Skilled lactation support using telemedicine in the neonatal intensive care unit

ABSTRACT BACKGROUND NICU mothers face unique challenges in initiating and sustaining breastfeeding, but previous studies have focused on outpatient breastfeeding support. We conducted a

retrospective study of NICU breastfeeding outcomes before and after implementing telelactation. METHODS Pre-Telemedicine mothers received in-person support by NICU lactation consultants,

while Telemedicine mothers received solely telemedicine consults after maternal discharge. RESULTS Exclusive breastmilk feeding at discharge increased in the Telemedicine group. Notably,

babies in the Telemedicine cohort who were fed any formula on admission experienced significant improvement in exclusive breastmilk feeding at discharge, and those whose mothers received at

least one NICU lactation consult had the greatest improvement in exclusive breastfeeding rates at discharge. CONCLUSIONS This study is the first to validate the use of telemedicine as a

means of maintaining access to skilled lactation support in the NICU when in-person consults are not feasible. Incorporating telemedicine can ensure access and continuity of skilled

lactation support, and sustain breastfeeding rates. Access through your institution Buy or subscribe This is a preview of subscription content, access via your institution ACCESS OPTIONS

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institutional subscriptions * Read our FAQs * Contact customer support SIMILAR CONTENT BEING VIEWED BY OTHERS MATERNITY CARE PRACTICES SUPPORTIVE OF BREASTFEEDING IN U.S. ADVANCED NEONATAL

CARE UNITS, UNITED STATES, 2022 Article 07 October 2024 DISCHARGE CRITERIA, PRACTICES, AND DECISION-MAKING IN THE TRANSITION OF PRETERM INFANTS TO HOME Article Open access 27 November 2024

REMOTE MONITORING FOR NEONATES REQUIRING CONTINUED NASOGASTRIC TUBE FEEDING: IMPLEMENTATION, PATIENT CHARACTERISTICS, AND EARLY OUTCOMES Article 19 July 2023 DATA AVAILABILITY The datasets

generated during and/or analyzed during the current study are available from the corresponding author on reasonable request. REFERENCES * Prevention CfDCa. Breastfeeding Report Card United

States, 2020. National Center for Chronic Disease Prevention and Health Promotion; (2020). * US Department of Health and Human Services OoDPaHP. Healthy People 2030: Infants [Available from:

https://health.gov/healthypeople/objectives-and-data/browse-objectives/infants. * Organization WH Infant and Young Child Feeding 2021 [updated June 9, 2021. Available from:

https://www.who.int/news-room/fact-sheets/detail/infant-and-young-child-feeding. * Meek JY, Noble L. Technical report: breastfeeding and the use of human milk. Pediatrics

2022;150:e2022057989. Article  PubMed  Google Scholar  * Meek JY, Noble L, Section on B. Policy statement: breastfeeding and the use of human milk. Pediatrics 2022;150:e2022057988. Article 

PubMed  Google Scholar  * Haase B, Brennan E, Wagner CL. Effectiveness of the IBCLC: have we made an impact on the care of breastfeeding families over the past decade? J Hum Lact.

2019;35:441–52. Article  PubMed  Google Scholar  * Kuan LW, Britto M, Decolongon J, Schoettker PJ, Atherton HD, Kotagal UR. Health system factors contributing to breastfeeding success.

Pediatrics. 1999;104:e28. Article  CAS  PubMed  Google Scholar  * Patel S, Patel S. The effectiveness of lactation consultants and lactation counselors on breastfeeding outcomes. J Hum Lact.

2016;32:530–41. Article  PubMed  Google Scholar  * Dweck N, Augustine M, Pandya D, Valdes-Greene R, Visintainer P, Brumberg HL. NICU lactation consultant increases percentage of outborn

versus inborn babies receiving human milk. J Perinatol. 2008;28:136–40. Article  CAS  PubMed  Google Scholar  * The Surgeon General’s Call to Action to Support Breastfeeding. Publications

and Reports of the Surgeon General. Rockville (MD) (2011). * Patnode CD, Henninger ML, Senger CA, Perdue LA, Whitlock EP. Primary care interventions to support breastfeeding: updated

evidence report and systematic review for the US Preventive Services Task Force. JAMA. 2016;316:1694–705. Article  PubMed  Google Scholar  * Organization WH Infant and Young Child Feeding:

Model Chapter for textbooks for medical students and allied health professionals. Switzerland: WHO Press; (2009). * Gianni ML, Bettinelli ME, Manfra P, Sorrentino G, Bezze E, Plevani L, et

al. Breastfeeding difficulties and risk for early breastfeeding cessation. Nutrients 2019;11:2266. Article  PubMed  PubMed Central  Google Scholar  * Gianni ML, Bezze EN, Sannino P, Baro M,

Roggero P, Muscolo S, et al. Maternal views on facilitators of and barriers to breastfeeding preterm infants. BMC Pediatr. 2018;18:283. Article  PubMed  PubMed Central  Google Scholar  *

Ikonen R, Paavilainen E, Kaunonen M. Preterm infants’ mothers’ experiences with milk expression and breastfeeding: an integrative review. Adv Neonatal Care. 2015;15:394–406. Article  PubMed

  Google Scholar  * Spatz DL, Davanzo R, Muller JA, Powell R, Rigourd V, Yates A, et al. Promoting and protecting human milk and breastfeeding in a COVID-19 World. Front Pediatr.

