Estimated Breastfeeding to Support Breastfeeding in the Neonatal Intensive Care Unit

Abstract

Objective: To evaluate the effects of estimated breastfeeding on infant outcomes in comparison to test weighing and to describe staff members’ experiences of estimated breastfeeding as a method for supporting the transition from tube feeding to breastfeeding.

Design: A mixed method evaluation.

Setting: Neonatal Intensive Care Unit (NICU) in Sweden.
Participants: The study included 365 preterm (25th–36th gestational weeks) infants and 45 nurses or nurse assistants.

Methods: A retrospective comparative medical record study was used to assess infant outcomes during a period of test weighing (196 infants) and again after the implementation of estimated breastfeeding (169 infants). A qualitative survey was conducted to explore the staff experiences of estimated breastfeeding.

Results: No differences were found between groups regarding duration of tube feeding, length of hospital stay, gestational age, weight at discharge, and rate of any breastfeeding. Infants in the estimated breastfeeding group had a higher risk of not being exclusively breast milk fed than infants in the test-weighing group (OR = 2.76, CI [1.5, 5.1]). Staff perceived estimated breastfeeding as a more facilitative and less stressful method for mothers than test weighing. Some staff had difficulty following guidelines while simultaneously providing person-centered care.

Conclusions: Estimated breastfeeding is a nonintrusive and feasible method for assessing and supporting the transition from tube feeding to breastfeeding among preterminfants in a NICU. However, the increased risk for not being exclusively breastfed is of concern. Additional research is needed to assess whether this method is appropriate and feasible in varying contexts and cultures.