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  • 1.
    Bandara, Sandya
    et al.
    Hospital Peradeniya, Sri Lanka.
    Nyqvist, Kerstin Hedberg
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
    Musmar, Samar M J
    Faculty of Medicine and Health Sciences, An-Najah National University, Palestine.
    Procaccini, Diane B
    Lactation Services, Capital Health Hospital, New Jersey, USA.
    Wang, Shu-Fang
    Buddhist Tzu-Chi General Hospital, Hualien, Taiwan.
    RoundTable discussion: Use of alternative feeding methods in the hospital2012In: Journal of Human Lactation, ISSN 0890-3344, E-ISSN 1552-5732, Vol. 28, no 2, p. 122-124Article in journal (Refereed)
  • 2.
    Flacking, Renée
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm , Center for Clinical Research Dalarna. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
    Nyqvist, Kerstin Hedberg
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
    Ewald, Uwe
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Wallin, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
    Long-term duration of breastfeeding in Swedish low birth weight infants2003In: Journal of Human Lactation, ISSN 0890-3344, E-ISSN 1552-5732, Vol. 19, no 2, p. 157-165Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to describe the long-term incidence of breastfeeding in a geographically defined cohort of low birth weight (LBW) (< 2500 g) Swedish infants (N = 70) at discharge from a neonatal unit and at the postnatal ages of 2, 4, 6, and 8 months. The infants' breastfeeding data were examined retrospectively and compared to annual breastfeeding data for all infants born in the same year and county (N = 2,751). Ninety-three percent of the LBW infants were fed breast milk at discharge and 36% at 6 months, compared to 97% and 75%, respectively, of the county population. Cox regression analysis showed that multiparity was a significant predictor associated with shorter breastfeeding in LBW infants (odds ratio = 2.51. 95% confidence interval, 1.35-4.69). LBW infants had a high breastfeeding incidence but a significantly shorter duration than controls. This result indicates the need for intensified support throughout the breastfeeding period.

  • 3.
    Gerhardsson, Emma
    et al.
    Pediatric Specialist Outpatient Department, University Hospital, Uppsala, Sweden.
    Nyqvist, Kerstin Hedberg
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
    Mattsson, Elisabet
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Volgsten, Helena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Hildingsson, Ingegerd
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Funkquist, Eva-Lotta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
    The Swedish Version of the Breastfeeding Self-Efficacy Scale-Short Form: Reliability and Validity Assessment2014In: Journal of Human Lactation, ISSN 0890-3344, E-ISSN 1552-5732, Vol. 30, no 3, p. 340-345Article in journal (Refereed)
    Abstract [en]

    Background:

    Among Swedish mothers, breastfeeding duration has been declining in recent years. An instrument for early identification of women at risk for shorter breastfeeding duration may be useful in reversing this trend.

    Objectives:

    The aims of this study were to translate and psychometrically test the Swedish version of the Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF), examine the relationship between breastfeeding self-efficacy and demographic variables, and evaluate associations with breastfeeding continuation plans in Swedish mothers.

    Methods:

    The BSES-SF was translated into Swedish using forward and back translation. The sample consisted of 120 mothers who, during the first week postpartum, came for a routine follow-up visit at the postnatal unit in a university hospital. The mothers were compared based on demographic data and their future breastfeeding plans.

    Results:

    The Cronbach's alpha coefficient for internal consistency for the BSES-SF was 0.91 and the majority of correlation coefficients exceeded 0.3. A 1-factor solution was found that explained 46% of the total variance. There was no difference in confidence in breastfeeding between mothers with early hospital discharge and mothers who received postnatal care at the hospital. Primiparas who stayed longer at the hospital were less confident in breastfeeding than primiparas who had a shorter hospital stay. Breastfeeding mothers who planned to partially breastfeed in the near future had lower BSES-SF scores, compared to those who planned to continue exclusive breastfeeding.

