TY - JOUR
T1 - Factors associated with infant feeding of human milk at discharge from neonatal intensive care
T2 - Cross-sectional analysis of nurse survey and infant outcomes data
AU - Hallowell, Sunny G.
AU - Rogowski, Jeannette A.
AU - Spatz, Diane L.
AU - Hanlon, Alexandra L.
AU - Kenny, Michael
AU - Lake, Eileen T.
N1 - Funding Information:
University of Pennsylvania School of Nursing, Office of Nursing Research , 2012 Student Research Pilot Grant (Hallowell, PI) – pre-doctoral funding.
Funding Information:
Neonatal intensive care units with better nurse staffing and work environments have higher rates of very low birth weight infants discharged home on human milk. This is the first study of a national sample of hospitals to examine how multiple features of neonatal intensive care unit organization and care provision relate to the nutritional status of very low birth weight infants at the point they are discharged to home. A common clinical idiom suggests that patient discharge begins on the day of admission; therefore establishment of a human milk supply must occur from the moment an infant is admitted to the neonatal intensive care unit. The constant presence of nurses in the neonatal intensive care unit positions them to achieve lactation goals determined by the infants medical needs and desires of the mother to provide human milk for her child. Although lactation consultants play an important supportive role in the neonatal intensive care unit they are a limited resource. Neonatal intensive care unit administrators must consider how to provide adequate staffing, improve nurse practice environments, and invest in the educational preparation of their nursing staff in order to ensure that the most vulnerable infants receive the best nutrition in the form of human milk at the point of discharge. In the U.S. nurse staffing has a significant association with infant outcomes related to evidence based nutrition through human milk provision in the neonatal intensive care unit. These findings suggest that global health for the sickest newborns may be improved through better hospital organization and nursing care.Conflict of interest: None declared. Funding: Research reported in this publication was supported by the National Institute of Nursing Research of the National Institutes of Health under award number T32NR007104 “Advanced Training in Nursing Outcomes Research” (Aiken, PI) – post-doctoral funding.
Funding Information:
Robert Wood Johnson Foundation Interdisciplinary Nursing Quality Research Initiative grant “Acuity-Adjusted Staffing, Nurse Practice Environments and NICU Outcomes” (Lake, PI). Parent Study for dataset funding.
Publisher Copyright:
© 2015 Elsevier Ltd.
PY - 2016/1/1
Y1 - 2016/1/1
N2 - Context: Nurses are principal caregivers in the neonatal intensive care unit and support mothers to establish and sustain a supply of human milk for their infants. Whether an infant receives essential nutrition and immunological protection provided in human milk at discharge is an issue of health care quality in this setting. Objectives: To examine the association of the neonatal intensive care unit work environment, staffing levels, level of nurse education, lactation consultant availability, and nurse-reported breastfeeding support with very low birth weight infant receipt of human milk at discharge. Design and setting: Cross sectional analysis combining nurse survey data with infant discharge data. Participants: A national sample of neonatal intensive care units (N = 97), nurses (N = 5614) and very low birth weight infants (N = 6997). Methods: Sequential multivariate linear regression models were estimated at the unit level between the dependent variable (rate of very low birth weight infants discharged on "any human milk") and the independent variables (nurse work environment, nurse staffing, nursing staff education and experience, lactation consultant availability, and nurse-reported breastfeeding support). Results: The majority of very low birth weight infants (52%) were discharged on formula only. Fewer infants (42%) received human milk mixed with fortifier or formula. Only 6% of infants were discharged on exclusive human milk. A 1 SD increase (0.25) in the Practice Environment Scale of the Nursing Work Index composite score was associated with a four percentage point increase in the fraction of infants discharged on human milk (p < 0.05). A 1 SD increase (0.15) in the fraction of nurses with a bachelor's degree in nursing was associated with a three percentage point increase in the fraction infants discharged on human milk (p < 0.05). The acuity-adjusted staffing ratio was marginally associated with the rate of human milk at discharge (p = .056). A 1 SD increase (7%) in the fraction of infants who received breastfeeding support was associated with an eight percentage point increase in the fraction of infants discharged on human milk (p < 0.001). Conclusions: Neonatal intensive care units with better work environments, better educated nurses, and more infants who receive breastfeeding support by nurses have higher rates of very low birth weight infants discharged home on human milk. Investments by nurse administrators to improve work environments and support educational preparation of nursing staff may ensure that the most vulnerable infants have the best nutrition at the point of discharge.
AB - Context: Nurses are principal caregivers in the neonatal intensive care unit and support mothers to establish and sustain a supply of human milk for their infants. Whether an infant receives essential nutrition and immunological protection provided in human milk at discharge is an issue of health care quality in this setting. Objectives: To examine the association of the neonatal intensive care unit work environment, staffing levels, level of nurse education, lactation consultant availability, and nurse-reported breastfeeding support with very low birth weight infant receipt of human milk at discharge. Design and setting: Cross sectional analysis combining nurse survey data with infant discharge data. Participants: A national sample of neonatal intensive care units (N = 97), nurses (N = 5614) and very low birth weight infants (N = 6997). Methods: Sequential multivariate linear regression models were estimated at the unit level between the dependent variable (rate of very low birth weight infants discharged on "any human milk") and the independent variables (nurse work environment, nurse staffing, nursing staff education and experience, lactation consultant availability, and nurse-reported breastfeeding support). Results: The majority of very low birth weight infants (52%) were discharged on formula only. Fewer infants (42%) received human milk mixed with fortifier or formula. Only 6% of infants were discharged on exclusive human milk. A 1 SD increase (0.25) in the Practice Environment Scale of the Nursing Work Index composite score was associated with a four percentage point increase in the fraction of infants discharged on human milk (p < 0.05). A 1 SD increase (0.15) in the fraction of nurses with a bachelor's degree in nursing was associated with a three percentage point increase in the fraction infants discharged on human milk (p < 0.05). The acuity-adjusted staffing ratio was marginally associated with the rate of human milk at discharge (p = .056). A 1 SD increase (7%) in the fraction of infants who received breastfeeding support was associated with an eight percentage point increase in the fraction of infants discharged on human milk (p < 0.001). Conclusions: Neonatal intensive care units with better work environments, better educated nurses, and more infants who receive breastfeeding support by nurses have higher rates of very low birth weight infants discharged home on human milk. Investments by nurse administrators to improve work environments and support educational preparation of nursing staff may ensure that the most vulnerable infants have the best nutrition at the point of discharge.
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U2 - 10.1016/j.ijnurstu.2015.09.016
DO - 10.1016/j.ijnurstu.2015.09.016
M3 - Article
C2 - 26518107
AN - SCOPUS:84955391823
VL - 53
SP - 190
EP - 203
JO - International Journal of Nursing Studies
JF - International Journal of Nursing Studies
SN - 0020-7489
ER -