| 1. |
- 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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| 2. |
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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, 1976-
(författare)
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Breastfeeding in mothers of preterm infants : Prevalence and effects of support
- 2018
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aim of this thesis was to describe the prevalence of breastfeeding in preterm infants and to evaluate the effectiveness and mother’s experiences of proactive person-centred telephone support after discharge. Furthermore, to describe the duration of breastfeeding and risks of ceasing breastfeeding up to 12 months. The first study, a register study with data from the Swedish Neonatal Quality register (SNQ), included breastfeeding data at discharge from 29 445 preterm infants born from 2004-2013. The results demonstrated that the prevalence of exclusive breastfeeding among preterm infants in Sweden decreased during the study period, especially among extremely preterm infants (<28 weeks). We also performed a multicentre randomised controlled trial (RCT) of 493 breastfeeding mothers of preterm infants discharged from six neonatal units in Sweden. The intervention consisted of a proactive breastfeeding telephone support system in which a breastfeeding support team called the mothers once everyday up to 14 days after discharge. The control group received reactive support; the mothers were invited to call the breastfeeding support team if they wanted to talk or ask any questions (i.e., usual care).The RCT demonstrated that the intervention did not affect exclusive breastfeeding at eight weeks after discharge (primary outcome) or up to 12 months. The proactive support did not affect maternal breastfeeding satisfaction, attachment, quality of life or method of feeding (secondary outcomes). However, parental stress was significantly reduced in mothers in the intervention group. Mothers in the intervention group were significantly more satisfied and involved in the support and felt empowered compared with mothers in the control group, who experienced reactive support as dual. Further findings showed that a lower maternal educational level, partial breastfeeding at discharge and longer stay in the neonatal unit increased the risk of ceasing breastfeeding during the first 12 months of postnatal age. In conclusion, the trend for exclusive breastfeeding at discharge in preterm infants is declining, which necessitates concern. The evaluated intervention of telephone support did not affect breastfeeding, in the short-or long-term. However, maternal stress was reduced and mothers were significantly more satisfied with the proactive support and felt empowered by the support.
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| 5. |
- Ericson, Jenny, et al.
(författare)
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Breastfeeding satisfaction post hospital discharge and associated factors - a longitudinal cohort study of mothers of preterm infants
- 2021
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Ingår i: International Breastfeeding Journal. - : BioMed Central (BMC). - 1746-4358. ; 16:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Mothers' satisfaction with breastfeeding is important for breastfeeding duration but rarely investigated in mothers of preterm infants. The aim of this study was to describe breastfeeding satisfaction and associated factors during the first year in mothers of preterm infants (gestational age < 37 weeks). Methods: This longitudinal cohort study, based on secondary analysis data from a randomized controlled trial, included 493 mothers of 547 preterm infants. Data on breastfeeding duration and satisfaction, parental stress and attachment were collected at 8 weeks post discharge, and at 6 and 12 months after birth. Breastfeeding satisfaction was measured by the Maternal Breastfeeding Evaluation Scale. Descriptive statistics and linear mixed effect models were used when analyzing the data. Results: During the first 12 months breastfeeding satisfaction increased in the mean summary scores and points in the dimensions "role attainment" and "lifestyle and maternal body image". In the dimension "infant growth and satisfaction", there was an increase in mean points from 6 to 12 months after birth, but not between 8 weeks after discharge and 12 months after birth. The findings also showed that partial and no breastfeeding, higher parental stress, and infant gestational age < 32 weeks were associated with decreased breastfeeding satisfaction. Older maternal age and greater maternal attachment were associated with increased maternal breastfeeding satisfaction. There were no associations between maternal breastfeeding satisfaction and maternal educational level, parity, multiple birth, or maternal birth country other than Sweden, during the first 12 months after birth. Conclusions: Breastfeeding satisfaction was clearly associated with breastfeeding duration during the first year after birth. Breastfeeding satisfaction may be important to take into account when supporting breastfeeding and when designing interventions to support breastfeeding. Furthermore, these findings highlight the complexity of breastfeeding and emphasize the need for early and good support during neonatal care, so that mothers feel trust in themselves and their infant and in exclusive breastfeeding at discharge and in the first months thereafter.
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| 6. |
- 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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| 7. |
- 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. |
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| 9. |
- Ericson, Jenny, et al.
(författare)
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Estimated Breastfeeding to Support Breastfeeding in the Neonatal Intensive Care Unit
- 2013
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Ingår i: Journal of Obstetric, Gynecologic and Neonatal Nursing. - : Elsevier BV. - 0884-2175 .- 1552-6909. ; 42:1, s. 29-37
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Tidskriftsartikel (refereegranskat)abstract
- Objective To evaluate the effects of estimated breastfeeding on infant outcomes in comparison to test weighing and to describe staff members experiences of estimated breastfeeding as a method for supporting the transition from tube feeding to breastfeeding. Design A mixed method evaluation. Setting Neonatal Intensive Care Unit (NICU) in Sweden. Participants The study included 365 preterm (25th36th gestational weeks) infants and 45 nurses or nurse assistants. Methods A retrospective comparative medical record study was used to assess infant outcomes during a period of test weighing (196 infants) and again after the implementation of estimated breastfeeding (169 infants). A qualitative survey was conducted to explore the staff experiences of estimated breastfeeding. Results No differences were found between groups regarding duration of tube feeding, length of hospital stay, gestational age, weight at discharge, and rate of any breastfeeding. Infants in the estimated breastfeeding group had a higher risk of not being exclusively breast milk fed than infants in the test-weighing group (OR = 2.76, CI [1.5, 5.1]). Staff perceived estimated breastfeeding as a more facilitative and less stressful method for mothers than test weighing. Some staff had difficulty following guidelines while simultaneously providing person-centered care. Conclusions Estimated breastfeeding is a nonintrusive and feasible method for assessing and supporting the transition from tube feeding to breastfeeding among preterm infants in a NICU. However, the increased risk for not being exclusively breastfed is of concern. Additional research is needed to assess whether this method is appropriate and feasible in varying contexts and cultures.
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