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American Academy of Pediatrics
Research Articles

Supporting Breastfeeding in Infants Hospitalized for Jaundice

Kelly Kovaric, Matthew Cowperthwaite, Corrie E. McDaniel and Grace Thompson
Hospital Pediatrics June 2020, 10 (6) 502-508; DOI: https://doi.org/10.1542/hpeds.2020-0056
Kelly Kovaric
aSt David’s Children’s Hospital, Austin, Texas;
bTexas A&M Health Science Center, Texas A&M University, Bryan, Texas;
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Matthew Cowperthwaite
aSt David’s Children’s Hospital, Austin, Texas;
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Corrie E. McDaniel
cSeattle Children’s Hospital, Seattle, Washington; and
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Grace Thompson
dThe University of Texas at Austin, Austin, Texas
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Abstract

BACKGROUND: Infants readmitted for neonatal hyperbilirubinemia requiring phototherapy are less likely to exclusively breastfeed than infants who are not readmitted for phototherapy. Our aim for this study was to increase breastfeeding exclusivity for infants admitted for neonatal hyperbilirubinemia.

METHODS: Using the Model for Improvement, we conducted 3 plan-do-study-act cycles to improve exclusive breastfeeding (EB). Our outcome measure was to increase the percentage of EB for infants hospitalized for phototherapy from 30% to 80% in 12 months. Our process measure was to increase lactation consultations from 60% to 80%. Balancing measures included the development of >10% weight loss, acute bilirubin encephalopathy, readmissions, and length of stay. Interventions involved staff breastfeeding education, automated orders for lactation consultations, and use of bilirubin blankets during breastfeeding. Data were analyzed by using run charts and statistical process control.

RESULTS: A total of 92 infants with neonatal hyperbilirubinemia were admitted from December 2016 to August 2019, with 61 in the postintervention period. After implementation of an automated order for lactation consultation, EB improved from 30% to 60% and completed lactation consultations increased from 60% to 90%. Infants who received a lactation consultation within the first shift during their hospitalization were 4 times more likely to have EB during hospitalization than infants who did not (odds ratio 3.8; confidence interval: 1.17–12.39.) No infant experienced >10% weight loss, acute bilirubin encephalopathy, or a readmission, and length of stay did not significantly change.

CONCLUSIONS: Early involvement of trained lactation consultants safely improves rates of EB for infants hospitalized with neonatal hyperbilirubinemia.

  • Copyright © 2020 by the American Academy of Pediatrics
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Hospital Pediatrics: 10 (6)
Hospital Pediatrics
Vol. 10, Issue 6
1 Jun 2020
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Supporting Breastfeeding in Infants Hospitalized for Jaundice
Kelly Kovaric, Matthew Cowperthwaite, Corrie E. McDaniel, Grace Thompson
Hospital Pediatrics Jun 2020, 10 (6) 502-508; DOI: 10.1542/hpeds.2020-0056

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Supporting Breastfeeding in Infants Hospitalized for Jaundice
Kelly Kovaric, Matthew Cowperthwaite, Corrie E. McDaniel, Grace Thompson
Hospital Pediatrics Jun 2020, 10 (6) 502-508; DOI: 10.1542/hpeds.2020-0056
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