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Biomedical subjects

Paula P Meier

Publications and source records attributed to Paula P Meier.

11 recordsLinked to original sources
PubMed2005

Accuracy of methods for calculating postnatal growth velocity for extremely low birth weight infants.

OBJECTIVE: No uniform method for calculating growth velocity (GV) (grams per kilogram per day) among extremely low birth weight (ELBW) infants has been reported. Because the calculation of actual GV is so labor intensive, investigators have estimated GV with varying approaches, making comparisons across studies difficult. This study compares the accuracy of 3 mathematical methods used for estimating average GV, namely, 2-point models using the difference between weights at 2 time points divided by time and weight (either birth weight [BW] or average weight), linear regression models that are normalized for either BW or average weight, and an exponential model. The accuracy of all models was compared with actual GVs calculated from daily weight measures for a group of ELBW infants. METHODS: Actual GVs were calculated from daily weights for 83 ELBW infants admitted to the special care nursery and were compared with estimated GVs from each of the 5 models for the same infants. RESULTS: The exponential model, using weights from 2 time points, ie, GV = [1000 x ln(Wn/W1)]/(Dn-D1), was extremely accurate, with mean absolute errors of 0.02% to 0.10%. The 2-point and linear models were highly inaccurate when BW was used in the denominator, with mean absolute errors of 50.3% to 96.4%. The 2-point and linear models were fairly accurate when average weight was used in the denominator, with mean absolute errors of 0.1% to 8.97%. Additional analyses showed that the accuracy of the 2-point and linear model estimates was affected significantly by the combination of BW, length of stay, and chronic lung disease, whereas the exponential model was not affected by these combined factors. CONCLUSIONS: GV estimates calculated with 3 commonly used models varied widely, compared with actual GVs; however, the exponential model estimates were extremely accurate. The exponential model provides the accuracy and ease of use that are lacking in current methods applied to infant growth research.

Anthropometry↗
PubMed2004

Mothers performing in-home measurement of milk intake during breastfeeding of their preterm infants: maternal reactions and feeding outcomes.

This study compares feeding outcomes and perceptions of mothers using in-home test weights and those who did not use test weights to manage breastfeeding of their preterm infants during the first month after hospital discharge. There were no significant differences in daily weight gain between the 2 groups during the study period. Maternal concerns cited in both groups were similar, namely, knowing how much milk infant is taking, infant gaining adequate weight, and infant getting enough milk. All women in the experimental group and two-thirds in the control group reported that in-home measurement of milk intake by test-weighing had been or would have been helpful. This prospective randomized study demonstrated that mothers of premature infants who performed in-home test-weighing procedures found the technique to be helpful and experienced no increased stress or lower achievement of breastfeeding goals when compared to mothers not performing test weighs.

Adult↗
PubMed2003

Does federal funding for breastfeeding research target our national health objectives?

OBJECTIVE: To determine the number and dollar amount of federally funded research projects in the area of infant nutrition/breastfeeding/lactation from 1994 to 1996, and the impact of these funded projects on the achievement of our national goals for increasing the rates of breastfeeding initiation and duration. METHODS: Data were obtained from the Computer Retrieval of Information on Scientific Projects database, available through the National Institutes of Health. Abstracts of funded projects were identified, printed, and subjected to content analysis. Key information identified from the abstracts included: National Institutes of Health institute, center, or division funding the project; type of extramural funding; amount of federal dollars awarded; and a classification of the project's impact (direct, indirect, or none) on achievement of the Healthy People 2000 goals for breastfeeding. RESULTS: The final sample consisted of 362 abstracts in the broad category of infant nutrition/breastfeeding/lactation, which were awarded approximately 40.4 million dollars in federal research funds over the 3 years addressed in this study. Of this amount, only 13.7% (5.6 million dollars) was awarded to projects determined to have either a direct or indirect impact on achieving the Healthy People 2000 goals for increasing the incidence and duration of breastfeeding. A total of 27 (7.5%) funded projects in this category, reflecting $4.1 million, had no relationship to breastfeeding per se, as they involved the use of human milk composition and technologies to improve artificial milks and develop new pharmaceuticals and therapies. CONCLUSIONS: These findings suggest an incongruity between the national priorities for breastfeeding and the funding of scientific research in this content area, and provide important information for researchers and policymakers with respect to identification and redirection of funding priorities.

