Adrienne Hoyt-Austin

Background: Among persons of childbearing age, advanced chronic kidney disease (stage 3–5) reportedly affects approximately 1 in 150 individuals. Birth rates compared to the general population are lower in kidney transplant recipients and in individuals undergoing dialysis, estimated at approximately 1:10 and 1:100, respectively. Despite these challenges, the incidence of pregnancy among those with chronic kidney disease is increasing, and birthing parents with advanced chronic kidney disease, including those undergoing dialysis or with a kidney transplantation, express a strong desire to breastfeed prenatally and initiate breastfeeding after childbirth. However, the factors influencing breastfeeding outcomes and their milk composition in birthing parents with kidney disease are not well understood. At present, no clinical practice guidelines exist to specifically address lactation management for birthing parents with kidney disease, leaving a gap in support and care for this population. Aims: Our primary aims are to describe lactation outcomes and define milk composition for birthing parents with advanced chronic kidney disease, post-kidney transplantation, or receiving dialysis therapy. Our secondary aims are to describe the breastfeeding experience, including attitudes, self-efficacy, and challenges, and evaluate infant health outcomes including developmental and medical history. Methods: We are conducting a prospective observational cohort study in California, using mixed methods to examine lactation outcomes, breastfeeding experience, parent-infant health, and milk composition among participants ( N ≈ 10) with chronic kidney disease, kidney transplantation or dialysis. Participants will complete surveys, oral interviews, breastfeeding telemedicine consultations, 24-hour infant test-weighing, and milk sample collection. Control participants without kidney disease and with either normal (600–1035 mL) or low (< 600 mL) milk supply will be recruited. Milk composition (macronutrients, metabolome, electrolytes, cytokines, and immunoglobulins) will be compared. We will use descriptive statistics to summarize participant characteristics, and inductive thematic analysis to generate contextual insight into lactation patterns and birthing parent experiences. Discussion: Outcomes of this study will guide practice recommendations for the multidisciplinary care team supporting birthing parents with advanced chronic kidney disease, kidney transplantation or undergoing dialysis, ensuring breastfeeding safety and appropriate support.

Objective: Human milk supports optimal health outcomes for infants in the neonatal intensive care unit; however, expressing milk is impacted by separation, stress, and time. We examined the impact of using videoconferencing with one’s infant while expressing milk on the volume, efficiency, human milk macronutrient content, and the milk expression experience. Methods: In this randomized controlled crossover trial (NCT03957941), mothers of premature infants expressed milk three times with videoconferencing and three times without. Milk volumes and expression time were self-recorded. Experience was assessed with the Breast Milk Expression Personal Experience (BMEE) subscale. Milk samples were analyzed using the Miris Human Milk Analyzer™. Data were analyzed using a panel data fixed-effects model to estimate within-person mean differences (MDs) between study arms in human milk volume, efficiency, macronutrient content, and BMEE scores. Results: A total of 39 women were enrolled in the study, 28 provided milk volume and efficiency data, 26 completed BMEE scores, and 24 provided milk samples. Videoconferencing improved the milk expression experience, with mean BMEE subscale scores higher with videoconferencing (MD 0.10; 95% confidence interval [CI]: 0.02, 0.18; p = 0.01). There was no difference in milk volume (MD −2.5 mL; CI: −11.9, 6.9; p = 0.6) nor efficiency (MD 0.3 mL/min; CI: −0.4, 0.9; p = 0.4). Conclusions: Videoconferencing with one’s hospitalized premature infant improves the pumping experience. However, the use of videoconferencing was not associated with significant effects on human milk expression nor efficiency.

