From the Field - The Case for a Paradigm Shift in Lactation Care for NICU Families: A Comprehensive Lactation Care Model

Abstract

The importance of a child receiving their mother’s own milk (MOM) in the care and treatment of preterm infants is undisputed in the literature. Despite this, lactation support in the Neonatal Intensive Care Unit is often fragmented. Gaps in adequate lactation care for infants receiving MOM, and barriers to that lactation care, can contribute to healthcare disparities and outcome inequalities. Here, I outline a comprehensive lactation care manager model based on the concepts of continuity of care and care management. This is a starting point for discussion that may be helpful in informing future research and adequate lactation care options.

Keywords

access to care breastfeeding International Board Certified Lactation Consultant lactation lactation education lactation management maternal behavior neonatology prematurity very low birth weight

Get full access to this article

View all access options for this article.

References

Barda

Mizrachi

Borokchovich

Yair

Kertesz

D. P.

Dabby

(2021). The effect of pregnancy on maternal cognition. Scientific Reports, 11(1), Article 12187. https://doi.org/10.1038/s41598-021-91504-9

Driver

H. B.

Hinegardner

C. L.

Rea

M. R.

Reed

P. H.

Ward

K. K.

(2001). Whose patient is it anyway? Coordinating nursing and case management services. Lippincott’s Case Management: Managing the Process of Patient Care, 6(6), 256–262.

Fang

Han

Chen

(2021). Quality improvement to increase breastfeeding in preterm infants: Systematic review and meta-analysis. Frontiers in Pediatrics, 9, Article 681341. https://doi.org/10.3389/fped.2021.681341

Faust

(2002). Orlando’s deliberative nursing process theory: A practice application in an extended care facility. Journal of Gerontological Nursing, 28(7), 14–18. https://doi.org/10.3928/0098-9134-20020701-05

Garner

C. D.

Ratcliff

S. L.

Thornburg

L. L.

Wethington

Howard

C. R.

Rasmussen

K. M.

(2016). Discontinuity of breastfeeding care: “There’s no captain of the ship”. Breastfeeding Medicine, 11(1), 32–39. https://doi.org/10.1089/bfm.2015.0142

Goldstein

G. P.

Pai

V. V.

Liu

Sigurdson

Vernon

L. B.

Lee

H. C.

Sylvester

K. G.

Shaw

G. M.

Profit

(2020). Racial/ethnic disparities and human milk use in necrotizing enterocolitis. Pediatric Research, 88(Suppl. 1), 3–9. https://doi.org/10.1038/s41390-020-1073-5

Gulliford

Naithani

Morgan

(2006). What is ‘continuity of care’? Journal of Health Services Research & Policy, 11(4), 248–250. https://doi.org/10.1258/135581906778476490

Grudniewicz

Gray

C. S.

Boeckxstaens

De Maeseneer

Mold

(2023). Operationalizing the chronic care model with goal-oriented care. The Patient, 16(6), 569–578. https://doi.org/10.1007/s40271-023-00645-8

Haggerty

J. L.

Reid

R. J.

Freeman

G. K.

Starfield

B. H.

Adair

C. E.

McKendry

(2003). Continuity of care: A multidisciplinary review. BMJ Clinical Research, 327(7425), 1219–1221. https://doi.org/10.1136/bmj.327.7425.1219

10.

Henry

J. F.

Sherwin

B. B.

(2012). Hormones and cognitive functioning during late pregnancy and postpartum: A longitudinal study. Behavioral Neuroscience, 126(1), 73–85. https://doi.org/10.1037/a0025540

11.

Qian

Han

Feng

Jiang

(2024). Mothers’ experiences of breast milk expression during separation from their hospitalized infants: A systematic review of qualitative evidence. BMC Pregnancy and Childbirth, 24(1), Article 124. https://doi.org/10.1186/s12884-024-06323-3

12.

Lund

A. M.

Domellöf

Pivodic

Hellström

Stoltz Sjöström

Hansen-Pupp

(2022). Mother’s own milk and its relationship to growth and morbidity in a population-based cohort of extremely preterm infants. Journal of Pediatric Gastroenterology and Nutrition, 74(2), 292–300. https://doi.org/10.1097/MPG.0000000000003352

13.

Marhefka

S. L.

Livingston

T. A.

Lockhart

Hernandez

Spatz

D. L.

Louis-Jacques

A. F.

(2021). A statewide evaluation of the breastfeeding resource nurse model. Nursing for Women’s Health, 25(5), 337–345. https://doi.org/10.1016/j.nwh.2021.07.007

14.

