Breastfeeding Challenges Made Easy for Late Preterm Infants: The Go-To Guide for Nurses and Lactation Consultants

276 Pages·2013·3.029 MB·English

by  Sandra Cole RNC IBCLC

C
O
L
Breastfeeding Challenges Made Easy E Breastfeeding
B
for R
E
A
Late Preterm Infants S
T Challenges
F
E
E
The Go-To Guide for Nurses and Lactation Consultants D
I
N
G
Made Easy
SANDRA COLE, RNC, IBCLC
C
H
A
Evidence-based research underscores the importance of breastfeeding for the healthy
L
development of late preterm infants, yet signifi cant challenges can impede its success. L
E
This is a groundbreaking, problem-solving guide to the most effective techniques for for
N
breastfeeding this vulnerable population. Written for lactation consultants, NICU nurses, G
obstetrical nurses, and nurse-midwives, the book offers simple evidence-based solutions to E
the distinct breastfeeding diffi culties affecting late preterm infants. S Late Preterm Infants
M
The guide describes the characteristics of late preterm infants and the physiological chal- A
lenges—often invisible and overlooked by health care providers—caused by disturbances of D
respiratory, metabolic, neurologic, and immunologic functions. These problems are often E

exacerbated by poor breastfeeding and result in 13% of hospital readmissions of late preterm E
A
infants. The book examines maternal conditions that affect breastfeeding success and pro-
S
vides detailed, easy-to-follow instructions for the most effective breastfeeding techniques. Y

It describes specifi c strategies health care professionals can take to overcome breastfeeding F
O
diffi culties, including proper positioning and latch technique, the use of breast pumps and
R
other helpful equipment, supplemental feedings, and more. Pictures illustrate correct tech-
L
niques, and user-friendly patient teaching guides further encourage successful breastfeeding. A
The book also supports the goals of many hospitals seeking to achieve WHO and UNICEF T
E
Baby-Friendly status, as well as the goals of the Multidisciplinary Guidelines for Care of Late
P
Preterm Infants recently issued by the National Perinatal Association. R
E
Key Features: T
E
• A comprehensive guide specifi c to the breastfeeding issues of late preterm infants R
M
• Describes developmental challenges faced by late preterm infants

