Clinical Interventions

More on Clinical Interventions

Mothers' Decisions to Change From Formula to Mothers' Milk for Very-Low-Birth-Weight Infants
Citation: Miracle D.J., Meier P.P., Bennett P.A. Mothers' Decisions to Change From Formula to Mothers' Milk For Very-Low-Birth-Weight Infants. JOGNN Vol. 33, No. 6 2004, 692-703.

Objective: The purpose of this study was to examine maternal decisions about providing milk for a very-low-birth-weight (VLBW) infant, when the initial maternal intent was to formula-feed.
Design: Using prospective, purposive sampling, semistructured interviews were conducted with 21 of23 eligible mothers over a 9-month period. Audiorecorded data were transcribed verbatim, coded, categorized, and subjected to dimensional analysis.
Setting: The study took place in a 52-bed, tertiary urban neonatal intensive-care unit.
Patients/Participants: Mean maternal age was 26.5 years (range = 18–38), and mean infant birth weight and gestational age were 705.4 g (range =504–1,310), and 25.8 weeks (range = 23–33), respectively. Of the 21 mothers, 76% were African American or Latina; 62% were low income.
Main Outcome Measures: We evaluated mothers’initial reasons for selecting formula and changing the decision to provide their milk, whether they were made to feel guilty or coerced, the processes of establishing and maintaining lactation, and breastfeedingoutcomes at 1-month postbirth.
Results: Mothers initially chose formula becausethey had no breastfeeding role models and were fearfulof pain and lifestyle modifications. They changed this decision after the nurse or physician talked withthem about the health benefits for their infant. Of the21 women, all denied feeling pressured, coerced, or guilty about the decision change, and all identified rewards to themselves and their infants. All mothers provided milk for greater than or equal to 30 days, 19 went on to feed at breast, and 2 became certified breastfeeding peer counselors for the Rush Mothers’ Milk Club.
Conclusion: These findings underscore the role of nurses and physicians in providing evidence-based information about mothers’ milk and indicate that
sharing this knowledge does not make mothers of VLBW infants feel pressured, coerced, or guilty.
JOGNN, 33, 692-703; 2004. DOI: 10.1177/
Keywords: Lactation—Breastfeeding decision—
Mothers’ milk—Very-low-birth-weight infants
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The Rush Mothers’ Milk Club: Breastfeeding Interventions for Mothers With Very-Low-Birth-Weight Infants
Citation: Meier P.P., Engstrom J.L., Mingolelli S.S., Miracle D.J., Kiesling S. The Rush Mothers' Milk Club: Breastfeeding Interventions for Mothers With Very-Low-Birth-Weight Infants. JOGNN Vol. 33 No. 2, 2003, 164-174.

Objective: To evaluate the effectiveness of an evidence-based breastfeeding program (Rush Mothers’ Milk Club) for mothers and their very-low-birthweight (VLBW) infants.
Design and Setting: Retrospective analysis of hospital records for 207 eligible VLBW infants cared for in a 52-bed urban neonatal intensive-care unit for a 24-month period in 1997-1998.
Patients/Participants: Entire medical records were reviewed for 207 VLBW infants whose mothers (44.9% African American, 35.7% White, 17.9% Latina) were eligible to provide own mothers’ milk(OMM).
Interventions: Standardized evidence-based interventions through the Rush Mothers’ Milk Club program.
Main Outcome Measures: Lactation initiation rate; mean dose of OMM at 15, 30, and 60 days postbirth; mean percent of fed-hospital days equal to exclusive and some OMM feedings.
Results: Lactation initiation rate was 72.9%.Mean dose of OMM over the first 15, 30, and 60 days postbirth was 81.7%, 80.1%, and 66.1%, respectively, of total volume fed. Exclusive and some OMM was received for a mean of 57.2% and 72.5%, respectively, of fed-hospital days. The outcomes for low-income African American women are the highest reported in the literature.
Conclusion: The Rush Mothers’ Milk Club effectively achieved lactation outcomes that approach the national health objective, although the mothers had significant risk factors for initiating and sustaining lactation. The findings have important implications for clinicians, researchers, administrators, and policy makers. JOGNN, 33, 164-174; 2004. DOI:
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Cup-Feeding for Preterm Infants: Mechanics and Safety
Citation: Dowling D.A., RN, PhD, Meier P.P, RN, DNSc, DiFiore J.M., BSEE, Blatz M.A., RNC, MSN, IBCLC, and Martin R.J., MD. Cup-Feeding for Preterm Infants: Mechanics and Safety. Journal of Human Lactation 18(1):2002, 13-20.  

