Impact of structured programs on breastfeeding initiation rates in preterm neonates in a socioeconomically deprived area in France: A 10-year population-based study.

Structured programs have a positive impact on breastfeeding (BF) but have rarely been evaluated for preterm neonates, frequently combining prematurity and socioeconomic deprivation as risk factors of a low BF rate. We aimed to assess BF initiation rates in very preterm (<33 weeks' gestational age), moderately preterm (33-36 weeks), and term neonates from 2002 to 2011 in a French administrative district characterized by socioeconomic deprivation. Structured activities to promote and support BF have been implemented in this area since 2002; they all started in neonatal units. This retrospective population-based study analyzed 302,102 first health certificates. Overall, the BF initiation rate significantly increased, from 52.9% [95% CI: (52.3; 53.4)] in 2002 to 61.0% [95% CI: (60.4; 61.6)] in 2011. In 2002, BF initiation rates did not differ between groups, but in 2011, it was higher for very preterm than for term and moderately preterm neonates [74.7% (69.7; 79.6)] vs. 60.9% (60.3; 61.5) and 59.9% (57.6; 62.2), respectively, both P<0.001. In 2011, however, no difference was observed between moderately preterm children and term-born children (P=0.40). The 2.2% yearly increase observed in very preterm neonates significantly differed from the 0.9% yearly increase in the French general population (P<0.001). CONCLUSION: Structured BF programs initiated in neonatal care units may have a positive impact on BF initiation rates in very preterm neonates, but not in moderately preterm neonates, whose specific needs should be further evaluated.

[Birth of a child with Down syndrome: parental choice or failure of screening policy?]. / Naissance d'un enfant porteur de trisomie 21: choix parental ou défaut de la politique de dépistage ?

OBJECTIVES: Birth of a child with Down syndrome (DS) can follow parental choice or failure of screening. The objective of this work is to describe the circumstances of births of children with DS in a French perinatal health network. METHODS: Retrospective multicentric study, with prospective trial registration of all children born alive with DS, between 2010 and 2013. RESULTS: Sixty-three children were born with DS. Complete screening was performed by 61 % of patients, incomplete screening by 29 % of patients and no screening test by 10 %. Among these births, 50 % occurred following parental choice, 40 % following failure of screening and for 10 %, parental choice concerning screening was unknown. False negative had often calculating risk close to 1/1000. CONCLUSION: In this study, the birth of a child with DS occurred following parental choice in half of cases. It's necessary, to optimize the follow-up, to document in medical records the medical information and parental choice concerning DS screening and data of screening when this was done.

[Breastfeeding: opinion and knowledge of pharmacists. A study in a semi-urban territory]. / Allaitement maternel : opinions et connaissances des pharmaciens dans la métropole lilloise.

BACKGROUND: Because of the French delay regarding breastfeeding compared to other Europeans countries, its promotion was one of the 9 specific nutritional goals of the 2001, 2006, and 2011 National Nutritional Health Program. The objective of this study was to establish the opinion and knowledge of pharmacists from a selected semi-urban territory of the Lille metropolitan area on breastfeeding. METHOD: The 33 pharmacies around the city of Villeneuve-d'Ascq were contacted. First, the goal and the principles of the study were presented to the pharmacists and they were invited to participate in a survey. This survey was divided into 6 topics with 26 questions. The topics were: advice on breastfeeding, pain and inflammation during breastfeeding, use of a breast pump, preservation and reheating of breast milk, breastfeeding and medication, breastfeeding and contraception, and breastfeeding promotion. The survey also evaluated their willingness to promote breastfeeding and the assistance needed for undertaking this promotion. By counting the right answers from 13 of the 26 questions, a global grade was calculated reflecting the knowledge of the participants. The maximum grade was 20 because many questions had several correct answers. RESULTS: Twenty-nine pharmacies agreed to participate (participation rate, 88%). The mean grade was 13.4 (95% CI: 12.7-14.0). Professional and personal experience had no influence on the grades. In the opinion of the pharmacists, the 3 topics most frequently raised by women were cracked nipples, mastitis, and painful breast (quoted by 83% of the pharmacists), the infant formula to use as a complete or partial substitute for breastfeeding (66%), and breastfeeding and medication (59%). Fifty-five percent of the participants were aware of the WHO recommendations on exclusive breastfeeding up to 6 months of age. The desire to promote breastfeeding was strong (68%). Thus, all pharmacists favored the distribution of a leaflet giving information on breastfeeding. CONCLUSION: This study shows a strong desire to promote breastfeeding among the pharmacists surveyed. It allows focusing on the themes that could be the target for continuing education, based on mothers' needs.

