time periods tested. The greatest improvement in rates of breastfeeding was seen with mothers who had infants weighing less than 1,500 g and who had received prenatal consultation with a physician who advocated breastfeeding. The increase in breastfeeding initiation at our urban center increased at a greater rate than was observed nationally during the same study periods, arguing for a local effect. While causality cannot be shown, since there was no control group during the study period, implementation of the breastfeeding educational program was associated with an increase in breastfeeding initiation in all groups, but particularly among mothers of preterm infants who had received more intensive antepartum antepartum /an·te·par·tum/ (-pahr´tum) occurring before parturition, or childbirth, with reference to the mother. an·te·par·tum adj. Of or occurring in the period before childbirth. physician counseling. There are many specific barriers to the success of breastfeeding infants, particularly those from socioeconomically disadvantaged families. (8,9,11) Seventy percent of the mothers at MUSC were enrolled in Medicaid and had an average educational level of less than 12 years. The finding of lower breastfeeding rates than the national average is consistent with other areas of the country where rates of breastfeeding are lower as a function of socioeconomic status socioeconomic status, n the position of an individual on a socio-economic scale that measures such factors as education, income, type of occupation, place of residence, and in some populations, ethnicity and religion. . (8,9,11,21-23) Some of the most effective techniques for the promotion of breastfeeding involve changes in hospital and physician practices. (21,22) Most women make decisions regarding methods of infant feeding before pregnancy, and almost all have made their decision by the last trimester trimester /tri·mes·ter/ (-mes´ter) a period of three months. tri·mes·ter n. A period of three months. Trimester The first third or 13 weeks of pregnancy. of pregnancy. (24) Prenatal birth classes have a positive effect on breastfeeding initiation; however, in this cohort, attendance at prenatal birth classes was low, and therefore the contribution of this educational forum likely contributed little to the overall increase in breastfeeding rates. Despite a mother's feeding choice for her infant before delivery, hospital policies and routines greatly influence breastfeeding patterns. (8,25,26) If there is little support of the breastfeeding mother-infant dyad dyad /dy·ad/ (di´ad) a double chromosome resulting from the halving of a tetrad. dy·ad n. 1. Two individuals or units regarded as a pair, such as a mother and a daughter. 2. during hospitalization and immediately after discharge, there is a higher risk of discontinuance Cessation; ending; giving up. The discontinuance of a lawsuit, also known as a dismissal or a non-suit, is the voluntary or involuntary termination of an action. DISCONTINUANCE, pleading. A chasm or interruption in the pleading. 2. of breastfeeding. (8,9,11,25-30) The findings of this study support the premise that a mother's decision to initiate breastfeeding may be influenced by health care professionals. (28-31) A major barrier to successful in-hospital breastfeeding is inconsistency of information and nursery practices related to breastfeeding management. (30) Information must be adapted for the particular mother-infant dyad, their personality characteristics, and their cultural and social milieu. (8,9,11,21-23) In addition, the information must be tailored to the medical needs of the mother and infant. (8,10,12,13,26-30) For example, advice to mothers of preterm infants is often adapted from recommendations that pertain to pertain to verb relate to, concern, refer to, regard, be part of, belong to, apply to, bear on, befit, be relevant to, be appropriate to, appertain to term infants and are often inappropriate for preterm or high-risk critically ill infants. In this study population, mothers whose infants weighed <1,500 g all received prenatal counseling regarding the benefits of human milk for their premature infants. Thus, the greatest increase in breastfeeding rates was seen with this group, likely reflecting the prenatal discussion that had occurred differentially between the two periods of study. According to according to prep. 1. As stated or indicated by; on the authority of: according to historians. 