• Provides detailed, easy-to-follow instructions for breastfeeding, and techniques for IN
overcoming diffi culties F
A The Go-To Guide for Nurses
• Offers simple evidence-based solutions that lactation consultants, nurses, and mid- N
wives can offer to mothers T
• Supports the goals of hospitals seeking WHO and UNICEF Baby-Friendly status S and Lactation Consultants
ISBN 978-0-8261-9603-3
SANDRA COLE
11 W. 42nd Street
New York, NY 10036-8002
9 780826 196033
www.springerpub.com
Breastfeeding Challenges Made Easy
for Late Preterm Infants
CCoollee__99660033__PPTTRR__FFMM__1100--1188--1133__ii--xxvviiiiii..iinndddd ii 1188//1100//1133 1111::5544 AAMM
Sandra Cole, RNC, IBCLC, began her career as a neonatal intensive care
nurse at the Royal Alexandra Hospital in Edmonton, Alberta, Canada, in 1990.
In 1992, she moved to the United States where she continued in neonatal
nursing until 2010, working at the University Medical Center in Lubbock,
Texas, Chester County Hospital in West Chester, Pennsylvania, Pascack Valley
Hospital in Westwood, New Jersey, and Good Samaritan Hospital in Suffern,
New York. She held many positions such as staff nurse, preceptor, charge
nurse, transport nurse, and extracorporeal membrane oxygenation (ECMO)
technician and earned the Neonatal Intensive Care Nursing Certifi cation in
2003.
Despite the myriad obstacles sick babies face while in the neonatal
intensive care unit (NICU), one of the most frustrating situations for Ms. Cole
to witness was late preterm infants struggling with breastfeeding. Realizing
that these babies required specialized breastfeeding assistance, she chose to
pursue the path of lactation consultant in order to better understand the
breastfeeding needs of these babies and to become better equipped to assist
in the transition to exclusive breastfeeding in this population. In 2007,
Ms. Cole earned her international board-certifi ed lactation consultant
(IBCLC) certifi cate and started a successful private lactation practice in New
York where she specialized in late preterm infants. It was through working
with these late preterm infants that her strategies for successful breastfeeding
were developed and fi ne tuned.
Ms. Cole is currently working as part of the lactation team at Sharp Mary
Birch Hospital where she continues to advance her knowledge base and
inspire breastfeeding parents.
CCoollee__99660033__PPTTRR__FFMM__1100--1188--1133__ii--xxvviiiiii..iinndddd iiii 1188//1100//1133 1111::5544 AAMM
Breastfeeding Challenges Made Easy
for Late Preterm Infants
The Go-To Guide for
Nurses and Lactation Consultants
Sandra Cole, RNC, IBCLC
CCoollee__99660033__PPTTRR__FFMM__1100--1188--1133__ii--xxvviiiiii..iinndddd iiiiii 1188//1100//1133 1111::5544 AAMM
Copyright © 2014 Springer Publishing Company, LLC
All rights reserved.
No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form
or by any means, electronic, mechanical, photocopying, recording, or otherwise, without the prior
permission of Springer Publishing Company, LLC, or authorization through payment of the appropriate
fees to the Copyright Clearance Center, Inc., 222 Rosewood Drive, Danvers, MA 01923, 978-750-8400,
fax [phone], [email protected] or on the Web at www.copyright.com.
Springer Publishing Company, LLC
11 West 42nd Street
New York, NY 10036
www.springerpub.com
Acquisitions Editor: Elizabeth Nieginski
Composition: Graphic World
ISBN: 978-0-8261-9603-3
e-book ISBN: 978-0-8261-9604-0
13 14 15 / 5 4 3 2 1
The author and the publisher of this Work have made every effort to use sources believed to be reliable
to provide information that is accurate and compatible with the standards generally accepted at the time
of publication. The author and publisher shall not be liable for any special, consequential, or exemplary
damages resulting, in whole or in part, from the readers’ use of, or reliance on, the information
contained in this book. The publisher has no responsibility for the persistence or accuracy of URLs for
external or third-party Internet websites referred to in this publication and does not guarantee that any
content on such websites is, or will remain, accurate or appropriate.
Library of Congress Cataloging-in-Publication Data
Cole, Sandra, 1967- author.
Breastfeeding challenges made easy for late preterm infants : the go-to guide for nurses and lactation
consultants / Sandra Cole.
p. ; cm.
Includes bibliographical references and index.
ISBN 978-0-8261-9603-3 — ISBN 978-0-8261-9604-0 (e-book)
I. Title.
[DNLM: 1. Breast Feeding—methods. 2. Infant Care—methods. 3. Infant, Premature—physiology.
4. Maternal-Child Nursing—standards. WS 125]
RJ216
613.2’69—dc23
2013037343
Special discounts on bulk quantities of our books are available to corporations, professional
associations, pharmaceutical companies, health care organizations, and other qualifying groups.
If you are interested in a custom book, including chapters from more than one of our titles, we can
provide that service as well.
For details, please contact:
Special Sales Department, Springer Publishing Company, LLC
11 West 42nd Street, 15th Floor, New York, NY 10036-8002
Phone: [phone] or 212-431-4370; Fax: [phone]
E-mail: [email protected]