Breast Feeding↗
PubMed2002

Mothers' milk feedings in the neonatal intensive care unit: accuracy of the creamatocrit technique.

OBJECTIVE: To establish the accuracy of the creamatocrit (CRCT) for estimating lipid and calories in a heterogeneous sample of own mothers' milk (OMM) in the neonatal intensive care unit (NICU), using a hematocrit reader, rather than fine vernier calipers. STUDY DESIGN: In this blinded study, CRCT techniques were performed on 32 fresh OMM samples (7 foremilk, 12 hindmilk, 13 composite milk) that were also analyzed for total lipid and caloric concentration. RESULTS: Mean lipid and caloric concentrations for the OMM samples were 50.87 g/l (28.3-86.5) and 703.96 kcal/l (477.2-1183.6), respectively. Results revealed a stronger linear relationship between CRCT and total lipid (r=0.94; p<0.001) than between CRCT and caloric density (r=0.76; p<0.001). CONCLUSION: The CRCT, using a hematocrit reader, is an accurate, inexpensive, and useful technique for estimating the lipid and caloric concentration of individual OMM samples in the NICU. The variability in lipid and calories in these 32 OMM samples underscores the utility of this technique.

Adolescent↗
PubMed2002

Cup-feeding for preterm infants: mechanics and safety.

Cup-feeding is 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, SaO2, and volume of intake during 15 cup-feeding sessions for 8 infants (mean gestational age at birth was 30.6 weeks). Mean duration of sipping bursts and pauses was 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 SaO2 > or = 90% during all 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.

Eating↗
PubMedDate not supplied

Rush SpecialKare Keepsakes.

When an infant is admitted to a neonatal intensive care unit (NICU), parents seldom have the opportunity to celebrate special events in the infant's life within the context of the family. Our Rush SpecialKare Keepsakes is a program for parents of NICU infants that combines therapeutic photography, journaling, and memento preservation, with the goal of documenting the infant's birth and place within the family. The program has two distinct components: weekly scrapbooking sessions, which are free of charge to all NICU families; and Holiday Family Photo Shoots, in which infants are photographed with their family members to celebrate traditional holidays throughout the year. The program, which was conceived and implemented in January 2001, is under the direction of two NICU bedside nurses, who blend scrapbooking techniques with clinical expertise, so that weekly scrapbooking sessions are transformed into a unique type of parent support group. Data from the first 6 months of the program indicate that all 173 parent participants overwhelmingly appreciated the opportunity to attend these sessions, which they perceived as a brief respite from the NICU and an opportunity to interact with other families.

Adult↗
PubMedDate not supplied

The Rush Mothers' Milk Club: breastfeeding interventions for mothers with very-low-birth-weight infants.

OBJECTIVE: To evaluate the effectiveness of an evidence-based breastfeeding program (Rush Mothers' Milk Club) for mothers and their very-low-birth-weight (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.

Adult↗
PubMedDate not supplied

Mothers' decisions to change from formula to mothers' milk for very-low-birth-weight infants.

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 of 23 eligible mothers over a 9-month period. Audio-recorded 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 breastfeeding outcomes at 1-month postbirth. RESULTS: Mothers initially chose formula because they had no breastfeeding role models and were fearful of pain and lifestyle modifications. They changed this decision after the nurse or physician talked with them about the health benefits for their infant. Of the 21 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.

Adult↗
PubMedDate not supplied

Sharing the science on human milk feedings with mothers of very-low-birth-weight infants.

Mother's milk provides protection from serious and costly morbidity for very-low-birth-weight infants (<1500 g), including enteral feeding intolerance, nosocomial infection, and necrotizing enterocolitis. However, NICU and maternity nurses may be hesitant to encourage mothers to initiate lactation because of a reluctance to make mothers feel guilty or coerced. This article reviews the evidence for the health outcomes of mothers' milk feeding in very-low-birth-weight infants and provides examples of ways to share this science with mothers so that they can make an informed feeding decision.

Breast Feeding↗