2. In keeping with: according to instructions. 3. our findings, physician advice to a mother regar ding breastfeeding during a particularly vulnerable time when her infant was at highest risk of perinatal morbidity appeared significant in this cohort. This educational program used on-site staff, who incorporated breastfeeding education into everyday teaching with no additional staff costs to the hospital. The potential cost savings of an effective breastfeeding educational program may be realized if a higher rate of breastfeeding among delivering mothers is achieved. Detailed literature shows that when compared with formula-fed infants, breastfed infants are expected to have enhanced health, particularly during the first year of life, with fewer infections, (5,8,9-15) decreased risk of necrotizing enterocolitis (by 2% to 3%), shorter length of stay for breastfed premature infants, (10,12,16,17) and fewer days to full feedings. (16) Increased rates of breastfeeding also translate into additional cost savings to the hospital, with fewer dollars spent in the purchase of proprietary formulas. In summary, an educational program that consisted of didactic sessions with health care providers and antepartum consultation by a physician with mothers in preterm labor Preterm labor Labor before the thirty-seventh week of pregnancy. Mentioned in: Incompetent Cervix was associated with increased rates of breastfeeding initiation and continuation of breastfeeding to discharge at an urban medical university. The greatest increase in breastfeeding rates was seen with the <l,500-g infant group whose mothers had received prenatal consultation with a physician advocating breastfeeding. Thus, physician encouragement of breastfeeding in the very low birth weight population is associated with improved rates of breastfeeding initiation and continued breastfeeding at discharge. [GRAPH OMITTED]
TABLE 1
Breastfeeding Educational Program
Staff Education
Yearly grand rounds to pediatric and obstetric colleagues
Rotating topics
Physiology of lactation
Special properties of human milk
Mechanics of breastfeeding
Benefits of human milk for infant and mother
Case presentation and discussion
Breastfeeding seminars--twice yearly
Beside teaching seminars: observing the breastfeeding mother
infant dyad
Journal club: discussion of relevant literature
Neonatology/physiology conference: 1 month devoted to
breastfeeding
Patient education about benefits of breastfeeding for infant and
mother
Prenatal birth classes
Antenatal discussion with neonatologist or pediatrician and
obstetrician
Postpartum discussion
TABLE 2
Total Breastfeeding Initiation Rates During Two Periods: 1993-1994 and
1996 to 1999
Total Breastfeeding
Year No. (%)
Preeducation
1993 2,395 445 (18.6)
1994 1,920 371 (19.3)
Total 4,315 816 (18.9)
Posteducation
1996 2,092 896 (42.8)
1997 2,273 1,067 (46.9)
1998 2,141 1,026 (47.9)
1999 2,218 1,118 (50.4)
Total 8,724 4,107 (47.1)
References (1.) American Academy of Pediatrics Policy Statement Based on Task Force Reports: The promotion of breastfeeding. Pediatrics 1997; 100:1035-1039 (2.) American Academy of Pediatrics and the American College of Obstetricians and Gynecologists: Maternal and newborn nutrition. Guidelines of Perinatal Care. Elk Grove Village Elk Grove Village, village (1990 pop. 33,429), Cook and Du Page counties, NE Ill., a suburb of Chicago; inc. 1956. With a population of c.100 at the time of its establishment on open farmland, the village has grown dramatically and steadily, largely because of its , III, AAP AAP - Association of American Publishers , 3rd Ed, 1992 (3.) Kramer MS, Kakuma R: The optimal duration of exclusive breastfeeding. a systematic review. Geneva