Human milk affords specific health benefits for low birth weight (LBW < 2500g) infants. While increasing the frequency and duration of breastfeeding is a national priority, only 35% of mothers who deliver LBW infants initiate breastfeeding and of these, less than 50% sustain breastfeeding beyond infant hospital discharge. These lower breastfeeding rates among mothers of LBW infants can be explained by the fact that these women experience numerous problems that are unique to breastfed LBW infants. Although models for providing breastfeeding support services have been described, these services are geared to mothers of healthy term infants and are inadequate for meeting the unique needs of mothers of LBW infants. Only one research-based model for providing in-hospital breastfeeding support services for mothers and preterm/high risk infants has been described in the literature; no models for providing post- discharge breastfeeding services for mothers of LBW infants have been described. Mothers of LBW infants need consistent, comprehensive breastfeeding services provided by individuals who are skilled in both the care of LBW infants and management of lactation. The Perinatal Advanced Practice Nurse (PAPN) is the ideal professional to meet this health care need. The PAPN would provide breastfeeding services (pre- and post-infant discharge) that are specific to mothers and LBW infants, including skilled assessment, technical assistance, education, and support. The purpose of this randomized clinical trial is to compare maternal outcomes, infant outcomes and cost of care between two groups of women who breastfeed their LBW infants; a control group receiving routine breastfeeding care and an intervention group receiving a structured program of breastfeeding services provided by PAPNs. The study will test the following hypotheses: A structured program of breastfeeding services provided by PAPNs compared to routine care for breastfeeding will result in: 1) Improved maternal outcomes: more frequent and earlier transition to breast; increased milk volume; increased duration of breastfeeding; and greater attainment of breastfeeding goals; decreased anxiety and depression and greater satisfaction with care; 2) Improved infant outcomes: fewer acute care visits and rehospitalizations; and improved mental and motor development; 3) Decreased cost of care: decreased total costs per subject and decreased average rehospitalization cost. Additionally, the study will examine differences in growth between the two groups, predictors of improved maternal/infant outcomes and interventions used by PAPNs. Both groups will be followed for 1 year post infant discharge. Data analysis will include MANOVA, chi-square and t-tests. Data will be important to consumers, researchers, providers, insurers, and policy makers.

Agency
National Institute of Health (NIH)
Institute
National Institute of Nursing Research (NINR)
Type
Research Project (R01)
Project #
1R01NR003881-01A1
Application #
2257882
Study Section
Nursing Research Study Section (NURS)
Project Start
1995-09-01
Project End
2000-06-30
Budget Start
1995-09-01
Budget End
1996-06-30
Support Year
1
Fiscal Year
1995
Total Cost
Indirect Cost
Name
University of Pennsylvania
Department
Other Health Professions
Type
Schools of Nursing
DUNS #
042250712
City
Philadelphia
State
PA
Country
United States
Zip Code
19104
Zukowsky, Ksenia (2007) Breast-fed low-birth-weight premature neonates: developmental assessment and nutritional intake in the first 6 months of life. J Perinat Neonatal Nurs 21:242-9
Brown, Linda P; Bair, Angel H; Meier, Paula P (2003) Does federal funding for breastfeeding research target our national health objectives? Pediatrics 111:e360-4
McDonald, Patricia E; Wykle, May L (2003) Predictors of health-promoting behavior of African-American and white caregivers of impaired elders. J Natl Black Nurses Assoc 14:1-12
Brooten, Dorothy; Naylor, Mary D; York, Ruth et al. (2002) Lessons learned from testing the quality cost model of Advanced Practice Nursing (APN) transitional care. J Nurs Scholarsh 34:369-75
Meier, P P (2001) Breastfeeding in the special care nursery. Prematures and infants with medical problems. Pediatr Clin North Am 48:425-42
Meier, P P; Brown, L P; Hurst, N M et al. (2000) Nipple shields for preterm infants: effect on milk transfer and duration of breastfeeding. J Hum Lact 16:106-14; quiz 129-31
Brown, L P; Bair, A H; Meier, P P et al. (1998) Accessing on-line information at the National Institutes of Health. Highlights and practical tips. Comput Nurs 16:198-201
Brown, L P; Meier, P; Spatz, D L et al. (1997) Resubmission of a grant application: breastfeeding services for LBW infants. Nurs Res 46:119-22
Meier, P P; Brown, L P (1996) State of the science. Breastfeeding for mothers and low birth weight infants. Nurs Clin North Am 31:351-65