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American Academy of Pediatrics
Research Articles

Effect of Early-Onset Sepsis Evaluations on In-Hospital Breastfeeding Practices Among Asymptomatic Term Neonates

Sagori Mukhopadhyay, Ellice S. Lieberman, Karen M. Puopolo, Laura E. Riley and Lise C. Johnson
Hospital Pediatrics April 2015, 5 (4) 203-210; DOI: https://doi.org/10.1542/hpeds.2014-0126
Sagori Mukhopadhyay
1Departments of Pediatric Newborn Medicine, and
2Harvard Medical School, Boston, Massachusetts;
3Section on Newborn Pediatrics, Children’s Hospital of Philadelphia Newborn Care at Pennsylvania Hospital, Philadelphia, Pennsylvania;
4University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania; and
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Ellice S. Lieberman
1Departments of Pediatric Newborn Medicine, and
2Harvard Medical School, Boston, Massachusetts;
5Obstetrics and Gynecology, Brigham and Women’s Hospital, Boston, Massachusetts;
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Karen M. Puopolo
1Departments of Pediatric Newborn Medicine, and
2Harvard Medical School, Boston, Massachusetts;
3Section on Newborn Pediatrics, Children’s Hospital of Philadelphia Newborn Care at Pennsylvania Hospital, Philadelphia, Pennsylvania;
4University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania; and
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Laura E. Riley
2Harvard Medical School, Boston, Massachusetts;
6Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, Massachusetts
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Lise C. Johnson
1Departments of Pediatric Newborn Medicine, and
2Harvard Medical School, Boston, Massachusetts;
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Abstract

Objective: To examine the effect of separation for early-onset sepsis (EOS) evaluations due to perinatal risk factors on breastfeeding practices among asymptomatic term newborns.

Methods: This observational study included 692 nulliparous women with term, singleton uncomplicated pregnancies who intended to breastfeed and whose infants were well appearing at birth. We examined the rate of early breastfeeding initiation (within 2 hours of birth) and formula supplementation (in the first 24 hours) among this mother–infant cohort.

Results: Asymptomatic infants separated for EOS evaluation within 2 hours of birth were more likely to have delayed initiation of breastfeeding (46.5% vs 12.5%; P < .001). This association remained significant when adjusted for potential confounders (adjusted odds ratio [aOR]: 5.5 [95% confidence interval (CI): 3.4–8.9]; P < .001). Among infants separated for EOS evaluation, mother–infant time together of ≤0.5 hour in the first 2 hours of life significantly delayed initiation (aOR: 8.9 [95% CI: 1.5–53.7]; P = .02) compared with infants spending >1.5 hours with their mothers. In bivariate analysis, both separation and initiation were associated with formula supplementation. After adjusting for confounders, only delayed initiation remained significantly associated with supplementation (aOR: 1.9 [95% CI: 1.1–3.5]; P = .03).

Conclusions: Early separation of asymptomatic infants from their mothers for EOS evaluation was significantly associated with delayed initiation of breastfeeding, which in turn was associated with increased formula supplementation in the first day of life. This unintended consequence of EOS evaluations among asymptomatic infants may be minimized by delaying early separation for performance of the evaluation, attempting breastfeeding initiation before separation, and/or applying more efficient criteria for identifying infants requiring evaluation.

  • asymptomatic infection
  • breastfeeding
  • early-onset sepsis
  • neonatal screening
  • system-based practice
  • Abbreviations:
    AAP
    American Academy of Pediatrics
    aOR
    adjusted odds ratio
    CDC
    Centers for Disease Control and Prevention
    CI
    confidence interval
    EOS
    early-onset sepsis
    GBS
    group B streptococcus
    • Copyright © 2015 by the American Academy of Pediatrics
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    Hospital Pediatrics: 5 (4)
    Hospital Pediatrics
    Vol. 5, Issue 4
    1 Apr 2015
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    Effect of Early-Onset Sepsis Evaluations on In-Hospital Breastfeeding Practices Among Asymptomatic Term Neonates
    Sagori Mukhopadhyay, Ellice S. Lieberman, Karen M. Puopolo, Laura E. Riley, Lise C. Johnson
    Hospital Pediatrics Apr 2015, 5 (4) 203-210; DOI: 10.1542/hpeds.2014-0126

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    Effect of Early-Onset Sepsis Evaluations on In-Hospital Breastfeeding Practices Among Asymptomatic Term Neonates
    Sagori Mukhopadhyay, Ellice S. Lieberman, Karen M. Puopolo, Laura E. Riley, Lise C. Johnson
    Hospital Pediatrics Apr 2015, 5 (4) 203-210; DOI: 10.1542/hpeds.2014-0126
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    Subjects

    • Gynecology
      • Maternal and Fetal Medicine
      • Gynecology
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      • Breastfeeding

    Keywords

    • asymptomatic infection
    • breastfeeding
    • early-onset sepsis
    • neonatal screening
    • system-based practice
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