Background: Despite health benefits to both infants and mothers, many are not breastfeeding as recommended by national guidelines. Prior studies examining the effects of housing insecurity and food insecurity on breastfeeding intention and duration have been limited and yielded mixed findings. Methods: To assess the relationship among housing insecurity, food insecurity, and breastfeeding, we conducted a secondary analysis of a cohort of nulliparous U.S.-born pregnant individuals with a singleton gestation of ≥28 weeks who completed web-based surveys on five occasions over their infant’s first year of life. Upon enrollment, we screened participants for housing and food insecurity and participation in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). We examined variations in breastfeeding intentions and practice by housing insecurity and food insecurity, controlling for demographic factors, using multivariable logistic regression. Results: Of 411 participants, 67 (16%) reported housing insecurity, and 48 (12%) reported food insecurity. Participants with housing insecurity were less likely to report exclusive breastfeeding at 6 months (17.9% versus 29.1%, p = 0.06) and significantly less likely to report any breastfeeding at 12 months (34.3% versus 56.9%, p = 0.003) compared to those with secure housing. In both bivariate and multivariable models, housing insecurity was significantly associated with cessation of breastfeeding before 12 months. Food insecurity was not significantly associated with breastfeeding duration or exclusivity. Conclusions: Housing insecurity is associated with and may adversely impact infant feeding, highlighting the need for screening and accessible and affordable family housing, with further investment in food assistance programs such as WIC.

Background: Telehealth use during family-centered rounds in the neonatal intensive care unit has been shown to shorten length of hospitalization and improve breastfeeding outcomes. For families who speak languages other than English, access to and use of telehealth technologies can be impeded by lack of interpreter services. We aim to evaluate the feasibility of telehealth use during family-centered rounds in the neonatal intensive care unit for families who speak languages other than English. Methods: In this study proposal, we will conduct an intervention evaluation using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework to assess the feasibility of telehealth use during family-centered rounds among families who speak languages other than English in a single-arm feasibility trial. We will provide language-appropriate materials to assist parents with accessing the telehealth technology and bring interpreters into the telehealth encounter directly with neonatal providers. All eligible infants whose families speak languages other than English in a single-site level 4 neonatal intensive care unit during the study period will be included. These families can participate in hospital rounds via telehealth, in-person, or not participate in hospital rounds. We will examine feasibility objectives that assess parental uptake of telehealth for rounds, parental participation in rounds, presence of a certified medical interpreter, telehealth technical issues, and parental survey response rates. We will conduct a mixed methods implementation evaluation using the RE-AIM framework. Exploratory outcomes include parent attendance, length of hospitalization of the infant, human milk feeding, frequency of medical error, parent-reported experience, parental comfort with their child’s care, and parental quality of life will be collected. Discussion: This study will aid in understanding gaps to telehealth care in languages other than English. We believe this approach will improve health outcomes for hospitalized premature infants, understanding of medical conditions, improve parental quality of life, and reduce inequities in access to healthcare via telehealth technologies. Trial registration: NCT05917899 Limited English Proficiency Virtual Family-Centered Rounds, first posted June 26, 2023, last update posted November 11, 2024.

Background: Scabies infections of the breast in lactating individuals are not well described, especially how maternal infection can impact human milk feeding of hospitalized infants in the intensive care setting. Methods: This case report presents a critically ill female infant with a complex surgical history whose mother had an active scabies infection around the breast postpartum and wished to provide expressed human milk. Results: In this case report, human milk was recommended despite maternal scabies infection. Conclusion: Given the limited information that is known about the risk of scabies transmission in human milk for critically ill infants, this case adds to the knowledge base and supports the call for further research.

