Jul 5, 2010 - d Department of Pediatrics, Arnold Palmer Hospital for Children, Florida State University College of. Medicine, Orlando, Florida; e Department ...
ABSTRACTS Residency Curriculum Improves Breastfeeding Care Pediatrics 2010;126;289-297; originally published online Jul 5, 2010 Lori Feldman-Winter, MD, MPHa, Lauren Barone, MPHb, Barry Milcarek, PhDc, Krystal Hunter, MBAc, Joan Meek, MD, MS, RDd, Jane Morton, MDe, Tara Williams, MDf, Audrey Naylor, MD, DrPHg,h, Ruth A. Lawrence, MDi a
Division of Adolescent Medicine, Department of Pediatrics, and Division of Research and Statistics, Cooper University Hospital, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, Camden, New Jersey; b Division of Pediatric Practice, American Academy of Pediatrics, Elk Grove Village, Illinois; d Department of Pediatrics, Arnold Palmer Hospital for Children, Florida State University College of Medicine, Orlando, Florida; e Department of Pediatrics, Stanford University, Palo Alto, California; f Division of Research and Statistics, Department of Pediatrics, Case Western Reserve University, Cleveland, Ohio; g Department of Pediatrics, University of Vermont College of Medicine, Burlington, Vermont; h Wellstart International, Shelburne, Vermont; and i Departments of Pediatrics and Obstetrics and Gynecology, University of Rochester, School of Medicine and Dentistry, Rochester, New York c
OBJECTIVES Multiple studies have revealed inadequacies in breastfeeding education during residency, and results of recent studies have confirmed that attitudes of practicing pediatricians toward breastfeeding are deteriorating. In this we study evaluated whether a residency curriculum improved physician knowledge, practice patterns, and confidence in providing breastfeeding care and whether implementation of this curriculum was associated with increased breastfeeding rates in patients. SUBJECTS AND METHODS A prospective cohort of 417 residents was enrolled in a controlled trial of a novel curriculum developed by the American Academy of Pediatrics in conjunction with experts from the American College of Obstetricians and Gynecologists, American Academy of Family Physicians, and Association of Pediatric Program Directors. Six intervention residency programs implemented the curriculum, whereas 7 control programs did not. Residents completed pretests and posttests before and after implementation. Breastfeeding rates were derived from randomly selected medical charts in hospitals and clinics at which residents trained. RESULTS Trained residents were more likely to show improvements in knowledge (odds ratio [OR]: 2.8 [95% confidence interval (CI): 1.5–5.0]), practice patterns related to breastfeeding (OR: 2.2 [95% CI: 1.3– 3.7]), and confidence (OR: 2.4 [95% CI: 1.4–4.1]) than residents at control sites. Infants at the institutions in which the curriculum was implemented were more likely to breastfeed exclusively 6 months after intervention (OR: 4.1 [95% CI: 1.8–9.7]). CONCLUSIONS A targeted breastfeeding curriculum for residents in pediatrics, family medicine, and obstetrics and gynecology improves knowledge, practice patterns, and confidence in breastfeeding management in residents and increases exclusive breastfeeding in their patients. Implementation of this curriculum may similarly benefit other institutions.
