Effect of Pre- and Postdischarge Interventions on Breastfeeding Outcomes and Weight Gain Among Premature Infants

1. Azza H. Ahmed1, 2. Laura P. Sands2

Article first published online: 7 JAN 2010 DOI: 10.1111/j.1552-6909.2009.01088.x

Journal of Obstetric, Gynecologic, & Neonatal Nursing

Volume 39, Issue 1, pages 5363, January/February 2010
Keywords:

premature infant; breastfeeding outcomes; weight gain; pre/postdischarge interventions

ABSTRACT

Objective: To investigate the effect of pre- and postdischarge interventions on breastfeeding outcomes and weight gain among preterm infants. Data Sources: PubMed and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) database were searched for study selection using MeSH terms infant/premature, breastfeeding, weight gain, patient discharge, postnatal care, and counseling. Study Selection: Inclusion criteria included studies that involved preterm infants who were born less than or equal to 37 weeks of gestation, randomized controlled trials that were in English, conducted in developed countries, and had breastfeeding and weight gain outcomes. A total of 8 articles met inclusion criteria. Data Extraction: All data related to breastfeeding outcomes including duration, exclusivity, maternal satisfaction, and weight gain were extracted from the randomized controlled trials for the purpose of data synthesis. Data Synthesis: A total of 310 studies were reviewed. Eight randomized controlled trials met the inclusion criteria. Gestational age of the infants in the studies ranged from 26 to 37 weeks. The results revealed that kangaroo care, peer counseling, in-home breast milk intake

measurement, and postdischarge lactation support improved breastfeeding outcomes among preterm infants, and that maternal satisfaction improved with postdischarge interventions. No significant evidence of pre- and postdischarge interventions on weight gain was found. Conclusions: Pre- and postdischarge interventions were effective in promoting breastfeeding exclusivity, duration, and maternal satisfaction among mothers of preterm infants. These findings have important clinical implications that support the need for evidence-based breastfeeding interventions for preterm infants before discharge and vigilant postdischarge support. Research to determine more effective interventions to promote exclusive and long-term breastfeeding among preterm infants is required. The rate of premature birth in the United States is increasing. It is estimated that 12.7% of live birth infants are premature, with more than half a million babies born prematurely each year (Hamilton, Martin, & Ventura, 2009). Prematurity is the leading cause of death among newborns.
Results

The search identified eight randomized controlled trials that had breastfeeding, maternal satisfaction, and weight gain outcomes. Seven studies had breastfeeding outcomes, and one had weight gain outcome but used breast- and bottle-fed infants. All studies were published between 1999 and 2008 with samples from four countries including the United States (five studies), Canada (one study), New Zealand (one study), and Australia (one study). Sample sizes ranged from 14 to 308 with the mean of 60 mother/infant dyads. The search analysis focused on weight gain and other breastfeeding outcomes such as (a) exclusivity of breastfeeding, (b) duration of breastfeeding, and (c) maternal satisfaction with pre- and postnatal support.
Breastfeeding outcomes Exclusivity of breastfeeding

A review of the studies indicated that there were four different interventions associated with increased exclusivity of breastfeeding among preterm infants. There was no consistent definition of exclusive breastfeeding among the studies, and it was not clear whether exclusive breastfeeding was by direct breastfeeding or feeding expressed breast milk. Kliethermes, Cross, Lanese, Johnson, and Simon (1999) studied the effect of using nasogastric tube supplementation instead of bottle feeding during the process of transitioning preterm infants to full oral breastfeeding with no other liquids or solids. They found that at discharge, the nasogastric tube group was 4.5 times more likely to breastfeed and 9.4 times more likely to fully breastfeed when compared to the bottle feeding group. This pattern persisted at 3 days and 3 months postdischarge. A New Zealand study included preterm infants with mean gestational age 33 2.4 weeks with early discharge after attaining full oral feeding and then a daily visit for the first 7 to 10 days by visiting nurse specialists who were also available by telephone 24 hours a day. This study