2020;8:633700. Article  PubMed  Google Scholar  * UNICEF. Breastfeeding when sick [Available from: https://www.unicef.org/parenting/health/breastfeeding-when-sick. * UNICEF Navigating

pregnancy during the COVID-19 pandemic 2022 [updated October 21, 2022]. Available from:

https://www.unicef.org/coronavirus/navigating-pregnancy-during-coronavirus-disease-covid-19-pandemic#covid-breastfeeding. * Organization WH Home care for patients with suspected or confirmed

COVID-19 and management of their contacts: Interim guidance. 2020 August 12, (2020). * ABM Statement on Coronavirus 2019 (COVID-19) [press release]. (2020). * UNFPA statement on novel

coronavirus (COVID-19) and pregnancy [press release]. March 5, 2020 (2020). * Continuing to Nurse Your Baby Through Coronavirus (2019-nCoV; COVID-19) and Other Respiratory Infections [press

release]. February 19, 2020 (2020). * ILCA Statement on Breastfeeding and Lactation Support During the COVID-19 Pandemic [press release]. March 18, 2020 (2020). * Pace RM, Williams JE,

Jarvinen KM, Belfort MB, Pace CDW, Lackey KA, et al. Characterization of SARS-CoV-2 RNA, Antibodies, and Neutralizing Capacity in Milk Produced by Women with COVID-19. mBio.

2021;12:e03192–20. Article  CAS  PubMed  PubMed Central  Google Scholar  * Ismail S, Unger S, Budylowski P, Poutanen S, Yau Y, Jenkins C, et al. SARS-CoV-2 antibodies and their neutralizing

capacity against live virus in human milk after COVID-19 infection and vaccination: prospective cohort studies. Am J Clin Nutr. 2023;119:485–95. * Telehealth Claim Lines Increase 8,336

Percent Nationally from April 2019 to April 2020 [press release]. * Glassman ME, Sarakki AP, Katz-Feigenbaum D, Zitaner J, Thind P, Stockwell MS. The Use of a Medical Center-Based Outpatient

Breastfeeding Support Program with Telelactation to Provide Ongoing Breastfeeding Support to a Diverse Patient Population. Breastfeed Med. 2023;18:362–9. Article  PubMed  Google Scholar  *

Walker K, Green J, Petty J, Whiting L, Staff L, Bromley P, et al. Breastfeeding in the context of the COVID-19 pandemic: A discussion paper. J Neonatal Nurs. 2022;28:9–15. Article  PubMed 

Google Scholar  * Badr H, Alghamdi S. Breastfeeding Experience among Mothers during the COVID-19 Pandemic. Int J Environ Res Public Health. 2022;19:4535. Article  CAS  PubMed  PubMed Central

  Google Scholar  * Siwik E, Larose S, Peres D, Jackson KT, Burke SM, Mantler T. Experiences of At-Risk Women in Accessing Breastfeeding Social Support During the Covid-19 Pandemic. J Hum

Lact. 2022;38:422–32. Article  PubMed  PubMed Central  Google Scholar  * Lubbe W, Niela-Vilen H, Thomson G, Botha E. Impact of the COVID-19 Pandemic on Breastfeeding Support Services and

Women’s Experiences of Breastfeeding: A Review. Int J Women’s Health. 2022;14:1447–57. Article  Google Scholar  * Pacheco F, Sobral M, Guiomar R, de la Torre-Luque A, Caparros-Gonzalez RA,

Ganho-Avila A. Breastfeeding during COVID-19: A Narrative Review of the Psychological Impact on Mothers. Behav Sci (Basel). 2021;11:34. Article  PubMed  Google Scholar  * Broom M, Youseman

ME, Kent AL. Impact of introducing a lactation consultant into a neonatal unit. J Paediatr Child Health. 2022;58:636–40. Article  PubMed  Google Scholar  * Hoban R, McLean L, Sullivan S,

Currie C. Proactive Lactation Care is Associated With Improved Outcomes in a Referral NICU. J Hum Lact. 2022;38:148–55. Article  PubMed  Google Scholar  * Mercado K, Vittner D, McGrath J.

What Is the Impact of NICU-Dedicated Lactation Consultants? An Evidence-Based Practice Brief. Adv Neonatal Care. 2019;19:383–93. Article  PubMed  Google Scholar  * Graham EQ, e ROPCG.

Telemedicine approaches to evaluating acute-phase retinopathy of prematurity: study design. Ophthalmic Epidemiol. 2014;21:256–67. Article  Google Scholar  * Fang JL, Campbell MS, Weaver AL,

Mara KC, Schuning VS, Carey WA, et al. The impact of telemedicine on the quality of newborn resuscitation: A retrospective study. Resuscitation. 2018;125:48–55. Article  PubMed  Google

Scholar  * Sable CA, Cummings SD, Pearson GD, Schratz LM, Cross RC, Quivers ES, et al. Impact of telemedicine on the practice of pediatric cardiology in community hospitals. Pediatrics.

