Evaluation of Home Phototherapy for Neonatal Hyperbilirubinemia.

OBJECTIVE: To characterize home phototherapy treatment for neonatal hyperbilirubinemia and assess the risk factors associated with the need for hospital admission during or after home phototherapy. STUDY DESIGN: This was a retrospective study of newborn infants born at ≥35 weeks of gestation who underwent comprehensive home phototherapy (that included daily in-home lactation support and blood draws) over an 18-month period. We excluded infants who lacked a recorded birth date or time, started treatment at age >14 days, or had a conjugated serum bilirubin level of ≥2 mg/dL (≥34.2 µmol/L). The primary study outcome was any hospital admission during or within 24 hours after completion of home phototherapy. Logistic regression was used to identify risk factors for hospitalization. RESULTS: Of the cohort of 1385 infants, 1324 met the inclusion criteria. At the time home phototherapy was initiated, 376 infants (28%) were at or above the American Academy of Pediatrics phototherapy threshold. Twenty-five infants required hospitalization (1.9%; 95% CI, 1.3%-2.8%). Hospital admission was associated with a younger age at phototherapy initiation (OR, 0.63 for each day older in age; 95% CI, 0.44-0.91) and a higher total serum bilirubin level relative to the treatment threshold at phototherapy initiation (OR, 1.71 for each 1 mg/dL above the treatment threshold; 95% CI, 1.40-2.08). CONCLUSIONS: Comprehensive home phototherapy successfully treated hyperbilirubinemia in the vast majority of the infants in this cohort.

Phototherapy for the Treatment of Neonatal Jaundice and Breastfeeding Duration and Exclusivity.

INTRODUCTION: Because neonatal jaundice remains one of the most commonly treated conditions of the newborn infant, it is important to assess the unintended consequences of treatment with phototherapy. The objective of this study was to evaluate whether treatment with phototherapy affects breastfeeding duration in newborns >35 weeks gestation. MATERIALS AND METHODS: We analyzed data from the Infant Feeding Practices Study II. The exposure of interest was treatment of neonatal jaundice with phototherapy. The outcomes of interest were any breastfeeding through 12 months and exclusive breastfeeding through 4 months. Logistic regression models were developed to evaluate the association between the exposure and outcomes of interest. All models were adjusted for maternal age, race, education, household income, and gestational age, as well as for several potential markers of suboptimal breastfeeding. RESULTS: Our study included 4,441 infants, of which 220 (5%) received phototherapy. We found no difference in the likelihood of any breastfeeding through 9 months of age, however, by 12 months, infants exposed to phototherapy were less likely to still be breastfed than those who were not exposed (adjusted odds ratio [aOR] 0.58, 95% confidence interval [95% CI] 0.37-0.92). Infants exposed to phototherapy were less likely to be exclusively breastfed throughout the first 4 months of life. CONCLUSION: Although phototherapy use did not substantially impact rates of any breastfeeding during the first year, it was associated with decreased rates of exclusive breastfeeding in the first 4 months of life. This suggests that we need to tailor messaging to mothers of infants receiving phototherapy to promote exclusive breastfeeding.

The Impact of Mailed Samples of Infant Formula on Breastfeeding Rates.

INTRODUCTION: Decades of research supports the health benefits of breastfeeding. Prior studies have shown that hospital discharge bags containing free samples of infant formula are associated with decreased breastfeeding exclusivity. This study aims to determine if receiving a free sample of infant formula in the mail has an impact on breastfeeding duration and exclusivity. MATERIALS AND METHODS: This was a cohort study analyzing data from the Infant Feeding Practices Study II. The main outcomes of interest were any breastfeeding through 12 months of age and exclusive breastfeeding through 6 months of age. The main predictor of interest was receipt of a free sample of infant formula in the mail around the time of the infant's birth. Logistic regression models were developed to evaluate the association between the outcomes and predictor of interest at each month. RESULTS: This study included 3,031 infants; mothers of 1,741 (57.4%) received a sample of infant formula in the mail. There was no difference in the likelihood of any breastfeeding at each month among those who received formula in the mail compared with those who did not. There was also no difference in exclusive breastfeeding through 5 months; however, by 6 months of age infants whose mothers received formula in the mail were less likely to be exclusively breastfed (odds ratio = 0.57; 95% confidence interval, 0.37, 0.89). CONCLUSIONS: Receiving infant formula in the mail decreases the likelihood of exclusive breastfeeding by 6 months of age while having no impact on the duration of any breastfeeding.

Relationship of maternal perceptions of workplace breastfeeding support and job satisfaction.

OBJECTIVES: Decades of research supports the health benefits of breastfeeding. Prior research has shown that unsupportive work environments are frequently cited as reasons women abandon breastfeeding early. The objective of this study is to determine if mothers' perceptions of workplace lactation support are associated with job satisfaction. MATERIALS AND METHODS: Female employees of Seattle Children's Hospital (SCH) and a large corporation were e-mailed a survey to measure perceptions of workplace lactation support. Women were eligible to participate if they had a child born within the last 5 years. Questions were asked about lactation support across five domains; organization, manager, coworker, time, and physical environment. The main outcome was job satisfaction. Linear regression models were run to evaluate the association between workplace support scores and the outcome of interest. RESULTS: The survey was completed by 420 women at SCH and 131 women at the large corporation (response rate, 47%). Ninety-eight percent of study participants initiated breastfeeding, and most sustained breastfeeding for at least 6 months. Increased total workplace support score was associated with increased job satisfaction at both companies (p<0.001). Increased support scores within each domain were independently associated with increased job satisfaction (p values<0.005). When all domains were considered together, only manager and coworker supports were significant at SCH (p=0.04), and only time support was significant at the large corporation (p=0.01). The workplace support score was not significantly associated with breastfeeding duration at either institution. CONCLUSIONS: Improved lactation support in the workplace may improve new mothers' job satisfaction, which could be beneficial to businesses.