Geneva, canton and city, Switzerland Geneva (jənē`və), Fr. Genève, canton (1990 pop. 373,019), 109 sq mi (282 sq km), SW Switzerland, surrounding the southwest tip of the Lake of Geneva. , Switzerland, World Health Organization, 2002 (4.) World Health Organization: Protecting, Promoting and Supporting Breastfeeding: The Special Role Of Maternity Services, Geneva, Switzerland, World Health Organization, 1989 (5.) Wagner CL, Anderson DM, Pittard WB: Special properties of human milk. Clin Pediatr 1996; 35:283-293 (6.) Wagner CL: An overview of the benefits of human milk as a nutritional and bioactive bi·o·ac·tive adj. Of or relating to a substance that has an effect on living tissue. bioactive having an effect on or eliciting a response from living tissue. substance. Management of High-Risk Pregnancy High-Risk Pregnancy Definition A high risk pregnancy is one in which some condition puts the mother, the developing fetus, or both at higher-than-normal risk for complications during or after the pregnancy and birth. . Queenan J (ed). Malden, Mass, Blackwell Science Inc. 4th Ed, 1999 (7.) Wagner CL, Purohit D: Preface. Clinical aspects of human milk and lactation. Clin Perinatol 1999; 26:505-525 (8.) Wagner CL, Wagner MT: The breast or the bottle: determinants of infant feeding behaviors. Clinical aspects of human milk and lactation. Chin Perinatol 1999; 26:505-525 (9.) Lawrence RA, Lawrence RM: Breastfeeding: A Guide for the Medical Professional. St. Louis, CV Mosby Co, 5th Ed, 1999 (10.) Schanler RJ: Overview: The clinical perspective. Symposium: Bioactivity bi·o·ac·tiv·i·ty n. The effect of a given agent, such as a vaccine, upon a living organism or on living tissue. in milk and bacterial interactions in the developing immature intestine. J Nutr 2000; 130:417S-419S (11.) Riordan J, Averbach KG: Breastfeeding and Human Lactation. Boston, Jones and Bartlett Publishers, 1993 (12.) Schanler RJ, Shulman RJ, Lau C: Feeding strategies for premature infants. Pediatrics 1999; 103:1150-1157 (13.) Schanler RJ, Hurst NM, Lau C: The use of human milk and breastfeeding in premature infants, Clinical aspects of human milk and lactation. Clin Perinatol 1999; 26:379-398 (14.) Naryanan J, Prakash K, Murthy NS, et al: Randomized controlled trial A randomized controlled trial (RCT) is a scientific procedure most commonly used in testing medicines or medical procedures. RCTs are considered the most reliable form of scientific evidence because it eliminates all forms of spurious causality. of effects of raw and holder pasteurized pas·teur·ize tr.v. pas·teur·ized, pas·teur·iz·ing, pas·teur·iz·es To subject (a beverage or other food) to pasteurization. pas human milk and of formula supplements on incidence of neonatal infections. Lancet 1984; 2:1111-1112 (15.) Wright AL, Bauer M, Naylor A, et al: Increasing breastfeeding rates to reduce infant illness at the community level. Pediatrics 1998; 101:837-844 (16.) Lucas A, Cole TJ: Breast milk and neonatal necrotizing enterocolitis, Lancet 1990; 336:1519-1523 (17.) Pitt J, Barlow B, Heird WC: Protection against necrotizing enterocolitis by maternal milk. I: Role of milk leukocytes. Pediatr Res 1977; 2:906-909 (18.) Office of Disease Prevention and Health Promotion: Healthy People 2000. DHHS DHHS Department of Health & Human Services (US government) DHHS Dana Hills High School (Dana Point, California) DHHS Deaf and Hard of Hearing Services DHHS Deaf and Hard of Hearing Services Publication No.(PHS (Personal Handyphone System) A TDMA-based cellular phone system introduced in Japan in mid-1995. Operating in the 1880-1930 MHz band, PHS uses microcells that cover an area only 100 to 500 meters in diameter, resulting in lower equipment costs but requiring more base ) 91-50212. Washington, DC, US Government Printing Office, 1990 (19.) Ross Laboratories National: Ross Mothers Survey. Ross Product Division, Abbott Laboratories Abbott Laboratories (NYSE: ABT) is a diversified pharmaceuticals and health care company. It has over 65,000 employees and operates in 130 countries. The corporate headquarters are in Abbott