Mother's Milk Topic

[babyrn69]

Hi,

I am looking for a thesis topic and I was wondering about breast milk and its benefits in the neurodevelopment of NICU infants. It is a well known fact that it helps them in their development, however I was hoping I could focus it somewhere else than just the obvious. Not sure yet, I am having a brainstorm of ideas, but nothing conclusive. If anybody out there could help me with topics around EBM/Breastfeeding and prematurity, I would really appreciate it. :). I need to make the ideas concrete.

Some brainstorming ideas:

EBM and Withdrawing infants

EBM administration prior to painful procedures

Barriers to breastfeeding in the East Indian Population. Influences of American Culture in their breastfeeding beliefs and how it affects the infants.

Anyways....these are just some of the ideas that I have "floating" in my head. Can somebody help me make them more concrete? Maybe you have more ideas? Any input is welcomed :).

[tinkerbell419]

I like the ebm and how effective it is in comparison with sucrose for example or ebm and belief systems rather than the obvious but go with whatever has the most research done on it

[cayenne06, MSN, CNM]

EBM for the prevention of prematurity-related morbidity, with a focus on identifying and overcoming systems-based and patient-specific barriers to using maternal or donor milk.

The dichotomy between the theoretical promotion of EBM for preemies, compared with the real-life lack of widespread implementation, is quite interesting and a good topic for a research paper.

[babyNP., APRN]

I would consider looking at the lack of breastfeeding rates with African Americans (it's lower as compared to caucasians). There have been links found between formula feeding and obesity and when you consider that the prevalence of obesity of African Americans is higher, you start to wonder about all of these cause and effects (of course, fresh food costs more money than cheap fatty foods, so wealth also plays a huge role). There is also a cultural bias against breastfeeding in some African American communities, unfortunately. A friend of mine breastfed her baby but was actively discouraged by her family, as it was considered "gross."

[babyrn69]

That is true, Tinkerbell419. Lots of research is good :). Thanks for the input.

[babyrn69]

It is true, Cayenneo6. We know it is necessary, but somehow it does not get implemented as much as it should. It is hard to classify for donor milk. Donor milk is saved for the micro preemies not just your regular 32 weeker with some respiratory problems or so despite the fact that they would also benefit them. Our milk is all donated it is reserved for the super sick...even if the parents offer to pay for it, the babe will not classify unless it is a micro preemie or super sick. Makes you wonder...I will keep it in mind.

[babyrn69]

Yes, I have heard about what you mention regarding the increase of obesity and formula in the African American Population. That is something to consider for sure. I was thinking the East Indian population as that is our main clientelle at the hospital that I work for and I would have more access to that particular group (very few African American). I was also thinking about the "gross" factor as it is prevalent in many societies and cultures. Something to look into for sure. Thanks, babyNP!

[TiffyRN, BSN, PhD]

The physician group I work with is a huge proponent of "mother's own milk as medicine". In fact, I might search that term for some good literature. Also "exclusive human milk diet" for NICU infants. It's good for more than their neurodevelopment. It dramatically reduces the rate of NEC and surgical NEC even more. Much improved progression of enteral feeds and decrease of TPN days. That by itself reduces the rates of sepsis due to less use of CVLs.

That's the approach I would take, but I'm kind of a "human milk for human babies" freak.

Maybe because I've personally watched the rate of NEC/ostomies/death drop dramatically since we went to exclusive human milk diet for all infants under 1200 or 1500 grams (shoot, can't remember the exact number).

We've also gotten DEBM approved for all infants with suspected/confirmed congenital/genetic issues (trisomies, CHD, gastroschesis) and for infants of diabetic mothers. The cost of the DEBM comes out the unit budget regardless. Insurance/medicaid reimburses based on diagnosis, not what we feed the infant. I suspect this is the same for all units, your manager just won't admit it. They are trying desperately to make DEBM and human-based milk fortifier a chargeable but it is not at this time (at least not in our State).

The unit does not require consent for DEBM, not even an information sheet. Our docs contend the consent should be for formula, not properly screened and pasteurized human milk. We verbally inform the mother at some point. It is not presented as "if it's okay with you" but rather as a matter of fact. We've had maybe 2-3 refuse in the last 4-5 years, with our volume, that is negligible.

If I'm bored tonight I may look up a couple of references. First of all, start with the AAP 2012 (I think?) policy statement on "the use of human milk".

[TiffyRN, BSN, PhD]

OK, just a few quick studies. Hope you have access through your school library:

[h=1]An Exclusively Human Milk-Based Diet Is Associated with a Lower Rate of Necrotizing Enterocolitis than a Diet of Human Milk and Bovine Milk-Based Products [/h]http://www.sciencedirect.com/science/article/pii/S0022347609010853

[h=1]

Outcomes of Human Milk-Fed Premature Infants[/h]http://www.sciencedirect.com/science/article/pii/S0146000510001473

[h=1]

Randomized Trial of Exclusive Human Milk versus Preterm Formula Diets in Extremely Premature Infants [/h]http://www.sciencedirect.com/science/article/pii/S0022347613008652

[h=1]

Breastfeeding and the Use of Human Milk (Policy statement from the AAP)[/h]http://pediatrics.aappublications.org/content/129/3/e827.short

(this one has the full PDF free online)