Abstract: Cup-feedingis recommended for breastfed preterm infants to avoid artificial nipples. However, the oral mechanisms used in cup-feeding, or its safety and efficacy, have not been described.The authors measured sipping, breathing, Oxygen Staturation, and volume of intake during 15 cup feeding sessions for 8 infants (mean gestational age at birthwas 30.6 weeks). Mean duration of sipping bursts and pauseswas 3.6 seconds and 28.1 seconds, respectively. Mean breathing rate during bursts and pauses was similar (46.2 ± 24.3 vs 45.7 ± 17.7, respectively), with Oxygen Saturation ≥ 90% duringall bursts. Mean duration of cup-feedings was 15.2 ± 3.9 minutes (range, 11.0-23.3), whereas mean volume of intake was only 4.6 ± 2.2 mL (range, 1.5-8). For the 15 sessions, 38.5% of milk taken from the cup was recovered on the bib. Although infants remain physiologically stable, cup-feeding has questionable efficacy and efficiency. Differentiating between actual intake versus spillage of milk merits attention. J Hum Lact. 18(1):13-20.

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Suck-breathe Patterning During Bottle and Breastfeeding For Preterm Infants

Citation: Meier P.P. Suck-breathe Patterning During Bottle and Breastfeeding For Preterm Infants. International Congress and Symposium. 1996, 9-20.


Abstract: An emerging body of scientific literature suggests that breastfeeding affords highly specific health benefits for preterm infants(I-l7),in addition to the universally recognized advantages of breastfeeding for term, healthy infants(18).Similarly, numerous publications have detailed the significance of breastfeeding for mothers of preterm infants, who have reported that breastfeeding was the 'only thing that they could do for their infants' at a time when all other caretaking responsibilities had been assumed by health care providers(19-22). Although these maternal and infant benefits have been well-documented, this population is characterized by a relatively low incidence of breastfeeding success.

In the United States, recent data demonstrate that only 35-38% of mothers giving birth to low birthweight (LBW) infants initiate breastfeeding efforts(23).Of even more concern, studies suggest that among women who initiate breastfeeding efforts for preterm and/or LBW infants, 25-75% will have discontinued breastfeeding efforts before the infant's discharge from the neonatal intensive care unit (NICU)(24-26). Although researchers from other countries have reported more favourable breastfeeding outcomes for this popwation, there remains an inverse relationship between infant gestational age and the duration of breastfeeding in the internationalliterature(27-28).

A clinical practice that interferes with optimal breastfeeding outcome for this population is the withholding of initial breastfeeding opportunities until preterm infants consume entire bottle feedings without disttess. This clinical practice is based on the undocumented assumption that breastfeeding is 'more work' or more sttessful physiologically than is bottle feeding. Thus, a preterm infant whose mother intends to breastfeed is typically n-ansitioned from gavage to bottle feedings, with breastfeedings inttoduced only a few days prior to hospital discharge. As a result the preterm infant develops a bottle feeding mechanism that may not n-ansfer readily to the breast, and the mother has few opportunities to practise breastfeeding during the infant's hospital stay. Frustrated with these attempts to breastfeed, many mothers elect to discontinue breastfeeding efforts during the infant's hospital stay or the early post-discharge period.