    Conclusion:

    The Swedish version of the BSES-SF has good reliability, validity, and agreement with mothers' plans regarding breastfeeding continuation and exclusivity.

  • 4.
    Hedberg Nyqvist, Kerstin
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
    Haggkvist, Anna-Pia
    Hansen, Mette Ness
    Kylberg, Elisabeth
    Frandsen, Annemi Lyng
    Maastrup, Ragnhild
    Ezeonodo, Aino
    Hannula, Leena
    Koskinen, Katja
    Haiek, Laura N.
    Expansion of the Ten Steps to Successful Breastfeeding into Neonatal Intensive Care: Expert Group Recommendations for Three Guiding Principles2012In: Journal of Human Lactation, ISSN 0890-3344, E-ISSN 1552-5732, Vol. 28, no 3, p. 289-296Article in journal (Refereed)
    Abstract [en]

    The World Health Organization/United Nations Children's Fund Baby-Friendly Hospital Initiative: Revised, Updated, and Expanded for Integrated Care (2009) identifies the need for expanding the guidelines originally developed for maternity units to include neonatal intensive care. For this purpose, an expert group from the Nordic countries and Quebec, Canada, prepared a draft proposal, which was discussed at an international workshop in Uppsala, Sweden, in September 2011. The expert group suggests the addition of 3 "Guiding Principles" to the Ten Steps to support this vulnerable population of mothers and infants: 1. The staff attitude to the mother must focus on the individual mother and her situation. 2. The facility must provide family-centered care, supported by the environment. 3. The health care system must ensure continuity of care, that is, continuity of pre-, peri-, and postnatal care and post-discharge care. The goal of the expert group is to create a final document, the Baby Friendly Hospital Initiative for Neonatal Units, including standards and criteria for each of the 3 Guiding Principles, Ten Steps, and the Code; to develop tools for self-appraisal and monitoring compliance with the guidelines; and for external assessment to decide whether neonatal intensive/intermediate care units meet the conditions required to be designated as Baby-Friendly. The documents will be finalized after consultation with the World Health Organization/United Nations Children's Fund, and the goal is to offer these documents to international health care, professional, and other nongovernmental organizations involved in lactation and breastfeeding support for mothers of infants who require special neonatal care.

  • 5.
    Hedberg Nyqvist, Kerstin
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Kylberg, Elisabeth
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Application of the baby friendly hospital initiative to neonatal care: suggestions by Swedish mothers of very preterm infants2008In: Journal of Human Lactation, ISSN 0890-3344, E-ISSN 1552-5732, Vol. 24, no 3, p. 252-262Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to obtain suggestions from mothers of very preterm infants regarding modification of the Baby Friendly Hospital Initiative (BFHI) 10 Steps to Successful Breastfeeding. Thirteen mothers were interviewed 2 to 6 months after their infants' discharge from the hospital. The interviews generated 13 steps, which partly agree with the BFHI steps. The new steps address respect for mothers' individual decisions about breastfeeding, education of staff in specific knowledge and skills, antenatal information about lactation in the event of preterm birth, skin-to-skin (kangaroo mother) care, breast milk expression, early introduction of breastfeeding, facilitation of mothers' 24-hour presence in the hospital, preference for mother's own milk, semi-demand feeding before transition to demand breastfeeding, special benefits of pacifier sucking, alternative strategies for reduction of supplementation, use of bottle-feeding when indicated, a family-centered and supportive physical environment, support of the father's presence, and early transfer of infants' care to parents.