revealed that there was no significant difference in the rate of breastfeeding between the routine and early discharge group (Gunn et al., 2000). Infants in the routine care group were discharged 2 to 4 days later than the experimental group and were followed by home care nurses available on weekdays. At discharge, 83% of the routine group mothers versus 80% of the early discharge group were breastfeeding. There were no significant differences in the rate of exclusive breastfeeding between the early discharge and routine groups at discharge (64.7% vs. 54.8%, respectively) or by 6 weeks (40.5% vs. 31.3%). These investigators classified breastfeeding into five categories: full breastfeeding, high partial, partial, low partial, or full formula feeds. In Canada, McKeever et al. (2002) compared the effect of breastfeeding support offered in hospital and home settings on breastfeeding outcomes and maternal satisfaction. Mother newborn pairs in the experimental group were assessed at 24 and 36 hours postpartum and sent home if they met the discharge criteria. Each mothernewborn pair was scheduled to receive three home visits from a community nurse certified as a lactation consultant. The experimental and control groups were composed of full-term and near-preterm infants (through 36 gestational weeks), stratified by gestational age. Among the near-preterm infants there was no significant difference in the rate of breastfeeding between the in-home versus hospital breastfeeding support groups. This finding was in contrast to results for full-term infants for whom in-home breastfeeding support was associated with a higher rate of exclusive breastfeeding at follow-up, which occurred by the end of the first week after discharge (p=.02). Hurst, Meier, Engstrom, and Myatt (2004) found that in-home measurement of milk intake among infants with gestational age 31 to 36 weeks through test weighing using a digital scale increased exclusive breastfeeding defined as feeding at breast. The control group followed a feeding routine including encouragement of early, frequent skin-to-skin contact and suckling at the emptied breast. Almost two thirds of the mothers who decided to exclusively breastfeed their preterm infants or supplement with expressed breast milk had met their goal or exceeded it by 4 weeks postdischarge (19 out of 31mother/infant dyads) but breastfeeding outcomes were similar between both groups at 4 weeks postdischarge. An Australian study conducted by Collins et al. (2004) found that cup feeding increased the odds of full breastfeeding defined as no other type of milk or solid given except vitamins and minerals at discharge compared to bottle feeding (odds ratio [OR]=1.73, confidence interval [CI]=1.042.88, p=.03). This study also randomized the infants to pacifier use versus no pacifier use and reported that pacifier use does not affect breastfeeding in preterm infants. A study of kangaroo care (skin-to-skin contact) was conducted in the United States by HakeBrooks and Anderson (2008) to determine its effectiveness on breastfeeding outcomes from postpartum to 18 months using a sample of 66 mother/infant dyads with 32 to 36 completed weeks of gestation who were healthy enough to experience kangaroo care. The results revealed that the kangaroo care group had a higher rate of exclusive breastfeeding at discharge, 1.5, 3, 6, 12, and 18 months compared to the control group (F=4.136, p=.047). Using classifications adapted from Labbok and Krasovec (1990) based on the Index of Breastfeeding Status, these investigators classified breastfeeding into exclusive (100%), almost exclusive (vitamins and minerals added), high (80%), medium high (80%-50%), medium-low (<50%-20%), low (<20), token (minimal), and none (0%).

Breastfeeding Duration

Four studies examined the effect of interventions on duration of breastfeeding: kangaroo care (skin-to-skin contact) (Hake-Brooks & Anderson, 2008), peer counseling (Merewood et al., 2006), in-home measurement of milk intake through test weighing using a digital scale (Hurst et al., 2004), and cup feeding study (Collins et al., 2004). The kangaroo care group had longer breastfeeding duration compared to the routine care (5.08 vs. 2.05 months: p=.003). The peer counseling group had 181% greater odds at 12 weeks of providing any amount of breast milk than those without peer counselors. In the cup feeding (Collins et al., 2004) and in-home measurement of milk intake (Hurst et al., 2004) studies, there was no significant difference between the experimental and control groups regarding duration. There was a minor but not significant increase in the prevalence of any breastfeeding in the cup feeding group compared to bottle feeding group at 3 (OR=1.31, CI=0.772.33, p=.33) and 6 months (OR=1.44, CI=0.812.57, p=.22). The mean duration of breastfeeding for the in-home measurement group was 5.9 4 months and the control group was 6.6 3 months.
Maternal Satisfaction

