Dr. Valerie Flaherman is applying for a Mentored Patient-Oriented Research Career Development Award (K23) to attain the training necessary for scientific independence in the field of newborn preventive interventions. As a specialist both in pediatrics and in preventive medicine. Dr. Flaherman brings a unique perspective to her long-term research goal of improving population health outcomes by developing targeted interventions in the newborn period. This K23 award will allow her to receive the additional training and mentored research experience she needs to attain her research goals and to establish herself as an independent clinical investigator. To provide her with continued mentoring during the K23 award, she has assembled a multidisciplinary team comprised of her sponsor and primary mentor. Dr. Thomas Newman, Professor of Epidemiology and Biostatistics and Pediatrics, who has extensive experience with clinical research among well newborns, and three co-mentors: Dr. Michael Cabana, Division Chief of General Pediatrics who has expertise in preventive trials in the well newborn population;Dr. Charles McCulloch, an expert in longitudinal methods and state-of-the-art biostatistical analysis;and Dr. Kathryn Lee, who has expertise in nursing interventions in the perinatal period. Breastfeeding reduces the incidence of all of the most common infectious diseases of infancy, yet many infants discontinue breastfeeding early. Dr. Flaherman's research will focus on improving the prevalence of breastfeeding.
In Aim 1, she will use retrospective medical record data to develop a clinical risk model to identify healthy term newborns at 36 hours who are at increased risk of weight loss S10% birth weight;this risk model will be used to identify a high-risk group of infants who would benefit from an intervention to promote continued breastfeeding.
In Aim 2, she will use focus groups to identify physician and nurse provider messages that influenced breastfeeding choices of mothers of infants falling into this high-risk group;these findings will be used to inform an intervention designed to improve breastfeeding outcomes in infants at high risk for breast feeding discontinuation.
In Aim 3, she will conduct a small pilot randomized controlled trial (RCT) ofthe intervention, which will assess feasibility and provide preliminary estimates of effect size and variance that can be used to design a larger-scale, adequately powered RCT to rigorously evaluate the effectiveness of the intervention, to be proposed in a subsequent R01 grant application at the end of the K award.

Public Health Relevance

If this research is successful in developing an inten/ention to promote continued breastfeeding among infants at high risk of discontinuation, it could help achieve Healthy People 2010 goals in improving breastfeeding prevalence at all ages past initiation. Since breastfeeding prevents infectious diseases and allergic disease in infancy and prevents breast and ovarian cancer among mothers, improving breastfeeding prevalence could have a strong positive impact on public health.

National Institute of Health (NIH)
Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD)
Mentored Patient-Oriented Research Career Development Award (K23)
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Study Section
Pediatrics Subcommittee (CHHD)
Program Officer
Raiten, Daniel J
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University of California San Francisco
Schools of Medicine
San Francisco
United States
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Taylor, James A; Burgos, Anthony E; Flaherman, Valerie et al. (2016) Utility of Decision Rules for Transcutaneous Bilirubin Measurements. Pediatrics 137:
Flaherman, Valerie J; Hicks, Katherine G; Huynh, Justine et al. (2016) Positive and negative experiences of breast pumping during the first 6 months. Matern Child Nutr 12:291-8
Flaherman, Valerie J; Beiler, Jessica S; Cabana, Michael D et al. (2016) Relationship of newborn weight loss to milk supply concern and anxiety: the impact on breastfeeding duration. Matern Child Nutr 12:463-72
Flaherman, Valerie J; Schaefer, Eric W; Kuzniewicz, Michael W et al. (2015) Early weight loss nomograms for exclusively breastfed newborns. Pediatrics 135:e16-23
Taylor, James A; Burgos, Anthony E; Flaherman, Valerie et al. (2015) Discrepancies between transcutaneous and serum bilirubin measurements. Pediatrics 135:224-31
Flaherman, Valerie J; Fuentes-Afflick, Elena (2014) Social and public health perspectives of promotion of breastfeeding. JAMA Pediatr 168:877-8
Flaherman, Valerie J; Lee, Henry C (2013) ""Breastfeeding"" by feeding expressed mother's milk. Pediatr Clin North Am 60:227-46
Flaherman, Valerie J; Gay, Barbara; Scott, Cheryl et al. (2013) Development of the breast milk expression experience measure. Matern Child Nutr 9:425-30
Flaherman, Valerie J; Kuzniewicz, Michael W; Li, Sherian et al. (2013) First-day weight loss predicts eventual weight nadir for breastfeeding newborns. Arch Dis Child Fetal Neonatal Ed 98:F488-92
Flaherman, Valerie J; Aby, Janelle; Burgos, Anthony E et al. (2013) Effect of early limited formula on duration and exclusivity of breastfeeding in at-risk infants: an RCT. Pediatrics 131:1059-65

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