Mercado

Vittner

Drabant

McGrath

(2019). Neonatal intensive care unit-specific lactation support and mother’s own breast milk availability for very low birth-weight infants. Advances in Neonatal Care: Official Journal of the National Association of Neonatal Nurses, 19(6), 474–481. https://doi.org/10.1097/ANC.0000000000000684

15.

Mercado

Vittner

McGrath

(2019). What is the impact of NICU-dedicated lactation consultants? An evidence-based practice brief. Advances in Neonatal Care: Official Journal of the National Association of Neonatal Nurses, 19(5), 383–393. https://doi.org/10.1097/ANC.0000000000000602

16.

Nagel

E. M.

Howland

M. A.

Pando

Stang

Mason

S. M.

Fields

D. A.

Demerath

E. W.

(2022). Maternal psychological distress and lactation and breastfeeding outcomes: A narrative review. Clinical Therapeutics, 44(2), 215–227. https://doi.org/10.1016/j.clinthera.2021.11.007

17.

Parker

M. G.

Stellwagen

L. M.

Noble

Kim

J. H.

Poindexter

B. B.

Puopolo

K. M.

, & Section on Breastfeeding, Committee on Nutrition, Committee on Fetus and Newborn. (2021). Promoting human milk and breastfeeding for the very low birth weight infant. Pediatrics, 148(5), Article e2021054272. https://doi.org/10.1542/peds.2021-054272

18.

Patel

A. L.

Johnson

T. J.

Meier

P. P.

(2021). Racial and socioeconomic disparities in breast milk feedings in US neonatal intensive care units. Pediatric Research, 89(2), 344–352. https://doi.org/10.1038/s41390-020-01263-y

19.

Perera

Dabney

B. W.

(2020). Case management service quality and patient-centered care. Journal of Health Organization and Management, 34(5), 551–568. https://doi.org/10.1108/JHOM-12-2019-0347

20.

Quitadamo

P. A.

Zambianco

Palumbo

Wagner

Gentile

M. A.

Mondelli

(2024). Monitoring the use of human milk, the ideal food for very low-birth-weight infants-a narrative review. Foods (Basel, Switzerland), 13(5), Article 649. https://doi.org/10.3390/foods13050649

21.

Romaine

Clark

R. H.

Davis

B. R.

Hendershot

Kite

Laughon

Updike

Miranda

M. L.

Meier

P. P.

Patel

A. L.

Smith

P. B.

Cotten

C. M.

Benjamin

D. K.

Jr. Greenberg

R. G.

(2018). Predictors of prolonged breast milk provision to very low birth weight infants. The Journal of Pediatrics, 202, 23–30.e1. https://doi.org/10.1016/j.jpeds.2018.07.001

22.

Sandnes

Le Floch

Riquin

Nocus

Müller

J. B.

Bacro

(2024). Parental stress and mental health outcomes following very preterm birth: A systematic review of recent findings. Journal of Affective Disorders, 355, 513–525. https://doi.org/10.1016/j.jad.2024.03.154

23.

Spatz

D. L.

(2018). Beyond BFHI: The Spatz 10-step and breastfeeding resource nurse model to improve human milk and breastfeeding outcomes. The Journal of Perinatal & Neonatal Nursing, 32(2), 164–174. https://doi.org/10.1097/JPN.0000000000000339

24.

Spatz

D. L.

Froh

E. B.

Flynn-Roth

Barton

(2015). Improving practice at the point of care through the optimization of the breastfeeding resource nurse model. Journal of Obstetric, Gynecologic, and Neonatal Nursing, 44(3), 412–418. https://doi.org/10.1111/1552-6909.12570

25.

Stark

A. R.

Pursley

D. M.

Papile

L. A.

Eichenwald

E. C.

Hankins

C. T.

Buck

R. K.

Wallace

T. J.

Bondurant

P. G.

Faster

N. E.

(2023). Standards for levels of neonatal care: II, III, and IV. Pediatrics, 151(6), Article e2023061957. https://doi.org/10.1542/peds.2023-061957

26.

Toney-Butler

T. J.

Thayer

J. M.

(2023). Nursing process. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK499937/

27.

Urbina

Balasundaram

Coughlin

Sorrells

Toney-Noland

Day

(2024). The why and how of family-centered care. NeoReviews, 25(7), e393–e400. https://doi.org/10.1542/neo.25-7-e393

28.

Yackobovitch-Gavan

Atia Shmueli

Morag

(2023). Neurodevelopmental outcomes among infants born preterm fed with mother’s own milk: A comparison of singletons and twins. The Journal of Pediatrics, 259, Article 113484. https://doi.org/10.1016/j.jpeds.2023.113484