Three studies assessed maternal satisfaction with breastfeeding interventions. Using a Likerttype questionnaire during the final visit, Hurst et al. (2004) asked the mothers to comment about their experience with in-home measurement of milk intake, all women in the experimental group reported that in-home milk intake measurement had been very helpful to them and did not make them nervous. In response to whether use of a digital scale made them nervous, 67% (n=10) stated not at all. In addition, of the 16 mothers in the control group, 75% indicated that inhome milk measurement would have been somewhat to extremely helpful to them. Gunn et al. (2000) found that most of the mothers were pleased with early discharge supported with home visits by a visiting nurse specialist. One mother commented that 24 hour access to care made me comfortable in the decision to take baby home. Having someone you have met in the unit to fall back on was fantastic. Mothers were asked about their comments as a part of the 6-week visit questionnaire. At the end of their study, McKeever et al. (2002) interviewed mothers of late preterm infants using open-ended interviews and found that 93% (n=15) of the mothers were satisfied with their postpartum care, which included early discharge with follow-up home visits by a nurse certified as a lactation consultant. Mothers listed the three primary benefits as familiar and comfortable environment of the home; 1:1 assistance with, and psychological support for, breastfeeding; and follow-up home visits that focused on the infant's feeding, weight, and overall health.
Weight Gain

The review found no significant differences in weight gain in four of the studies. The other four studies did not include weight gain as an outcome. A study conducted in Canada by Puckett, Grover, Holt, and Sankaran (2008) investigated the effect of cue-based versus scheduled feeding on the amount of intake, weight gain, nurse/patient ratio, and length of stay at hospital among

preterm infants with mean gestational age 31.7 2.5 weeks among the control group and 32.1 1.9 weeks among the intervention group. The mean infant gestational age at the time of entrance to the study was 34.5 2.5 weeks among the control group and 34.4 0.9 weeks among the intervention group. The weights were compared at discharge. Sample size was 79 preterm infants (40 control and 39 experimental) who were bottle and breastfed. All intervention infants met at least the minimum expected weight gain set out in the study design. The mean absolute weights at discharge were not significantly different between the groups. The weight gain was 12.7 3.5 g/kg/day among the control group and 12.6 4.1 g/kg/day among the intervention group with p=.83. The investigators noted that appropriate weight gain was a sufficient indicator that the infants consumed adequate volume and calories. Hurst et al. (2004) reported in-home measurement of milk intake among infants with gestational age 31 to 36 weeks through test weighing using a digital scale. The mean daily weight gain among the experimental group versus the control group at the first week postdischarge was 37.5 12.4 versus 35.5 18.4 g. At 2 weeks, the weight gain was 40.2 15.5 versus 44.7 20.1 g and at 4 weeks it was 46.1 17.1 versus 48.5 19.9 g/kg for the experimental and control groups. Kliethermes et al. (1999) found that there was no significant difference in weight among a nasogastric tube feeding group and a bottle feeding group on discharge. The mean weight, 2.1 kg among the control group compared to 2.2 kg among the nasogastric tube feeding group, reflected the similarity in weight gain for both groups. Gunn et al. (2000) also found that the infants in the routine group were a mean of 160 g heavier 6 weeks after discharge compared to the early discharge group that had in-home lactation support (p=.04). However, there was no significant difference in weight gain between the two groups.
Discussion

The purpose of this systematic review was to examine the effect of pre- and postdischarge breastfeeding interventions on breastfeeding and weight gain outcomes among preterm infants as measured by exclusivity and duration of breastfeeding, maternal satisfaction, and weight gain. Eight randomized controlled trials that presented various pre- and postdischarge interventions related to breastfeeding outcomes and weight were reviewed.
Predischarge Interventions

This review found that kangaroo care (skin-to-skin contact) was associated with increased exclusivity and duration of breastfeeding. Hake-Brooks and Anderson's (2008) randomized controlled trial was the most recent trial testing kangaroo care. That study confirmed the benefits of kangaroo care in improving breastfeeding exclusivity and duration among preterm infants with gestational age 32 to 36 weeks. In support of these results, skin-to-skin care was associated with increased mother's milk volume when initiated among low-birth-weight infants in the early intensive care phase (Hurst, Valentine, Renfro, Burns, & Ferlic, 1997). A Cochrane review conducted by Conde-Agudelo, Diaz-Rosselo, and Belizan (2003) on the use of kangaroo care for low-birth-weight infants also noted some improvement in breastfeeding, but the authors expressed concern about study methodology and could not make recommendations about use of