Prolonged and Exclusive Breastfeeding Reduces the Risk of Infectious Diseases in Infancy Pediatrics published online Jun 21, 2010 DOI: 10.1542/peds.2008-3256 Liesbeth Duijts, MD, PhDa,b, Vincent W. V. Jaddoe, MD, PhDa,b,c, Albert Hofman, MD, PhDc, Henriëtte A. Moll, MD, PhDb a
Generation R Study Group, Rotterdam, Netherlands; and Departments of b Pediatrics and c Epidemiology, Erasmus Medical Center, Rotterdam, Netherlands OBJECTIVE To examine the associations of duration of exclusive breastfeeding with infections in the upper respiratory (URTI), lower respiratory (LRTI), and gastrointestinal tracts (GI) in infancy. METHODS This study was embedded in the Generation R Study, a population-based prospective cohort study from fetal life onward in the Netherlands. Rates of breastfeeding during the first 6 months (never; partial for 2 months, with complete data on all variables (n = 1907). Predictor variables included indicators of 6 "Baby-Friendly" practices (breastfeeding initiation within 1 hour of birth, giving only breast milk, rooming in, breastfeeding on demand, no pacifiers, fostering breastfeeding support groups) along with several other maternity-care practices. The main outcome measure was breastfeeding termination before 6 weeks. RESULTS. Only 8.1% of the mothers experienced all 6 "Baby-Friendly" practices. The practices most consistently associated with breastfeeding beyond 6 weeks were initiation within 1 hour of birth, giving only breast milk, and not using pacifiers. Bringing the infant to the room for feeding at night if not rooming in and not giving pain medications to the mother during delivery were also protective against early breastfeeding termination. Compared with the mothers who experienced all 6 "Baby-Friendly" practices, mothers who experienced none were 13 times more likely to stop breastfeeding early. Additional practices decreased the risk for early termination. CONCLUSIONS. Increased "Baby-Friendly" hospital practices, along with several other maternity-care practices, improve the chances of breastfeeding beyond 6 weeks. The need to work with hospitals to implement these practices continues to exist, as illustrated by the small proportion of mothers who reported experiencing all 6 of the "Baby-Friendly" hospital practices measured in this study.
Breastfeeding Rates in US Baby-Friendly Hospitals: Results of a National Survey Pediatrics 2005;116;628-634 Anne Merewood, Supriya D. Mehta, Laura Beth Chamberlain, Barbara L. Philipp and Howard Bauchner OBJECTIVES. The objectives of this study were to analyze all available breastfeeding data from US Baby-Friendly hospitals in 2001 to determine whether breastfeeding rates at Baby-Friendly designated hospitals differed from average US national, regional, and state rates in the same year and to determine prime barriers to implementation of the Baby-Friendly Hospital Initiative. SUBJECTS AND METHODS. In 2001, 32 US hospitals had Baby-Friendly designation. Using a crosssectional design with focused interviews, this study surveyed all 29 hospitals that retained that designation in 2003. Demographic data, breastfeeding rates, and information on barriers to becoming Baby-Friendly were also collected. Simple linear regression was used to assess factors associated with breastfeeding initiation. RESULTS. Twenty-eight of 29 hospitals provided breastfeeding initiation rates: 2 from birth certificate data and 26 from the medical record. Sixteen provided inhospital, exclusive breastfeeding rates. The mean breastfeeding initiation rate for the 28 Baby-Friendly hospitals in 2001 was 83.8%, compared with a US breastfeeding initiation rate of 69.5% in 2001. The mean rate of exclusive breastfeeding during the hospital stay (16 of 29 hospitals) was 78.4%, compared with a national mean of 46.3%. In simple linear regression analysis, breastfeeding rates were not associated with number of births per institution or with the proportion of black or low-income patients. Of the Ten Steps to Successful Breastfeeding
the 3 described as most difficult to meet were Steps 6, 2, and 7. The reason cited for the problem with meeting Step 6 was the requirement that the hospital pay for infant formula. CONCLUSIONS. Baby-Friendly designated hospitals in the United States have elevated rates of breastfeeding initiation and exclusivity. Elevated rates persist regardless of demographic factors that are traditionally linked with low breastfeeding rates.
