Growth Measurement Practices from a National Survey of Neonatal Nurses.

PURPOSE: To describe neonatal nurses' growth measurement practices, attitudes, knowledge, bases of practice knowledge, and barriers and facilitators for changing practice; and to identify differences in practices and knowledge by nursing organization, unit type, education, and experience. DESIGN AND METHODS: A cross-sectional online survey of U.S. neonatal nurses was distributed through two neonatal nursing organizations. RESULTS: The survey was completed by 301 nurses. Some evidence-based practices (EBPs) were infrequently reported including recording frontal-occipital head circumference (FOC) and length using 0.1 cm increments (17.9% and 17.6%, respectively); measuring FOC, weight, and length more than once before recording (61.9%, 27.2%, and 39.6%, respectively); and for length, using a length board instead of tape measure (19.4%), with a second person assisting (25.1%), with Frankfort plane head positioning (3.3%), and measuring from crown to heels of both feet (19.1%). Most nurses perceived their measurements as accurate or highly accurate (96.7% for FOC, 99.3% for weight, and 87.1% for length). The mean percentage correct on knowledge items was 68.1%. NICU nurses scored slightly better than well-newborn nurses (mean 69.3% correct vs. 65.1% correct, p = .04). Most based measurement practices on clinical practice guidelines (86.6%) and unit policies and procedures (85.9%). Team culture (33.3%) and insufficient resources (32.6%) were the most common barriers to EBP. The support of nurse managers (70.0%) and unit educators (68.5%) were common facilitators. CONCLUSIONS AND IMPLICATIONS: Knowledge gaps and practice improvement areas were identified. Results can inform interventions to improve the accuracy and reliability of neonatal growth measurement practices.

First-time mothers' breast-feeding maintenance: role of experiences and changes in maternal perceptions.

OBJECTIVE: Breast-feeding initiation rates have increased in the USA; however, maintenance of breast-feeding for recommended durations is low. The objective of the present study was to identify factors that may facilitate breast-feeding for longer durations among first-time mothers, including physiological and social experiences and changes in maternal perceptions. DESIGN: Survival analysis and linear regression methods were used to explore the relationship between experiences and breast-feeding duration, and the possible mediating effect of changes in maternal perceptions. SETTING: Secondary data from the Infant Feeding Practices Study II, conducted in the USA between 2005 and 2007. SUBJECTS: Data from 762 first-time mothers who ever breast-fed were analysed. RESULTS: Experiencing trouble with baby's latch, problems with milk flow/supply and painful breast-feeding were significantly associated with breast-feeding duration (64, 26 and 36 % shorter duration, respectively). Meanwhile, positive changes in perception with respect to breast-feeding self-efficacy, opinion about infant feeding and belief about breast milk were associated with 16-27 % longer duration. Furthermore, changes in perception were observed to partially mediate the impact of physiological experiences on breast-feeding duration. CONCLUSIONS: Perceptions of breast-feeding self-efficacy, beliefs and opinions can change over time and are influenced by breast-feeding experiences. The combined effect of experience and perception plays a key role in influencing breast-feeding duration. Future research should explore interventions to maintain or improve these perceptions while accounting for physiological experiences to support breast-feeding for recommended durations among first-time mothers.

Influence of Experiences and Perceptions Related to Breastfeeding One's First Child on Breastfeeding Initiation of Second Child.

Introduction Multiparas tend to initiate breastfeeding less than primiparas. While mothers often repeat the feeding method used for their first child with their second child, the way in which experiences and maternal perceptions related to breastfeeding one's first child may influence breastfeeding initiation with a second child remain underexplored. The objective of this study was to investigate whether physiological or social experiences, and related psychological factors, reported at the end of breastfeeding one's first child influence breastfeeding initiation with a second child. Methods Data from 174 multiparas who participated in the Infant Feeding Practices Study II, breastfed their first child, and completed the Year 6 Follow Up were analyzed using exact logistic regression. Results Mothers who reported experiencing trouble with the first baby's suck or latch had lower odds of initiating breastfeeding (OR 0.15, 95% CI 0.04-0.56) than those who did not report this experience, whereas mothers who agreed that breastfed children are less likely to become obese had greater odds of initiating breastfeeding with a second child (OR 11.49, 95% CI 1.56-513.18) than those who did not agree. Discussion Efforts to facilitate breastfeeding initiation among multiparas may consider mothers' previous experiences and beliefs associated with breastfeeding. Strategies to facilitate initiation may focus on addressing barriers mothers experienced while breastfeeding their first child and increasing awareness about how breastfeeding may prevent childhood obesity. Future research should explore how such approaches may impact breastfeeding outcomes with subsequent children.

The Beginning Breastfeeding Survey: measuring mothers' perceptions of breastfeeding effectiveness during the postpartum hospitalization.

No current breastfeeding assessment tool assesses the mother's perception of breastfeeding effectiveness during the early postpartum. Psychometric analysis of a new tool, the Beginning Breastfeeding Survey (BBS), in a multi-racial sample of 131 women revealed a coefficient alpha of .90. Factor analysis yielded three factors, (a) Maternal Breastfeeding Competence and Emotional Satisfaction, (b) Maternal Discomfort and Anxiety, and (c) Infant Breastfeeding Skill and Emotional Satisfaction. The BBS demonstrated discriminant validity in known group analyses and convergent validity with breastfeeding self-efficacy and postpartum fatigue. Future research will focus on improving the internal consistency reliability of the BBS and examining its ability to identify women at risk for breastfeeding problems during the postpartum hospitalization.