kangaroo care for low-birth-weight infants. Unlike prior reviews of kangaroo care that did not focus on preterm infants, the Hake-Brooks and Anderson study focused on preterm infants. Further, they had a larger sample size; earlier, longer, and more frequent kangaroo care; more precise definition of breastfeeding; and longer follow-up than the studies used in the review conducted by Conde-Agudelo et al. Guidelines for implementation of kangaroo care for physiologically stable premature infants of 30 weeks gestation are now available and provide protocol for implementation by health professionals (Ludington, Morgan, & Abouelfettoh, 2009). These findings support expected outcome #1 that the pre- and postdischarge interventions would improve the breastfeeding outcomes among healthy preterm infants. Another predischarge intervention discussed in this review is cup feeding. When cup feeding was used during transitioning the preterm infant to breast, there was a minor difference between cup and bottle feeding groups in breastfeeding at discharge, although there were no statistical differences between the control and cup feeding group Collins et al. (2004). There were also no statistical differences between groups at 3 and 6 months after discharge. The investigator also reported a high noncompliance rate among the cup feeding group. About 56% of the infants randomized to cup feeding had a bottle introduced during the study. In a systematic review examining cup feeding versus other forms of supplemental enteral feeding for newborn infants unable to fully breastfeed, Flint, New, and Davies (2007) examining cup feeding versus other forms of supplemental enteral feeding for newborn infants unable to fully breastfeed concluded that cup feeding could not be recommended over bottle feeding as it conferred no significant benefits and was associated with longer hospital stay. Furthermore, using nasogastic tube feeding during transitioning to breastfeeding was associated with significant increase in breastfeeding on discharge. However, a Cochrane review study testing avoidance of the bottle during transitioning preterm infants to breastfeeding found that there is currently insufficient evidence on which to base recommendations for a tube alone approach to supplementing breast feeds (Collins, Makrides, Gillis, & McPhee, 2009).
Postdischarge Interventions

This review compared various postdischarge interventions that contributed to increasing breastfeeding exclusivity and duration. Peer counseling(Merewood et al., 2006), in-home measurement of milk intake (Hurst et al., 2004), and early discharge with daily visits for the first 7 to 10 days by a visiting nurse specialist who was also available by telephone 24 hours a day (Gunn et al., 2000) were associated with increasing breastfeeding outcomes and satisfaction among mothers of preterm infants. In another study, early discharge with home support by a lactation nurse in the form of a home visit and phone calls was associated with a significant increase in breastfeeding outcomes among term infants, but was not significantly effective among near-term (late preterm) infants (McKeever et al., 2002). The authors explained that the results were not surprising because near-term infants are less likely to be exclusively breastfed than term infants. These results highlight the vulnerability of late preterm infants for feeding problems. Recent literature confirms the vulnerability of late preterm infants to morbidities and

their need for special attention (Jorgensen, 2008; Meier, Furman, & Degenhardt, 2007; Raju, 2006). In 2005, the National Institute of Child Health changed the name of near-term to late preterm to stress the importance of treating these infants as preterm and highlighting their special needs (Raju et al., 2006). Late preterm infants who are breastfeeding at discharge are at high risk for exposure to morbidities as a result of feeding difficulties due to their state disorganization, lack of stamina, and/or physiological immaturity (Jorgensen, 2008; Meier et al., 2007; Raju, 2006). Further research is needed to improve the quality of care for late preterm infants and to decrease their morbidities and hospital readmissions. The review found that mothers expressed satisfaction with different breastfeeding interventions such as in-home measurement of milk intake, early discharge with 24-hour access to a lactation nurse plus daily home visits during the first week after discharge, and early discharge with follow-up home visits by a nurse certified as a lactation consultant. Maternal satisfaction with postpartum care affects mothers' mental status and may be associated with fewer symptoms of postpartum depression. Maternal satisfaction with breastfeeding was related to low incidence of postpartum depression among breastfeeding mothers (Dennis & McQueen, 2009). In terms of weight gain, the review found no significant differences among the control and intervention groups in most of the studies. These findings do not support expected outcome #2: that the pre- and postdischarge interventions would contribute to a steady weight gain among healthy preterm infants. However, there were inconsistencies in reporting weight gain measurement. Weight measurement is a critical growth parameter that needs attention, especially after discharge. Daily weighing is crucial during the first 2 weeks after discharge to ensure the adequacy of feeding among preterm infants, especially late preterm infants who discharge within 48 hours postpartum. Two studies, Puckett et al. (2008) and Kliethermes et al. (1999), compared the effect of the interventions on weight gain on discharge without follow-up. Another two other studies compared weight gain on discharge and after discharge. Gunn et al. (2000) compared the weight only at discharge and 6 weeks after discharge, even though the family had a daily visit by a visiting nurse specialist for 7 to 10 days postdischarge. There was no explicit description of the technique of weight measurement during the follow-up. Another study, Hurst et al. (2004), used home visits by a research assistant and mentioned that the research assistant used the same scale in weighing the infants during follow-up. Although this review targeted RCTs, which are the gold standard method for testing interventions and an accurate method to establish causation, one of the main limitations of this review was testing different interventions' effect on breastfeeding outcomes and weight gain among preterm infants. It would be better if there were several studies that examined the effect of each intervention or focused on one intervention. Limiting the search to RCTs in developed countries also limited the number of reviewed articles. There were few RCTs that discussed breastfeeding interventions for preterm infants, which reflects the difficulty of using RCTs in breastfeeding research.

