Parental Leave Policies and Pediatric Trainees in the United States.

BACKGROUND: The American Academy of Pediatrics (AAP) states that each residency program should have a clearly delineated, written policy for parental leave. Parental leave has important implications for trainees' ability to achieve their breastfeeding goals. OBJECTIVE: This study aimed to measure the knowledge and awareness among members of the AAP Section on Medical Students, Residents, and Fellowship Trainees (SOMSRFT) regarding parental leave. METHODS: An online survey was emailed to SOMSRFT members in June 2013. Quantitative data are presented as percentage of respondents. Awareness of leave policies was analyzed based on having children and the sex of respondents. RESULTS: Nine hundred twenty-seven members responded to the survey. Among those with children, 40% needed to extend the duration of their training in order to have longer maternity leave, 44% of whom did so in order to breastfeed longer. Thirty percent of respondents did not know if their program had a written, accessible policy for parental leave. Trainees without children and men were more unaware of specific aspects of parental leave such as eligibility for the Family Medical Leave Act as compared to women and those with children. CONCLUSION: Despite the fact that United States national policies support parental leave during pediatrics training, and a majority of programs comply, trainees' awareness regarding these policies needs improvement.

"Frustrated," "depressed," and "devastated" pediatric trainees: US academic medical centers fail to provide adequate workplace breastfeeding support.

BACKGROUND: Exclusive breastfeeding (EBF) is recommended until about 6 months of age. Pediatricians are at the forefront of encouraging mothers to achieve this goal, yet pediatricians who parent during their training may face substantial barriers in achieving their own breastfeeding goals. OBJECTIVES: This study aimed to assess breastfeeding support available to US pediatricians in training and the effect of trainees' personal experiences on their attitude toward breastfeeding. METHODS: An online survey was emailed to American Academy of Pediatrics Section on Medical Students, Residents, and Fellowship Trainees members. RESULTS: There were 927 respondents, of which 421 had children and 346 breastfed their children. Almost 80% agreed that 6 months is the ideal duration for EBF. One in 4 did not have access to or were not aware of a private room to express milk or breastfeed. Forty percent needed to extend the duration of their training for a longer maternity leave, with breastfeeding a factor for longer leave among 44%. One in 4 did not meet their breastfeeding duration goal, and 1 in 3 did not meet their goal for EBF. Negative emotions were common among those not meeting goals. Ninety-two percent felt that their or their partner's experience with breastfeeding affected their clinical interaction with patients' mothers. CONCLUSION: A majority of respondents cited problems with breastfeeding support during training, and many failed to meet their intended goals. Not meeting personal breastfeeding goals was associated with negative emotions and influenced how they counsel about breastfeeding as a result of personal and often negative attitudes.

Nascent regional system for alerting infection preventionists about patients with multidrug-resistant gram-negative bacteria: implementation and initial results.

OBJECTIVE: To build and to begin evaluating a regional automated system to notify infection preventionists (IPs) when a patient with a history of gram-negative rod multidrug-resistant organism (GNRMDRO) is admitted to an emergency department (ED) or inpatient setting. DESIGN: Observational, retrospective study. SETTING: Twenty-seven hospitals, mostly in the Indianapolis metropolitan area, in a health information exchange (HIE). PATIENTS: During testing of the new system: 80,180 patients with microbiology cultures between October 1, 2013, and December 31, 2013; 573 had a GNRMDRO. METHODS/INTERVENTION: A Health Level Seven (HL7) data feed from the HIE was obtained, corrected, enhanced, and used for decision support (secure e-mail notification to the IPs). Retrospective analysis of patients with microbiology data (October 1, 2013, through December 31, 2013) and subsequent healthcare encounters (through February 6, 2014). RESULTS: The 573 patients (median age, 66 years; 68% women) had extended-spectrum ß-lactamase-producing Enterobacteriaceae (78%), carbapenem-resistant Enterobacteriaceae (7%), Pseudomonas aeruginosa (9%), Acinetobacter baumannii (3%), or other GNR (3%). Body sources were urine (68%), sputum/trachea/bronchoalveolar lavage (13%), wound/skin (6%), blood (6%), or other/unidentified (7%). Between October 1, 2013, and February 6, 2014, 252 (44%) of 573 had an ED or inpatient encounter after the GNRMDRO culture, 47 (19% of 252) at an institution different from where the culture was drawn. During the first 7 weeks of actual alerts (January 29, 2014, through March 19, 2014), alerts were generated regarding 67 patients (19 of 67 admitted elsewhere from where the culture was drawn). CONCLUSIONS: It proved challenging but ultimately feasible to create a regional microbiology-based alert system. Even in a few months, we observed substantial crossover between institutions. This system, if it contributes to timely isolation, may help reduce the spread of GNRMDROs.

