BREASTFEEDING MEDICINE

Volume 15, Number 10, 2020

ª Mary Ann Liebert, Inc.
DOI: 10.1089/bfm.2020.29162.abstracts
Downloaded by FUNDAÇÃO UNIV. FEDERAL DE CIÊNCIAS DA SAÚDE DE PORTO ALEGRE from www.liebertpub.com at 09/30/21. For personal use only.

Abstracts

The Academy of Breastfeeding Medicine

25th Annual International Meeting

Online November 5–7, 2020

 Poster Abstracts
1. ASSESSING CLINICAL RECOMMENDATIONS FOR
INTERRUPTION OR CESSATION OF BREASTFEEDING
Sara Oberhelman1, Jacqueline Zayas1
1 this data for presentation at the meeting.
Mayo Clinic, Rochester, Minnesota, USA
Category: Clinical Practice/Lactation Management
Downloaded by FUNDAÇÃO UNIV. FEDERAL DE CIÊNCIAS DA SAÚDE DE PORTO ALEGRE from www.liebertpub.com at 09/30/21. For personal use only.
Background: Breastfeeding has clearly been identified as the
ideal form of infant nutrition with a plethora of health benefits for
the mother and child as well as societal advantages. While the
World Health Organization, American Academy of Family
Physicians and American Academy of Pediatrics all recommend
that infants exclusively breastfeed for at least 6 months, less than
30% of mother-infant dyads meet this objective. Studies have
shown that 60% of breastfeeding mothers do not meet their
personal breastfeeding duration goals with one of the most com-
mon reasons identified for premature cessation being concerns
regarding maternal medical conditions or need to take medication.
To the best of our knowledge, there have been no studies per-
formed identifying the frequency in which health care professional
recommend either temporary interruption of breastfeeding or
premature cessation of breastfeeding due to concerns regarding
maternal testing, procedures or medication use.
Objective(s): Identify the most common indications for
which clinicians recommend interruption or cessation of
breastfeeding. Determine how frequently a clinician’s recom-
mendation for interruption or cessation of breastfeeding im-
pacted a mother’s ability to reach her breastfeeding goals.
Compare the most common indications that clinicians document
their recommendation for interruption or cessation of breast-
feeding compared to patient’s perception of recommendations
for interruption or cessation of breastfeeding.
Materials/Methods: Initially, we performed a retrospective
cohort chart review utilizing Advanced Cohort Explorer, a Mayo
Clinic repository that allows for text-based queries of EHRs, to
identify charts related to breastfeeding interruption or cessation.
Inclusion criteria for this study included female patients between
the ages of 18–55 from between January 1, 2015 and April 30,
2018 with terms related to breastfeeding interruption or cessation
within the EHR: An extensive list of search terms were used to
identify records including, but not limited to, ‘‘pump and dump’’,
‘‘discard breastmilk’’, and ‘‘stop breastfeeding’’. Data from this
portion of our study is complete. Work in progress: We are now in
the process of surveying patients who gave birth at Mayo Clinic
from January 1, 2014-April 1, 2018. Invitation to participate in this
survey will be sent by email. The survey will ask these patients
whether they had a procedure, had an imaging study or were
prescribed a medication while they were lactating; if a clinician
made a recommendation to continue, interrupt or cease breast-
feeding due to this procedure/study/medication; if they met their
lactation goals and what impacted meeting/not meeting said goals.
We plan to have this data for presentation at the meeting.
Results: Initial results: 785 recommendations met our inclu-
sion criteria. Providers reassured patients that breastfeeding in-
terruption was not indicated in 129 records (16.4%). Providers
recommended an alternative therapy or delay in therapy to pre-
serve breastfeeding in 155 records (19.7%). In 488 records
(62.2%), breastfeeding interruption or cessation was re-
commended. Indications for breastfeeding interruption included
medications (63%), procedures (16%), and imaging studies
(12%). The most common medications were antibiotics and pain
A-2
medications; the most common procedures required general
anesthesia; and the most common imaging study was MRI with
contrast. Patient survey results: work in progress, we plan to have
Conclusions: We identified the most frequent indications for
which recommend breastfeeding interruption or cessation using
Mayo Clinic EHRs as medications, procedures, and imaging
studies. Many of the instances where clinicians recommended
that a mother ‘‘pump and dump’’ are known to be safe during
lactation. We are currently evaluating the patient perspective via
the survey study and will have additional conclusions for the
meeting. We hope to use this data to create quality improvement
projects to help clinicians provide accurate counseling and help
mothers meet their breastfeeding goals.
2. STUDY ON THE EFFECT OF COMBINED
TREATMENT OF ABSCESS PUNCTURE ON MILK
VOLUME
Haifeng Gao1
1
Haidian Maternal and Child Health Hospital, Beijing, China
Category: Clinical Practice/Lactation Management
Background: The world health organization recommends
breastfeeding for two years, however, some nursing mothers still
have to give up breastfeeding because of a mammary abscess, in part
because of reduced milk production. treatment methods from the
traditional incision and drainage to minimally invasive puncture,
and vacuum breast biopsy system interventional therapy, etc., the
cure rate is improved, while the recurrence rate is lower, fewer
complications. Debord et al.studied that 87.8% of patients with
mammary abscess could continue breastfeeding on the healthy side,
and 48.5% could continue breastfeeding on the affected side. This
study analyzed the specific changes in the milk volume of the
healthy side and the affected side before and after the comprehensive
treatment of mammary abscess puncture, so as to provide a reference
for doctors to make comprehensive treatment plans and enhance the
confidence of nursing mothers to continue breastfeeding.
Objective(s): To summarize the changes of patients’ milk
volume before and after comprehensive treatment of abscess
puncture. To explore the effect of comprehensive treatment of
mammary abscess puncture on milk volume.
Materials/Methods: Prospective selected breast abscess pa-
tients in lactation from Beijing haidian district maternal and child
health care hospital in March 2017 to November 2018, The
24-hour milk secretion of both sides was summarized before and
after breast abscess puncture combined with increased frequency
and degree of emptying, SPSS24.0 statistical software was used
to analyze the changes in the milk volume of the healthy side and
the affected side using paired t test. P < 0.05 was considered
statistically significant.
Results: A total of 50 patients were enrolled. The comparison
of bilateral milk volume before treatment t = 3.016, P = 0.004, and
the comparison of bilateral milk volume after treatment t = 4.336,
P = 0.000, the differences were statistically significant. The total
amount of milk in the healthy side, affected side and bilateral sides
before treatment was 254.18 – 175.38ml, 159.76 – 144.02ml,
423.74 – 228.90ml, after the treatment respectively was354.86 –
211.94ml (t = -4.789, P = 0.000), 210.12 – 174.64ml (t = -2.555,
 POSTER ABSTRACTS A-3

P = 0.014), 543.78 – 305.90ml (t = -3.288, P = 0.002), the differ-
ence was statistically significant.
Conclusions: The total amount of milk on the affected side of
mammary abscess in lactation is less than the total amount of
milk on the healthy side. the treatment of abscess puncture
combined with increasing frequency of milk and milk emptying
can promote increased milk production on both sides, it can help
the mother realize the desire of breastfeeding.
3. REPORT ON A SERIES OF CASES
Downloaded by FUNDAÇÃO UNIV. FEDERAL DE CIÊNCIAS DA SAÚDE DE PORTO ALEGRE from www.liebertpub.com at 09/30/21. For personal use only.
Category: Clinical Practice/Lactation Management
Background: 35 year old, G4P013, and her 23 day old son
present to breastfeeding medicine clinic due to decreased breast
milk production. Baby was born at 40 weeks 5 days gestation via
emergency c/s after difficult labor. At 5 hours of life, baby was
intubated due to desaturations and seizure activity, transported to
outside NICU and placed on a therapeutic hypothermia protocol
for 90 hours. Baby was diagnosed with hypoxic ischemic en-
cephalopathy. Mother began pumping following delivery. While
baby was in the NICU for 18 days, his mother pumped for 20
minutes 10 times/day and by 1 week of life, was able to pump

OF GRANULOMATOUS MASTITIS IN MULTIPARAE about 4 oz/day. By the clinic visit, she was pumping for 20
DURING PREGNANCY AND LACTATION minutes 8 times/day and producing 1 oz/day. She had success-
fully breastfed her 2 older daughters for 2 years each and had
Yajun Gao1
1 experience pumping. Prior to pregnancy, she was treated with
Haidian Maternal and Child Health Hospital, Beijing, China
Rexulti for a history of bipolar 2 disorder. She stopped Rexulti in
the first trimester and restarted 2mg daily during the third tri-
Category: Clinical Practice/Lactation Management
mester due to increasing depressive symptoms. While baby was
Background: The incidence of granulomatous mastitis (GLM)
in the NICU, her supply of Rexulti was low and she took her pill
in multiparae has continued to increase, which seriously affect the
every other day. Once back home, she was able to resume taking
quality of life and breastfeeding of pregnant women after delivery.
it daily.
Treatment of GLM during pregnancy and breastfeeding is rarely
Objective(s): This case is the first report suggesting Rexulti
reported. Therefore, the purpose of this study was to explore treat-
may suppress breast milk production in lactating women. New
ment safety and prognosis of GLM during pregnancy and lactation.
mothers who fail to achieve expected milk volumes after delivery
Objective(s): To explore the breastfeeding safety of mothers
should be promptly identified and referred for evaluation.
with granulomatous mastitis during pregnancy. To investigate
Materials/Methods: N/A
the relationship between the healing time of granulomatous
Results: Even though this mother-infant dyad had many risk
mastitis during pregnancy and whether it is breastfeeding
factors for breastfeeding difficulties (a difficult labor, stress, early
Materials/Methods: A retrospective analysis was performed
separation and ongoing pump dependence) her ample production
on 10 cases of GLM treated at the Haidian Maternal and Child
with previous children and adequate early breast emptying indi-
Health Hospital, Breast department, Beijing and three cases of
cated another possible cause of her low milk production. Rexulti is
GLM treated in the Weihai Municipal Hospital, Breast depart-
similar to another atypical antipsychotic, Abilify, that is known to
ment Weihai, Shandong, CN, from February 2017 to May 2018.
interfere with prolactin and milk production. After weighing the
The recovery time, success rate of lactation, safety, and feasi-
risks and benefits to the dyad, mother decided to stop her Rexulti
bility of treatment in these cases were discussed.
and use a short course of metoclopramide to increase her prolactin.
Results: Among the 13 patients, conservative symptomatic
On follow up, she reported within 10 days of stopping Rexulti, her
treatment was adopted during pregnancy and lactation: anti-
milk supply increased and she was able to breastfeed almost ex-
infective therapy consisting of oral cephalosporin antibiotic for
clusively with adequate infant weight gain and her prolactin level
patients with or without fever and with inflammatory breast
increased to 97, normal for lactation
swelling and pain; ultrasound-guided puncture and drainage of pus
Conclusions: This case is the first report suggesting Rexulti
or incision and drainage after abscess formation. Observation
may suppress breast milk production in lactating women. Further-
continued during the sinus tract phase. Postpartum breastfeeding
more, there was a restoration of milk production after discontinuing
was encouraged, especially on the affected side. The healing time
the drug. More research is required to investigate the relationship
of postpartum granuloma ranged from 2 to 18 months. In this
between Rexulti and milk production to provide information for
study, the median healing time was 20 months and the average
healthcare providers and nursing mothers during informed consent
healing time was 30.4 months in five healthy breast lactation cases.
discussions and in evaluating mothers with insufficient milk pro-
In eight cases of bilateral breast lactation, the median healing time
duction who are being treated for mood disorders.
was 30 months and the average healing time was 26.5 months. One
patient with GLM was able to breastfeed for 2 months, two pa-
tients were able to breastfeed for 3–6 months, and 10 cases were
able to breastfeed for >6 months. Univariate analysis: due to the 5. PERIOPERATIVE MANAGEMENT OF A
small sample size, whether the affected breast was breast-fed after LACTATING CANCER PATIENT UNDERGOING
delivery had no effect on the postpartum wound healing time, SURGICAL PLACEMENT AND REMOVAL OF AN
P = 0.817. The wounds of 13 patients healed well after lactation, IODINE-125 BRACHYTHERAPY PLAQUE FOR UVEAL
and none of them recurred since the last follow-up visit. MELANOMA
Conclusions: Conservative symptomatic treatment for GLM
Elizabeth Rieth1, Kara Barnett1, Jennifer Simon1
of multiparous women during pregnancy and lactation and en- 1
Memorial Sloan Kettering Cancer Center, New York,
couraging breastfeeding after delivery have no effect on infant
New York, USA
health and on the recovery time of patients with GLM.