Conclusion

Considering the beneficial effect of breastfeeding and human milk for preterm infants, this systematic review was conducted to investigate the effect of pre- and postdischarge breastfeeding interventions on breastfeeding and weight gain outcomes among preterm infants. From the results of this systematic review, the following conclusions can be drawn:

Kangaroo care (skin-to-skin care) was effective in promoting breastfeeding outcomes among healthy infants with gestational age 32 to 36 weeks.

Early discharge supported with 24/7 lactation support was effective in promoting breastfeeding outcomes among healthy preterm infants.

Peer counseling was effective in promoting breastfeeding outcomes among healthy preterm infants.

Mothers were satisfied with the continuation of the lactation support and follow-up after discharge.

Weight monitoring after discharge and in-home milk intake measurement should be encouraged as it appears to ensure feeding adequacy and enhances maternal satisfaction.

More research is needed to examine the effect of these interventions on longterm breastfeeding or longer duration of breastfeeding.

REFERENCES

Aggett, P., Agostoni, C., Axelsson, I., Curtis, M., Goulet, O., Hernell, O., et al. (2006). Feeding preterm infants after discharge, a commentary by the ESPGHAN committee on Nutrition. Journal of Pediatric Gastroenterology and Nutrition, 42, 596-603. o CrossRef, o PubMed,

o Web of Science Times Cited: 15 Ahmed, A. (2008). Breastfeeding preterm infants: An educational program to support mothers of preterm infants in Cairo, Egypt. Pediatric Nursing, 34 (2), 125-138. o PubMed American Academy of Pediatrics and the American College of Obstetricians and Gynecologists. (2005). Guidelines for perinatal care (5th ed.). Elk Grove Village, IL: Author. Anderson, A., Damio, G., Young, S., Chapman, D., & Pereze-Escamilla, R. (2005). A randomized trial assessing the efficacy of peer counseling on exclusive breastfeeding in a predominantly Latina low income community. Archives of Pediatrics and Adolescent Medicine, 159 (9), 836-841. o CrossRef, o PubMed, o Web of Science Times Cited: 33 Ben, X. M. (2008). Nutritional management of newborn infants: Practical guidelines. World Journal of Gastroenterology, 14 (40), 6133-6139. o CrossRef, o PubMed, o ChemPort, o Web of Science Times Cited: 1 Collins, C., Makrides, M., Gillis, J., & McPhee, A. J. (2009). Avoidance of bottle during the establishment of breast feeds in preterm infants, Cochrane Database of Systematic Reviews, 4, CD005252, doi: DOI: 10.1002/14651858.CD005252.pub2. Collins, C., Ryan, P., Crowther, C., McPhee, A., Paterson, S., & Hiller, J. (2004). Effect of bottles, cups, and dummies on breastfeeding in preterm infants: A randomized controlled trial. British Medical Journal, 329 (7459), 193-196. doi: DOI: 10.1136/bmj.38131.675914.55. o CrossRef, o PubMed, o Web of Science Times Cited: 23 Conde-Agudelo, A., Diaz-Rosselo, J., & Belizan, J. (2003). Kangaroo mother care to reduce morbidity and mortality in low birth weight infants. Cochrane Database of Systematic Reviews, 2, CD00277, doi: DOI: 10.1002/14651858.CD002771. Dennis, C. L., & McQueen, K. (2009). The relationship between infant-feeding outcomes and postpartum depression: A qualitative systematic review. Pediatrics, 123, e736-e751. o CrossRef, o PubMed, o Web of Science Times Cited: 3 Engle, W. (2006). A recommendation for the definition of late preterm (near-term) and the birth weight-gestational age classification system. Seminar in Perinatology, 30, 2-7. o CrossRef, o PubMed, o Web of Science Times Cited: 32