Earlier. inttoduction of breastfeeding for preterm infants would prevent these problems, and may positively influence breastfeeding outcome for this population(22).However, few studies have been focused on physiological responses of preterm infants to breastfeeding, so clinicians have been reluctant to initiate earlier breastfeeding opportunities. The purpose of the research reported here was to compare physiological responses to bottle and breastfeeding for preterm infants. In this paper, selected results of this research, which highlight differences in the coordination of sucking and breathing for the two feeding methods, will be presented.

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Responses Of Small Preterm Infants To Bottle- And Breast-feeding
Citation: Meier P.P., Anderson G.C. Responses Of Small Preterm Infants to Bottle- And Breast-feeding. MCN: The Maternal Journal of Child Nursing, Vol. 12: March/April 1987, 97-105. return to top

Calculating postnatal growth velocity in very low birth weight (VLBW) infants
Citation: Calculating postnatal growth velocity in very low birth weight (VLBW) infants return to top

Improving the Use of Human Milk During and After the NICU Stay

Citation: PP Meier, JL Engstrom, AL Patel, BL Jegier, NE Bruns, (2010) Improving the Useof Human Milk During and After the NICU Stay. Clinics in Perinatology, 37,217-245. 

Introduction: The feeding of human milk (milk from the infant’s own mother; excluding donor milk) during the newborn intensive care unit (NICU) stay reduces the risk of short-and long-term morbidities in premature infants, including enteral feed intolerance, nosocomial infection, necrotizing enterocolitis (NEC), chronic lung disease (CLD), retinopathy of prematurity (ROP), developmental and neurocognitive delay, and rehospitalization after NICU discharge. The mechanisms by which human milk provides this protection are varied and synergistic, and appear to change over the course of the NICU stay. In brief, these mechanisms include specific human milk components that are not present in the milk of other mammals, such the type and amount of long-chain polyunsaturated fatty acids and digestible proteins, and the extraordinary number of oligosaccharides (approximately 130) Human milk also contains multiple lines of undifferentiated stem cells, with the potential to impact a variety of health outcomes throughout the life span. Other human milk mechanisms change over the course of lactation in a manner that complements the infant’s nutritional and protective needs. These mechanisms include immunologic, anti-infective, anti-inflammatory, epigenetic, and mucosal membrane protecting properties. Thus, human milk from the infant’s mother cannot be replaced by commercial infant formula or donor human milk, and the feeding of human milk should be a NICU priority. Recent evidence suggests that the impact of human milk on improving infant health outcomes and reducing the risk of prematurity-specific morbidities is linked to specific critical exposure periods in the post-birth period during which the exclusive use of human milk and the avoidance of formula may be most important. Similarly, there are other periods when high doses, but not necessarily exclusive use of human milk, may be important. This article reviews the concept of ‘‘dose and exposure period’’ for human milk feeding in the NICU to precisely measure and benchmark the amount and timing of human milk use in the NICU. Similarly, the critical exposure periods when exclusive or high doses of human milk appear to have the greatest impact on specific morbidities are reviewed. Finally, the current best practices for the use of human milk during and after the NICU stay for premature infants are summarized.


SUMMARY: The evidence about human milk feedings for premature infants in the NICU indicates that there are critical exposure periods post-birth when exclusive or high doses of human milk provide the greatest protection from costly and handicapping morbidities in premature infants. These data should form the basis for research, practice, and quality outcome indicators in the NICU. Best practices to increase the dose and exposure period of human milk feedings in the NICU include: encouraging the mother to provide milk for her infant, providing cost-effective, expert lactation and human milk feeding support for families and staff; prioritizing the initiation, establishment, and maintenance of maternal milk volume; and using lactation technologies to manage human milk feeding problems.


KEYWORDS: Human milk feeding; Newborn intensive care unit; Milk dose and exposure period;Prematurity-specific morbidity

Original Article2009- Improving the Use of Human Milk-Sem Perinatol

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