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| 2. |
- Ericson, Jenny, et al.
(författare)
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Breastfeeding and risk for ceasing in mothers of preterm infants - long-term follow-up
- 2018
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Ingår i: Maternal and Child Nutrition. - : Wiley. - 1740-8695 .- 1740-8709. ; 14:4
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Tidskriftsartikel (refereegranskat)abstract
- Breastfeeding is challenging for mothers of preterm infants. The aim of this paper is to describe risk factors for ceasing breastfeeding and methods of feeding until 12 months postnatal age in mothers who breastfed their preterm infants at discharge from neonatal intensive care units (NICUs). The data come from a randomised controlled trial, which evaluated the effectiveness on exclusive breastfeeding at 8 weeks of proactive telephone support compared with reactive support offered to mothers of preterm infants following discharge from NICU. Six NICUs across Sweden randomised a total of 493 mothers. We used regression and survival analyses to assess the risk factors for ceasing breastfeeding and the long-term outcomes of the intervention. The results showed that 305 (64%) of the infants were breastfed at 6 months and 49 (21%) at 12 months. Partial breastfeeding at discharge, low maternal educational level, and longer length of stay in the NICU increased the risk for ceasing breastfeeding during the first 12 months. Furthermore, the Kaplan-Meier analysis showed that the proportion of mothers who ceased breastfeeding did not differ between the intervention (n = 231) and controls (n = 262) during the first 12 months (log-rank test p = .68). No difference was found between groups on method of feeding. More than 85% of the infants were fed directly at the breast. These findings provide important insights for health professionals who are supporting mothers of preterm infants to breastfeed long term.Registered in www.clinicaltrials.gov (NCT01806480).
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| 3. |
- Ericson, Jenny, et al.
(författare)
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Breastfeeding duration in preterm infants and the effects of a proactive telephone support: a randomized controlled trial
- 2018
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Konferensbidrag (refereegranskat)abstract
- IntroductionThe first months at home may be troublesome for mothers of preterm infants (< 37 gestational weeks) due to lack of support and thereby an increased risk for ceasing breastfeeding (Kair, Flaherman, Newby, & Colaizy, 2015; Niela-Vilen, Axelin, Melender, & Salantera, 2015). Breastfeeding prevalence in preterm infants is lower than in term infants and decreases during the first months at home (Akerstrom, Asplund, & Norman, 2007; Flacking, Nyqvist, Ewald, & Wallin, 2003). The aim of this trial was to evaluate the effects of a proactive breastfeeding telephone support to mothers of preterm infants on breastfeeding, method of feeding and to describe breastfeeding duration and risks for ceasing breastfeeding up to one year of infant age. MethodThis is a multicentre randomized controlled trial with six neonatal units in Sweden participated. At each unit a breastfeeding support team, BST (10 staff/unit) recruited, randomized and delivered the telephone support to eligible and participating mothers. The intervention was a proactive telephone call initiated by the BST day 1-14 after discharge from the neonatal unit. In the control group, the mothers received a telephone number to the BST if they wanted to call and ask or talk about anything. The outcomes reported were breastfeeding, method of feeding, duration of and risks for ceasing breastfeeding. All researchers were blind to group allocation throughout the study period. ResultsIn total 493 mothers were randomized. There were no statistical significant differences between intervention (n=231) and control (n=262) group on breastfeeding, at discharge (OR 0.70, 95% CI 0.44-1.12, p=0.09), eight weeks after discharge (OR 1.12, 95% CI 0.75-1.69, p=0.45), six months (OR 1.21, 95% CI 0.78-1.88, p=0.29) and 12 months (OR 0.87, 95% CI 0.42-1.79, p=0.52) of infant age. Not either on method of feeding. Most infants received human milk directly at the breast; few infants received human milk by bottle, cup or tube feeding. At discharge, eight weeks after discharge and six months of infant age 82%, 58% and 23% of the infants were exclusively breastfed respectively. At 12 months of infant age, 21% were partially breastfed. Partial breastfeeding at discharge (HR 1.81, 95%CI 1.35-2.41, p=<0.001) and secondary school or lower maternal educational level (HR 1.42, 95%CI 1.13-1.79, p=0.003) increased the risk for ceasing breastfeeding during the infants first year of life. A shorter length of stay in weeks reduced the risk of ceasing breastfeeding during the infants first year of life (HR 0.96, 95% CI 0.92-0.99, p=0.021). ConclusionA two-week daily proactive telephone breastfeeding support did not affect exclusive breastfeeding and method of feeding during the infants first year of life. Few infants received human milk by other method than at breast-feeding. However, partial breastfeeding at discharge from the neonatal unit, secondary school or lower maternal educational level and longer hospital stay significantly increased the risk for ceasing breastfeeding during the infants first year of life. The study gives a unique long-term follow-up on breastfeeding in preterm infants.
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| 4. |
- Ericson, Jenny, et al.
