Breastfeeding very low birth weight (VLBW) infants (birth weight < 1500 grams) is now a goal for most newborn intensive care units (NlCUs) in the USA. Historically, there is a high rate of breastfeeding failure in mothers of preterm infants. Our NICU implemented a nursing Standard of Care in 1995 designed to maximize successful breastfeeding infants in the Special Care Nursery (SCN). Elements of the plan included bedside maternal education by nurses and lactation consultants, breast pumping eight to ten times per day, and initiating breastfeeding at 32 weeks which was continued for two weeks prior to introducing bottled breast milk. No alternative methods of bottle feeding (cup feeding, finger feeding) were used. A preliminary study was done to determine the effectiveness of the protocol in improving the breastfeeding rate at six-weeks post-hospital discharge. In this preliminary survey we concluded that though we improved the historical rate of successful breastfeeding after discharge in VLBW infants, we did not achieve our 50% goal. In general, the success rate was higher in the larger infants with shorter duration of hospital stay. We felt the retrospective data relying on mothers' memories one to two years later had its own inherent problems. In this study we wish to follow a larger population over two years and include babies up to 2000 grams. Infants will be identified from admissions to the SCN at Meriter Hospital whose mother plans to breastfeed after discharge. Mothers will follow the SCN protocol of beginning pumping and storage of breast milk eight to ten times daily shortly after delivery. Infants will begin breastfeeding at 32 weeks if they meet the medical and behavioral criteria. As long as the mother is available to increase breastfeeding sessions, a bottle will not be introduced until the infant is closer to 34 weeks gestation. The manner and timing in which a bottle is introduced will be a collaborative decision between the mother, the nurse, and the medical staff. An introductory letter will be sent three to four weeks post discharge asking permission to conduct a telephone interview around six to eight weeks post discharge. A reply prepaid postcard will be sent with the introductory letter and will act as consent for the telephone interview. The data collected in this fashion will be more timely and accurate, and therefore, more helpful in answering our questions. There is so much that can be done to improve breastfeeding in this group and a randomized controlled trial of additional methods to improve breastfeeding is indicated in our NICU.
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