A Nurse Practitioner led Evaluation of a Clinical Protocol in the Primary Care Setting to Increase the Exclusivity and Duration of Breastfeeding to Six Months of Age.

다국어 초록 (Multilingual Abstract)

Purpose: Increasing the exclusivity and duration of breastfeeding is an important public health initiative identified by the Centers for Disease Control and Prevention, the World Health Organization, the United Nations Children's Fund, and the U.S. Department of Health and Human Services along with multiple other agencies. The purpose of this evaluation was to determine whether implementing an evidence-based guideline affects breastfeeding rates within a pediatric primary care setting.
Methods: A program based on the Academy of Breastfeeding Medicine (ABM) clinical protocol and endorsed by the Agency for Healthcare Research and Quality was used. "The Breastfeeding-Friendly Physician's Office Part 1: Optimizing care for infants and children" was developed based on the WHO/UNICEF Baby-Friendly Hospital Initiative (WHO & UNICEF, 2009).
Participants: The population includes 757 mother-infant pairs located in Northern Virginia. A two group pre- and post-protocol design was used. Data collection points include the hospital stay, the first newborn visit, and the 2-, 4- and 6-month health maintenance visits.
Procedure: The ABM protocol was used as a template within the practice and implemented by a team consisting of four nurses beginning in 2009. To evaluate this program, comparisons between the pre- and post-protocol groups was observed to determine the protocol's effectiveness as a method of increasing breastfeeding rates. Data was abstracted from electronic medical records of infants born before and after the protocol was in place. Chi-square analysis was used to compare breastfeeding rates between the two groups.
General Findings: The results of this evaluation are positive for exclusive breastfeeding with group comparisons showing a 10% increase in breastfeeding duration rates at all five time points (p ≤ .003). Families who deliver healthy infants at ≥ 37 weeks gestation, and receive care in a primary care setting that has implemented the ABM protocol may have increased rates of EXCLUSIVE (no-formula) breastfeeding up to 6-months of age.
Conclusion: Implementation of the ABM protocol with subsequent data collection provided an important evaluation of this program with useful data for clinical practice and further research. The ABM protocol provides a mechanism for continued breastfeeding support following hospital discharge within the primary care setting.