Family-centered, evidence-based phototherapy delivery.

Jaundice develops in most newborn infants and is one of the most common reasons infants are rehospitalized after birth. American Academy of Pediatrics clinical practice guidelines strongly support the recommendation that clinicians promote and support breastfeeding. Recognizing that the disruptions associated with phototherapy interfere with breastfeeding, the challenge often faced by clinicians is how to provide effective phototherapy while supporting evidence-based practices, such as rooming-in, skin-to-skin contact, and breastfeeding. We report here on a case that reflects a common clinical scenario in newborn medicine in order to describe a technique for providing phototherapy while maintaining evidence-based practices. This approach will assist clinicians in providing best-practices and family-centered care.

Breastfeeding experiences among physicians.

BACKGROUND: During medical school and residency training, physicians are taught that breastfeeding is the preferred feeding for all infants, with rare exceptions. But evidence is accumulating that while physician mothers have a high rate of breastfeeding initiation, they face significant obstacles to sustained breastfeeding. METHODS: In our academic medical center, we conducted a brief survey of physicians who have young children, to explore their own experiences with breastfeeding. The survey explored the physician-as-parent's own experiences with breastfeeding -- prenatal intentions, postnatal difficulties, ability to meet goals, emotions if goals were not met, resources for support pre- and postnatally, and ideas about what would have helped her breastfeed longer. RESULTS: Two-thirds of the physicians who initiated breastfeeding had difficulties. Among those with difficulties, about three-fourths were able to resolve them. CONCLUSIONS: Even mothers who are medical professionals experience, and often cannot overcome, difficulties with breastfeeding. Women in medicine need enhanced breastfeeding support and services/resources. Advocacy is needed, in our work environments, for better breastfeeding support not only for our physician colleagues, but also for all lactating employees within our institutions.

American Academy of Pediatrics Section on Breastfeeding.

The Section on Breastfeeding is one of 50 sections of the American Academy of Pediatrics. In this Physicians' Focus, we describe the mission, vision, and activities of the Section on Breastfeeding and the benefits it provides to patients, health care professionals, and the general public. We also highlight opportunities to participate in the section.

Contemporary ethical issues in human milk-banking in the United States.

Donor human milk has been used in the United States for >90 years, but recent advances in human milk science and laboratory techniques have led to increasing use of this resource. Pediatricians began using donor human milk in the 1900s in response to anecdotal observation that premature infants had better health outcomes when receiving their own mothers' milk. Since then, a formalized human milk-banking system developed in the mid-1980s and distributed >1 million ounces of pasteurized donor human milk in 2008. Despite growth in the use of pasteurized donor human milk, there is little discussion in the medical literature regarding the ethical considerations of collection and use of this resource. Key ethical considerations include issues surrounding medical decision-making and informed consent, increasing the limited supply of human milk, how ethically to allocate this scarce resource, and concerns linked to the marketing of a human milk.

The Academy of Breastfeeding Medicine.

The Academy of Breastfeeding Medicine is a worldwide organization of physicians dedicated to the promotion, protection, and support of breastfeeding and human lactation. In this Physician Focus, we describe the mission and activities of the Academy. We also highlight opportunities for physicians to participate.

Breastfeeding and the Bahá'í Faith.

The Bahá'í Sacred Writings reference breastfeeding literally and symbolically and provide guidance as to its practice. Breastfeeding is endorsed as the ideal form of infant nutrition. The importance of breastfeeding is underscored by the exemption of breastfeeding women from fasting, as well as by the identification of breastfeeding as being linked to the moral development of children. Several of the central principles of the Bahá'í Faith, such as the equality of women and men and the harmony of science and religion, may engender attitudes that support the practice of breastfeeding. The implications of the Bahá'í Writings with regard to breastfeeding are explored and summarized here.

Induced lactation and exclusive breast milk feeding of adopted premature twins.

