Title: Peer Counselors Increase Breastfeeding Rates in the NICU: Results of an RCT
1Peer Counselors Increase Breastfeeding Rates in
the NICU Results of an RCT
- Anne Merewood, MA, IBCLC1
- Laura Beth Chamberlain, BA, IBCLC2
- Barbara L. Philipp, MD, IBCLC1
- John T. Cook, PhD1
- Kirsten Malone, BA, IBCLC2
- Howard Bauchner, MD1
1 Division of General Pediatrics, Boston Medical
Center, Boston University School of Medicine
2The Breastfeeding Center, Boston Medical
Center Funded by the Bureau of Maternal Child
Health (R40 MC 00252-03)
2Background
- Rates of breastfeeding low in premature infants
- Health risks of formula-feeding high in premature
infants - Significant barriers exist to breastfeeding
premies among women of low SES - Peers increase breastfeeding rates in term
infants of women of low SES
3Objective
- To determine whether peer counselors increase
breastfeeding duration among premature infants in
the NICU
4Study setting
- The Neonatal Intensive Care Unit (NICU) at Boston
Medical Center - February 2002 - August 2004
- Level III, 15-bed NICU
- Inner city teaching hospital with 2000 births/350
NICU admits per year - Baby-Friendly hospital
5Baby-Friendly Hospital Initiative
- UNICEF/WHO award for hospitals that meet The Ten
Steps to Successful Breastfeeding - Evidence based best practice for breastfeeding
- 18,000 Baby-Friendly hospitals worldwide
- 46 in the US
6Study design
- Randomized Controlled Trial
- Women assigned to control group (standard of
care) or intervention group (standard of care
plus peer) - Pairs followed for 12 weeks
- Data collected at 2, 4, 8, 12 weeks by RA unaware
of group assignment
7Eligibility
- Infant
- 26 - 37 weeks gestational age
- Otherwise healthy
- AGA
- Mother
- Intent to breastfeed
- Eligible to breastfeed (AAP statement, 1997)
- Spoke English, French, or Spanish
8Intervention
- Peer counselor A woman from a similar
socioeconomic, racial/ethnic background to that
of the mother, with breastfeeding experience - Peers trained at 5-day breastfeeding course,
passed exam, and trained on the unit by Board
Certified Lactation Consultants
9(No Transcript)
10Intervention
- Peer met with mother within 72 hours of birth
- Peer contact weekly for 6 weeks
- Face-to-face contact when infant in NICU
- Telephone contact when infant at home
- Peers kept field records
11Intervention
- Initial peer encounter
- Discussed pumping 100
- Helped mother pump 72
- Accompanied mother to NICU 72
- Helped mother to breastfeed, kangaroo-care, or
both 30
12Statistical analysis
- 1. Chi square tests to test null hypothesis of
provision of any gt50 exclusive breast milk at
2, 4, 8, 12 weeks - 2. Cox proportional hazard model to examine
pooled data for overall differences in
breastfeeding duration over 4 observation periods
13Definitions
- Any breast milk (any at all)
- Mostly breast milk (gt50)
- Exclusive breast milk
14Results
- 577 pairs assessed for eligibility
- 469 excluded/ineligible (GA multiples refusals
etc.) - 108 pairs enrolled and randomized
- 7 subsequent exclusions (positive drug
tests/mother withdrew)
15Results
- 48 women in intervention group (IG)
- 53 women in control group (CG)
- Groups equivalent on all measured
sociodemographic factors
16Results
- Mean GA 32 weeks (range 26-37)
- Mean birthweight 1875g (range 682-3005)
- Average length of stay 27 days (IG) 25 days
(CG) (range 1 - 104 days)
17Results Any breast milk
- Peer
- 2 weeks 100
- 4 weeks 98
- 8 weeks 83
- 12 weeks 73
No peer 89 79 57 49
P value 0.016 0.005 0.007 0.026
18Results Mostly breast milk
Peer 2 weeks 85 4 weeks
78 8 weeks 64 12 weeks 43
No peer 74 62 35 23
P value 0.143 0.084 0.005 0.053
19Results Exclusive breast milk
Peer 2 weeks 56 4 weeks
41 8 weeks 19 12 weeks 11
No peer 43 39 14 9
P value 0.197 0.865 0.524 0.197
20Results Number needed to treat
- Example The number needed to treat at 12 weeks
for any breastmilk is 4
21Results Blacks only, any breast milk
- Peer
- 2 weeks 100
- 4 weeks 97
- 8 weeks 88
- 12 weeks 75
No peer 86 80 53 47
P value 0.020 0.027 0.003 0.028
70/101 69 of total study population
22Results Blacks only, all observation points
- Peer
- Any
- breast milk 91
- Mostly
- breast milk 68
- Exclusive
- breast milk 25
No peer 67 50 32
P value lt 0.001 0.003 0.209
23Results Complete sample
Plt0.001
24Results Blacks only
P0.001
25Limitations
- Most infants between 32-37 weeks
- Insufficient statistical power to measure effect
in younger age group - Baby-Friendly environment may have enhanced peer
effectiveness - 17 women lost to follow up over 12 week period
26Conclusions
- Peer counselors increased breastfeeding duration
rates among premature infants in the NICU - Peer counselors increased amount of breast milk
consumed - Peer counselors would help increase breast milk
intake in this vulnerable population
27Future directions
- Larger trials to investigate effect on
exclusivity - Peer programs should follow consistent guidelines
including face to face contact - Peer programs should be rigorously evaluated to
create effective model