Flint, A., New, K., & Davies, M. W. (2007). Cup feeding versus other forms of supplemental enteral feeding for newborn infants unable to breastfeed. Cochrane Database of Systematic Review, 2, CD005092, doi:DOI: 10.1002/14651858.CD005092.pub2. Gunn, T. R., Thompson, J., Jackson, H., McKnight, S., Buckthought, G., & Gunn, A. J. (2000). Does early hospital discharge with home support of families with preterm infants affect breastfeeding success? A randomized trial. Acta Pediatrica, 89, 1358-1363. o CrossRef, o PubMed, o ChemPort, o Web of Science Times Cited: 9 Hake-Brooks, S., & Anderson, G. (2008). Kangaroo care and breastfeeding of mother-preterm infant dyads 0-18 months: A randomized controlled trial. Neonatal Network, 27 (3), 151-159. o PubMed Hamilton, B. E., Martin, J. A., & Ventura, S. J. (2009). Births: Preliminary data for 2007. National Vital Statistics Reports, 57 (12), 1-5. Hannula, L., Kaunonen, M., & Tarka, M. (2008). A systematic review of professional interventions for breastfeeding. Journal of Clinical Nursing, 17, 1132-1143. Direct Link: Abstract Full Article (HTML) PDF(184K) References Higgins, J. P. T., & Green, S. (Eds.). (2008). Cochrane handbook for systematic reviews of interventions, version 5.0.1 [updated September 2008]. The Cochrane Collaboration. Retrieved from http://www.cochrane-handbook.org Hoyer, S., & Horvat, L. (2000). Successful breast-feeding as a result of a health education program for mothers. Journal of Advanced Nursing, 32 (5), 1158-1167.
o o o o

Direct Link: Abstract Full Article (HTML) PDF(167K) References Hurst, N., Meier, P., Engstrom, J., & Myatt, A. (2004). Mothers performing inhome measurement of milk intake during breastfeeding of their preterm infants: Maternal reactions and feeding outcomes. Journal of Human Lactation, 20 (2), 178-187. o CrossRef, o PubMed, o Web of Science Times Cited: 14
o o o o

Hurst, N., Valentine, C., Renfro, L., Burns, P., & Ferlic, L. (1997). Skin-to-skin holding in the neonatal intensive care unit influences maternal milk volume. Journal of Perinatology, 17 (3), 213-217. o PubMed, o ChemPort Institute of Medicine. (2006). Preterm births: Causes, consequences, and prevention. Retrieved from http://www.nap.edu/catalog.php? record_id=11622#toc Jorgensen, A. (2008). Late preterm infants: Clinical complications and risk. Nursing for Womens' Health, 12 (4), 317-329. Kaijser, M., Bonamy, A. K., Akre, O., Cnattingius, S., Granath, F., Norman, M., et al. (2009). Perinatal risk factors for diabetes in later life. Diabetes, 58 (3), 523-526. o PubMed, o ChemPort, o Web of Science Times Cited: 3 Kliethermes, P., Cross, M., Lanese, M., Johnson, K., & Simon, S. (1999). Transitioning preterm infants with nasogastric tube supplementation: Increased likelihood of breastfeeding. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 28 (3), 264-273. o ChemPort Labbok, M., & Krasovec, K. (1990). Toward consistency in breastfeeding definitions. Studies in Family Planning, 21, 226-230. o CrossRef, o PubMed, o ChemPort, o Web of Science Times Cited: 205 Larroque, B., Ancel, P., Marret, S., Marchand, L., Andre, M., Arnaud, C., et al. (2008). Neurodevelopmental disabilities and special care of 5-year-old children born before 33 weeks of gestation (the EPIPAGE study): A longitudinal cohort study. Lancet, 371 (9615), 813-820. o CrossRef, o PubMed, o Web of Science Times Cited: 49 Ludington, S., Morgan, K., & Abouelfettoh, A. (2009). A clinical guideline for implementation of kangaroo care with premature infants of 30 or more weeks postmenstrual age. Advances in Neonatal Care, 8 (3S), S3-S23. McKeever, P., Stevens, B., Miller, K., MacDonell, J., Gibbins, S., Cuettiere, D., et al. (2002). Home versus hospital breastfeeding support for newborn: A randomized controlled trial. Birth, 29 (2), 258-265. Direct Link:
o o o o