Category: Clinical Practice/Lactation Management
Background: Melanoma is the most commonly diagnosed
4. LOW BREAST MILK PRODUCTION ASSOCIATED
malignancy during pregnancy. In addition, the overall inci-
WITH BREXIPIPRAZOLE (REXULTI)
dences of both breastfeeding and melanoma are increasing. As a
Shruti Berlin1, Karen Bodnar1 result, anesthesiologists are more likely to encounter lactating
1
Inova Children’s Hospital, Falls Church, Virginia, USA women requiring melanoma treatment. Plaque brachytherapy is a
 A-4
common form of treatment for uveal melanoma. Prior reports
have described management of uveal melanoma during preg-
nancy. This is the first known case report of an anesthesiologist-led
multidisciplinary team dedicated to perioperative management of
a lactating patient undergoing plaque brachytherapy.
Objective(s): Understand the utility of a perioperative mul-
tidisciplinary team to coordinate care of complex patients, such
as lactating cancer patients. Describe perioperative medication
safety in lactation, including the use of plaque brachytherapy.
Describe strategies for maintaining perioperative lactation in
situations requiring temporary breastfeeding interruption.
Downloaded by FUNDAÇÃO UNIV. FEDERAL DE CIÊNCIAS DA SAÚDE DE PORTO ALEGRE from www.liebertpub.com at 09/30/21. For personal use only.
Materials/Methods: N/A
Results: This 42-year old woman presented for treatment of
uveal melanoma. She was breastfeeding an 11-month old infant.
She underwent general anesthesia for placement of an iodine-125
plaque on postoperative day (POD) 0, with subsequent removal
on POD 3. Between POD 0 and 3, she was placed on radioactive
isolation, during which time she intermittently expressed breast
milk with a breast pump and stored the milk. Through consul-
tation with the department of medical physics, it was determined
that the plaque was a sealed source, so radiation would not be
present in her breast milk. She was counseled that commonly
used perioperative medications are typically compatible with
lactation, but that she could not be in close proximity to her infant
for the duration of brachytherapy (1).
Conclusions: Anesthesiologists are often called upon by pa-
tients and surgeons to review the safety of perioperative medi-
cations in lactation. Recent models of perioperative care, such as
the Perioperative Surgical Home (2), highlight robust involve-
ment of anesthesiologists in the perioperative journey of the
surgical patient. Because of the patient’s lactation status, com-
plexity of perioperative medications, and use of radiotherapy in
this case, an anesthesiologist-led multidisciplinary team was
formed to coordinate complex patient-centered perioperative
care. To our knowledge, this is the first report that describes how
perioperative lactation may be safely maintained during plaque
brachytherapy treatment. References: 1. Hale TW. Medications
& Mothers’ Milk 2019. 2. ASA Perioperative Surgical Home.
https://www.asahq.org/psh. Accessed 3/31/2020.
6. INSUFFICIENT GLANDULAR TISSUE: LACTATION
FAILURE?
Mariana Colmenares1
1
Acclam, Mexico City, Mexico
Category: Clinical Practice/Lactation Management
Background: Breastfeeding is the normative way to feed
babies al over the world. We have access to tons of scientific
evidence that supports it. Advocates of breastfeeding such as
health care professionals that protect, promotes and support the
breast/chest feeding dyad can struggle sometimes with women or
babies who cannot breastfeed as the World Health Organization
suggests. Mothers with low milk supply are often supported by
family, friends and health care with well meaning advices and
remedies to help them do their best. Women who have insuffi-
cient glandular tissue (IGT) struggle with their milk supply, de-
spite good breastfeeding management. Is common to see families
with this issue in the second or third lactation failure without really
understanding what might be going wrong. This babies can have
dehydration in the neonatal period, hypernatremia or even death
without anybody that could help with a correct diagnosis or help
with achievable goals that can benefit both, mother and baby. It is
of great importance to help with accurate diagnosis that can benefit
POSTER ABSTRACTS
also psychologically and choose continue breastfeeding with
breast/ chest supplementation.
Objective(s): Learn the theoretical framework that can give us
useful information for a timely and appropriate diagnosis of In-
sufficient Glandular Tissue. Encourage and support the best way
possible for the dyad to achieve a healthful breastfeeding experience.
Learn about useful tools that can help achieve the personal goals.
Materials/Methods: Review from the literature
Results: Clinical. Experience and review from the literature.
Conclusions:
7. INCREASING LACTATION CLINIC PATIENTS PER
HOUR: A QUALITY IMPROVEMENT PROJECT
Jennifer Somers1, Jamie Ellis1
1
Greater Lawrence Family Health Center, Lawrence,
Massachusetts, USA
Category: Clinical Practice/Lactation Management
Background: Greater Lawrence Family Health Center serves a
underserved, primarily Latinx, community north of Boston. Our
goal is to improve access to outpatient lactation support, provide
early interventions to assist with breastfeeding, and offering a high
quality teaching clinic for Family Medicine residents.
Objective(s): Improve Lactation Clinic Volume. Improve
Clinical Lactation Teaching for Residents. Provide greater access
to outpatient lactation services for an underserved community.
Materials/Methods: Our aim was to improve lactation clinic
attendance by better meeting the needs of our community. We
chose to change multiple factors that improved our clinic volume
and show rate. Our first intervention switched the clinic time
from mornings to afternoons began July of 2019. We had gath-
ered feedback from our patients that arriving in the morning was
much harder for them. Our second intervention was to encourage
the hospital discharge planners to automatically offer a lactation
clinic appointment to all women discharging from the hospital
this was fully operational October of 2019. In order to evaluate
the effectiveness of our interventions we manually counted the
number of patients seen in our weekly Lactation clinics over the
course of a year, from March 2019 to March 2020. We then
modeled the clinic numbers using a simple line graph, plotting
individual clinic sessions. In order to evaluate effectiveness of
our interventions and get a sense of overall numbers rather than
individual sessions, the average number of patients seen during
each period was evaluated with period one being prior to inter-
vention (March 2019 through July 2019), period 2 being PDSA
cycle 1 ( July 2019 through October 2019) and period 3 being
PDSA cycle 2 (October 2019 through March 2020). The time of
evaluation for PDSA cycle 2 was lengthened to minimize the
effect of the more erratic nature of clinic sessions over the winter
holidays due to sessions occurring less frequently.
Results: In PDSA cycle 1 our volume went from an average of
2 patients to 7.5 per clinic. The number of patients per hour went
from <1 to 2.5. In PDSA cycle 2 we then went to an average of 9
patients per clinic, 3 patients per hour. We were able to quadruple
our volume in 9 months by intentionally changing the timing of
the clinic and how we referred patients into the clinic.
Conclusions: Best practices for lactation clinics have been
based primarily on the presence of access to lactation consultants
and/or other outpatient non-physician support providers. There is
very little data about providing high quality breastfeeding med-
icine outpatient clinics. In our quality improvement project, we
found that by offering a lactation clinic in the afternoon increased
our volume. Offering a lactation follow-up appointment in a
 POSTER ABSTRACTS
local primary care clinic for all post-partum patients, signifi-
cantly increased the patients per hour in our lactation clinic.
Having an increased volume and a more robust clinic provided
greater learning opportunities for our residents as well as access
to outpatient lactation support for the community we serve.
8. CHARACTERISTICS OF NEONATAL PATIENTS
WHO RECEIVED COMBINED IN-HOME MEDICAL
CARE AND LACTATION SUPPORT IN 2019
Downloaded by FUNDAÇÃO UNIV. FEDERAL DE CIÊNCIAS DA SAÚDE DE PORTO ALEGRE from www.liebertpub.com at 09/30/21. For personal use only.
Jessica Madden1
1
Rainbow Babies and Children’s Hospital, Willowick, Ohio, USA
Category: Clinical Practice/Lactation Management
Background: As a neonatologist, I have a wealth of experi-
ence tending to the medical needs of newborn babies and the
psychosocial needs of their mothers. I opened an independent
pediatric and lactation home-visiting practice in Cleveland, Ohio
in 2018. The main goal of starting my practice, Primrose New-
born Care, was to improve ‘‘fourth trimester’’ support for new
moms. I presented an overview of the steps involved in starting
Primrose, along with pilot data, at the Academy of Breastfeeding
Medicine conference in 2019.
Objective(s): To present a detailed overview of my first full
year in practice as a home-visiting neonatologist and lactation
specialist. To describe characteristics of newborns seen during
in-home visits in 2019. To discuss barriers to this current model
of care and explore areas for expansion of services offered.
Materials/Methods: Each in-home visit was 60 minutes long
and included a review of pregnancy and delivery, a newborn
physical exam, measurement and plotting of growth parameters,
transcutaneous bilirubin check, discussion of feeding and
sleeping, screening for postpartum depression, and referrals to
community resources. Additional services I began to offer in
2019 included virtual (video) visits, telephone visits, and text
message and email consultations.
Results: From January 1, 2019 through December 31, 2019 I
worked with 36 mother-infant dyads. Of my 36 patients, 56%
were female and 44% were male. 78% of my patients were full-
term and 22% were preterm (born at less than 37 weeks gesta-
tion). The majority were singletons (88%). The most common
maternal concerns I encountered were related to breastfeeding
(52.8%), prematurity (19.4%), infections (16.7%), gastroesoph-
ageal reflux (16.7%), postpartum depression (16.7%), bronch-
iolitis (13.9%), formula-feeding (13.9%), sleeping patterns
(13.9%), and suspected milk-protein allergies (8.3%). Other di-
agnoses I encountered included laryngomalacia, ankyloglossia,
blocked tear ducts, eczema, failure to thrive, hyperbilirubinemia
(both indirect and direct), a history of hypoxic-ischemic en-
cephalopathy, delayed developmental milestones, respiratory
distress, teething, thrush, and diaper candidiasis. 15 of my 36
patients were seen for in-home visits. The average number of
home visits per patient were 2, with a range from 1–7 total visits
per patient. Of the additional 21 patients, 10 were evaluated via
telemedicine (video visits), and the remaining 11 babies were
evaluated by phone. Parents’ preferred method of continuing
contact with me after our initial encounter was via text message,
followed by phone, and then email. 100% percent of my parental
encounters were with my patients’ mothers, however I met al-
most every father in the in-home setting. I had an additional 6
phone encounters in which I needed to refer patients directly to
local emergency rooms. One was for a possible head injury after
an accidental fall and five were for respiratory distress secondary
to bronchiolitis.
A-5
Conclusions: Barriers to continuing my newborn practice
include difficulty negotiating reimbursement from local insurers
and Medicaid, the cost of malpractice insurance, time dedicated
to travel, and my lack of IBCLC certification. Ideas for expansion
and growth include being able to offer virtual visits (tele-
medicine) for those who live within my state but outside of my
geographic area, obtaining certification to become an IBCLC
(in process), offering rentals and drop-offs of breastfeeding and
baby supplies, being able to provide in-home phototherapy, and
working with local milk banks to be able to distribute donor
breast milk for supplementation. In summary, physician in-home
newborn visits are an innovative way to support breastfeeding,
newborn care, and the physical, mental, and emotional transition
to motherhood in geographic locations that currently lack ade-
quate postpartum supports for new moms and babies.
9. VENLAFAXINE FOR FUNCTIONAL BREAST
AND NIPPLE PAIN IN A BREASTFEEDING WOMAN:
CASE REPORT
Sarah Calhoun1
1
University of Missouri, Colombia, Missouri, USA
Category: Clinical Practice/Lactation Management
Background: Persistent breast and nipple pain while breast-
feeding may lead to early weaning and is associated with post-
partum depression. Known treatments for functional breast pain
include nonsteroidal anti-inflammatory medications, proprano-
lol, and selective serotonin reuptake inhibitors.
Objective(s): To present a case report of a breastfeeding
mother who had resolution of functional breast pain and post-
partum depression with venlafaxine. To consider venlafaxine as
a treatment for functional breast pain during breastfeeding.
Materials/Methods: Not applicable, case report.
Results: A 28-year-old breastfeeding mother developed per-
sistent breast and nipple pain despite evaluation and treatment for
known causes of pain. Her pain was determined to be functional
in nature and improved with the use of propranolol and escita-
lopram. Her pain score decreased from an 8 to a 6 on a numeric
pain rating scale of 0 through 10. As is common in women with
breast and nipple pain, she developed postpartum depression.
Her symptoms had not resolved with the maximum dosage of
escitalopram so venlafaxine was initiated for better control of
postpartum depression. Not only did postpartum depression
symptoms improve, but the breast and nipple pain resolved. She
ultimately tapered off propranolol and escitalopram with con-
tinued improvement in pain with only venlafaxine.
Conclusions: Venlafaxine has known benefits for the treat-
ment of neuropathic pain. Venlafaxine may be considered as a
treatment option for functional breast and nipple pain in lactating
women with postpartum depression.