The authors report the first published case of premature twins whose adoptive mother induced lactation. Both infants are receiving exclusively human milk (adoptive mother's milk) at 2 months of age. This remarkable achievement reflects careful planning by the adoptive mother beginning in the prenatal period, her active role during the infants' hospital stay, and support from health care personnel and family members. Health care professionals are encouraged to support any adoptive mother who expresses interest in breastfeeding her infant(s).

Maternal membranous glomerulonephritis and successful exclusive breastfeeding.

Despite the fact that exclusive breastfeeding is the gold standard for feeding babies through 6 months of age, there is a notable paucity of information regarding the effect of various chronic maternal illnesses on lactation. With increasingly effective obstetrical and subspecialty management of pregnancy in these women, a growing number of questions about breastfeeding in the context of chronic maternal illnesses will be asked. Here we describe a case of successful exclusive breastfeeding by a woman with long-standing membranous glomerulonephritis.

Breastfeeding knowledge, attitudes, and practices among providers in a medical home.

OBJECTIVE: Breastfeeding offers numerous health advantages to children, mothers, and society. From obstetrics to pediatrics, breastfeeding dyads come in contact with a wide range of healthcare providers. The American Academy of Pediatrics (AAP) calls for pediatricians to support breastfeeding enthusiastically and for all children to have a medical home. We studied an inner-city healthcare system with a Dyson Community Pediatrics Training Initiative Model Medical Home clinic, to explore how a breastfeeding/baby-friendly medical home might be built upon this framework. We describe breastfeeding knowledge, attitudes, and practices among a full range of providers and healthcare system-level barriers to effective and coordinated breastfeeding services. METHODS: We conducted eight focus groups using semistructured interviews: (1) pediatricians; (2) obstetricians; (3) pediatric nurses and allied health professionals; (4) obstetric nurses and allied health professionals; (5) 24-hour telephone triage answering service nurses; (6) public health nurses; (7) Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) personnel; and (8) lactation consultants and peer counselors. RESULTS: We identified gaps in providers' breastfeeding knowledge, counseling skills, and professional education and training. Providers' cultures and attitudes affect breastfeeding promotion and support. Providers used their own breastfeeding experiences to replace evidence-based knowledge and AAP policy statement recommendations for breastfeeding dyads. There were communication disconnects between provider groups. Providers underestimated their own, and overestimated others', influence on breastfeeding. The system lacked a coordinated breastfeeding mission. CONCLUSIONS: This study illuminated key disconnectedness challenges (and, hence, opportunities) for a model medical home in fostering continuous, comprehensive, coordinated, culturally effective, and evidence-based breastfeeding promotion and support.

Quintuplets and a mother's determination to provide human milk: it takes a village to raise a baby--how about five?

This is the first published case of quintuplets who breastfeed and receive expressed mother's own milk and supplemental pasteurized donor human milk. In this case, all 5 babies receive exclusively human milk at 7 months. This result is achieved because of the mother's strong advocacy for human milk feedings and a remarkable support system of 200 individuals drawn from family, friends, and congregation.

Prenatal syphilis screening rates measured using medicaid claims and electronic medical records.

BACKGROUND: To prevent congenital syphilis, the Centers for Disease Control and Prevention and professional organizations recommend universal prenatal syphilis screening. State-level or larger-scale evaluations of adherence to these guidelines have relied on administrative data. We measured prenatal syphilis screening rates in Indiana women with prenatal Medicaid coverage and also used electronic medical records to examine the completeness of syphilis screening claims in Medicaid administrative data. METHODS: In statewide Indiana Medicaid claims data, diagnosis and procedure codes were used to identify women who delivered an infant between October 1, 1998, and September 30, 2002. Claims for prenatal (that is, during the 40 weeks before and including the delivery date) syphilis screens, including the "obstetric panel" of tests, and for prenatal visits were extracted. A subset of the study population received prenatal care in a large public hospital and its affiliated clinics served by an electronic medical records system. For these women, claims data were compared with laboratory reports. RESULTS: Among 74,188 women with one delivery in Medicaid claims data, 60% had at least 1 prenatal syphilis screening claim, and 15% had 2 or more. Women with continuous Medicaid enrollment during pregnancy or with at least one prenatal visit claim had higher rates. Among the 3960 women for whom Medicaid claims and laboratory data were available, 49.8% had at least one prenatal syphilis screen in Medicaid claims, but 99.3% had at least one laboratory report of a syphilis screen. CONCLUSIONS: Measurements made using Medicaid administrative data appear to substantially underestimate true prenatal syphilis screening rates.