(författare)
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Changes in the prevalence of breast feeding in preterm infants discharged from neonatal units : a register study over 10 years
- 2016
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Ingår i: BMJ Open. - London, United Kingdom : BMJ Publishing Group Ltd. - 2044-6055. ; 6:12
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Tidskriftsartikel (refereegranskat)abstract
- Objective: There are indications that the prevalence of exclusively breastfed preterm infants is decreasing in Sweden. The objective was to investigate trends in exclusive breast feeding at discharge from Swedish neonatal units and associated factors in preterm infants.Design, setting and participants: This is a register study with data from the Swedish Neonatal Quality Register. Data from 29 445 preterm infants (gestational age (GA) <37 weeks) who were born during the period 2004–2013 were retrieved. Data included maternal, perinatal and neonatal characteristics. Data were analysed for the whole population as well as for 3 GA groups.Results: From 2004 to 2013, the prevalence of exclusive breast feeding decreased, in extremely preterm (GA 22–27 weeks) from 55% to 16%, in very preterm (GA 28–31 weeks) from 41% to 34% and in moderately preterm infants (GA 32–36 weeks) from 64% to 49%. The decline was statistically significant (p<0.001) in all 3 GA groups. This decline remained significant when adjustments were made for factors negatively associated with exclusive breast feeding andwhich became more prevalent during the study period, that is, small for GA (all groups) and maternal mental illness (very preterm and moderately preterm infants).Conclusions: In the past 10 years, Sweden has experienced a lower rate of exclusive breast feeding in preterm infants, especially in extremely preterm infants. The factors analysed in this study explain only a small proportion of this decline. The decline in exclusive breast feeding at discharge from neonatal units raises concern and present challenges to the units to support and promote breast feeding.
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| 5. |
- Ericson, Jenny, et al.
(författare)
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Decrease in Breast Milk intake in Preterm Infants Discharged from Swedish Neonatal Units 2004-2013
- 2015
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Konferensbidrag (refereegranskat)abstract
- Objective: Sweden is traditionally regarded as a pro-breastfeeding culture with high rates of breastfeeding. The objective was to describe breast milk intake in preterm infants at discharge from neonatal units during 2004-2013 and to describe potential influencing factors for not receiving breast milk at discharge.Method: This study is a registry study with data collected from the Swedish Neonatal Quality Register (SNQ). 29.433 preterm infants who had information about breast milk intake at discharge, in the register, were included. Results: There is a decrease in exclusive breastfeeding from 59 % in 2004 to 45 % in 2013. Among extremely preterm infants (n=1931), the rate of any breastfeeding decreased from 73 % to 55 %, in very preterm infants (n=4587) from 81 % to 75 % and in moderately preterm infants (n=22.915) from 92 % to 89 %, during the study period. The adjusted odds ratios for not receiving breast milk at discharge were; gestational age 2.2 (2.0-2.4), multiple births 2.1 (1.9-2.3), gestational diabetes 2.1 (1.7-2.7), mothers’ mental health 2.1 (1.8-2.6), cesarean section 1.8 (1.7-2.0), mothers’ health 1.7 (1.6-1.9), ventilator treatment 1.5 (1.3-1.7), CPAP treatment 1.3 (1.1-1.4), small for age 1.2 (1.1-1.4) and neonatal illness 1.2 (1.0-1.4)Conclusions: Breast milk intake at discharge from hospital has decreased among preterm infants in Sweden from 2004 to 2013. Gestational age, multiple births, and mothers’ health were the strongest risk factors for not receiving breast milk at discharge. This negative trend raises concern, and presents challenges to neonatal units to support and promote increased breast milk intake.
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| 8. |
- Ericson, Jenny, et al.
(författare)
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Proactive telephone support provided to breastfeeding mothers of preterm infants after discharge : a randomised controlled trial
- 2018
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Ingår i: Acta Paediatrica. - : Wiley. - 0803-5253 .- 1651-2227. ; 107:5, s. 791-798
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Tidskriftsartikel (refereegranskat)abstract
- AIM: The aim was to evaluate the effectiveness of proactive telephone support provided to breastfeeding mothers of preterm infants after discharge from neonatal intensive care units (NICU).METHODS: Between March 2013 and December 2015, a randomised controlled trial was conducted at six NICUs across Sweden. At each NICU, a breastfeeding support team recruited, randomised and delivered the support to participating mothers. The intervention group received a daily proactive telephone call up to 14 days after discharge from the support team. The control group could initiate telephone contact themselves. Primary outcome was exclusive breastfeeding eight weeks after discharge. Secondary outcomes were maternal satisfaction with breastfeeding, attachment, quality of life and parental stress.RESULTS: In total, 493 mothers were randomised, 231 to intervention group and 262 to control group. There were no differences between the groups for exclusive breastfeeding, odds ratio 0.96, 95% CI 0.66-1.38, nor for maternal satisfaction with breastfeeding, attachment or quality of life. The intervention group reported significantly less parental stress than the controls, t=2.44, 95% CI 0.03-0.23, effect size d=0.26.CONCLUSION: In this trial, proactive telephone support was not associated with increased exclusive breastfeeding prevalence eight weeks following discharge. However, intervention group mothers showed significantly lower parental stress. This article is protected by copyright. All rights reserved.