Objective: To assess the effects of prenatal counseling about the maternal health benefits of lactation on postpartum knowledge, breastfeeding intentions, and infant feeding behaviors. Materials and Methods: We conducted a randomized trial with 411 nulliparous U.S.-born women carrying a singleton gestation. Participants were recruited online; after completing a baseline survey that assessed breastfeeding knowledge and intentions, participants were randomized to receive a 10-minute virtual counseling session about the benefits of breastfeeding or attention-control counseling about smoke-free homes. We collected data on breastfeeding knowledge, intentions, and infant feeding behaviors through 12 months postpartum and conducted an intention-to-treat analysis. Results: On enrollment, awareness of the maternal health benefits of lactation was similarly low in both study groups. Postpartum, participants who received this prenatal counseling intervention had significantly greater awareness that breastfeeding decreases maternal risk of breast cancer, ovarian cancer, diabetes, heart disease, and rheumatoid arthritis ( p < 0.001 for all). On enrollment, intended duration of breastfeeding was similar between groups (10.1 months versus 9.7 months, p = 0.41). At 1-month postpartum, intended duration of breastfeeding had increased from baseline among those who received this counseling (+0.7 months versus −0.7 months among controls, p = 0.004); among intervention participants intended duration of breastfeeding decreased less at 3 (−0.8 versus −1.6, p = 0.18), 6 (−2.0 versus −3.0, p = 0.06), 9 (−2.8 versus −4.2, p = 0.03), and 12 months postpartum (−4.8 versus −6.2, p = 0.09). Rates of exclusive breastfeeding and any breastfeeding were similar between groups. Conclusion: Prenatal counseling on the maternal health benefits of lactation increases awareness of these maternal health benefits and extends intended duration of breastfeeding. ClinicalTrials.gov Identifier: NCT04601987.

Introduction Adverse childhood experiences (ACEs) are common and have been associated with poor developmental outcomes. We aimed to investigate the relationship between early ACE exposure, subsequent diagnosis of developmental delay, and receipt of developmental delay services by young children. In addition, we aimed to assess the impact of health-promoting behaviors such as breastfeeding and daily reading on these relationships. Methods In this cross-sectional analysis of nationally-representative data from the 2017–2018 National Survey of Children’s Health, we examined the relationship between ACEs, prior breastfeeding, daily reading, and developmental delay diagnosis among 7837 children aged 3–5 years, using multivariate logistic regression to adjust for family, personal, and sociodemographic characteristics. Results We found a dose-dependent relationship between ACEs and developmental delay diagnosis; compared to those without ACEs, developmental delay was more common among those with either one ACE (aOR = 2.03, 95% CI 1.17–3.52) or two or more ACEs (aOR = 2.34, 95% CI 1.25–4.37). Neither breastfeeding (exclusively breastfed for 6 months vs. never breastfed aOR = 0.70, 95% CI 0.33–1.46) nor daily reading (no reading versus daily reading aOR = 1.15, CI 0.57–2.33) were associated with incidence of developmental delay among study participants. There was no significant difference in receipt of services intended to meet developmental needs between children with and without ACEs. Discussion Children with very early ACE exposure are at increased risk for diagnosis of developmental delay. Early screening for ACEs and developmental delay may mitigate the early developmental manifestations of ACE exposure in vulnerable children.

Background: Prior research suggests that physicians' personal experience with breastfeeding may influence their attitudes toward breastfeeding. This phenomenon has not been explored in well‐newborn care physician leaders, whose administrative responsibilities often include drafting and approval of hospital breastfeeding and formula supplementation policies.Methods: We conducted a mixed‐methods study, surveying physicians in the Better Outcomes through Research for Newborns (BORN) network. We examined physician attitudes toward recommending breastfeeding and their breastfeeding experience. Qualitative analysis was conducted on responses to the question: “How do you think your breastfeeding experience influences your clinical practice?”Results: Of 71 participants, most (92%) had a very positive attitude toward breastfeeding with 75% of respondents reporting personal experience with breastfeeding. Of these, 68% had a very positive experience, 25% had a somewhat positive experience, and 6% had a neutral experience. Four themes emerged with respect to the effect of breastfeeding experience on practice: (1) empathy with breastfeeding struggles, (2) increased knowledge and skills, (3) passion for breastfeeding benefits, and (4) application of personal experience in lieu of evidence‐based medicine, particularly among those who struggled with breastfeeding.Conclusions: Well‐newborn care physician leaders reported positive attitudes about breastfeeding, increased support toward breastfeeding persons, and a perception of improved clinical lactation skills. Those who struggled with breastfeeding reported increased comfort with recommending formula supplementation to their own patients. Medical education about evidence‐based breastfeeding support practices and provision of lactation support to physicians has the potential to affect public health through improved care for the patients they serve.