10. UTILIZATION OF A NEW BREASTFEEDING
MEDICINE CONSULT SERVICE
Holly Cummings1, Anna Graseck1, Kirstin Leitner1
1
University of Pennsylvania Perelman School of Medicine,
Philadelphia, Pennsylvania, USA
Category: Clinical Practice/Lactation Management
Background: At our quaternary-care, academic medical
center, breastfeeding initiation rates were 83% in FY18. How-
ever, breastfeeding continuation remains low. Only 33.7% of US
women are still breastfeeding at 12 months.1 This is mirrored at
our institution, where within one practice at our center, 6-month
 A-6
continuation rates are 30%. The reasons for early discontinuation
are multiple, but one study showed that 60% of women stopped
breastfeeding sooner than they desired. Thirteen percent of
women cited their own medical illness or use of medication as a
reason they stopped breastfeeding.2 Residents in obstetrics and
gynecology (OB/Gyn) have formal learning objectives related to
lactation knowledge identified by the Council on Resident
Education in Obstetrics and Gynecology (CREOG).3 A breast-
feeding medicine inpatient consult service was created at our
hospital after performing a needs assessment and obtaining
stakeholder feedback4 and debuted in September 2019.
Downloaded by FUNDAÇÃO UNIV. FEDERAL DE CIÊNCIAS DA SAÚDE DE PORTO ALEGRE from www.liebertpub.com at 09/30/21. For personal use only.
Objective(s): Our objective was to develop an inpatient
breastfeeding medicine consult service, staffed by OB/Gyn
physicians with a particular interest and knowledge base in lac-
tation. The consult service goals are:- to provide evidence-based
guidance to breastfeeding women who are admitted to the hos-
pital beyond routine postpartum hospitalization. This typically
will be for patients admitted to services other than obstetrics,
such as general surgery or medicine. To educate these patients
and their physicians on safety of imaging, medications, and
maternal illness while lactating. to collaborate with lactation
consultants (LCs) who will facilitate a plan for maintaining
lactation while hospitalized. To educate OB/@Gyn resident
physicians on formal residency learning objectives regarding
breastfeeding
Materials/Methods: The inpatient breastfeeding medicine
consult service was created after soliciting feedback from key
stakeholders, including the department chair, hospital LCs, res-
idency program director, and attending physicians. A consult
order was created for the electronic medical record (EMR) sys-
tem. A resident curriculum was developed to support education
on the service. The service debuted in September 2019. All
consults were tracked. As word of the service spread, additional
opportunities for patient management were identified by the LCs
in the intensive care nursery, facilitating further collaboration for
the care of lactating patients.
Results: In the first seven months, consults were requested
eight times from non-OB/Gyn hospital services. The reason for
consult included safety of medication use in lactation; questions
regarding perioperative management of lactation; breastmilk
expression logistics; and clogged duct. The consult requests
came from a variety of other departments, including neurosur-
gery (6 patients), plastic surgery (1 patient), colo-rectal surgery
(1 patient), and internal medicine (1 patient). Within the first
month of the service, LCs in the neonatal intensive care unit
reached out to the physician consultants to discuss management
of maternal patients with low milk supply. This developed into a
regular collaboration, with management of 10 intensive care
nursery dyads, and the identification of a possible medication-
related case reportable event. One lactation ‘‘tipsheets’’ was
created by the residents during their postpartum rotation. Anec-
dotally, residents have been noticed to discuss lactation, including
challenges and medical implications, during team signouts more
frequently than in prior years. Opportunities for improvement of
the consult service were identified, including specifying when
separate LC involvement was recommended to address issues of
storing expressed breastmilk, infant latch, or assistance with milk
expression in the postoperative phase of care.
Conclusions: The breastfeeding medicine consult service has
been utilized by non-OB/Gyn departments, demonstrating the
efficacy and need for such a service. Resident CREOG education
goals are being addressed, supporting education efforts during
service. A previously unidentified opportunity for collaboration
between breastfeeding medicine physicians and LCs in the in-
POSTER ABSTRACTS
tensive care nursey was identified, thereby increasing the num-
bers of breastfeeding dyads being served. Future goals for the
service include increasing awareness of the service among other
hospital departments; further facilitating inpatient to outpatient
transition of breastfeeding patients from the intensive care
nursery to the OB/Gyn office; and increasing resident completion
of the educational goals of the service. References:1. Centers for
Disease Control National Immunization Survey. ‘‘Breastfeeding
Among U.S. Children Born 2002–2014’’. https://www.cdc.gov/
breastfeeding/data/nis_data/results.html Accessed July 18 2018.
2. Odom EC et al. ‘‘Reasons for earlier than desired cessation of
breastfeeding.’’ Pediatrics. 2013 Mar;131(3):e726–32. 3. Coun-
cil on Resident Education in Obstetrics and Gynecology
(CREOG). ‘‘Educational Objectives: Core Curriculum in Ob-
stetrics and Gynecology.’’ 11th edition, 2016.4. Graseck, A;
Cummings, H; Leitner, K: Development of a Breastfeeding
Medicine Consult Service. Academy of Breastfeeding Medicine
Annual Meeting, San Francisco, CA November 2018 Notes:
Poster presentation November 2018.
11. EXPERIENCES OF BREASTFEEDING AND MILK
EXPRESSION IN A LATINX COMMUNITY IN RURAL
IOWA
Amelia Underwood1, Stephanie Radke1, David Bedell1
1
University of Iowa, Iowa City, Iowa, USA
Category: Clinical Practice/Lactation Management
Background: Latina mothers have a rate of initiation of
breastfeeding above the national average but levels of exclusive
breastfeeding at 4 months as low as 22% 1. In previous studies,
Latina mothers have cited multiple reasons for non-exclusive
breastfeeding, including concerns about supply, lack of support
from medical professionals, influence by family and friends, and
concerns about returning to work or school2. The concern about
being successful in breastfeeding following return to work or
school exists despite mothers’ stated willingness to express milk
at work2. Although these concerns about supply and returning to
work are given as reasons for non-exclusive breastfeeding or
cessation of breastfeeding, little work has been done to identify
specific barriers to breastfeeding or the expression of breast milk
in working mothers, and no studies have looked at the perception
and practice of expressing breast milk among a Latinx popula-
tion. References 1. Bartick M, Reyes C. Las Dos Cosas: An
Analysis of Attitudes of Latina Women on Non-Exclusive
Breastfeeding. Breastfeed Med. 2011;7(1):19–24. doi:10.1089/
bfm.2011.00392. Linares AM, Rayens MK, Dozier A, Wiggins
A, Dignan MB. Factors influencing exclusive breastfeeding at 4
months postpartum in a sample of urban Hispanic mothers in
kentucky. J Hum Lact. 2015;31(2):307–314. doi:10.1177/
0890334414565711
Objective(s): To gain an understanding of the experiences of
breastfeeding and milk expression among Latina mothers in rural
Iowa. To identify potential barriers- economic, social,
employment-related and educational- to expressing milk and
feeding of expressed milk in a rural Iowan Latinx population.
Materials/Methods: The setting for this study was a family
practice clinic in rural Iowa which is associated with a large
academic hospital. The inclusion criteria for this study were
women who self-identified as Latina or Hispanic, who spoke
English or Spanish, who had given birth in the past three years
and who had ever breastfed. Eligible participants were identified
using the electronic medical record patient schedule of the clinic
 POSTER ABSTRACTS
and approached by one of the authors. Thirteen eligible women
were interviewed in their preferred language. We specifically
investigated knowledge, expectations, experience, facilitators
and barriers to breastfeeding and milk expression. Interviews
were transcribed in their original language and analyzed sepa-
rately for principal themes by two bilingual researchers.
Results: This group was diverse in age, education level,
number of children, and experience with breastfeeding and the
expression of breast milk. There was great variability in the
exposure to and experience with pumping milk, with some
women who exclusively pumped and those who had minimal
Downloaded by FUNDAÇÃO UNIV. FEDERAL DE CIÊNCIAS DA SAÚDE DE PORTO ALEGRE from www.liebertpub.com at 09/30/21. For personal use only.
exposure to the concept of pumping breast milk. We found that
many women in this study had unrealistic expectations of the
experience of breastfeeding or misunderstandings about lacta-
tion. For example, some women found themselves unprepared
for the initial normal discomfort of direct breastfeeding, leading
them to believe there was a physical problem with themselves or
their infant. Others expected their milk to come in sooner and
interpreted the scant amount of early colostrum as inadequate
milk production, often leading to supplementation. Many of
these same women expressed that they would have liked more
education or resources from their healthcare providers in prep-
aration for breastfeeding or pumping, and increased in-person
lactation support during their post-partum hospital stay, offered
in their primary language.
Conclusions: The breastfeeding experiences of Hispanic and
Latina women in rural Iowa are diverse and no single educational
strategy will be appropriate for every mother. Wide variation in
knowledge of the expression of breast milk suggests that this
topic is not being routinely or comprehensively covered in the
prenatal breastfeeding education offered at this particular clinic.
More work needs to be done to determine what constitutes ad-
equate prenatal education on milk expression in this population
and the larger population of rural Iowa. In order to support
women in meeting their breastfeeding goals, healthcare provid-
ers must help manage expectations surrounding the normal
physiologic process of lactation and provide education on the
options for successful breastfeeding including the role of milk
expression. Additionally, it is important that this information be
provided early enough in the prenatal period to allow for indi-
vidual preparation, such as the acquisition of equipment to ex-
press breastmilk. Finally, it is important to offer services to
women in their preferred language whenever possible, particu-
larly skill-based patient education such as lactation support.
12. ASSOCIATIONS BETWEEN MATERNAL MEDICAL
HISTORY AND SYMPTOMS OF DYSPHORIC MILK
EJECTION REFLEX
Anitha Muddana1, Alison Stuebe1, Noemi Salinas1
1
University of North Carolina, Chapel Hill, North Carolina, USA
Category: Clinical Practice/Lactation Management
Background: Dysphoric Milk Ejection Reflex (DMER) is a
complication of breastfeeding characterized by transient nega-
tive emotions associated with milk let down. Although D-MER
has been described in case reports, little is known about the
underlying pathophysiology.
Objective(s): To understand Dysphoric Milk Ejection Reflex
(DMER) frequency and associations. To improve research and
care provided for breastfeeding dyads.
Materials/Methods: We analyzed associations between
DMER symptoms and patient history as reported on intake forms
for the Breastfeeding Medicine Consult Clinic at the University
A-7
of North Carolina Women’s Hospital. The clinic is a regional
referral center staffed by a breastfeeding medicine physician and
an international board-certified lactation consultant. Patients
presenting for evaluation complete a standardized intake form.
To assess DMER, patients are asked, ‘‘Some mothers experience
negative emotions such as anxiety, unpleasantness or dread
during milk let down. Have you experienced this?’’ Patients who
respond ‘‘yes’’ are further asked to what extent they experience
specific sensations during milk let down using a five-point Likert
scale from ‘‘Not at all’’ to ‘‘extremely.’’ Likert square responses
were summed to create a composite DMER score. Women who
reported pain with breastfeeding also completed the Catastro-
phizing subscale of the Coping Strategies Questionnaire. For
women with more than one visit to the clinic, data from the first
visit was used. We used Fisher’s Exact tests to evaluate associ-
ations between reporting any DMER symptoms and presenting
complaint, pregnancy complications, and maternal medical his-
tory. Among women with pain, we further quantified correlations
between DMER symptoms and catastrophizing.
Results: Among 302 patients presenting for breastfeeding
medicine care, 271 responded to the question about DMER
symptoms, and 42 (15.5%) reported DMER. We found no as-
sociation between DMER and presenting complaint or pregnancy
complications. Women with DMER symptoms were more likely to
report a history of panic attacks (28.6 vs. 12.2%, OR 2.87, 95% CI
1.23–6.25) and depression (35.7 vs. 22.3%, OR 1.94, 95% CI 0.96–
3.92), although confidence intervals for depression were wide.
Among the 28 women with DMER symptoms and breastfeeding-
associated pain, catastrophizing scores were correlated with DMER
symptom scores (Pearson r = 0.44, p = 0.02).
Conclusions: We found associations between DMER symp-
toms and self-reported history of both panic attacks and de-
pression. Our findings should be interpreted with caution given
that we sampled women presenting to a referral clinic; associa-
tions may differ in the general population. More research is
needed to understand the pathophysiology of DMER and to de-
velop evidence-based treatment approaches.
13. THE ROLE OF LIP TIE RELEASE IN INFANTS
WITH BREASTFEEDING CHALLENGES ASSOCIATED
WITH A TIGHT MAXILLARY FRENULUM
Stephanie Johng1, Parhom Towfighi1,
Michelle Lally1, Earl Harley1
1
Georgetown University School of Medicine, Washington, DC,
USA
Category: Clinical Practice/Lactation Management
Background: Despite extensive literature supporting the nu-
merous health benefits associated with breastfeeding to both
mother and infant, many mothers discontinue breastfeeding be-
fore the recommended 6-months. While the clinical indications
of lingual frenotomies has recently been called into question,
there is little known about the impact the presence of a maxillary
frenulum can have on breastfeeding.
Objective(s): To characterize breastfeeding habits of infants
who undergo a lingual frenotomy but not a maxillary frenotomy.
To determine if the presence of a maxillary frenulum negatively
impacts overall duration of time mothers breastfeed.