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| 9. |
- Ericson, Jenny, et al.
(författare)
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Risk Factors for Not Breastfeeding at Discharge in Mothers of Preterm Infants
- 2016
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Konferensbidrag (refereegranskat)abstract
- Background: Breastfeeding has nutritional, cognitive and immunological advantages compared to formula feeding1. Breastfeeding rates among preterm infants are lower than in term infants2. The aim was to investigate risk factors for not breastfeeding at discharge in mothers of preterm infants.Method: In this registry study, data on maternal and infant health were obtained from the Swedish Neonatal Quality Register (SNQ). The study included data on 29.445 preterm infants (<37 gestational weeks, gw) and their mothers who were discharged to home and where information on breastfeeding was available 2004-2013.Results: During the study period (2004-2013), there was a statistical significant increase in the proportion of mothers with a notification of any illness (15% to 29%), mental illness (2% to 6%), administration of antenatal corticosteroids (31% to 34%) and infants born small for age (4% to 9%). Factors that had a statistical significant adjusted odds ratios for not breastfeeding at discharge were; notification of any illness in mother 1.7 (1.5-1.8), mental illness 1.9 (1.6-2.2), gestational diabetes 1.8 (1.4-2.2), administration of antenatal corticosteroids 1.1 (1.0-1.2), cesarean sectio 1.6 (1.5-1.8), multiple births 1.3 (1.2-1.4), infants gestational week at birth: 22-27 gw 5.6 (4.8-6.5), 28-31 gw 2.6 (2.3-3.0) (gw 32-36 ref.), small for age 1.2 (1.1-1.4), and neonatal illness 1.4 (1.2-1.6).Conclusions: The strongest risk factors for not breastfeeding at discharge were low gestational weeks at birth, maternal illnesses and caesarean sectio. These findings are important and present challenges to health care to improve breastfeeding outcomes in these vulnerable groups of mothers and infants. References: 1. Victora CG, Bahl R, Barros AJD, França GVA, Horton S, Krasevec J, et al. Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect. The Lancet.387(10017):475-490. 2. Flacking R, Nyqvist KH, Ewald U. Effects of socioeconomic status on breastfeeding duration in mothers of preterm and term infants. European journal of public health. 2007;17(6):579-584.
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| 10. |
- Ericson, Jenny, et al.
(författare)
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The effectiveness of proactive telephone support provided to breastfeeding mothers of preterm infants : study protocol for a randomized controlled trial
- 2013
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Ingår i: BMC Pediatrics. - : Springer Science and Business Media LLC. - 1471-2431. ; 13
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Tidskriftsartikel (refereegranskat)abstract
- Background: Although breast milk has numerous benefits for infants' development, with greater effects in those born preterm (at < 37 gestational weeks), mothers of preterm infants have shorter breastfeeding duration than mothers of term infants. One of the explanations proposed is the difficulties in the transition from a Neonatal Intensive Care Unit (NICU) to the home environment. A person-centred proactive telephone support intervention after discharge from NICU is expected to promote mothers' sense of trust in their own capacity and thereby facilitate breastfeeding.Methods/design: A multicentre randomized controlled trial has been designed to evaluate the effectiveness and cost-effectiveness of person-centred proactive telephone support on breastfeeding outcomes for mothers of preterm infants. Participating mothers will be randomized to either an intervention group or control group. In the intervention group person-centred proactive telephone support will be provided, in which the support team phones the mother daily for up to 14 days after hospital discharge. In the control group, mothers are offered a person-centred reactive support where mothers can phone the breastfeeding support team up to day 14 after hospital discharge. The intervention group will also be offered the same reactive telephone support as the control group. A stratified block randomization will be used; group allocation will be by high or low socioeconomic status and by NICU. Recruitment will be performed continuously until 1116 mothers (I: 558 C: 558) have been included. Primary outcome: proportion of mothers exclusively breastfeeding at eight weeks after discharge.Secondary outcomes: proportion of breastfeeding (exclusive, partial, none and method of feeding), mothers satisfaction with breastfeeding, attachment, stress and quality of life in mothers/partners at eight weeks after hospital discharge and at six months postnatal age. Data will be collected by researchers blind to group allocation for the primary outcome. A qualitative evaluation of experiences of receiving/providing the intervention will also be undertaken with mothers and staff.Discussion: This paper presents the rationale, study design and protocol for a RCT providing person-centred proactive telephone support to mothers of preterm infants. Furthermore, with a health economic evaluation, the cost-effectiveness of the intervention will be assessed. Trial registration: NCT01806480
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