Breast milk is the best optimal source of nutrients for babies, especially those weighing below 1,500 grams when they are born. The benefits obtained from the mother’s own milk (MOM) include improved maturity of the gastrointestinal system, better tolerance for feeding, and a reduced risk of life-threatening infections, for instance, sepsis and necrotizing enterocolitis (University of South Florida, 2016). Such children also have a lower rate of mortality, better visual development, reduced chronic diseases in older age, and higher IQ scores. Moreover, such feeding also promotes bonding between the infant and its parent, improves the health of the mother, and reduces the costs of health care (University of South Florida, 2016).
However, at times, the mother may have insufficient breast milk and alternative source of enteral nutrition have to be sought for the child. They include breast milk from donors and artificial formulas (Quigley & McGuire, 2014). The donated breast milk may contain some amounts of the non-nutritive benefits of the mother’s own milk for preterm or low birth weight babies. In addition, while artificial formulas ensure a consistent supply of nutrients at an optimal level, a controversy exists regarding their impact on the child’s health (Quigley & McGuire, 2014). Uncertainty, therefore, exists concerning the risks and benefits of feeding such children with the donated milk from mothers and artificial formulas versus giving them their own mother’s milk (Quigley & McGuire, 2014). This paper aims at highlighting the question of the continued use of donor milk and formula in the NICU for the very low birth weight babies. In addition, possible solutions to this existing problem will be provided.
1.1 Background of the Study
Breast milk is the regular food for infants that is globally accepted and provides the optimal source of nutrition. The milk from the baby’s own mother, excluding that from donors, during the Neonatal Intensive Care Unit (NICU) stay, decreases short- and long-term risks of infant mortality (Meier, Engstrom, Patel, Jegier, & Bruns, 2010). It also reduces the risk of developing such infections as chronic lung infection (CLD), retinopathy, (ROP), nosocomial infections and neurocognitive delay, as well as rehospitalization following the discharge from NICU (Meier et al., 2010). The protective mechanisms change over time during the stay at the NICU and are also specific to human milk components (Meier et al., 2010). In addition, human milk from the infant’s own mother cannot be replaced by any other donor’s milk from another human, and the feeding of own mother’s milk should be a priority for the NICU.
However, despite the fact that the majority of women intend to breastfeed their own infants, some mothers with sick and hospitalized infants have inadequate volumes of milk to provide the necessary amounts of food for their children. This is especially true for the children with low birth weights, as the women often suffer from numerous physical and emotional barriers that interfere with their breastfeeding abilities (Panczuk, Unger, O’Connor, & Lee, 2014). When the milk of the mother is unavailable, their children can have inadequate daily supplies of milk, and so either pasteurized human donor milk or, alternatively, commercial milk formula is given to such babies either alone or together with their mother’s milk (Panczuk et al., 2014).
Numerous studies have indicated that the interventions in the form of donor breast milk and milk formulas have reduced nutritional and immunological benefits compared to mother’s own milk. For instance, they have been found to have lower protein and energy content. They also have varying contents of nutrients due to the manufacturing and treatment processes. Despite these factors, there has been increased use of donor human milk and milk formulas in the NICU, and this fact has been attributed to the shortage of mother’s own milk. For instance, in 2013, only 47.5% of infants born with low birth weights in Florida’s NICUs received any form of mother’s own breast milk (University of South Florida, 2016). Due to the dangers of not receiving any milk, donated or artificial milk formulas that match the uniqueness and value of the mother’s own milk have to be provided. The need for NICU to provide sufficient and quality milk to the newborns requires several steps, which are highlighted below.
1.2 Statement of the Problem
As already mentioned, recently there has been an increased use of human donated milk and artificial nutritional formulas in NICUs in the country. Human milk, and especially the mother’s own milk, has nutritional value and components that cannot be found in any other animal’s milk or artificially prepared product. In addition, due to the processing (pasteurization) involved in preparing and preserving this human donated milk, some of its beneficial values are lost. Moreover, different types of artificial milk vary in content and, therefore, may not meet the physical and nutritional demands of the infants in NICUs. Therefore, the preterm and low birth weight infants do not receive adequate nutrients for growth and the development of a strong immune system.
The attempts to meet the shortage of mother’s own milk by using donated milk and artificial formulas have been found to be non-beneficial to the children. Hence, there is a need to find solutions to address this problem and meet the demand for the mother’s own milk in NICUs. This paper, therefore, focuses on the disadvantages of using donated milk and artificial formulas and provides other possible solutions for addressing this problem.
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1.4. Purpose of the Study
The purpose of this study is to highlight the increased use of donor milk and formulas in the NICUs for very low birth weight babies (< or = 1500 grams) caused by the shortage of mother’s milk own. It is necessary to highlight possible solutions and increase the production of the mother’s own milk. Such milk should be prioritized in the NICUs.