Materials/Methods: A retrospective chart review of infants
who presented for tongue-tie consultation between January
2014-December 2018 was conducted. Parents of infants who
were diagnosed with both maxillary and lingual frenulum, but
underwent only a release of the lingual frenulum, were emailed
 A-8
an anonymous survey. The survey contained questions inquiring
about symptoms the mother-infant dyad experienced while
breastfeeding, overall duration of breastfeeding, and what fac-
tors, if any, led the mother to cease breastfeeding.
Results: A minimum of 1-year between date of initial visit and
follow up in the online survey was required to assess the impact
on breastfeeding including infant weight-gain trends and overall
duration of time the mother spent breastfeeding. Results from the
anonymous online survey showed that the presence of a maxil-
lary frenulum had minimal impact on the infant’s ability to nurse
once the lingual frenulum was released.
Downloaded by FUNDAÇÃO UNIV. FEDERAL DE CIÊNCIAS DA SAÚDE DE PORTO ALEGRE from www.liebertpub.com at 09/30/21. For personal use only.
Conclusions: Since the early 18th century, lingual freno-
tomies have been conducted to improve tongue mobility which is
believed to ease breastfeeding difficulties. Similar to the negative
impact a lingual frenulum can have on breastfeeding, the pres-
ence of a maxillary frenulum has been speculated to also con-
tribute to difficulties breastfeeding. However, without conclusive
evidence supporting these speculations, clinicians will continue
to remain divided over the necessity of maxillary frenotomies
and the role it may play in breastfeeding.
14. FEEDING OUTCOMES IN INFANTS WITH TONGUE
TIE WHO DID NOT UNDERGO LINGUAL FRENOTOMY:
IMPLICATIONS ON BREASTFEEDING
Stephanie Johng1, Lacey Nelson1, Niki Noe1,
Michelle Lally1, Earl Harley1
1
Georgetown University School of Medicine, Washington, DC,
USA
Category: Clinical Practice/Lactation Management
Background: Despite studies citing both short- and long-term
benefits from breastfeeding, many infants are not breastfed for
the minimum, recommended 6-months. Multi-factorial reasons
including pain, frustration, as well as external pressure to return
to work are all thought to play a role. While frenotomies have
been conducted since the 18th century, recent literature has
called into question the clinical benefits of frenotomies.
Objective(s): To characterize the duration of time that infants
with a tight lingual frenulum are breastfed. To present factors
that led mothers to cease breastfeeding.
Materials/Methods: A retrospective chart review of infants
who presented for tongue-tie consultation between January 2015 –
December 2018 was conducted. Parents of infants who ulti-
mately did not have surgical action at the time of visit were
emailed an online survey inquiring about symptoms the mother-
infant dyad might have experienced while breastfeeding, overall
duration the infant was breastfed, and what factors led the mother
to cease breastfeeding.
Results: A minimum of 1-year between date of initial visit and
follow up in the online survey was required to assess long-term
consequences including infant weight-gain trends and overall time
the mother spent breastfeeding. Results from the anonymous survey
indicated that infants who did not undergo a frenotomy struggled
with weight gain and the mothers of these infants experienced
more discomfort and frustration while trying to breastfeed; both
of which contributed to early termination of breastfeeding.
Conclusions: While recent literature has stated that freno-
tomies have little added clinical benefit to patients, our study
demonstrates the impact not undergoing a frenotomy can have on
both mother and infant. With the renewed interest in breast-
feeding and a lack of clear clinical guidelines, the long-term
benefits of breastfeeding should be taken into consideration when
an infant presents with a lingual frenulum.
POSTER ABSTRACTS
15. TRANSFORMING GROWTH FACTOR BETA-1
IN HUMAN BREAST MILK AND ITS CORRELATION
WITH INFANTS’ PARAMETERS
Jehan Alsharnoubi1
1
Cairo University, Giza, Egypt
Category: Human Milk Composition
Background: Breastfeeding provides optimal nutrition and
health protection for the infant; it contains many anti-inflammatory
factors, including transforming growth factor beta-1 (TGF-b1)
Objective(s): To measure the level of TGF-b1 in human
milk. To find its correlation with some infant anthropometric
characteristics.
Materials/Methods: A milk sample was collected from 84
mothers and the level of TGF-b1 was measured using enzyme-
linked immunosorbent assay.
Results: TGF-b1 was significantly higher in vegetarian
mothers compared with non-vegetarian mothers( p = 0.044).
Additionally, the mean value of breast milk TGF-b1 was sig-
nificantly higher in mothers using contraceptive pills compared
with those who do not ( p = 0.021). Also, the mean value of TGF-
b1 was significantly higher in infants 3–6 months than those <3
months ( p = 0.010); also there was a significant difference re-
garding infants’ weight and length with average weight and
length ( p = 0.042) and ( p = 0.009), respectively.
Conclusions: TGF-b1 in human milk may play a role in in-
fants’ growth and development; mothers’ diet is known to in-
fluence TGF-b1 level and its relation to infants’ age and weight.
Contraceptive method could have an influence on TGF-b1 levels
during breastfeeding.
16. METHODS MATTER: A COMPARISON
OF MACRONUTRIENT-BASED METHODS FOR
DERIVING ENERGY VALUES IN HUMAN MILK
Erin Hamilton Spence1, Maryanne Perrin2, Mandy Belfort3,
Margaret Parker4, Lars Bode5
1
Mother’s Milk Bank of North Texas, Pediatric Medical Group,
Cook Children’s Hospital, Ft. Worth, Texas, USA
2
University of North Carolina Greensboro, Greensboro,
North Carolina, USA
3
Brigham Women’s Hospital and Harvard Med, Boston,
Massachusetts, USA
4
Boston Medical Center: Boston University, Boston,
Massachusetts, USA
5
University of California, San Diego, San Diego, California, USA
Category: Human Milk Composition
Background: Energy values for human milk are increasingly
available through labeled human milk products, and the use of
infrared point-of-care analyzers. There are currently no agreed
upon reference methods for reporting calories in human milk.
Objective(s): To compare published methods for calculating
calories in human milk using a common set of human milk
samples. To determine if important differences in these methods
may have research and clinical implications.
Materials/Methods: Ten human milk samples were mea-
sured for macronutrients using laboratory methods. Calorie were
calculated using 2 different sets of macronutrient values: gross
nutrients (GROSS) which included crude protein, total fat, and
total carbohydrates; and digestible nutrients (DIGESTIBLE)
which included true protein, total fat, and lactose. Four calorie
conversion factors were used: Atwater general (ATW-GEN);
Atwater milk specific (ATW-MILK), human milk specific
 POSTER ABSTRACTS
(HUM-MILK), and combustible conversions (COMBUST). Dif-
ferences in calories derived from GROSS and DIGESTIBLE mac-
ronutrients were assessed using ANOVA analysis. Macronutrients
were also measured in all samples using an FDA approved mid-
infrared human milk analyzer that reports calorie values.
Results: GROSS macronutrients with COMBUST conversion
factors produced the highest calorie values whereas DIGES-
TIBLE macronutrients with HUM-MILK conversion factors
produced the lowest calorie values. The mean difference between
these values was 3.1 kcal/ounce (19.2%). There was a significant
difference (P < 0.0001) in derived calorie values based on calorie
Downloaded by FUNDAÇÃO UNIV. FEDERAL DE CIÊNCIAS DA SAÚDE DE PORTO ALEGRE from www.liebertpub.com at 09/30/21. For personal use only.
conversion methods that used GROSS versus DIGESTIBLE
macronutrients. Calorie values reported by the mid-infrared an-
alyzer were similar to those derived using GROSS macronutri-
ents with COMBUST conversion factors.
Conclusions: Calorie differences of 3 kcal/ounce (20%) is
clinically important when determining feeding therapies for the
preterm infant. There is a need for standard methods of reporting
calories in human milk to support clinical practices and research.
17. TANDEM BREASTFEEDING AND ITS IMPACT
ON HUMAN MILK MACRONUTRIENTS CONTENT – A
PROSPECTIVE STUDY
Dror Mandel1, Gilad Rosenberg1,
Laurence Mangel1, Ronit Lubetzky1
1
Tel Aviv Medical Center, Tel Aviv, Israel
Category: Human Milk Composition
Background: Tandem Breastfeeding is defined as two or more
offsprings of different ages who breastfeed at the same time. Based
on the feedback from social forums, tandem breastfeeding in Israel
is on the rise. There is a paucity of publications on breastfeeding
during pregnancy and tandem breastfeeding.
Objective(s): We aimed to evaluate the impact of tandem
breastfeeding on the macronutrient content of human milk (HM).
Materials/Methods: Milk samples from 18 Tandem-
Breastfeeding mothers were compared to milk samples from 31
Non-Tandem-Breastfeeding mothers. Samples were collected
during the last month of pregnancy (Pregnancy milk), within the
72 hours (Colostrum) and 14 to 60 days after delivery (Mature
milk). Macronutrients content was measured using mid-infrared
spectroscopy.
Results: In Tandem-Breastfeeding (TBF) mothers, fat content
in pregnancy milk was lower than in mature milk (2.5 – 1.4 vs
4.2 – 1.2, p = 0.0096). Pregnancy milk protein content was higher
than in colostrum and mature milk (4.3 – 1.7 vs 2.6 – 1 and vs
1.4 – 0.3, p = 0.00236 and 0.00044, respectively). Inversely,
carbohydrate content was lower than in colostrum and mature
milk (6.4 – 1.4 vs 7.1 – 1 and vs 8.1 – 0.2, p = 0.0198 and 0.0012,
respectively). In addition, energy content of pregnancy milk was
similar to the one found in colostrum but lower than the one
observed in mature milk (63.4 – 11.4 vs 71.9 – 10, p = 0.04338).
When compared to Non-Tandem-Breastfeeding (NTBF) moth-
ers, fat and energy content in pregnancy milk was lower than in
mature milk (2.5 – 1.4 vs 4.8 – 1.9 and 63.4 – 11.4 vs 76.9 – 14.8,
p = 0.00012 and p = 0.00132, respectively), and protein content
was higher than in colostrum and mature milk (4.3 – 1.7 vs
3.2 – 2.4 and vs 1.5 – 0.4, p = 0.0244 and p < 0.00001, respec-
tively). Carbohydrate content was higher in pregnancy milk than
in colostrum of NTBF mothers (6.4 – 1.4 vs 5.1 – 1.6, p = 0.011).
In TBF mothers, carbohydrate content in colostrum and mature
milk was higher than the ones of NTBF mothers (7.1 – 1 vs
5.1 – 1.6 and 8.1 – 0.2 vs 6.2 – 1.5, p < 0.00001, for both).
A-9
Conclusions: HM during pregnancy has different macronu-
trient content than HM produced after delivery. However, colos-
trum and mature milk of TBF mothers are similar to HM produced
by NTBF mothers, to the exception of carbohydrate content.
18. A MIXED-METHOD EVALUATION OF THE VIEWS
OF MEDICAL TEACHERS ON THE APPLICABILITY
OF INFANT AND YOUNG CHILD FEEDING CHAPTER
IN SAUDI MEDICAL COLLEGES
Fouzia Alhreashy1, Hanan Mohammad Fouad Alkadri2,
Abdulelah Mobierek3, Albert Scherber4
1
Ministry of Health, Chicago, Illinois, USA
2
King Saud in Abdulziz for Health Science, Riyadh, Saudi
Arabia
3
King Saud University, Riyadh, Saudi Arabia
4
Maastricht University, Maastricht, Netherlands
Category: Medical Education
Background: Lack of sufficient preparation of physicians for
the provision of breastfeeding support and counselling has been
well-documented. The development of training in breastfeeding
medicine for medical students is currently ongoing worldwide.
This study was conducted to gain insights into a potential
framework for a breastfeeding education curriculum.
Objective(s): The general opinion on breastfeeding medicine
education in medical colleges. The opinion on contents of the
chapter under investigation. The opinion on cultural points re-
garding Saudi Arabia and breastfeeding education in medical
colleges.
Materials/Methods: A mixed-method design was used to
evaluate the opinions of medical teachers regarding current
lactation education and the applicability of the World Health
Organization (infant and young child feeding: model chapter for
textbooks for medical students and allied health professionals in
medical colleges in Riyadh, Saudi Arabia. Twelve teachers from
three medical schools were invited to participate in three rounds
of the research. The first round was carried out through an in-
terview using open-ended questions under three headings: 1) the
general opinion on breastfeeding medicine education in medical
colleges, 2) the opinion on contents of the chapter under inves-
tigation, and 3) the opinion on cultural points regarding Saudi
Arabia and breastfeeding education in medical colleges. This
was followed by a thematic analysis. Self -administered, close
ended questionnaire was created in the second round based on the
results of the first round. The third round addressed areas of
disagreement in opinions. To assess the degree of agreement
objectively, rounds 2 and 3 were analyzed according to the
5-point likert scale, with responses merged to a 3-point Likert
scale where appropriate. A consensus was reached when greater
than 70% agreement achieved.