  • 6.
    Nor, Barni
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Zembe, Yanga
    Daniels, Karen
    Doherty, Tanya
    Jackson, Debra
    Ahlberg, Beth Maina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Ekström, Eva-Charlotte
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    "Peer but not peer": considering the context of infant feeding peer counseling in a high HIV prevalence area2009In: Journal of Human Lactation, ISSN 0890-3344, E-ISSN 1552-5732, Vol. 25, no 4, p. 427-434Article in journal (Refereed)
    Abstract [en]

    Postnatal transmission of HIV through breastfeeding remains an unsolved problem in resource poor settings, where refraining from breastfeeding is neither feasible nor safe. This study describes how women experienced infant-feeding peer counseling within a community-based intervention trial in 3 settings in South Africa. In total, 17 interviews and 10 observations were done with HIV-infected and uninfected women. The findings raise questions on the concept of "peer." Some women feared the peer counselor visits and questioned their intentions. Others, especially HIV-infected women, valued peer counseling for the emotional support provided. Being HIV infected with limited or no network of support appeared stressful for most women. The effects of data collection on the delivery and uptake of peer counseling are discussed. The findings underline the contextual barriers facing peer counselors and show that these challenges could have important implications for the effectiveness of infant-feeding counseling in high HIV prevalence countries.

  • 7.
    Nyqvist, Kerstin Heberg
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
    Lack of Knowledge Persists about Early Breastfeeding Competence in Preterm Infants2013In: Journal of Human Lactation, ISSN 0890-3344, E-ISSN 1552-5732, Vol. 29, no 3, p. 296-299Article in journal (Refereed)
  • 8.
    Nyqvist, Kerstin Hedberg
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
    Haggkvist, Anna-Pia
    Hansen, Mette N.
    Kylberg, Elisabeth
    Frandsen, Annemi L.
    Maastrup, Ragnhild
    Ezeonodo, Aino
    Hannula, Leena
    Haiek, Laura N.
    Expansion of the Baby-Friendly Hospital Initiative Ten Steps to Successful Breastfeeding into Neonatal Intensive Care: Expert Group Recommendations2013In: Journal of Human Lactation, ISSN 0890-3344, E-ISSN 1552-5732, Vol. 29, no 3, p. 300-309Article in journal (Refereed)
    Abstract [en]

    In the World Health Organization/United Nations Children's Fund document Baby-Friendly Hospital Initiative: Revised, Updated and Expanded for Integrated Care, neonatal care is mentioned as 1 area that would benefit from expansion of the original Ten Steps to Successful Breastfeeding. The different situations faced by preterm and sick infants and their mothers, compared to healthy infants and their mothers, necessitate a specific breastfeeding policy for neonatal intensive care and require that health care professionals have knowledge and skills in lactation and breastfeeding support, including provision of antenatal information, that are specific to neonatal care. Facilitation of early, continuous, and prolonged skin-to-skin contact (kangaroo mother care), early initiation of breastfeeding, and mothers' access to breastfeeding support during the infants' whole hospital stay are important. Mother's own milk or donor milk (when available) is the optimal nutrition. Efforts should be made to minimize parent-infant separation and facilitate parents' unrestricted presence with their infants. The initiation and continuation of breastfeeding should be guided only by infant competence and stability, using a semi-demand feeding regimen during the transition to exclusive breastfeeding. Pacifiers are appropriate during tube-feeding, for pain relief, and for calming infants. Nipple shields can be used for facilitating establishment of breastfeeding, but only after qualified support and attempts at the breast. Alternatives to bottles should be used until breastfeeding is well established. The discharge program should include adequate preparation of parents, information about access to lactation and breastfeeding support, both professional and peer support, and a plan for continued follow-up.

  • 9.
    Nyqvist, Kerstin Hedberg
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Rubertsson, Christine
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Ewald, Uwe
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
    Sjödén, Per-Olow
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Development of the Preterm Infant Breastfeeding Behavior Scale (PIBBS): a study of nurse-mother agreement1996In: Journal of Human Lactation, ISSN 0890-3344, E-ISSN 1552-5732, Vol. 12, no 3, p. 207-219Article in journal (Other academic)
    Abstract [en]

    Research on the development of preterm infant feeding behavior has focused mainly on bottlefeeding, using invasive methods or observations by professionals. In this study, a clinical method for observing breastfeeding was developed in collaboration between observers and mothers for the purpose of enabling neonatal personnel and mothers to describe developmental stages in preterm infant breastfeeding behavior. Tests of interobserver reliability resulted in acceptable agreement between observers, but a somewhat lower level of agreement between observers and mothers. The scale showed a good capacity to discriminate between infant gestational ages and can be used for helping mothers to identify their infants' emerging competence.

