Healthy People 2020 recognizes breastfeeding as the ideal form of infant nutrition and targets goals of 81.9% initiation of breastfeeding, 60.6% to age 6 months, and 34.1% to age 12 months. Nationally, breastfeeding support interventions are making strides with a 2007-2009 breastfeeding rate of 74%, 43.5%, and 22.7%, respectively. Steady improvements in U.S. breastfeeding rates deserve acknowledgement, but also warrant investigation of disparities in achieving this goal. One fragile subpopulation with persistent difficulties in sustaining breast milk intake is preterm infants. Preterm infants often cannot breastfeed directly due to supplemental nutrition requirements and immature motor skills. Therefore to successfully breastfeed, a mother must use a breast pump to pump her milk, add nutritional supplementation to the milk, and slowly transition to breastfeeding over months. In these ways, a preterm infant/mother couple has significant obstacles to reaching the goal of sustaining breastfeeding through the first year. Preterm infants need access to a support system to enable successful breastfeeding in order to improve health outcomes and reduce disparities. Clinical research must identify methods for preterm infant/mother couples to overcome the barriers to successful breastfeeding. The barriers to successful breastfeeding are heightened by racial, socioeconomic, and geographical disparities and, therefore, warrant investigation specifically in populations faced with these challenges. This study of preterm infant/mother post-hospital discharge lactation success in an eight-county region of Coastal South Carolina contains 2 primary objectives-1) to perform a clinical trial to investigate the effectiveness of a -month post-hospital discharge, community pediatrician- based preterm infant lactation support system [Promoting Lactation Education, Access, and Support Efforts (PLEASE) for Preterm Infants] on infant breastfeeding behaviors and duration of time receiving mother's milk and 2) to evaluate implementation of the intervention to promote development of an accessible and sustainable preterm infant lactation support system in South Carolina community pediatric practices based on the outcomes of the effectiveness trial. The PLEASE for Preterm Infants program is unique in that it takes specialized hospital-based preterm infant/mother dyad lactation support techniques such as equipment and counseling and empowers community pediatric care providers with these evidence-based methods to support accessible and efficient preterm infant mother lactation support. The implementation study of the PLEASE for Preterm Infants intervention will provide critical information concerning barriers and methods to overcome barriers to preterm infant breastfeeding. Therefore, dissemination of the results of the trial and the educational process through South Carolina and the U.S. is an essential step in overcoming the disparities in preterm infant breastfeeding. These goals and plans match maternal and child health policies to promote quality of care and health development and to eliminate health disparities and barriers to health care access.

Public Health Relevance

Preterm infants suffer from a crucial paradox that, though breastfeeding offers substantial health benefit, they have grave difficulty establishing breastfeeding due to both heightened nutritional needs and immature oral motor ability. Development of a community-based, preterm infant/maternal lactation support system with study of both the effect on preterm infant breastfeeding success and the success of implementation in a racially, socioeconomically, and geographically diverse population will provide real-world, adoptable knowledge to be disseminated throughout South Carolina and the United States.

National Institute of Health (NIH)
Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD)
Research Project (R01)
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Psychosocial Development, Risk and Prevention Study Section (PDRP)
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Raiten, Daniel J
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Medical University of South Carolina
Schools of Medicine
United States
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