Perceptions and experiences of using a nipple shield among parents and staff - an ethnographic study in neonatal units

Background: Preterm infants have an immature sucking behavior and the capacity to be exclusively breastfed may be reduced for a period of weeks or months, depending on gestational age. Nipple shields have been used, not only as a device to help mothers with sore nipples, but also to facilitate the infant’s latch on to the breast. However, the benefits of using nipple shields have been debated. The aim of this study was to explore perceptions and experiences of using a nipple shield among parents and staff in neonatal units in Sweden and England. Methods: An ethnographic study was undertaken where observations and interviews were conducted in four neonatal units in Sweden and England. The data were analyzed using a thematic networks analysis. Result: The global theme was developed and named, ‘Nipple shield in a liminal time’. This comprised of two organizing themes: ‘Relational breastfeeding’ and ‘Progression’. ‘Relational breastfeeding’ was underpinned by the basic themes, ‘good enough breast’, ‘something in between’ and ‘tranquil moment’. ‘Progression’ was underpinned by the basic themes, ‘learning quicker’, ‘short-term solution’ and ‘rescue remedy’. Although breastfeeding was seen primarily as a nutritive transaction, the relational aspects of breastfeeding were of crucial importance. These two organizing themes show the tension between acknowledging the relational aspects of breastfeeding and yet facilitating or supporting the progression of breastfeeding in the period from tube feeding or cup feeding to breastfeeding. It is a liminal time as mothers and their infants are “in between” phases and the outcome, in terms of breastfeeding, is yet to be realized. Conclusion: This study demonstrates parents’ and staffs’ perceptions of the nipple shield as a short term solution to help initiation of breastfeeding but also as a barrier between the mother and infant. It is important that the mother and baby’s own particular needs are taken into account, in a person-centred way and on an ongoing basis. Furthermore, we need to emphasise the importance of the ‘relational’ whilst understanding the need for ‘progression’. Holding these in balance may be the key to appropriate use of the nipple shield

Preterm infants’ first breastfeeding attempt:Early initiation and performance: A large multicentre questionnaire study based on maternal observations

The Baby-friendly Hospital Initiative for neonatal wards and the World Health Organization recommend that stable preterm infants initiate breastfeeding regardless of gestational age, postmenstrual age (PMA), or weight. Documented practice, however, is limited. We aimed to describe PMA at first breastfeeding attempt of stable preterm infants, to analyse delaying factors, to detect differences in breastfeeding performance across gestational age groups and use of nasal-CPAP. This Danish multicentre cohort study was based on questionnaires answered by mothers of 992 preterm infants gestational age 23–36 weeks. Differences in PMA between gestational age groups at first breastfeeding attempt were analysed by One-way ANOVA, and associations between PMA and selected factors by linear regression models. The lowest PMA at first breastfeeding attempt was 27.57 weeks. Of the extremely and very preterm infants, 61% and 46%, respectively, had the first breastfeeding attempt before PMA 32 weeks. Mechanical ventilation significantly delayed first breastfeeding attempt by seven days (p &lt; 0.0001). Performance at the preterm infants’ first breastfeeding attempt were predominantly without swallowing (78%). During first attempt, 29% were at breast with nasal-CPAP. Performance was in general not affected by nasal-CPAP treatment. In this cohort of preterm infants, we conclude that early initiation of breastfeeding is possible, also at low PMA and while maintained on nasal-CPAP. Hence, nasal-CPAP should not be a barrier for breastfeeding initiation. At first breastfeeding, even preterm infants before PMA 32 weeks demonstrated breastfeeding behaviours, although the majority did not swallow. Preterm infants need time to familiarize with the breast.</p

Protocol for the SUPPORTED study:a Danish multicentre complex intervention for first-time fathers of preterm infants