Baby-Friendly Hospital Initiative Improves Breastfeeding Initiation Rates in a US Hospital Setting Pediatrics 2001; 108:677– 681 Barbara L. Philipp, MD, IBCLC; Anne Merewood, MA, IBCLC; Lisa W. Miller, BA; Neetu Chawla, BA; Melissa M. Murphy-Smith, BS; Jenifer S. Gomes, BA; Sabrina Cimo, BA, MPH; and John T. Cook, PhD OBJECTIVE. Breastfeeding initiation rates were compared at Boston Medical Center before (1995),during (1998), and after (1999) Baby-Friendly policies were in place. Boston Medical Center, an inner-city teaching hospital that provides care primarily to poor, minority, and immigrant families, achieved Baby-Friendly status in 1999. METHODS. Two hundred complete medical records, randomly selected by a computer, were reviewed from each of 3 years: 1995, 1998, and 1999. Infants were excluded for medical records missing feeding data, human immunodeficiency virus–positive parent, neonatal intensive care unit admission, maternal substance abuse, adoption, incarceration, or hepatitis C–positive mother. All infant feedings during the hospital postpartum stay were tallied, and each infant was categorized into 1 of 4 groups: exclusive breast milk, mostly breast milk, mostly formula, and exclusive formula. RESULTS. Maternal and infant demographics for all 3 years were comparable. The breastfeeding initiation rate increased from 58% (1995) to 77.5% (1998) to 86.5% (1999). Infants exclusively breastfed increased from 5.5% (1995) to 28.5% (1998) to 33.5% (1999). Initiation rates increased among US-born black mothers in this population from 34% (1995) to 64% (1998) to 74% (1999). CONCLUSIONS. Full implementation of the Ten Steps to Successful Breastfeeding leading to BabyFriendly designation is an effective strategy to increase breastfeeding initiation rates in the US hospital setting.
Promotion of Breastfeeding Intervention Trial (PROBIT) A Randomized Trial in the Republic of Belarus JAMA. 2001;285:413-420. Michael S. Kramer, MD; Beverley Chalmers, PhD; Ellen D. Hodnett, PhD; Zinaida Sevkovskaya, MD; Irina Dzikovich, MD,PhD; Stanley Shapiro, PhD; Jean-Paul Collet, MD,PhD; Irina Vanilovich, MD; Irina Mezen, BA; Thierry Ducruet, MSc; George Shishko, MD,DMSc; Vyacheslav Zubovich, MD,PhD; Dimitri Mknuik, MD,PhD; Elena Gluchanina, MD; Viktor Dombrovskiy, MD,PhD; Anatoly Ustinovitch,
MD,PhD; Tamara Kot, MD; Natalia Bogdanovich, MD,PhD; Lydia Ovchinikova, RN; Elisabet Helsing, PhD; for the PROBIT Study Group Context Current evidence that breastfeeding is beneficial for infant and child health is based exclusively on observational studies. Potential sources of bias in such studies have led to doubts about the magnitude of these health benefits in industrialized countries. OJJECTIVE To assess the effects of breastfeeding promotion on breastfeeding duration and exclusivity and gastrointestinal and respiratory infection and atopic eczema among infants. METHOD The Promotion of Breastfeeding Intervention Trial (PROBIT), a cluster-randomized trial conducted June 1996–December 1997 with a 1-year follow-up. Thirty-one maternity hospitals and polyclinics in the Republic of Belarus. A total of 17 046 mother-infant pairs consisting of full-term singleton infants weighing at least 2500 g and their healthy mothers who intended to breastfeed, 16491 (96.7%) of which completed the entire 12 months of follow-up. Sites were randomly assigned to receive an experimental intervention (n = 16) modeled on the Baby-Friendly Hospital Initiative of the World Health Organization and United Nations Children's Fund, which emphasizes health care worker assistance with initiating and maintaining breastfeeding and lactation and postnatal breastfeeding support, or a control intervention (n = 15) of continuing usual infant feeding practices and policies. MEASURES Duration of any breastfeeding, prevalence of predominant and exclusive breastfeeding at 3 and 6 months of life and occurrence of 1 or more episodes of gastrointestinal tract infection, 2 or more episodes of respiratory tract infection, and atopic eczema during the first 12 months of life, compared between the intervention and control groups. RESULTS Infants from the intervention sites were significantly more likely than control infants to be breastfed to any degree at 12 months (19.7% vs 11.4%; adjusted odds ratio [OR], 0.47; 95% confidence interval [CI], 0.32-0.69), were more likely to be exclusively breastfed at 3 months (43.3% vs 6.4%; P