2002;109:E3. Article  PubMed  Google Scholar  * Makkar A, McCoy M, Hallford G, Foulks A, Anderson M, Milam J, et al. Evaluation of Neonatal Services Provided in a Level II NICU Utilizing

Hybrid Telemedicine: A Prospective Study. Telemed J E Health. 2020;26:176–83. Article  PubMed  PubMed Central  Google Scholar  * Hoffman AM, Lapcharoensap W, Huynh T, Lund K. Historical

Perspectives: Telemedicine in Neonatology. Neoreviews. 2019;20:e113–e23. Article  PubMed  Google Scholar  * Nandula PS, Hudak ML. Remote Lactation Support in the COVID-19 Era. Neoreviews.

2021;22:e392–e7. Article  PubMed  Google Scholar  * Uscher-Pines L, Ghosh-Dastidar B, Bogen DL, Ray KN, Demirci JR, Mehrotra A, et al. Feasibility and Effectiveness of Telelactation Among

Rural Breastfeeding Women. Acad Pediatr. 2020;20:652–9. Article  PubMed  Google Scholar  * Demirci J, Kotzias V, Bogen DL, Ray KN, Uscher-Pines L. Telelactation via Mobile App: Perspectives

of Rural Mothers, Their Care Providers, and Lactation Consultants. Telemed J E Health. 2019;25:853–8. Article  PubMed  PubMed Central  Google Scholar  * Habibi MF, Springer CM, Spence ML,

Hansen-Petrik MB, Kavanagh KF. Use of Videoconferencing for Lactation Consultation: An Online Cross-Sectional Survey of Mothers’ Acceptance in the United States. J Hum Lact. 2018;34:313–21.

Article  PubMed  Google Scholar  * Feinstein JSE, Bernstein HH. Telehealth Can Promote Breastfeeding During the COVID-19 Pandemic. New Engl J Med Catalyst. 2021;1–11. * Flacking R, Nyqvist

KH, Ewald U. Effects of socioeconomic status on breastfeeding duration in mothers of preterm and term infants. Eur J Public Health. 2007;17:579–84. Article  PubMed  Google Scholar  * Dhillon

S, Dhillon PS. Telelactation: A Necessary Skill With Puppet Adjuncts During the COVID-19 Pandemic. J Hum Lact. 2020;36:619–21. Article  PubMed  Google Scholar  Download references

ACKNOWLEDGEMENTS We appreciate the hard work of Jitzy Marrero, Administrative Assistant and Billing Coordinator, for her meticulous bookkeeping and for providing access to submitted bills.

FUNDING This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. The authors have no financial relationships relevant to this

article to disclose. AUTHOR INFORMATION AUTHORS AND AFFILIATIONS * Division of Neonatology, Maria Fareri Children’s Hospital, Valhalla, New York, USA Melanie Leong, Maria Obaid, Maria

Cristina Fernandez Ramos & Boriana Parvez * Westchester Medical Center, Valhalla, New York, USA Melanie Leong, Maria Obaid, Maria Cristina Fernandez Ramos, Regina Eichenberger, Annamma

John, Patricia Krumholtz-Belkin, Tina Roeder & Boriana Parvez * Department of Pediatrics, New York Medical College, Valhalla, New York, USA Melanie Leong & Boriana Parvez Authors *

Melanie Leong View author publications You can also search for this author inPubMed Google Scholar * Maria Obaid View author publications You can also search for this author inPubMed Google

Scholar * Maria Cristina Fernandez Ramos View author publications You can also search for this author inPubMed Google Scholar * Regina Eichenberger View author publications You can also

search for this author inPubMed Google Scholar * Annamma John View author publications You can also search for this author inPubMed Google Scholar * Patricia Krumholtz-Belkin View author

publications You can also search for this author inPubMed Google Scholar * Tina Roeder View author publications You can also search for this author inPubMed Google Scholar * Boriana Parvez

View author publications You can also search for this author inPubMed Google Scholar CONTRIBUTIONS ML collected and reviewed data, interpreted results, and revised several versions of the

manuscript. MO collected data and contributed to the initial draft. MCFR contributed to the initial draft. RE performed lactation consults and contributed to the initial draft. AJ and PKB

performed lactation consults. TR collected data. BP designed the study, and critically reviewed and revised the manuscript. All authors reviewed the results and approved the final version of

the manuscript. CORRESPONDING AUTHOR Correspondence to Melanie Leong. ETHICS DECLARATIONS COMPETING INTERESTS The authors declare no competing interests. ADDITIONAL INFORMATION PUBLISHER’S

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Fernandez Ramos, M.C. _et al._ Skilled lactation support using telemedicine in the neonatal intensive care unit. _J Perinatol_ 44, 687–693 (2024). https://doi.org/10.1038/s41372-024-01894-7

Download citation * Received: 21 November 2023 * Revised: 19 January 2024 * Accepted: 23 January 2024 * Published: 10 February 2024 * Issue Date: May 2024 * DOI:

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