Park, Illinois, a neighborhood of North Chicago, Illinois. , Columbus, Ohio Columbus is the capital and the largest city of the American state of Ohio. Named for explorer Christopher Columbus, the city was founded in 1812 at the confluence of the Scioto and Olentangy rivers, and assumed the functions of state capital in 1816. , 1997 (20.) SAS/STAT User's Guide, Version 6, 4th Ed, Vol 2. Cary, NC, SAS Institute SAS Institute Inc., headquartered in Cary, North Carolina, USA, has been a major producer of software since it was founded in 1976 by Anthony Barr, James Goodnight, John Sall and Jane Helwig. Inc, 1989 (21.) Zimmerman DR: You can make a difference: increasing breastfeeding rates in an inner-city clinic. J Hum Lact 1999; 15:217-220 (22.) Humphreys AS, Thompson NJ, Miner KR: Intention to breastfeed breast·feed or breast-feed v. breast-fed , breast-feed·ing, breast-feeds v.tr. To feed (a baby) mother's milk from the breast; suckle. v.intr. To breastfeed a baby. in low-income pregnant women: the role of social support and previous experience. Birth 1998; 25:169-174 (23.) Piper S, Parks PL: Predicting the duration of lactation: evidence from a national survey. Birth 1996; 23:7-12 (24.) Sarett HP, Bain KR, O'Leary JC Decision on breastfeeding or formula feeding and trends in infant-feeding practices. Am J Dis Child 1983; 37:719-723 (25.) Caldwell K: Reaching the goals of "Healthy People 2000" regarding breastfeeding. Clinical Aspects of Human Milk and Lactation. Glin Perinatol 1999; 26:527-537 (26.) Wheeler JL, Johnson M, Collie collie, breed of large, agile working dog developed in Scotland during the 17th and 18th cent. It stands from 22 to 26 in. (55.9–66 cm) high at the shoulder and weighs from 50 to 75 lb (22.7–34 kg). L, et al: Promoting breastfeeding in the neonatal intensive care unit. Breastfeeding Rev 1999; 7:15-18 (27.) Powers N: Slow weight gain and low milk supply in the breastfeeding DYAD. Clinical aspects of human milk and lactation. Clin Perinatol 1999; 26:505-525 (28.) Pereira GR: Breastfeeding in neonatal intensive care: beneficial effects of maternal counseling. Perinatol Neonatol 1984; 8:35-42 (29.) Kavanaugh K, Meier P, Zimmerman B, et al: The rewards outweigh the efforts: breastfeeding outcomes for mothers of preterm infants. J Hum Lact 1997; 13:15-21 (30.) Jaeger jaeger (yā`gər), common name for several members of the family Stercorariidae, member of a family of hawklike sea birds closely related to the gull and the tern. The skua is also a member of this family. MC, Lawson M, Filteau S: The impact of prematurity ant neonatal illness on the decision to breast-feed breast-feed v. To feed a baby mother's milk from the breast; suckle. . J Adv Nursing 1997; 25:729-737 (31.) Humenick SS, Hill PD, Spiegelberg PL: Breastfeeding and health professional encouragement. J Hum Lart 1998; 14:305-310 RELATED ARTICLE: KEY POINTS * Breastfeeding rates in the Southeast remain significantly lower than those in other regions of the United States. * Educational programs that include mothers and health care providers are effective in improving rates of breastfeeding. * The acknowledgement of the importance of human milk for infant health and development during prenatal consultations appears to play a role in improving rates of breastfeeding initiation. * In this study, the greatest improvements in rates of breastfeeding initiation were seen with mothers of preterm infants. From the Division of Neonatology and the Division of Pediatric Epidemiology and Health Systems Research, Department of Pediatrics, children's Hospital A children's hospital is a hospital which offers its services exclusively to children. The number of children's hospitals proliferated in the 20th century, as pediatric medical and surgical specialties separated from internal medicine and adult surgical specialties. , Medical University of South Carolina, Charleston. Reprint requests to Carol L. wagner, MD, Medical University of South Carolina, 165 Ashley Ave, PO Box 250917, Charleston, SC 29425. |
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