Special Issue on the Science of Human Milk No abstract available

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Your New NANN Board of Directors and NANNP Council Members No abstract available

Barriers to Providing Mother's Own Milk to Extremely Preterm Infants in the NICU Background: Mothers' own milk (MOM) has more than nutritional benefits for extremely preterm infants (<28 weeks). However, mothers encounter barriers that make it difficult to provide their own milk to their extremely preterm infants. Purpose: The aim of this study was to describe and understand the experiences of mothers of extremely preterm infants regarding barriers to providing their own milk during infant hospital stay in the neonatal intensive care unit (NICU). Methods: This study followed a qualitative, interpretative design using Gadamer's hermeneutic approach and included 15 in-depth semistructured interviews. The data were analyzed using a modified form of the steps described by Fleming. Results: Fifteen mothers of extremely preterm infants participated in the study. The following themes were extracted from the data analysis: (1) “unexpected and unusual lactation,” including the subthemes “the extremely preterm birth and the decision to provide MOM,” “the battle to produce milk,” and “my job was to make milk”; and (2) “providing MOM to a tiny infant in an unknown technological environment,” with the subthemes “the limitations of providing MOM in the NICU” and “the difficulties of having an extremely preterm infant.” Implications for Practice: To provide MOM to an extremely preterm infant, there is a need for informational and practical counseling by neonatal nurses educated in breastfeeding according to mothers' requirements and emotional needs. Implications for Research: Future research may analyze the parents' and neonatal nurses' experience about facilitators to improve MOM provision and the influence of women's sociodemographic characteristics in providing MOM to the extremely preterm infants.

Considerations for Preterm Human Milk Feedings When Caring for Mothers Who Are Overweight or Obese Background: Mother's milk is the recommended source of nutrition for all newborns. Preterm infants may be further compromised by maternal factors that impede successful lactation and alter milk composition. Purpose: To review and summarize the state of the science regarding implications of maternal overweight and obesity on successful lactation and associated alterations in preterm mother's milk composition. Methods/Search Strategy: PubMed, EMBASE, and Web of Science searches were performed using relevant key words to identify references addressing maternal overweight or obesity, prematurity, human milk, and lactation. Findings/Results: In the United States, more than half of women enter pregnancy with an overweight or obese body mass index. These women have increased risk of adverse pregnancy outcomes and obstetric complications that can undermine successful initiation and continuation of lactation, including preterm birth. Maternal overweight and obesity are also associated with alterations in mother's milk composition. Implications for Practice: Mother-preterm infant dyads affected by maternal overweight and obesity are at risk for barriers to initiation and continuation of lactation. Support for early initiation of milk expression is needed. Continued support, especially during the first weeks of lactation, can facilitate sustained milk production. Implications for Research: Considerable knowledge gaps remain in this area of human milk science. Future research is needed to facilitate more comprehensive understanding of differences in milk composition associated with maternal overweight and obesity and their impact on clinical outcomes in the preterm infant.

To Consent, or Not to Consent, That Is the Question: Ethical Issues of Informed Consent for the Use of Donor Human Milk in the NICU Setting Background: Evidence supports the superiority of mother's own milk (MOM) in reducing the comorbidities common to prematurity and very low birth weight. In situations where an insufficient amount of MOM is available or maternal contraindications prevent its use, pasteurized donor human milk (DHM) is a viable substitution. When DHM is deemed best, a common practice in many neonatal intensive care units (NICUs) is for parents to provide their consent. However, no universal mandate for informed consent exists. Often, healthcare providers present and obtain the consent for DHM use prior to delivery or shortly after birth and this consent may be “bundled” along with other standardized NICU treatment consents. This approach is likely less than ideal since it provides insufficient time for decision making and often precedes the mother's ability to initiate the expression of her own milk. Purpose: To review the history of DHM use and the ethics surrounding the consenting process including the ethical principles involved in infant feeding decision making. We argue for the standardization and consistent use of informed consent for DHM in the NICU and offer clinical practice implications. Findings/Results/Implications for Practice and Research: Providers face several challenges in the consenting process for the use of DHM in the NICU setting. These include limited time to support parents and educate them appropriately during the decision-making process. Standardized and consistent use of informed consent is essential to address the ethical concerns surrounding the use of DHM in the NICU setting.

Human Milk and Breastfeeding Outcomes in Infants With Myelomeningocele Background: In 2015, the study setting instituted an enteral feeding pathway, “PO Ad Lib Feeding to Support Breastfeeding.” Many infants admitted to the study setting's newborn/infant intensive care unit with a primary diagnosis of myelomeningocele fall within the setting's enteral feeding pathway's inclusion criteria. Purpose: The primary objective of this study is to describe the enteral feeding exposure and trends, by type and method, among infants with myelomeningocele. Methods: Retrospective descriptive cohort design. Participants were infants with a primary diagnosis of myelomeningocele between 2013 and 2016. The electronic health record was used to collect descriptive data (demographics and daily enteral feeding exposure). Data were analyzed using descriptive statistics. Findings/Results: More than 80% (n = 148, 81.3%) of the participants' mothers had a personalized prenatal nutrition consultation and the majority of those mothers (n = 102/118, 86.4%) had a goal to breastfeed for more than 6 months. The majority (n = 144/182, 79.1%) of the study cohort was exposed to mothers' own human milk as their first feed. It is also notable that 80.8% (n = 147) fed at least once directly at the breast; however, infants were also fed by bottle or by feeding tube. Implications for Practice: It demonstrates that with appropriate evidence-based breastfeeding interventions, mothers having infants with myelomeningocele can expect to feed their infants human milk as well as direct breastfeed. Implications for Research: Future research should focus on human milk/breastfeeding outcomes of infants with myelomeningocele post–hospital discharge. Long-term breastfeeding may have an important role in the development of infants with myelomeningocele.

