Human milk and breastfeeding support in United States paediatric cardiac ICUs: a multicentre cohort and survey study.

Abstract

Human milk and direct breastfeeding are recommended for all infants, but rates are low in CHD with limited data on institutional lactation support. We aimed to describe lactation-supportive practices within US paediatric cardiac ICUs and to determine associations between these practices and human milk/breastfeeding outcomes. This retrospective cohort study and site survey included centres from Collaborative Research from the Pediatric Cardiac Intensive Care Society. Linear regression assessed associations between the total number of lactation-supportive practices and sites' human milk and breastfeeding percentages, during the neonatal period and at discharge. Potentially strong clinical practices were identified through a phased analysis. Survey respondents represented 34 sites, with detailed data for 832 patients from 24 sites. Implementation of 22 lactation-supportive practices varied (median: 10; range: 2-20); smaller sites reported fewer practices (p = 0.006). Common practices included in-room breast pumps (100%), feeding protocols (91%), and staff training (79%), while skin-to-skin protocols (41%) and automatic lactation orders (44%) were underutilised. While total practices did not correlate with outcomes, sites with high versus low implementation of "strongest" practices demonstrated generally better lactation outcomes, especially at discharge: 11.7% higher human milk volume (95% CI: 0.1%-23.3%); 8.2% higher breastfeeding rate (95% CI: -0.3%-16.6%). These strongest practices involved institutional formalisation of lactation support. Lactation-supportive practices varied among sites. Findings suggest formalisation of practices including a developmental care protocol, comprehensive parent education/support, and protocols recommending human milk/breastfeeding may improve lactation outcomes in critical CHD.