Results: All participants agreed that breastfeeding education
is suboptimal. Although they considered the world health orga-
nization resource on infant and young child chapter a suitable
reference for the curriculum, they agreed that modifications to
suit the Saudi Arabian context are necessary. The medical
teachers suggested a unique curriculum for medical students,
which is similar for both genders. However, disagreement ex-
isted regarding the provision of extra clinical training to female
students.
Conclusions: Breastfeeding medicine education in medical
colleges should be developed using resources that are rich in
content, are physician-specific and take into consideration the
culture.
 A-10
19. BREASTFEEDING EDUCATION: AN APPROACH
TO EDUCATING FIRST YEAR MEDICAL STUDENTS
Camron Johnson-Privitera1, Jennifer Cleveland1
1 breastfeeding promotion and management is effective at in-
Virginia Tech School of Medicine, Roanoke, Virginia, USA
Category: Medical Education
Background: The long-term health impacts of breastfeeding
has been well established globally, yet, its emphasis within
medical school curriculum is limited. Medical school students
can benefit from increased content exposure on breastfeeding to
Downloaded by FUNDAÇÃO UNIV. FEDERAL DE CIÊNCIAS DA SAÚDE DE PORTO ALEGRE from www.liebertpub.com at 09/30/21. For personal use only.
provide solid foundational knowledge and increased comfort-
ability when discussing with future patients.
Objective(s): Assess the breastfeeding knowledge and per-
ceptions of first year medical students. Provide foundational
pathophysiology of breastfeeding and long-term outcomes
associated.
Materials/Methods: Using a pre and post-questionnaire de-
sign, we invited 42 first year medical students (M1) to explore
the basics of breastfeeding to evaluate mastery of content and
perception of a novel educational session. Prior to the session,
students reviewed session objectives along with two brief articles
addressing the physiology of lactation and prolactin. During
class, students completed the pre-exercise questionnaire, par-
ticipated in a 40- minute educational session on the physiology,
pathophysiology and importance of breastfeeding, followed by
the post-exercise questionnaire.
Results: 100% of students present participated in the study.
Students’ knowledge scores on breastfeeding when evaluated on
post questionnaires showed a statistically significant increase
compared to the pre-questionnaires (n = 15, p = 0.007). There was
no change in students’ perceived level of importance of breast-
feeding on long term outcomes. However, 100% of students
increased their confidence in comfort level discussing breast-
feeding with families after the activity.
Conclusions: The long-term benefits of breastfeeding to
mothers and children has long been established. Yet despite the
accepted implications to population health, the education cur-
riculum for medical students and residents has been lacking in its
presentation. Our results indicate that the inclusion of breast-
feeding education in the first year is an effective way to convey
pathophysiology and long-term benefits. This education builds
confidence in future physicians ability to discuss long term im-
plications of human milk nutrition. Incorporation of a small
exposure, such as this, provides an opportunity for programs to
address this critical gap in curriculum.
20. EFFECTIVENESS OF WORKSHOP FOR TEACHING
BREASTFEEDING PROMOTION AND MANAGEMENT
TO MEDICAL STUDENTS
Miena Hall1, Maureen Gecht-Silver2
1
AMITA Adventist Hinsdale Hospital, Hinsdale, Illinois, USA
2
University of Illinois at Chicago, Chicago, Illinois, USA
Category: Medical Education
Background: Breastfeeding education for physicians is ex-
traordinarily varied across the United States despite the relatively
standardized process of medical school coursework and resi-
dency curriculum. Although lactation is listed as testable content
for board examinations, ACGME only requires residents in-
volved in direct neonatal care to learn about breastfeeding. Given
that most physicians have the potential to care for patient who is
breastfeeding or lactating, it is imperative that all medical stu-
dents and residents have a basic understanding of the physiology
POSTER ABSTRACTS
of lactation, the contraindications to its use, and the safety of
medications during its course.
Objective(s): To determine if a three-hour workshop covering
creasing the breastfeeding knowledge of medical students on
their family medicine clerkship. To evaluate the effect that past
exposure to breastfeeding has on medical students’ knowledge
changes following the educational intervention. To assess
changes to medical students’ confidence levels in addressing and
managing common breastfeeding concerns following the edu-
cational intervention.
Materials/Methods: The study was a randomized controlled
trial in which 46 medical students during their third-year family
medicine clerkship were assigned to either the educational in-
tervention or control groups. All subjects took the pretest at the
beginning of the clerkship, participated in either the three-hour
breastfeeding workshop or received an email outlining the topics
to be covered, and were administered the posttest at the end of
their rotation. The pretest and posttest were validated assessment
tools taken from the AAP Breastfeeding Residency Curriculum.
Results: Breastfeeding knowledge increased significantly
following the workshop. Clinical exposure to breastfeeding dy-
ads during clerkship rotations was similar between groups and
provided baseline knowledge. Increased student age and per-
sonal breastfeeding exposure was correlated with higher pretest
scores. Participation in the workshop significantly increased
students’ confidence in addressing breastfeeding questions and
management. Students felt that breastfeeding training in medical
school would strongly influence how they care for mothers and
babies in the future.
Conclusions: In our study, we showed that small-group, active
learning sessions on breastfeeding were well received by medical
students. Our curriculum, based on resident-level content and
assessment tools, was appropriate to educate third-year medical
students, allowed students to recognize that training in breast-
feeding was clinically important, and increased their interest in the
subject. We showed that a workshop during a third-year Family
Medicine clerkship was effective at increasing medical students’
knowledge and confidence about breastfeeding.
21. IMPLEMENTATION AND EVALUATION
OF A BREASTFEEDING MEDICINE CURRICULUM
IN UNDERGRADUATE MEDICAL EDUCATION
Piper Sandel1, Megha Fitzpatrick1,
Karen McDonnell1, Janine Rethy1
1
MedStar Georgetown University Hospital, Washington, DC, USA
Category: Medical Education
Background: Breastfeeding improves lifelong health out-
comes for both the mother and the infant. The American Acad-
emy of Pediatrics recommends exclusive breastfeeding in the
first 6 months of life. However, breastfeeding rates in the U.S. are
sub-optimal and disparities are stark. Physician breastfeeding
education has been shown to improve breastfeeding outcomes.
Breastfeeding education in undergraduate and graduate medical
education is recommended so that physicians can adequately
support breastfeeding initiation and maintenance. Education on
breastfeeding is however not a core element of most medical
school curricula. Challenges to integration into existing curric-
ulum include time, faculty expertise, and multi-specialty support.
Objective(s): To design and integrate a breastfeeding medi-
cine curriculum into undergraduate medical education. To
evaluate a breastfeeding medicine curriculum.
 POSTER ABSTRACTS
Materials/Methods: Faculty in the Division of Community
Pediatrics in collaboration with the Pediatric Clerkship Director
developed and implemented a new medical student curriculum on
breastfeeding medicine using the Wellstart International Lactation
Management Self-Study Level 1 Modules and supplemental video
and reading materials. The materials are designed to be completed
in one half day. The curriculum was integrated as a requirement
into the third year Pediatric Clerkship and fourth year Community
Pediatrics elective. It was evaluated using the Wellstart assessment
tool for knowledge and additional questions assessed acceptability
and potential for impact on practice.
Downloaded by FUNDAÇÃO UNIV. FEDERAL DE CIÊNCIAS DA SAÚDE DE PORTO ALEGRE from www.liebertpub.com at 09/30/21. For personal use only.
Results: 196 students completed the curriculum as part of
their required pediatric clerkship and 9 as part of an elective in
academic year 2018–2019. Participants of this study were largely
third year medical students (85.5%). Of the 134 students who
took the pre-test, 89.6% reported less than 2 hours of prior
breastfeeding medicine education. 76 students took both the pre
and post-tests. Mean total scores increased from 19.0 (67.9%) to
24.16 (86.3%) out of 28.0 (p < 0.001) as well as in each knowl-
edge category (Anatomy & Physiology, Clinical Assessment &
Anticipatory Guidance, Public Health & Policy and Diagnosis,
Management & Pathophysiology) (p < 0.001). Of the 80 students
who took the post test, 95% thought the content was at the ap-
propriate learning level, 91% said they are at least sometimes
likely to use what they learned, and 56% said it will at least
moderately change the way they practice medicine.
Conclusions: Development and integration of a focused
breastfeeding medicine curriculum into clinical rotations in un-
dergraduate medical education is feasible and effective. This
study demonstrates significant improvement in knowledge, cur-
riculum acceptance and intention to change clinical practice after
completing the curriculum. This model is easily replicable in
other medical school settings and can have an important impact
on maternal and infant health.
22. EFFICACY OF A PEDIATRIC RESIDENT
DEVELOPED EDUCATIONAL MODULE
IN INCREASING RESIDENT KNOWLEDGE
OF DONOR MILK
Xiang Ng1, Parvathy Krishnan1, Jorge Revelo Escobar1,
Kevin Heringman1, Lawrence Noble2, Anita Noble3
1
Elmhurst Hospital Center, Queens, New York, USA
2
Icahn School of Medicine at Mount Sinai, New York City,
New York, USA
3
Hadassah-Hebrew University, Jerusalem, Israel
Category: Medical Education
Background: The AAP recommends the use of pasteurized
donor human milk (DHM) for preterm infants with very low birth
weight (VLBW) infants (< 1500 g) when own mother’s milk is
inadequate or unavailable. Pasteurized donor milk, when provided
as a sole diet or in conjunction with mother’s own milk for preterm
infants, is protective against necrotizing enterocolitis (NEC).
Knowledge of donor milk is vitally important for pediatric resi-
dents who manage the care of VLBW infants in the NICU.
Objective(s): The purpose of this study was to develop and
evaluate an educational module for pediatric residents to im-
prove knowledge of donor human milk for preterm infants.
Materials/Methods: This was an educational intervention
study that included the development of a module regarding the
knowledge and use of donor human milk for VLBW infants.
Developed by pediatric residents for use by pediatric residents
and medical students, the module underwent expert validity by
neonatologists specializing in human milk. A convenience
A-11
sample of 20 pediatric residents and medical students completed
the modular study during a designated lecture period. All par-
ticipants were invited to complete a pre & post-tests. Data was
collected and analyzed by t-test with SPSS 25.
Results: Participants scores increased from a mean pretest
score of 19.8 + 1.6 to posttest score 23.5 + 1.5 (P = 0.000). The
percentage of correct answers was 48.2 + 10.5% prior to the
module and improved to 73.4 + 9.0% post-survey (P = 0.000).
Pediatric residents’ mean confidence level was 3.4 + 0.7 prior and
increased to 4.4 + 0.9 after completing the module (P = 0.002).
Resident knowledge significantly improved in multiple subject
areas, including eligibility criteria for donor milk, process to
eliminate non-infectious contaminant of DHM, process of pas-
teurization and benefits of DHM.
Conclusions: Participants scores increased from a mean
pretest score of 19.8 + 1.6 to posttest score 23.5 + 1.5 (P = 0.000).
The percentage of correct answers was 48.2 + 10.5% prior to the
module and improved to 73.4 + 9.0% post-survey (P = 0.000).
Pediatric residents’ mean confidence level was 3.4 + 0.7 prior and
increased to 4.4 + 0.9 after completing the module (P = 0.002).
Resident knowledge significantly improved in multiple subject
areas, including eligibility criteria for donor milk, process to
eliminate non-infectious contaminant of DHM, process of pas-
teurization and benefits of DHM.
23. PREVENTING DENTAL CARIES
IN BREASTFEEDING TODDLERS: 2020 UPDATES
Gina Weissman1
1
Laniado Hospital, Netanya, Israel
Category: Medical Education
Background: Breastfeeding is an unequalled way of provid-
ing ideal food for the healthy growth and development of infants.
Exclusive breastfeeding for 6 months is the optimal way of
feeding infants. Thereafter infants should receive complemen-
tary foods with continued breastfeeding up to 2 years of age or
beyond. Breast milk promotes sensory and cognitive develop-
ment, and protects the infant against infectious and chronic
diseases. The increasing awareness to the benefits of breast-
feeding has led an incremental rise in toddler breastfeeding.
Common recommendations to toddlers who are diagnosed with
Early Childhood Caries (ECC) are dental treatment under gen-
eral anesthesia and weaning from the breast. Dental caries is a
chronic disease that relates to the modern lifestyle. It is affected
by nutrition habits, oral hygiene and oral bacteria composition.
Prolonged acidity in oral cavity increases the risk of developing
tooth decay. Being an experienced Lactation Consultant and a
DMD, Dr Weissman presents a unique perspective of treating
and preventing dental caries in breastfeeding toddlers.
Objective(s): To review current studies in breastfeeding-
dental caries correlation. To assess risk factors for dental caries.
To review alternatives for conventional dental treatment and
present a conservative protocol for treating ECC.
Materials/Methods: Literature regarding breastfeeding and
dental caries will be reviewed, as well as alternatives for con-
ventional dental treatment. A variety of Case Studies will be
presented including clinical photos.