1.5. Objectives of the Study
i. To highlight the increased use of donor milk and formulas in the NICUs for very low birth weight babies (< or = 1500 grams);
ii. To highlight the importance of using the mother’s own milk in the NICUs for very low birth weight babies (< or = 1500 grams);
iii. To establish possible solutions for using and promoting the use of mother’s own milk in the NICUs for very low birth weight babies (< or = 1500 grams).
1.6. Research Questions
i. Is there an increased use of donor milk and formulas in the NICU for very low birth weight babies (< or = 1500 grams)?
ii. What is the importance of using mother’s own milk in the NICUs for very low birth weight babies (< or = 1500 grams)?
iii. What are the possible solutions for using and promoting the use of mother’s own milk in the NICUs for very low birth weight babies (< or = 1500 grams)?
1.7. Significance of the Study
The research in this area will provide insight and understanding into why there is increased use of human donated milk and milk formulas in NICUs for very low birth weight babies (< or = 1500 grams). It will also supply the much-needed knowledge regarding the importance of breastfeeding for mothers by highlighting the physical, nutritional and immunological value mother’s own breast milk provides to the child. Hence, it will be possible to expand the already existing body of literature. Finally, this work will also mention possible solutions to the problem of increased use of donated and artificial formulas. In such a way, NICUs will be able to deal with the existing shortage of mother’s own milk and promote education as well as motivation for mothers to use it.
1.8. Limitation of the Study
The following limitations are expected:
i. Resistance from participants in availing information;
ii. The extent of generalizability of the results;
iii. Research design.
1.9. Assumptions of the Study
The following are the assumptions of the study:
i. All respondents will cooperate and provide reliable responses;
ii. Participants understand the concept of breastfeeding and the need to feed children with mother’s own milk;
iii. At the time of data collection, the parents will have an infant in the NICU or will have had one in the past.
2.1. Overview of the Importance of Breastfeeding
Breastfeeding is the most nutritional source for all infants, and exclusive breastfeeding is recommended by the WHO for at least six months. Breast milk has various functions that include the protection from infections, autoimmune disease, dysfunctions of the gastrointestinal system, and the promotion of cognitive development (Hunter & Gottheil, 2012). It contains fats that are vital for the development of the brain, hormones and enzymes, and growth factors that are responsible for gastrointestinal development. It also has antibodies and living cells for the prevention of infections and nutrients, sugars, fats, and proteins essential for the baby’s growth (Hunter & Gottheil, 2012). Therefore, virtually all children benefit from being breastfed regardless of their place of origin and residence, because breast milk contains all the nutrients required for the babies to remain healthy (Hunter & Gottheil, 2012). According to the study conducted by the UNICEF in 2000, if every child globally would have been breastfed exclusively up to six months, approximately 1.5 million lives would be not only saved but also enhanced annually (Hunter & Gottheil, 2012). Mother’s own milk is the perfect food for babies during the first six months of their life with no artificial product matching it.
Premature infants in NICUs are a heterogeneous group that has widely varying nutritional and immune protection requirements. If they are not met, then there is the risk of developmental delays, a failure to grow, necrotizing enterocolitis, and an on-set of sepsis later in life (Underwood, 2013). Therefore, breastfeeding should be the primary diet for such children. The recent policy statement of the American Academy of Pediatrics (AAP) regarding breastfeeding represents a significant shift from its early recommendation that human milk should be given together with donated milk to preterm children instead of a formula (Underwood, 2013). This situation is appropriate only when the mother cannot provide adequate amounts of breast milk.
Today, they state that mother’s own milk should be provided to the preterm babies exclusively due to its impressive array of benefits to this highly vulnerable population. Its advantages include fewer re-hospitalizations in the first year of life and improved neurodevelopmental outcomes (Underwood, 2013). In addition, a premature infant who consumes human milk has fewer complications because of the stronger immune system than that of the infant receiving a formula.
2.2 The Problem of Increased Used of Donated Milk and Formulas
Despite the importance of mother’s own breast milk for the preterm low birth weight infants, not all mothers are able to provide adequate volumes of breast milk. The situation is usually caused by psychological and physical problems that these mothers have experienced before and after giving birth to their children (Underwood, 2013). As a result, there has been an increased use of donated milk and milk formulas in order to meet the nutritional requirements of infants in NICUs all over the country.
However, the donated milk and milk formulas have several disadvantages that render them ineffective in meeting the nutritional demands of some infants. For instance, the process of pasteurization of the donated milk causes an alteration and/or reduction in the nutritional content of such milk (Quigley & McGuire, 2014). This process also affects the immunological element of breast milk. More specifically, even though pasteurization inactivates some viruses and bacteria, it also removes beneficial immune cells present in the donated milk hence reducing its immunological properties.