Abstract Full Article (HTML) PDF(432K) References

McLaurin, K. K., Hall, C. B., Jackson, E. A., Owens, O. V., & Mahadevia, P. J. (2009). Persistence of morbidity and cost differences between late-preterm and term infants during the first year of life. Pediatrics, 123 (2), 653-659. o CrossRef, o PubMed, o Web of Science Times Cited: 7 Meier, P., Furman, L., & Degenhardt, M. (2007). Increased lactation risk for late preterm infants and mothers: Evidence and management strategies to protect breastfeeding. Journal of Midwifery and Women's Health, 52 (6), 579587. o CrossRef, o PubMed, o Web of Science Times Cited: 6 Merewood, A., Chamberlain, L., Cook, J., Philipp, B., Malone, K., & Bauchner, H. (2006). The effect of peer counselling on breastfeeding rates in the neonatal intensive care unit: Results of randomized controlled trial. Archives of Pediatrics and Adolescent Medicine, 160, 681-685. o CrossRef, o PubMed, o Web of Science Times Cited: 13 Mizuno, K., & Ueda, A. (2003). The maturation and coordination of sucking, swallowing, and respiration in preterm infants. Journal of Pediatrics, 142, 3640. o CrossRef, o PubMed, o Web of Science Times Cited: 37 Nyqvist, K., Farnstrand, C., Eeg-Olofsson, K., & Ewald, U. (2001). Early oral behavior in preterm infants during breastfeeding: An EMG study. Acta Pediatrica, 90, 658-663. o CrossRef, o PubMed, o ChemPort, o Web of Science Times Cited: 7 Olivo, S. A., Macedo, L. G., Gadotti, I. C., Fuentes, J., Stanton, T., & Magee, D. (2008). Scales to assess the quality of randomized controlled trials: A systematic review. Physical Therapy, 88 (2), 156-171. o PubMed, o Web of Science Times Cited: 15 Owen, C., Martin, R., Whincup, P., Smith, D., & Cook, D. (2006). Does breastfeeding influence risk of type 2 diabetes in later life? A quantitative analysis of published evidence. American Journal of Clinical Nutrition, 84 (5), 1043-1054. o PubMed, o ChemPort, o Web of Science Times Cited: 31 Owen, C., Whincup, P., Kaye, S., Martin, R., Smith, D., Cook, D., et al. (2008). Does initial breastfeeding lead to lower cholesterol in adult life? A quantitative review of the evidence. American Journal of Clinical Nutrition, 88, 305-314.

PubMed, ChemPort, Web of Science Times Cited: 14 Petrini, J. R., Dias, T., McCormick, M. C., Massolo, M. L., Green, N. S., & Escobar, G. J. (2009). Increased risk of adverse neurological development for late preterm infants. Journal of Pediatrics, 154 (2), 169-176. o PubMed, o Web of Science Times Cited: 10 Puckett, B., Grover, V., Holt, T., & Sankaran, K. (2008). Cue-based feeding for preterm infants: A prospective trial. American Journal of Perinatology, 25, 623-628. o CrossRef, o PubMed, o Web of Science Times Cited: 2 Raju, T. (2006). Epidemiology of late preterm (near-term) births. Clinics in Perinatology, 33 (4), 751-763. o CrossRef, o PubMed, o Web of Science Times Cited: 21 Raju, T., Higgins, R., Stark, A., & Leveno, K. (2006). Optimizing care and outcome for late-preterm (near-term) infants: A summary of the workshop sponsored by the National Institute of Child Health and Human Development. Pediatrics, 118 (3), 1207-1214. o CrossRef, o PubMed, o Web of Science Times Cited: 74 Russell, R., Green, N., Steiner, C., Meikle, S., Howse, J., Poschmsn, K., et al. (2007). Cost of hospitalization of preterm and low birth weight infants in the United States. Pediatrics, 120 (1), e1-e9. o CrossRef, o PubMed, o Web of Science Times Cited: 18 Schurr, P., & Perkins, E. M. (2008). The relationship between feeding and necrotizing enterocolitis in very low birth weight infants. Neonatal Network, 27 (6), 397-407. o PubMed World Bank. (2009). Developing countries. Retrieved from http://www.worldbank.org/depweb/english/beyond/global/glossary.html#12
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