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.

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Publication Details

Journal
Cardiology in the Young
Published
2026-09-29
DOI
https://doi.org/10.1017/s1047951126124093
Primary Topic
Breastfeeding Practices and Influences
Type
article
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article

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

Kristin M. Elgersma, Meghan Chlebowski, Asaad G. Beshish, Dana M. Mueller et al.
Cardiology in the Young
Breastfeeding Practices and Influences
article

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

Kristin M. Elgersma, Meghan Chlebowski, Asaad G. Beshish, Dana M. Mueller, Sukumar Suguna Narasimhulu, Nimrod Goldshtrom, Christopher W. Mastropietro, Katherine Cashen, Raya Safa, Monique R. Radman, Jordan Schneider, Jamie M. Furlong-Dillard, Saúl Flores, Reshma Reddy, Stephanie A. Goldstein, Brian F. Joy, Jennifer E. Schramm, Robert Marcel Huibonhoa, Kimberly I. Mills, Karan B. Karki, Brittany L. Shutes, Ahmed Asfari, Joshua H. H. Wong, Zuofu Huang, Andrea Beach, K. Sofia Mendieta, Grace Liao
article en

Abstract

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.

Cardiology in the Young
Boston Children's Hospital (US), University of Minnesota (US), Lucile Packard Children's Hospital (US), Children's National (US), University of Louisville (US), Johns Hopkins University (US), Emory University (US), Medical University of South Carolina (US), University of Tennessee Health Science Center (US), Central Michigan University (US), Duke University (US), Grinnell College (US), Baylor College of Medicine (US), University of Washington (US), University of Utah (US), Columbia University Irving Medical Center (US), University of Florida (US), University of California San Diego (US), Cohen Children's Medical Center (US), Lurie Children's Hospital (US), Advocate Children's Hospital (US), Duke University Health System (US), Advocate Children's Hospital (US), Indiana University School of Medicine, The Ohio State University (US), University of Cincinnati (US), The University of Texas Southwestern Medical Center (US)
Openalex Percentile: Top 11%
Breastfeeding Practices and Influences
DOIOpen Access PDFOpenAlex
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