  • 10.
    Oras, Paola
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
    Thernström Blomqvist, Ylva
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
    Hedberg Nyqvist, Kerstin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
    Gradin, Maria
    Rubertsson, Christine
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Hellström-Westas, Lena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
    Funkquist, Eva-Lotta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
    Breastfeeding Patterns in Preterm Infants Born at 28-33 Gestational Weeks2015In: Journal of Human Lactation, ISSN 0890-3344, E-ISSN 1552-5732, Vol. 31, no 3, p. 377-385Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    Studies of breastfeeding patterns during preterm infants' first year of life are scarce but are important for providing breastfeeding mothers of preterm infants with optimal support.

    OBJECTIVE:

    This study aimed to describe breastfeeding patterns in preterm infants up to 1 year of corrected age.

    METHODS:

    As part of a larger study on kangaroo mother care in Sweden, a 24-hour breastfeeding diary was sent home after discharge from hospital, and at 2, 6, and 12 months of the infant's corrected age. Eighty-three mothers responded to the follow-up questionnaires, and the number of respondents to the breastfeeding diary was 48 at discharge, 43 at 2 months, 22 at 6 months, and 8 at 12 months. Infants were born at a median (range) gestational age of 32 (28-33) weeks. Breastfeeding patterns were analyzed according to durations, frequencies per 24 hours, and intervals between sessions.

    RESULTS:

    In exclusively breastfed infants, the median (range) breastfeeding session frequency was 14 (8-26) times per 24 hours including 4 (1-9) times per night after discharge (n = 24) and 10 (6-25) times per 24 hours including 2 (0-5) times per night at 2 months (n = 23). In partially breastfed infants, the median (range) frequency was 5 (1-14) times per 24 hours including 2 (0-4) times per night at 6 months (n = 20) and 5.5 (1-12) times per 24 hours including 2 (0-3) times per night at 12 months (n = 8).

    CONCLUSION:

    Mothers reported large variations in breastfeeding patterns, with higher median breastfeeding session frequencies than previously described in term infants in affluent settings.

  • 11. Östlund, Åsa
    et al.
    Nordström, Maria
    Dykes, Fiona
    Flacking, Renée
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm , Center for Clinical Research Dalarna. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Breastfeeding in Preterm and Term Twins-Maternal Factors Associated With Early Cessation: A Population-Based Study2010In: Journal of Human Lactation, ISSN 0890-3344, E-ISSN 1552-5732, Vol. 26, no 3, p. 235-241Article in journal (Refereed)
    Abstract [en]

    To investigate the duration of breastfeeding and the impact of maternal factors for cessation of breastfeeding in twin infants, the authors undertook a population-based cohort study. Breastfeeding data obtained from Child Health Centres were matched with data on infant and maternal demographics from Swedish national registers. A total of 1.657 twins were included, of whom 695 were born preterm. Breastfeeding frequencies in preterm twins were 79% at 2 months, 58% at 4 months, 39% at 6 months, 14% at 9 months, and 6% at 12 months. In term twins, the corresponding frequencies were 84%, 63%, 45%, 18%, and 6%, respectively. In both preterm and term mothers, mothers who had a lower educational level or smoked at first antenatal care visit were subject to earlier cessation of breastfeeding by 6 months of age. In addition, in mothers of term infants, mothers who were < 23 years old or primiparous had a higher risk for cessation of breastfeeding before 6 months. Thus, mothers of twins have a good potential to breastfeed, but additional support is needed for those more susceptible to early cessation of breastfeeding.

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