Nurse-Driven Initiative to Increase Exclusive Human Milk Feeding by Using Pasteurized Donor Human Milk to Treat Hypoglycemic Term Neonates.

OBJECTIVE: To increase exclusive breastfeeding by offering pasteurized donor human milk (PDHM) to newborns with hypoglycemia. DESIGN: Quality improvement project. SETTING/LOCAL PROBLEM: A Baby-Friendly Hospital Initiative-designated urban academic medical center in the northeastern United States serving a diverse population where, by policy, virtually all newborns with hypoglycemia received supplemental infant formula. Approximately 85% of women cared for at this center initiate breastfeeding, but many struggle with exclusive breastfeeding during the hospital stay. PARTICIPANTS: All staff members in the labor and delivery unit and the mother/baby unit, including registered nurses, unit clerks, patient care technicians, and lactation consultants. Term, breastfed newborns identified as being hypoglycemic per our guidelines were eligible to receive PDHM. INTERVENTION/MEASUREMENTS: Registered nurses provided education about PDHM to parents of newborns who were hypoglycemic, obtained consent, and initiated the order. We offered PDHM instead of infant formula when mother's own milk was not available in sufficient quantity per our hypoglycemia guidelines. We measured newborns' glucose levels and monitored breastfeeding outcomes, including continued breastfeeding. RESULTS: During the 4-month trial, 83 newborns were eligible for PDHM. Of those, 76% of parents opted for PDHM rather than formula. Most newborns in both groups were still breastfeeding at discharge, and 53% of those who received PDHM were fed human milk exclusively during their hospital stays. CONCLUSION: A nurse-driven protocol offering PDHM to otherwise healthy newborns with hypoglycemia is a viable option for increasing exclusive breast milk feeding during the hospital stay.

Nurses' Views on Using Pasteurized Donor Human Milk for Hypoglycemic Term Infants.

PURPOSE: The purpose of this study was to explore maternal child nurses' knowledge and beliefs about using pasteurized donor human milk (PDHM) to treat newborns with hypoglycemia. Pasteurized donor human milk has been used for decades in neonatal intensive care units, but its use is relatively new in the well-baby population. STUDY DESIGN AND METHODS: Focus groups of maternal child nurses were conducted to explore this topic. RESULTS: Six focus groups that included a total 20 nurses were held. Four themes were identified: 1) nurses presumed safety of PDHM but lacked knowledge, 2) nurses' role as patient-family advocate, 3) nurses' logistical concerns about implementation of PDHM, and 4) nurses lacked clarity on formal milk sharing versus PDHM. CLINICAL IMPLICATIONS: As the use of PDHM increases for well babies, nurses will need more education about PDHM, its safety profile, its use in breastfeeding support and protection of the infant microbiome, and how PDHM differs from informal milk sharing. Nurses play an important role in helping parents weigh risks and benefits of using PDHM or formula when supplementation is needed during the hospital stay. It is important that nurses feel confident in their own knowledge and ability to address parental concerns so they can advocate for their patients and support parental decision-making.

Sudden Unexpected Postnatal Collapse of the Newborn.

Sudden unexpected postnatal collapse is a rare but devastating neonatal event. A well-appearing, full-term newborn with Agpar scores of eight or more suddenly crashes, often with full respiratory and cardiac arrest. Up to half of newborns with sudden unexpected postnatal collapse die, with many survivors suffering serious neurological damage. The first 2 hours of life are the hours of greatest risk, coinciding with the time frame when nurses encourage breastfeeding and uninterrupted skin-to-skin contact between women and newborns. Nursing assessments and measures to promote neonates' optimal transition to extrauterine life through skin-to-skin contact and early breastfeeding while decreasing the risk of this catastrophic event are described. Nursing surveillance to promote optimal transition in a safe environment is essential, and birth facilities should allocate staffing resources accordingly.

Barriers to skin-to-skin care during the postpartum stay.

PURPOSE: To determine both mothers' and nurses' understanding of barriers to skin-to-skin care (SSC) during the postpartum hospital stay. STUDY DESIGN: Mixed-method study including surveys and focus groups with both nurses working in a postpartum unit, and mothers who had recently given birth. METHODS: Fourteen nurses and 15 mothers completed surveys. Survey questions related to beliefs about SSC as well as perceived barriers and were drawn from the literature. Additionally, several focus groups with nurses and one focus group with new mothers explored attitudes, beliefs, and practices related to SSC, barriers, and potential interventions. RESULTS: All nurses indicated that SSC was important for both mothers and infants, and identified perceived barriers to the practice. By a large margin, visitors in the patient room and others wanting to hold the baby were the most frequently cited barriers to SSC. Most nurses believed that mothers were unaware of the benefits of SSC and did not spend enough time SSC, yet most mothers said that they were aware of the importance of SSC and that they had spent enough time SSC. Barriers most often identified by mothers were visitors in the room, other people wanting to hold the baby, and safety concerns related to feeling groggy. CLINICAL IMPLICATIONS: Identifying barriers to SSC and intervening to reduce them may have implications for both maternal role development and breastfeeding success, thus positively impacting long-term health of mother and child. Studies such as this should be conducted with other populations in other centers.