[Lactation counselling support provided to mothers of preterm babies who intend to breastfeed. Evaluation of an educational intervention in a level III perinatal unit]. / Accompagnement des mères de nouveau-nés prématurés dans leur projet d'allaitement maternel. Evaluation d'un programme de formation dans une unité périnatale de niveau III.

OBJECTIVE: To evaluate the educational intervention provided in a perinatal unit to support mothers of preterm babies who intend to breastfeed. PATIENTS AND METHODS: The study was prospective and included all the infants born between 30 and 34 weeks of gestation at the Jeanne-de-Flandre university hospital in Lille and whose mothers intended to breastfeed. The studied period extended from January to December 2005, comparing the first and the last semester. The different actions were guided by the formation of the staff and lactation counselling to mothers, especially in the initiation of lactation. They were provided by one full-time nurse who was lactation consultant. The main outcome measure was the time to the first breast milk expression. Secondary outcome was the rate of infants breastfed at discharge. RESULTS: Twenty-one educational interventions were organised for all the people working in the unit. One hundred thirty-two nurses and 17 doctors attended to these sessions. During the study period, 175 babies were born preterm at a gestational age between 30 and 34 weeks: 81 during the first semester and 94 during the second. The two populations were comparable for gestational age and the social class of the mothers, but the birth weight was higher during the second semester (1681+/-140 vs 1774+/-216 g, P=0, 01). Mothers of 65.1% of the neonates intended to breastfeed. The time of the first breast milk expression decreased significatively during the second semester (37,5 vs 30,7 h, P<0, 01). The rate of exclusively or partially breastfed neonates at discharge was stable (88,5 vs 91,9%, ns). CONCLUSION: The program improved the initiation of lactation. This work emphasises the difficulties and the different steps necessary to promote breastfeeding in preterm babies with respect to developmental care.

[Skin to skin contact in neonatal care: knowledge and expectations of health professionals in 2 neonatal intensive care units]. / Le peau à peau en médecine néonatale: connaissances et attentes des professionnels de santé dans deux unités de néonatologie de niveau III.

UNLABELLED: Skin to skin contact is a method derived from kangaroo care whose implementation in industrialized countries has rarely been assessed. OBJECTIVES: To evaluate the barriers, knowledge and expectations of health professionals regarding this care in 2 level III neonatal care units in the Nord-Pas-de-Calais. MATERIALS AND METHODS: Investigation was conducted by means of 2 questionnaires, one intended to physicians, the other to the nursing staff sharing some common questions. The 2 neonatal units differed by the level of implementation of skin to skin contact. Results were compared according to occupation and site of work. RESULTS: 80% of the physicians and 71.4% of the paramedical staff answered to the questionnaires. The difficulties were linked to technical or architectural constraints. Responses were not very different between the 2 teams. The majority (90%) considered this practice as a fully-fledged care. The positive effects on attachment (96% of the answers) were well-known but those on sleep (2,9%), breast-feeding (5%) and pain (0%) were only rarely mentioned. Barriers to implementation were centred on infant's safety. The majority of the team wished to benefit from an educational intervention. DISCUSSION: Although the perception of skin to skin contact was positive in these 2 teams, increased knowledge of the evidence supporting its practice could enable babies and parents to benefit from all its positive effects. The need for educational program was clearly mentioned to improve parents' information. CONCLUSION: This work emphasises the complexity of introducing new procedures in neonatal care particularly in the field of developmental care.