The risk of hospital-acquired neonatal infections has been recorded and is connected to the way in which the donated milk is given to the baby. Infants have been found to develop bacterial infections following the intake of milk from milk banks (Quigley & McGuire, 2014). For instance, a single outbreak of F. meningosepticum was found to come from one of the milk bottle stoppers, cleaned milk teats, and the environment. Other causes of deaths of children who had received donated milk from the same donors were reported (Quigley & McGuire, 2014). The infections found in children who had taken donated breast milk were those found in normal human skin’s flora. Similar dangers also exist for infants who use a formula in the place of breast milk. For instance, such children have higher risks of infectious morbidity (Quigley & McGuire, 2014). In addition, they have a high risk of developing cancer, and they also have poor neurological and intelligence development, as well as a poor immune system, as the toxins in formulas interfere with their immunity.
2.3. Dealing with the Problem
Due to the ever-increasing problems experienced by mothers after birth-giving, there has been more use of donated milk and milk formulas in NICUs for preterm babies. However, these “emergency measures” have apparent negative consequences, and thus there is a need for alternative solutions to address the problem of lacking mother’s milk. For instance, a better decision may be increasing the production of mother’s own milk combined with the increase of NICUs’ usage of mother’s milk while decreasing the use of donor milk or formulas. Simultaneously, it is necessary to ensure that the in-service staff of NICUs understands the goals and the needs to increase MOM and decrease donor and formula use. These goals can be attained by placing flyers/cards in the family/patient areas to provide families with information regarding the importance of MOM.
Moreover, it is advisable to place a TV with PowerPoint/video answering the most asked questions in the family area as well as the mothers’ room. In addition, the unit has to be supplied with the pumping logs to give to the mothers. Moreover, extra logs should be put at the patient’s bedside to remind the mother to document and keep track of her pumping. The success of this decision can be reinforced by preparing the staff to answer questions mothers may have regarding their pumping. It is also possible to place posters and/or flyers in the staff areas in order to remind the staff about the MOM initiative.
CHAPTER THREE: RESEARCH METHODOLOGY
This section illustrates the research design, study area, study population, sample size and sampling procedures, research instruments, data collection procedures, data analysis, and ethical considerations.
3.1 Research Design.
The study will use a non-experimental approach. Additionally, the descriptive survey design will be applied under this approach.
3.2 Population of the Study
The population of the study will include the staff working in the NICU, mothers with infants in NICU, and mothers who have children who went through the NICU.
3.3. Sampling Size and Sampling Procedures
This research will employ a convenient non-probability sampling procedure for all three categories of the target population. However, apart from the staff, the sample of the mothers with infants in NICU and that with the babies who previously went through the NICU and completed the treatment program will be determined by the following formula recommended by Israel (1982):
N = N
1 + N (e) 2
where n is the sample size,
N is the total population,
And e is the margin for error, which is 0.051.
3.4. Research Instruments
This study will use questionnaires as its research instrument, where both open- and closed-ended questions will be included. The questionnaires will be used because some of the responses may be personal, and, therefore, questionnaires will ensure confidentiality and allow to avoid identification of the respondents.
The questionnaires will be the researcher made. They will contain closed-ended questions where respondents will be required to give a YES/NO answer. Open-ended questions will require a brief explanation of the respondent’s answer. Any additional requirements will be explained thoroughly under each open-ended question.
3.3 Data Collection Procedures
First, an introduction letter will be first requested by the university. It will later be used to seek permission from the hospital’s administration to conduct the study at the chosen hospital. An authorization letter or permit will then be collected from the hospital, which will allow the study to commence. After the acquisition of these two documents, a formal consent of the participation of the study will be distributed among the participants. Upon the acquisition of these consent forms with signatures, the questionnaires will be administered only to those participants who will have agreed to take part in the study for data collection.
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3.4 Data Analysis
First of all, after collection, the data will be edited and coded. Afterward, the coded data will be analyzed in various stages. Statistical descriptive analysis will then be carried out and the mean, mode, and standard deviation will be determined. Further inferential statistical analysis will be done and the data will be prepared for presentation with the help of tables and bar graphs. A table of data analysis will also be prepared and it will contain the research question, the independent variable, the dependent variable, and the type of statistic.
3.5 Ethical Consideration
i. The respondents have the right to choose whether to participate or not;
ii. The respondents will have an unrestricted right to leave the study at any time;
iii. The questionnaires distributed among the participants will have a cover letter explaining the intention and the purpose of the study;
iv. The researchers will explain the purpose of the study to the participants in order for them to make an informed decision of whether to participate in the study or not;
v. The participants will not be required to write their names on the questionnaires to ensure anonymity;
vi. The identities of the participants will be concealed to ensure confidentiality.