What Is the Impact of NICU-Dedicated Lactation Consultants? An Evidence-Based Practice Brief Background: Benefits of exclusive human milk diets for preterm and low birth-weight infants are well established. Despite known benefits, supporting mothers in the provision of mother's own milk for high-risk infants is challenging. Lactation support in the neonatal intensive care unit (NICU) is highly variable. Lactations consultants (LCs) are often shared between postpartum units and the NICU, potentially increasing LC workload with less time spent with high-risk mothers. Furthermore, less than half of NICUs in the United States staff an international board-certified lactation consultant. Limited understanding exists regarding impacts of NICU-specific lactation support on breastfeeding outcomes. Purpose: The purpose of this evidence-based practice brief is to synthesize the literature on the impact of NICU-specific lactation support, LCs who work exclusively in the NICU, and provide guidance about how NICU staffing with LCs solely focused on supporting mothers of high-risk infants impacts breastfeeding outcomes for low birth-weight infants. Search Strategy: CINAHL PLUS, PubMed, Cochrane Library, and OVID databases were searched using key words and restricted to English language. Findings: During hospitalization, NICUs staffed with dedicated board-certified LCs have increased potential to yield improved breastfeeding rates through hospital discharge, increased proportion of infants who receive mother's own milk, and increased duration of breastfeeding or human milk expression through hospital discharge. Implications for Practice: Human milk nutrition is related to improved outcomes for high-risk infants. Neonatal intensive care unit–specific lactation support can potentially optimize maternal breastfeeding practices and improve outcomes for high-risk infants. Implications for Research: There is a need for further studies pertaining to NICU-specific lactation consultants and influences on breastfeeding outcomes.

Maternal Distress in the Neonatal Intensive Care Unit: A Concept Analysis Background: The neonatal intensive care unit (NICU) can cause significant psychological distress in a mother. There is no common definition of maternal distress in the NICU currently in use. Purpose: To develop a clear conceptual understanding of maternal distress in the NICU using conceptual definitions and empirical findings. Methods/Search Strategy: A literature search was conducted using EBSCOhost, MEDLINE, CINAHL, PsychINFO, and Google Scholar. The concept analysis was guided by Walker and Avant's (2011) guide. Findings/Results: Maternal distress in the NICU consists of a combination of depressive, anxiety, trauma, and posttraumatic stress symptoms. The symptoms occur together on a spectrum and present differently in each mother. The antecedents to maternal distress are a NICU hospitalization and a perceived interruption to the transition to motherhood. Consequences of maternal distress in the NICU are issues with developing a healthy maternal–infant bond, adverse infant development, and decreased maternal quality of life. Implications for Practice: A complete understanding of maternal distress in the NICU will lead to increased awareness of adverse mental health states in this population. Implications for Research: Identification of mothers at risk for maternal distress in the NICU, as well as the identification of antecedents and consequences related to the mother and the infant from maternal distress in the NICU. Using a single, clear definition of maternal distress in the NICU population will lead to a more cohesive body of literature.

Role of the Neonatal Nurse Practitioner in the Community Hospital Background: The role of the neonatal nurse practitioner (NNP) is well established in the neonatal intensive care unit. The level IV NNP is traditionally supported by large multidisciplinary teams while the level I to III NNP may be the sole in-house provider with limited resources. Purpose: The purpose of this research project is to identify the NNP role, responsibilities, and barriers to practice in the level I, II, and III newborn care settings. Methods: This study used a descriptive, exploratory design to examine NNP roles and responsibilities in level I, II, and III care centers via an online survey. Results: Of the respondents (171), the majority (71.3%) work 24-hour shifts, 51.5% being the single NNP during the day with 67.8% being alone at night. Nearly 27% have limited or are without ancillary support while 29.8% cannot meet some standards of care due to inadequate resources. Almost 22% lack written protocols and procedural opportunities are limited or a concern for 15.8% of the NNPs. Implications for Practice: A better understanding of the responsibilities of the level I to III NNP will assist with developing staffing guidelines, influence practice models, and guide recruitment and retention of the NNP. Implications for Research: A systematic literature review yielded articles on the value of nurse practitioners and their ability to deliver safe, effective and cost-conscience care but not on what the role entails on a daily basis. Further studies are needed to specifically compare the role of the level IV NNP to the level I, II, and III NNP to further delineate NNP functionality according to level of care.