INTRODUCTION: Fathers of preterm infants wish to be actively involved and attentive in caring for their children. The positive impacts of paternal caregiving on preterm infants' cognitive and social development have been recognised. Awareness of the need to support fathers during early parenthood is increasing, but fathers may feel excluded when their infants are in the neonatal intensive care unit. Here, we present the protocol for a study involving the development and national implementation of a complex intervention supporting first-time fathers of preterm infants in early parenthood. METHODS AND ANALYSIS: The study adheres to the Medical Research Council framework for complex interventions. A multicentre, prospective, non-blinded, quasi-experimental design will be applied to evaluate the effect of a clinical and technology-based intervention targeting both nurses and the fathers. Outcomes from participants enrolled during the control (2023-2024) and intervention (2025-2026) periods, comprising 295 fathers and their partners, will be compared. Effects on parental confidence, stress, depression and mood and family and reflective functioning as well as infants' emotional and social development will be assessed. A comprehensive process evaluation will be applied using both qualitative and quantitative methods. ETHICS AND DISSEMINATION: The study has been registered at Clinicaltrials.org [no. NCT0 6 116 747 (The SUPPORTED study - First-time Fathers of Preterm Infants), approved on 3 November 2023]. The Danish Data Protection Agency has approved the study (P-2022-792). The findings will be disseminated through peer-reviewed publications. TRIAL REGISTRATION NUMBER: NCT06116747.</p

Skin-to-skin contact after birth : Developing a research and practice guideline

Funding Information: Funding for the two in‐person meetings (one of the Steering Group and one of the Expert Panel) was provided through a grant from Healthy Children Project, Inc., a not‐for‐profit (501c3) non‐governmental organisation (NGO) located in the United States. Publisher Copyright: © 2023 The Authors. Acta Paediatrica published by John Wiley & Sons Ltd on behalf of Foundation Acta Paediatrica. © 2023 The Authors. Acta Paediatrica published by John Wiley & Sons Ltd on behalf of Foundation Acta Paediatrica.Aim: Skin-to-skin contact immediately after birth is recognised as an evidence-based best practice and an acknowledged contributor to improved short- and long-term health outcomes including decreased infant mortality. However, the implementation and definition of skin-to-skin contact is inconsistent in both practice and research studies. This project utilised the World Health Organization guideline process to clarify best practice and improve the consistency of application. Methods: The rigorous guideline development process combines a systematic review with acumen and judgement of experts with a wide range of credentials and experience. Results: The developed guideline received a strong recommendation from the Expert Panel. The result concluded that there was a high level of confidence in the evidence and that the practice is not resource intensive. Research gaps were identified and areas for continued work were delineated. Conclusion: The World Health Organization guideline development process reached the conclusion immediate, continuous, uninterrupted skin-to-skin contact should be the standard of care for all mothers and all babies (from 1000 g with experienced staff if assistance is needed), after all modes of birth. Delaying non-essential routine care in favour of uninterrupted skin-to-skin contact after birth has been shown to be safe and allows for the progression of newborns through their instinctive behaviours.Peer reviewe

Compliance with the Baby-friendly Hospital Initiative for Neonatal Wards (Neo-BFHI): A cross-sectional study in 36 countries

In 2012, the Baby‐friendly Hospital Initiative for Neonatal Wards (Neo‐BFHI) began providing recommendations to improve breastfeeding support for preterm and ill infants. This cross‐sectional survey aimed to measure compliance on a global level with the Neo‐BFHI's expanded Ten Steps to successful breastfeeding and three Guiding Principles in neonatal wards. In 2017, the Neo‐BFHI Self‐Assessment questionnaire was used in 15 languages to collect data from neonatal wards of all levels of care. Answers were summarized into compliance scores ranging from 0 to 100 at the ward, country, and international levels. A total of 917 neonatal wards from 36 low‐, middle‐, and high‐income countries from all continents participated. The median international overall score was 77, and median country overall scores ranged from 52 to 91. Guiding Principle 1 (respect for mothers), Step 5 (breastfeeding initiation and support), and Step 6 (human milk use) had the highest scores, 100, 88, and 88, respectively. Step 3 (antenatal information) and Step 7 (rooming‐in) had the lowest scores, 63 and 67, respectively. High‐income countries had significantly higher scores for Guiding Principles 2 (family‐centered care), Step 4 (skin‐to‐skin contact), and Step 5. Neonatal wards in hospitals ever‐designated Baby‐friendly had significantly higher scores than those never designated. Sixty percent of managers stated they would like to obtain Neo‐BFHI designation. Currently, Neo‐BFHI recommendations are partly implemented in many countries. The high number of participating wards indicates international readiness to expand Baby‐friendly standards to neonatal settings. Hospitals and governments should increase their efforts to better support breastfeeding in neonatal wards.</p