Mother-Infant Breastfeeding Progress Tool: a guide for education and support of the breastfeeding dyad.

OBJECTIVE: To describe the development of the Mother-Infant Breastfeeding Progress Tool to be used at the bedside by nurses to guide ongoing support and education for the mother-baby dyad. DESIGN: Cross-sectional study. SETTING: Community hospital in a Midwestern city. PARTICIPANTS: Sixty-two English-speaking mother-infant dyads. METHODS: Three nurse raters (two per session) independently scored the eight characteristics on the Mother-Infant Breastfeeding Progress Tool during 81 breastfeeding sessions. MAIN OUTCOME MEASURE: Percent agreement between raters and suggested modifications for the Mother-Infant Breastfeeding Progress Tool. RESULTS: The results support the use of the tool as a checklist for assessment of the breastfeeding mother-infant dyad to guide education and support. CONCLUSIONS: The interrater agreement was high for individual items of the Mother-Infant Breastfeeding Progress Tool. The Mother-Infant Breastfeeding Progress Tool is useful as a checklist for assessing maternal and infant breastfeeding progress, though additional research is needed to support the validity of the tool.

A concept analysis of effective breastfeeding.

OBJECTIVE: To provide a concept analysis of effective breastfeeding. DATA SOURCES: Medline and CINAHL electronic databases, reference lists from selected articles, and 7 breastfeeding assessment tools. Search terms included the following: breastfeeding and effective, adequate, successful. STUDY SELECTION: Literature was selected according to whether the concept of effective breastfeeding was defined or described. DATA EXTRACTION: Literature was reviewed and data organized as definitions or descriptions, with descriptions grouped into categories sharing similar characteristics. DATA SYNTHESIS: Four characteristics were chosen as essential attributes of effective breastfeeding: positioning, latch, sucking, and milk transfer. CONCLUSIONS: The concept of effective breastfeeding requires further concept development to define and describe effective positioning, latch, sucking, and milk transfer. Future research is needed to determine the relationships between the antecedents, attributes, and consequences of effective breastfeeding.

The healthy newborn hydration model: a new model for understanding newborn hydration immediately after birth.

The normal small volume of breast milk produced in the first 2 days following birth may raise concerns about adequate hydration in breast-fed newborns. These concerns are further magnified when breast-fed infants lose ≥7% of their birth weight within 2 days postnatally. Weight loss following birth is presumably mostly water loss that could result in hypohydration and subsequent hypernatremic dehydration. However, excess fluid loss immediately following birth is a normal and necessary process. Furthermore, newborns exposed to excess fluid intake during labor may need to lose ≥7% of birth weight in the first 2 days following birth in order to achieve euhydration. Normal newborn fluid loss following birth confounds the use of weight loss as the sole measure of newborn hydration. We thus propose the healthy newborn hydration model that highlights the normalcy of newborn weight loss immediately following birth and the healthy newborn's compensatory mechanisms for preserving adequate hydration. We also recommend the use of serum sodium to measure intravascular osmolarity in addition to monitoring weight loss to obtain a more comprehensive newborn hydration assessment. Research is necessary in healthy newborns to identify relationships among fluids received in utero, newborn weight loss, and hydration, as evaluated with laboratory measures, in the first 2 days following birth. This information will guide clinicians in correctly identifying newborns with inadequate hydration who are in need of supplementary fluids versus newborns with adequate hydration for whom exclusive breast-feeding can be supported and encouraged.

Excessive weight loss in breastfed infants during the postpartum hospitalization.

OBJECTIVE: To examine differences in breastfeeding frequency, voids, and stools in infants with weight losses < or > or =7% during the postpartum hospitalization. DESIGN: Secondary analysis of data from a primary psychometric study examining the Mother Infant Breastfeeding Progress Tool (MIBPT). SETTING: A midwestern community hospital in a multicultural racially diverse community. PARTICIPANTS: Convenience sample of 53 breastfeeding women and infants hospitalized after birth. METHODS: Data were collected during a chart review; infants were divided into < or > or =7% weight loss groups at 2 days postpartum, and breastfeeding frequency, voiding, and stooling were examined between groups and used to predict a > or =7% weight loss at 2 days postpartum. RESULTS: Of the 53 infants, 20.8% lost > or =7% of their birth weight. Infants who lost > or =7% of their birth weight had significantly more total voids and a higher breastfeeding frequency on the day of birth than infants who lost <7% of their birth weight. A logistic regression analysis resulted in total voids being the only significant predictor of a > or =7% weight loss, with an odds ratio of 1.74 (95% CI=1.09, 2.75, p <; .05). CONCLUSION: In the absence of other indicators of ineffective breastfeeding, breastfeeding infants who lose > or =7% of their birth weight during the first 2 days postpartum might be experiencing a physiologic diuresis after birth, unrelated to their breastfeeding behaviors. More research is necessary to determine the cause of a > or =7% weight loss in newborns during the first 48 hours after birth.