Results: Clinical research demonstrates a protective effect of
breastmilk on dental caries development up to 12 months in
comparison with other feeding methods. Breast milk contains
immunomodulators and microbiome which are necessary for
flora’s equilibrium. As for the age range of 13–23 months, no
significant correlation was observed between breastfeeding and
 A-12
dental caries. Clinical research did show increased dental caries
rate for children above 24 months. However, most studies did not
refer to oral hygiene, fluoride exposure and complementary
foods.
Conclusions: When assessing dental caries risk, one needs to
consider the effect of pre-natal and post-natal complications and
the dental and systemic condition of both mother and baby.
These have been proven to have an effect on enamel structure
and resiliency and the levels of cariogenic bacteria. When
treating ECC a conservative approach should be considered.
Dental treatment usually includes inhaled sedation, deep seda-
Downloaded by FUNDAÇÃO UNIV. FEDERAL DE CIÊNCIAS DA SAÚDE DE PORTO ALEGRE from www.liebertpub.com at 09/30/21. For personal use only.
tion or general anesthesia. Conservative methods arenon-
restorative dental treatment and frequent follow-ups that include
use of topical fluorides, nutrition and OH modification. Only in
cases of severe ECC one should consider avoiding ad-libitum
night breastfeeding.
24. INTERNATIONAL LACTATION TRAINING TRIP
IN CHINA
Jie Chang1
1 ensure that the benefits of human milk are extended to infants of
Stanford Children’s Hospital, Palo Alto, California, USA
Category: Medical Education
Background: China, a country with the largest population in
the world, reported having only 568 International Board Certified
Lactation Consultants (IBCLC’s) in 2018, (1) and an exclusive
breastfeeding rate for infants under six-month-old, of 29.2%,2
which is lower than the world’s average rate of 43%. (2) In-
adequate number of IBCLC leads to a delivery of inaccurate
information and low exclusive breastfeeding rates. (3)
Objective(s): To promote professional lactation service in
China by providing a comprehensive education for Chinese
health providers. Effective professional lactation training for
Chinese health providers.
Materials/Methods: Lucile Packard Children’s Hospital
Stanford developed and delivered a three day course on Lacta-
tion. The content was based on ‘‘Core Curriculum for Lactat-
ion Consultant Practice’’. A post questionnaire survey was
conducted. (4)
Results: A total of 191 trainees from 22 local hospitals and
institutes attended the training, including physicians (65), nurses
(125) and a hospital administrator. Post questionnaire surveys
(86) were completed. The program was rated excellent for
courses’ organization (87%, 75/86), the presenters’ knowledge
(82.5%, 71/86), relevant and helpful teaching material (80%, 69/
86). The three favorite topics were lactation pharmacology,
building an effective breastfeeding service, managing breast and
nipple problems. The suggestions for course improvement were
to increase the interaction between instructor and trainees and
provide more opportunities for hands on clinical practice.
Conclusions: Evidence based and clinical practical lactation
knowledge, techniques, principle, and protocol, all of which are
needed to inform and support Chinese health providers.
25. NON-MATERNAL NURSING IN THE MUSLIM
COMMUNITY: A HEALTH PERSPECTIVE REVIEW
Fouzia Alhreashy1
1
Ministry of Health, Chicago, Illinois, USA
Category: Other
Background: Non-maternal nursing is a valuable option for
healthy infant nutrition. It is currently practiced as direct wet
POSTER ABSTRACTS
nursing and feeding of expressed milk from a wet nurse, and the
applicability of both varies across cultures. Review of the rele-
vant literature revealed an understanding of the characteristics,
benefits, and challenges in the practice of wet nursing across
different cultures. There is a paucity of literature on direct wet
nursing in medicine. On the other hand, there is a considerable
amount of discussion on the indirect method (donor human milk
feeding) in the context of milk banks and feeding premature
infants or sharing in the community. The ideal characteristics of a
wet nurse and/or a human milk donor are addressed. The chal-
lenges that face non-maternal nursing include health, economic,
cultural, and other challenges – the majority of which can be
overcome at the individual or community level. Finally, in the
context of Muslim communities, milk kinship should not be
considered an obstacle to non-maternal nursing; indeed, it should
be addressed as a fortunate feature that can expand human re-
lations between the wet nurses and the receiving families. The
findings of this review indicate the need for evidence-based
guidelines for non-maternal nursing across various social context
and clinical scenarios. Moreover, it is important to utilize modern
technology in donor human milk feeding in specific situations to
all cultures.
Objective(s): This review seeks to answer a series of ques-
tions: 1. What is the current practice of wet nursing in the Muslim
world? 2. Is direct wet nursing preferable to the use of human
milk expressed by a wet nurse? 3. What are the ideal charac-
teristics of a wet nurse? 4. What are the health indications for
non-maternal nursing? 5. What are the challenges to wet nursing
practice in the Muslim community?
Materials/Methods: Review
Results: Review Paper
Conclusions: The options for non-maternal nursing vary in
quality, feasibility, customs, and cost across communities; this is in
addition to the physiological variabilities of lactation. Direct wet
nursing is a valuable resource that should be encouraged with ap-
propriate support from the medical community. Islam supports
breastfeeding from mothers as well as from wet nurses. However,
the parents must know the identity of the human milk donors as a
mark of respect for the kinship created between the wet nurse and
the infant according to Islamic law. Thus, there is a need for mul-
tidisciplinary, evidence-based guidelines for non-maternal nursing
of healthy and sick infants that are in keeping with cultural norms.
26. A GRAVES’ MATTER: POOR WEIGHT GAIN
IN A BREASTFED INFANT
Janean Wedeking1, Dillon Savard1
1
Offutt Air Force Base, Sarpy County, Nebraska, USA
Category: Other
Background: Poor weight gain, or failure to thrive (FTT), has
myriad possible etiologies and is relatively common in primary care
practice. Also known, through large population studies, that it is
estimated the incidence rate of maternal hyperthyroidism is 65 per
100,000 mothers per year with the highest rate during the 7 to 9
months postpartum. It is also estimated that 40–45% of all new
Graves’ disease in parous women happens in the postpartum
timeframe. Presented, is a case report of a breastfed infant with FTT
in the setting of unknown, uncontrolled maternal Graves’ disease.
A normal breastfed infant began to have slowed growth at four
months of age. The social situation was optimal and laboratory
work-up was normal. The mother’s only medication was
etonogestrel-releasing contraceptive implant. The mother engaged
 POSTER ABSTRACTS
in breast massage and supplemented with expressed breast milk.
Full fats were also added to the infant’s solid diet, yielding no
improvement in growth. Unknown to the infant’s physician, from 4
to 11 months postpartum the mother lost 30 pounds, had palpita-
tions, and exophthalmos. She began methimazole for Graves’ dis-
ease and, once optimized, the infant’s weight rapidly normalized.
Objective(s): Thoroughly assess the details of the case report
of a breastfed infant with FTT in the setting of unknown, un-
controlled maternal Graves’ disease, and attempt to identify an
underlying cause. Review literature to understand the underlying
pathophysiology of maternal hyperthyroidism and how it may
Downloaded by FUNDAÇÃO UNIV. FEDERAL DE CIÊNCIAS DA SAÚDE DE PORTO ALEGRE from www.liebertpub.com at 09/30/21. For personal use only.
lead to changes in breastfeeding and possibly infant FTT. De-
termine what implications this case has for primary care practice
and providing care for mothers and infants.
Materials/Methods: N/A
Results: Data is lacking regarding Graves’ disease’s effects
on lactation and breastfed infants. In rats, induced maternal hy-
perthyroidism is associated with milk stasis and lower weight
gain in rat pups. In the infant reported here, decreased growth
was likely related to uncontrolled maternal Graves’ disease, gi-
ven that growth dramatically responded to maternal treatment.
However the underlying pathophysiology of this is in humans is
not clearly known.
Conclusions: Primary care providers routinely encounter in-
fant FTT. This case illustrates the importance for clinicians to
include a broad range of maternal health causes in their differ-
ential for FTT in breastfed infants, including hyperthyroidism.
Currently the American Thyroid Association does not recom-
mend treatment of Graves’ disease on the basis of improving
lactation alone. However, this case demonstrates that treating
maternal Graves’ disease may improve lactation for breastfed
infants. Also demonstrated in this case is the importance of in-
clusive infant and maternal pre/postnatal care. Employing this
model of care may have facilitated earlier identification and
treatment of this infant’s FTT and maternal Graves’ disease.
27. IDIOPATHIC GRANULOMATOUS MASTITIS
DIAGNOSED DURING PREGNANCY ASSOCIATED
WITH SUCCESSFUL BREASTFEEDING EXPERIENCE
Adeola Awomolo1, Adetola Louis-Jacques2, Susan Crowe3
1
University of Arizona, Tucson, Arizona, USA
2
University of South Florida, Tampa, Florida, USA
3 28. LACTATION IN THE WORKPLACE: A PEDIATRIC
Stanford University, Stanford, California, USA
Category: Other
Background: Idiopathic granulomatous mastitis (IGM) is a
rare inflammatory breast condition with unclear etiology. It oc-
curs primarily in women of childbearing age and can mimic two
common breast conditions, breast abscess and breast malig-
nancy. Most common symptoms include unilateral breast ten-
derness, breast mass, erythema, nipple retraction, and axillary
adenopathy. The diagnosis of IGM can be challenging and is
often delayed. Due to a lack of consensus on treatment, choice,
and duration of treatment add another layer of complexity to
IGM management. There is also limited guidance on IGM and
breastfeeding management.
Objective(s): Describe a rare diagnosis that should be con-
sidered with atypical presentation of mastitis. Describe co-
management of IGM associated with successful breastfeeding
experience.
Materials/Methods: Case Report
Results: Case Description: A 30- year-old gravida 3 para 1
with a history of intrauterine fetal demise and eczema presented
A-13
to her prenatal visit at 33 weeks’ gestation with left breast pain
and galactorrhea. Physical examination revealed erythema and
induration, and dicloxacillin was initiated for presumed mastitis.
Within a day of starting dicloxacillin, she developed joint pain
and erythematous plaques and was switched to clindamycin. Due
to persistent symptoms despite treatment, breast surgery was
consulted. Ultrasound revealed dilated fluid-filled ducts and
hypervascularity of overlying skin. Fine-needle aspiration
showed acute inflammation with no growth on culture.
Ultrasound-guided breast core biopsy revealed chronic granu-
lomatous inflammation, neutrophilic and eosinophilic inflam-
mation, and a diagnosis of IGM was made. Simultaneously, the
joint pain and erythematous plaques worsened. Dermatology
diagnosed concurrent erythema nodosum. Rheumatology re-
commended prednisone, the erythema nodosum and polyarthritis
responded well to prednisone, but the breast condition remained
severe. She was noted to have drainage from multiple sites on
the left breast and methotrexate was recommended postpartum.
She had vaginal birth at 39 weeks and due to multiple draining
fistulas on her left breast, she was started on Bactrim for bac-
terial mastitis prophylaxis. She initiated breastfeeding with her
right breast. The left breast was hand expressed for comfort. She
declined methotrexate because she desired to breastfeed, and
azathioprine was initiated. She was co-managed by a breast-
feeding medicine specialist and rheumatology. Eight weeks
postpartum, the patient was breastfeeding exclusively. There
was some induration and multiple residual draining fistulas on
her left breast. At 3 months postpartum, her breast exam was
improved with minimal residual induration but persistent
draining fistulas. She chose to discontinue azathioprine. At
seven months postpartum, her breast exam was normal except
for a 2cm firm area. The patient reported breastfeeding exclu-
sively for 6 months, and breastfeeding continued throughout the
first year.
Conclusions: IGM is a challenging diagnosis that should be
considered in cases of sterile breast abscesses. Management is
complex and regardless of therapeutic intervention reported
duration to resolution ranges from 6 to 12 months. This case
illustrates how a multidisciplinary approach in the management
of idiopathic granulomatous mastitis during pregnancy and
postpartum can facilitate a successful breastfeeding experience.
EMPLOYEE SURVEY
Tavor Allali1, Cristina Senger1, Wayne Franklin1
1
Loyola University Medical Center, Maywood, Illinois, USA
Category: Other
Background: Numerous benefits of breastfeeding exist, in-
cluding lower incidence of diabetes, asthma, and eczema for
infants and decreased risk of postpartum bleeding and depression
for mothers. Employers of breastfeeding mothers have improved
employee productivity, morale, company image, and employee
retention. The AAP recommends exclusive breastfeeding until
six months of age; however, in the US, only 25% of mothers
report meeting that goal. Studies investigating the relationship
between breastfeeding and employment found that working
mothers are more likely to stop breastfeeding in the first month of
return to work compared to their non-working counterparts.
Barriers to pumping at work include an unsupportive environ-
ment, and lack of privacy, time or access to a lactation room. The
latter two are positively correlated with continuation of breast-
feeding in working mothers.
 A-14
Objective(s): Determine the current lactation preferences and
practices of women within the pediatrics department at Loyola
University Medical Center (LUMC). Identify strengths and
weaknesses of the current staff lactation room at LUMC. Propose
an intervention to improve workplace lactation in the pediatrics
department at LUMC.