Printed in the United States of America by Edwards Brothers Malloy.
CCoollee__99660033__PPTTRR__FFMM__1100--1188--1133__ii--xxvviiiiii..iinndddd iivv 1188//1100//1133 1111::5544 AAMM
To all the late preterm infants and their families whom I have had the pleasure
to work with throughout the years, thank you for enlightening me.
CCoollee__99660033__PPTTRR__FFMM__1100--1188--1133__ii--xxvviiiiii..iinndddd vv 1188//1100//1133 1111::5544 AAMM
CCoollee__99660033__PPTTRR__FFMM__1100--1188--1133__ii--xxvviiiiii..iinndddd vvii 1188//1100//1133 1111::5544 AAMM
Contents
Foreword Barbara Morrison, PhD, APRN-CNM ix
Preface xiii
Acknowledgments xvii
Part I: Physiological Challenges That Undermine Successful
Breastfeeding for the Late Preterm Infant
Prologue
Special Characteristics of the Late Preterm Infant
Chapter 1: Defi ning the Late Preterm Infant 3
Chapter 2: Risk Factors for Late Preterm Births 9
Specifi c Physiological Challenges for the Late Preterm Infant
Chapter 3: Immature Neurological Development and Hypotonia 17
Chapter 4: Temperature Instability, Hypoglycemia, and Increased
Metabolism 25
Chapter 5: Hyperbilirubinemia 33
Chapter 6: Unstable Respiratory Status 41
Chapter 7: Increased Risk for Infection 49
Maternal Conditions Affecting Breastfeeding Success
Chapter 8: Maternal Conditions Affecting Breast Milk Supply 53
Chapter 9: Maternal Self-Esteem and Its Effect on Breastfeeding 65
Chapter 10: The Risks of Not Breastfeeding 69
vii
CCoollee__99660033__PPTTRR__FFMM__1100--1188--1133__ii--xxvviiiiii..iinndddd vviiii 1188//1100//1133 1111::5544 AAMM
viii Contents
Part II: Conquering Breastfeeding Challenges for the Late Preterm Infant
Prologue
Setting the Stage for Successfully Breastfeeding the Late
Preterm Infant
Chapter 11: Health Initiatives 81
Chapter 12: Early and Frequent Breastfeeding 89
Specifi c Strategies for Overcoming Breastfeeding Challenges
Chapter 13: Decrease Stimuli and Energy Expenditure 95
Chapter 14: Proper Positioning and Latch Technique 103
Chapter 15: Breast Compressions 115
Chapter 16: Nipple Shields 121
Chapter 17: Breast Pumps 137
Chapter 18: Breast Massage and Hand Expression 153
Chapter 19: Supplemental Feedings 161
Encouragement for a Successful Breastfeeding Experience
Chapter 20: Overcoming Other Challenges 175
Chapter 21: Maternal Satisfaction and Breastfeeding Success:
The Big Picture 181
Chapter 22: Putting It All Together: Summary of Important Highlights
for Successful Breastfeeding for Late Preterm Infants 185
Appendix A: Late Preterm Infant Breastfeeding Algorithm 191
Appendix B: Sample In-Hospital Late Preterm Infant Initiative 193
Appendix C: Follow-Up Care of the Breastfeeding Late Preterm Infant 199
Appendix D: Sample Patient Teaching Handout: Your Late Preterm
Infant 201
Appendix E: Sample Late Preterm Infant Feeding Plan 203
References 205
Additional Reading 227
Resources for Nurses and Parents 235
Index 239
CCoollee__99660033__PPTTRR__FFMM__1100--1188--1133__ii--xxvviiiiii..iinndddd vviiiiii 1188//1100//1133 1111::5544 AAMM
Foreword
Breastfeeding is one of the greatest gifts a mother can give to
her newborn baby. Breastfeeding and skin-to-skin holding, or
kangaroo care, provide ongoing nutrition and nurturance, enhancing
cardiorespiratory and metabolic stability during the immediate post-
partum period (birth through the fi rst few days of life) and increasing
maturation of immature body systems as newborns continue to adapt
to life outside the womb (American Academy of Pediatrics, 2012).
In their natural habitat, with kangaroo care, newborn infants are main-
tained in a neutral thermal environment; they have ready access to
food and move to the breast with minimal assistance; gain protection
from acute infections and many chronic illnesses through colostrum,
breast milk, and skin-to-skin contact; and hear sounds and smell odors
that are familiar because of experiences in the womb. Additionally,
bonding, social and emotional regulation, and cognitive and language
development are facilitated through maternal–infant interactions
spontaneously occurring in kangaroo care. However, infants born
early, between 34 0/7 and 36 6/7 weeks gestation and known as late
preterm infants (LPIs; Phillips, 2013), and their mothers have unique
challenges when trying to adapt to extra-uterine life. While LPIs look
like full-term newborns (37 0/7 to 41 6/7 weeks gestation), they
are physiologically and metabolically less mature, frequently with
insuffi cient self-regulatory abilities to react to the demands of life
outside the uterus (Phillips, 2013). Due to their immaturity, breastfeed-
ing challenges are common for mother–LPI dyads but may go unrec-
ognized, secondary to health care providers’ lack of awareness and
identifi cation of potential risks for LPIs and timely intervention.
Breastfeeding Challenges Made Easy for Late Preterm Infants is an impor-
tant, evidence-based primer for nurses, midwives, nurse practitioners,
physician assistants, lactation consultants, physicians, and other health
care providers supporting and encouraging breastfeeding efforts of
ix
CCoollee__99660033__PPTTRR__FFMM__1100--1188--1133__ii--xxvviiiiii..iinndddd iixx 1188//1100//1133 1111::5544 AAMM