Materials/Methods: A survey was sent to 265 women in the
pediatric department at Loyola Medical Center in Illinois.
Questions were aimed at identifying current pumping practices,
locations, and attitudes within the workplace.
Results: A total of 127 participants (48%) responded. Parti-
Downloaded by FUNDAÇÃO UNIV. FEDERAL DE CIÊNCIAS DA SAÚDE DE PORTO ALEGRE from www.liebertpub.com at 09/30/21. For personal use only.
cipants included nurses (52%), residents (17%), attending phy-
sicians (11%), and other clinical or administrative staff. About
70% of participants work in the hospital, 13% in administration
or the outpatient center, and 16% are residents, who rotate
through multiple locations. Of the participants, 47% reported no
lactation room in their department and 52% didn’t know the
location of it or that one existed. 47% of participants had pumped
at work, and of those, 60% exclusively used a room other than the
existing lactation room. The majority of participants stored their
breast milk in the employee refrigerator (35%) or a personal
cooler (29%). Women (49%) reported they wouldn’t use the
existing room, citing its lack of cleanliness, inconvenient loca-
tion, and limited space as major reasons. Despite these short-
comings, 80% of women felt their workplace was supportive and
only 30% were dissatisfied with available resources.
Conclusions: Our proposal is to renovate and update the ex-
isting lactation room in our facility to provide a cleaner and more
inviting space and encourage long term continuation of breast-
feeding. To increase awareness of the existing room, we created a
website on the employee intranet portal that includes information
about the room and an official employee breastfeeding policy.
Our proposal also includes plans to convert several more con-
veniently located rooms into employee-only lactation rooms.
Breastfeeding is beneficial for infants, mothers, employers, and
society. One role of pediatricians is to promote and support
breastfeeding in clinics, communities, and society. Studies in-
dicate that personal success with breastfeeding is positively as-
sociated with breastfeeding advocacy amongst physicians. As
the specialty with the highest percentage of women physicians,
pediatrics should be at the forefront of lactation support in the
workplace. This includes providing a clean, quiet, relaxing, and
private environment for women to pump. Surveying healthcare
workers is crucial in gaining knowledge about their attitudes
towards employer resources and support of lactation. An inter-
vention that improves the current conditions will not only lead to
improved employee morale, but also enhanced breastfeeding
promotion to benefit our patients.
29. SHARING THE SCIENCE OF LACTATION
AND MOTHERS’ OWN MILK WITH NICU FAMILIES
AND STAFF
Paula Meier1, Aloka Patel1, Judy Janes1
1 1
Rush University Medical Center, Chicago, Illinois, USA
Category: Other
Background: The evidence for the use of mothers’ own milk
(MOM) for premature and other infants hospitalized in the
newborn intensive care unit (NICU) is substantial, and includes a
dose-dependent reduction in the risk of potentially preventable
morbidities that are serious and costly. Similarly, there is con-
siderable evidence about initiating and maintaining lactation in
breast pump dependent mothers of NICU infants. However, there
POSTER ABSTRACTS
is a significant gap between this evidence and its routine im-
plementation into best NICU practices.
Objective(s): To share a recently completed demonstration
project, Translating Research to Practice: Evidence Based Toolkit
to Optimize Mothers’ Own Milk Feeding in the NICU, that
standardizes messaging and practices for NICU families and staff.
Describe NICU implementation strategies for project materials.
Materials/Methods: This project prepared 25 one-page
parent education sheets and 20 short segment video clips that
share the latest science about lactation and MOM with NICU
families and staff. The content was developed with a specific
focus on questions and concerns commonly experienced by
NICU families and staff. A core tenet of the project was de-
picting otherwise complicated scientific mechanisms in words
or visuals that were understandable and actionable by users,
including the enteromammary pathway, barrier protection with
MOM oligosaccharides, and neuroprotection of developing
brain white matter.
Results: Included among the one-page education sheets are:
Why does my milk matter for my premature baby? What is co-
lostrum and why is it important for my NICU baby? How does
my milk help my baby’s brain grow and develop? Are my
medications safe while I am providing milk for my NICU baby?
Benefits to mothers who provide milk for their NICU babies.
Kangaroo care for mothers and NICU babies. Mouth care with
mother’s milk for your NICU baby. Fresh, refrigerated, frozen
and pasteurized milk for NICU babies. Mastitis in the NICU.
Marijuana and providing milk for a NICU baby. Among the
video footage are very short (30 seconds) and longer (9 minutes)
segments for use with families and staff. Examples include: Skin-
to-skin holding in the NICU (for NICU staff; demonstrates
transfer of intubated, critically ill infant into skin-to-skin posi-
tion). Skin-to-skin holding in the NICU (for NICU families,
demonstrating transfer, and addressing common questions such
as ‘‘Is my baby really ready to be held skin-to-skin?’’). Mouth
care with MOM. Making individualized decisions about medi-
cations in MOM. Effective, efficient and comfortable breast
pump use in the NICU. Positioning premature babies for feedings
at the breast. Performing test weights to measure milk intake
during breastfeeding. Preparing to breastfeed after NICU dis-
charge: What to expect in the first month at home.
Conclusions: For families, these materials provide evidence-
based information about NICU-specific lactation and MOM
concerns. For NICU staff, these materials standardize practice
and messaging, and provide a valuable addition to current quality
improvement initiatives that seek to improve outcomes for lac-
tation and MOM in the NICU.
30. THE VALUE OF BREASTFEEDING AND THE
COSTS OF ARTIFICIAL FEEDING TO SOCIETY:
AN ANALYSIS OF THE METHODS AND COMPARISON
OF RESULTS
Melissa Bartick1, Briana Jegier2, Julie Smith3
Mt. Auburn Hospital, Harvard Medical School, Cambridge,
Massachusetts, USA
2
D’Youville College, Buffalo, New York, USA
3
Research School of Population Health, Australia National
University, Canberra, Australia
Category: Quality Improvement Advocacy
Background: Economic analyses of breastfeeding are diverse
in focus - yielding vastly different estimates and using very
different methods to assess costs.
 POSTER ABSTRACTS
Objective(s): To compare and contrast the different cost es-
timates for the costs of artificial feeding, as these estimates can
differ widely. To review the different methodologies for the
estimates, which thus largely explained the wide variability in
cost estimates. To explain to policy-makers and advocates the
differences in the types of estimates, so in order to better guide
decision-making.
Materials/Methods: We reviewed peer-reviewed and major
grey literature between 1995–2020 using keywords on the cost of
suboptimal breastfeeding or artificial feeding. Articles were ex-
cluded if they did not have monetary values assigned or evalu-
Downloaded by FUNDAÇÃO UNIV. FEDERAL DE CIÊNCIAS DA SAÚDE DE PORTO ALEGRE from www.liebertpub.com at 09/30/21. For personal use only.
ated breastfeeding programs or donor milk only.
Results: We identified 2 types of costs and several methodolo-
gies, arising from different perspectives on costs. Costs consisted of
a) resource costs and b) longer-term societal costs. Resource costs
included direct and indirect medical costs and lost wages, which
can be calculated by several methods. Longer term societal costs are
human capital costs measured by lost productivity, and included the
costs of premature death and of cognitive losses. The bulk of eco-
nomic costs come from societal costs and can vary widely depending
on method of calculation. Although direct medical treatment costs
can vary widely in their precision depending on method of calcu-
lation, this variation has little effect on overall estimates when
compared to the much larger cognitive or death costs.
Conclusions: When evaluating economic analyses of breast-
feeding, it is important for readers to be familiar with key eco-
nomic concepts, methodologies, and the distribution of resource
and societal costs. Readers also must be cautious that direct
medical costs should not be summed with costs for lost pro-
ductivity. Governments may be more concerned about societal
and resource costs, whereas businesses and insurers may be more
concerned about resource costs.
31. IMPROVING POSTPARTUM BREAST PUMPING
IN MOTHERS OF BABIES IN THE NICU
Karampreet Kaur1, Lisa Zuckerwise1,
Stephanie Attarian2, Mary Dye2
1
Vanderbilt University Medical Center, Nashville, Tennessee, USA
2
The Monroe Carell Jr. Children’s Hospital at Vanderbilt,
Nashville, Tennessee, USA
Category: Quality Improvement Advocacy
Background: Human milk provides ideal nutrition for pre-
mature infants in the Neonatal Intensive Care Unit (NICU). Hu-
man milk’s unique properties protect these vulnerable patients
from morbidities such as late onset sepsis, central catheter asso-
ciated blood stream infections (CLABSI), necrotizing enteroco-
litis (NEC), feeding intolerance, and retinopathy of prematurity
(ROP). Stage II lactogenesis marks the start of abundant human
milk production in the postpartum period. Delayed lactogenesis II
leads to decreased total milk volume and lactation time, especially
in mothers of infants admitted to the NICU. Initiation of milk
expression within one hour following delivery increases milk
volume and decreases time to lactogenesis II in mothers of very
low birth weight infants. Despite these known benefits, only
*57% of NICU mothers delivering at Vanderbilt University
Medical Center initiate breast-pumping within 6 hours of delivery.
Objective(s): Determine our current performance with post-
partum pumping. Decrease the median time to first breast pump
in NICU mothers by 50%.
Materials/Methods: The baseline time to first breast pump
was calculated for mothers who delivered between 10/01/2019
and 10/31/2019 and were seen for consultation in our Fetal
A-15
Center by a single Maternal Fetal Medicine (MFM) provider
(LCZ). For patients who delivered vaginally, we determined the
time from delivery to first breast pump using time stamps in the
electronic medical record (EMR). For patients who delivered via
Cesarean delivery, we calculated time interval from exiting the
operating room to first breast pump. Intervention 1 was con-
ducted from 11/5/19 -12/17/19 in The Fetal Center at Vanderbilt
during a single MFM physician’s clinic (LCZ). During this in-
tervention, patients were identified in their 3rd trimester and
counseled on the importance of early breast pumping using a
brief educational narrative about the benefits of short interval to
first pump. Intervention 2 was conducted from 12/20/19 - 12/27/
19 on the inpatient antepartum service. During bedside rounds
with nursing staff present, the same physician counseled women
likely to deliver neonates requiring NICU care about the im-
portance of short interval to first breast pump after delivery. Time
to first breast pump was similarly calculated for intervention
patients via time stamps in the EMR.
Results: Nine patients seen by our MFM physician were de-
livered during the baseline data collection period. Among this
group, the median [interquartile range, IQR] baseline time in hours
from delivery to first breast pump was 8.38 [7.55–10.22]. Ten of 15
patients who received Intervention 1 commenced breast pumping
after delivery. The median time in hours to first breast pump in this
group was 4.63 [2.52–5.67]. Five patients who received Inter-
vention 2 commenced breast pumping after delivery. The median
time to first breast pump was 9.92 [6.28–11.12] hours. Two
mothers who received the inpatient intervention took >17 hours to
initiate pumping. One did not receive her breast pump supplies in a
timely manner and the other’s child was unstable and NPO, which
may have contributed to delays in pumping. The overall combined
intervention median was 4.92 [2.88–8.12] hours. This represented
a 41% decrease from the baseline time to first breast pump among
patients with neonates admitted to the NICU who received directed
counseling in either the outpatient or inpatient setting.
Conclusions: Overall, our educational interventions reduced
median time to first breast pump amongst mothers whose babies
went to the NICU, and this was especially true of our outpatient
counseling intervention. Next, we plan to recruit more MFM
attendings to implement the outpatient counseling on breast
pumping, create a flier to supplement patient education, and
modify the surgical ’time out’ protocols for deliveries of neo-
nates at risk for NICU care to include intraoperative retrieval of a
breast pump for the mother’s postpartum recovery room.
32. INCREASING THE USE OF DONOR EXPRESSED
BREAST MILK IN THE NICU
Lakshmy Vaidyanathan1
1
UT Dell Medical School, Austin, Texas, USA
Category: Quality Improvement Advocacy
Background: Breastmilk has numerous health benefits for
newborn infants, including many that formula does not provide.
Donor expressed breastmilk (DEBM) is available for infants in
the neonatal intensive care unit (NICU) but is often underutilized
in lieu of formula.
Objective(s): The purpose of this project was to determine the
barriers to DEBM usage in the NICU, assess the understanding
and educational awareness about DEBM amongst nursing staff
and families, and create an intervention to increase the use of
DEBM in the NICU. Conduct short bedside educational sessions
to NICU nurses with the goal of increasing their educational
awareness about DEBM.
 A-16
Materials/Methods: A pre-education survey was created for
families whose infants were receiving DEBM and for NICU
nurses which included questions about education regarding
DEBM and possible barriers to usage. Nine families and thirty-
six nursing staff members completed these surveys. After ana-
lyzing the survey results, determined that the families had a good
level of understanding of DEBM and did not need further edu-
cation; however there were several areas we identified for po-
tential improvement on the nursing staff surveys. We created a
20-minute educational presentation about the benefits and pro-
cessing of DEBM using educational materials provided by Mo-
Downloaded by FUNDAÇÃO UNIV. FEDERAL DE CIÊNCIAS DA SAÚDE DE PORTO ALEGRE from www.liebertpub.com at 09/30/21. For personal use only.
ther’s Milk Bank in Austin, along with articles from Pediatrics,
the Journal of Perinatology, and Pediatric Research. Twenty
nurses attended one of three educational sessions, which were
given during two day shifts and one night shift. Following the
educational sessions another survey with similar questions was
distributed to assess what was learned and what changes, if any,
the nurses anticipated making to their practice.
Results: Seventeen out of twenty nurses completed the post-
education survey. 100% of nurses found the presentation useful
and relevant to their clinical practice. 82% reported they would
discuss the benefits of exclusive breastmilk feeding with fam-
ilies who indicate their feeding plan is breastmilk and formula.
100% (pre-survey 94%) would discuss DEBM as a choice for
feeding when a mother has not pumped sufficient milk. 94%
(pre-survey 69%) would offer DEBM to all families who re-
quire supplementation in addition to the mother’s breastmilk.
94% (pre-survey 67%) would discuss DEBM as a choice for
supplementation with the physician team when only formula is
ordered. 88% (pre-survey 61%) would offer DEBM before
formula for supplementing a >/ = 33 week old infant. 82% (pre-
survey 47%) would discuss DEBM with a family if a physician
has not ordered it. 82% reported learning something from
the presentation. 35% would make changes to their existing
practice.
Conclusions: A short educational presentation can increase
education about and intent to offer DEBM in the NICU.
33. INITIATION, DURATION OF BREASTFEEDING
AND SPECIFICATION FACTORS THAT
INFLUENCE IT
Chrysoula Papachristou1, Eleni Sakellari1,
Georgia Vlachou1, Georgia Della1
1
General Hospital of Trikala, Trikala, Greece
Category: Quality Improvement Advocacy
Background: Exclusive breastfeeding is difficult to achieve.
Objective(s): The purpose of this retrospective study was to
record the frequency of breastfeeding for the first 6 months of
life. The secondary purpose of this retrospective study was to
record factors that contribute to the establishment and continu-
ation of breastfeeding.
Materials/Methods: We performed a retrospective study
using a telephone questionnaire to all mothers who gave birth at
the obstetrics clinic of General Hospital of Trikala from January
2015 to December 2016.
Results: Data were collected from 268 mothers. About
84,87% begun to nurse after birth, 37,64% of mothers continued
with exclusive or partial breastfeeding up to 6 months, while
33,58% continued with exclusive breastfeeding up to the sixth
postpartum month. Mothers who adopted lactation exclusively
rather partial breastfeeding declared very well informed about
the process, especially from the obstetric and medical staff of the
POSTER ABSTRACTS
hospital (p < 0.001). Home help did seem to play a role in the
choice of exclusive comparing with partial breastfeeding
(p = 0,016).
Conclusions: It appears that on the part of mothers there is
strong interest in the initiation and establishment of breastfeed-
ing. Almost all of the mothers who breastfeed up to sixth post-
partum months continue with exclusive breastfeeding. The overall
breastfeeding rates decline. The approach of obstetric and pedi-
atric care is not enough and the health care system should focus on
the support of breastfeeding at the community too, apart from the
hospital services, for better breastfeeding rates to be achieved.
34. DONOR BREAST MILK VERSUS FORMULA
FOR TREATMENT OF HYPOGLYCEMIA
IN A NEWBORN NURSERY
Allison Heizelman1, Ellen Bryant1,
Nicole Baumann-Blackmore1, Michael Lasarev1,
Elizabeth Goetz1
1
University of Wisconsin, Madison, Wisconsin, USA
Category: Quality Improvement Advocacy
Background: Oral dextrose gel with feed supplementation is
shown to treat neonatal hypoglycemia, avoiding intensive care
admission for intravenous fluids. It remains unclear whether
donor breast milk (DBM) or formula (FM) is a superior sup-
plementation choice.
Objective(s): Investigate the impact of feed type on hypo-
glycemia. Determine whether our hypoglycemia protocol should
be revised to include supplementation type.
Materials/Methods: Analysis of newborns with hypoglyce-
mia in a community-based hospital center from Jan to Oct 2019
was performed through chart review. Patients received oral
dextrose gel with self-selected feeding supplementation (DBM,
FM, DBM+FM) per hospital protocol. General characteristics
and potential confounding factors were assessed. Main outcomes
included ICU admission, total gel doses required and ability to
resolve hypoglycemia with one gel dose. Feeding intention was a
secondary outcome. Statistical analyses included binomial re-
gressions, Kaplan-Meier estimation, log-rank test and Cox pro-
portional hazards regression.
Results: 393 newborns were analyzed: 28% (n = 110) DBM,
63% (n = 248) FM and 9% (n = 35) DBM+FM, 3 excluded for
inadequate documentation or refusal of supplementation. Sex,
mode of delivery and Apgar scores were comparable between
groups. Infant size showed imbalance among groups, shown in
Table 1. Feeding type at discharge and presence of low body
temperature at time of hypoglycemia (p = 0.33) did not statisti-
cally differ among groups. Percent of infants requiring ICU care
differed among the three groups (p < 0.001). No difference ex-
isted when comparing DBM and FM, with overall ICU admis-
sion rate of 8.4% (95% CI: 5.9–11.8%) when one feed type used.
DBM+FM was associated with a 3.41 (95% CI: 1.82–6.38;
p < 0.001) fold increase in ICU admission rate relative to other
groups (28.6% vs 8.4%). Hypoglycemia resolution with only one
dose did not differ between DBM and FM individually.
DBM+FM had a 77% lower chance of resolution with an average
of 2.80 (95% CI: 1.83–4.28; p < 0.001) additional gels required.
DBM+FM also had earlier onset of hypoglycemia after birth
(median 2 hrs; 95% CI: 1.5–3hrs), followed by DBM (median
4 hrs; 95% CI: 2–5hrs), than FM (median 4 hrs; 95% CI: 4–5hrs).
Table 1. Description of Demographic Characteristics Full co-
hort(n = 393)Donor Breast Milk(n = 110)Formula(n = 248)Donor
Breast Milk + Formula(n = 35)Sex (%)FemaleMale177 (45%)216
 POSTER ABSTRACTS
(55%)48 (43.6%)62 (56.4%)116 (46.8%)132 (53.2%)13
(37.1%)22 (62.9%)Gestational age weeks range median
(IQR)30.0 - 41.738.2(36.9, 39.3)35.1 - 41.438.8(37.1, 39.4)30.0 -
41.738.0(36.9, 39.2)35.0 - 41.137.5(36.5, 39.0)Birth Weight
grams range median(IQR)2020 - 56203179(2698, 3794)2190 -
56203371(2807, 4012)2020 - 49003083(2650, 3671)2250 -
51103232(2657, 3979)Size for Age n (%)SGAAGALGA53
(13.5%)247 (63.0%)92 (23.5%)17 (15.6%)57 (52.3%)35
(32.1%)34 (13.7%)166 (66.9%)48 (19.4%)2 (5.7%)24 (68.6%)9
(25.7%)Route of Delivery (%)Vaginal Cesarean section222
(56.5%)171 (43.5%)63 (57.3%)47 (42.7%)136 (54.8%)112
Downloaded by FUNDAÇÃO UNIV. FEDERAL DE CIÊNCIAS DA SAÚDE DE PORTO ALEGRE from www.liebertpub.com at 09/30/21. For personal use only.
(45.2%)23 (65.7%)12 (34.3%)Apgar Scores median (IQR)1
minute5 minute Score improvement8 (7, 9)9 (9, 9)1 (0, 1)8 (8,
9)9 (9, 9)1 (0, 1)8 (7, 9)9 (9, 9)1 (0, 1)8 (7, 9)9 (9, 9)1 (0, 2)Low
Temp (<36.5C)with Hypoglycemia n (%)85 (21.6%)22
(20.0%)52 (21.0%)11 (31.4%)IQR = Interquartile RangeTable 2.
Comparing Outcomes of Interest Between Donor Breast Milk
and Formula Donor Breast Milk(n = 110)Formula(n = 248)P-
value (RR, CI)ICU admission for treatment of hypoglycemia n
(%)9 (8.2 %)21 (8.5 %)0.93 (1.03, 0.50–2.19)Hypoglycemia
resolved with first treatment*n (%)54 (49.1 %)144 (58.1 %)0.13
(1.18, 0.95–1.47)Number of additional treatments* required
mean (95% CI)0.92 (0.72–1.18)0.79(0.66–0.94)0.33(0.86, 0.64–
1.17)*Treatment includes oral dextrose gel + feed supplemen-
tation RR = Relative Risk CI = Confidence Interval
Conclusions: We found no difference in ICU admission rate
between DBM and FM, supporting either option to treat hypo-
glycemia with oral dextrose gel. DBM+FM had quicker onset
hypoglycemia and worse outcomes across all categories; this
small group may be intrinsically different, requiring further in-
vestigation. Feeding type at discharge was equivalent between all
groups, suggesting formula supplementation did not dissuade
caregivers from breast milk feeding.
35. UTILIZATION OF TEAM-BASED LACTATION
CONSULTANT/PRIMARY CARE PROVIDER
BREASTFEEDING SUPPORT IN A SOCIO-
ECONOMICALLY DIVERSE PRACTICE
Rachel Witt1, Lauren Lasko1, Thanvi Vatti1, Ann Witt1
1
Breastfeeding Medicine of Northeast Ohio, South Euclid, Ohio,
USA
Category: Quality Improvement Advocacy
Background: A team based, integrated lactation consultant
(LC) and primary care provider (PCP) program improves
breastfeeding rates in some outpatient settings, but limited
studies have assessed efficacy in socioeconomically disadvan-
taged communities.
Objective(s): Following implementation of team-based
LC/PCP breastfeeding care at a federally qualified health center
(FQHC) in 2018, quality improvement efforts were undertaken
to assess utilization of services. Preliminarily analyze breast-
feeding rates and patient satisfaction.
Materials/Methods: One year after implementation of rou-
tine team-based LC/PCP breastfeeding program at the FQHC, a
survey of patient experience was conducted (N = 20). Ad-
ditionally, a retrospective chart review examined consecutive
newborns in the 6 months of 2017 before (N = 89) implementa-
tion and in the full year of 2019 after (N = 250) implementation.
Primary variables reviewed included LC visit utilization and
feeding status at the newborn, 2, 4, and 6 month well visits
(WCC). Chi-square analysis compared pre and post im-
plementation feeding rates at all time points and included a sub
analysis of patients who initiated breastfeeding (BF).
A-17
Results: After LC/PCP implementation, a LC saw 72% of
infants initiating breastfeeding (n = 204) at some point with 55%
of families receiving the care at their first PCP visit. Mean LC
visit per BF patient was 1.13(SD +1.2). There was no significant
difference in practice wide BF rates before and after im-
plementation. However, among patients who initiated BF in
2019, those who received a LC/PCP visit were significantly more
likely to be breastfeeding at 2 weeks (94% vs 80%, p = 0.004) and
4 months (68% vs 47%, p = 0.014) than those BF patients who did
not receive a LC/PCP visit. Patient survey reported the LC visit
to be ‘‘much better than expected,’’ (85%) and said ‘‘helpful
information and advice’’ (85%) was given. The three most
commonly helpful aspects of the visit were ‘‘latch instruction’’
(60%), ‘‘breastfeeding questions answered’’ (80%) and ‘‘learn-
ing about massage and hand expression’’ (50%).
Conclusions: Team-based LC/PCP care is feasible at a FQHC
and facilitated 75% of BF patients receiving lactation support at
the primary care office. Patients were satisfied with the care and
found it helpful. A larger sample size maybe needed to identify
practice-wide improvement in BF rates; however, among fami-
lies who initiated breastfeeding, receiving LC/PCP care was
associated with increased breastfeeding duration at two weeks
and four months. These findings are consistent with past research
indicating team-based care helps address breastfeeding problems
and barriers in health care services among patients initiating
breastfeeding.
36. ADDRESSING COMMUNITY GAPS IN
BREASTFEEDING SUPPORT: FROM HOSPITAL
TO FIRST VISIT
Julie Ware1, Jennifer McAllister1, Clara Chlon1,
Erica Walters1, Robin Steffen1, Rebecca Haehnle1,
Laura Ward1, Suzanne Crable2
1
Cincinnati Children’s Hospital, Cincinnati, Ohio, USA
2
TriHealth, Cincinnati, Ohio, USA
Category: Quality Improvement Advocacy
Background: Although there is an increasing trend for more
mothers to initiate breastfeeding in the US, there is a rapid de-
cline after initiation, and racial disparities persist. A multidisci-
plinary team comprised of pediatricians, neonatologists, prenatal
lactation support, primary care lactation experts, and members of
the community partnered to address the cessation of breast-
feeding before the first ‘‘Newborn’’ visit at our institution’s busy
primary care safety net clinics, using Quality Improvement
methodology.
Objective(s): Explain QI tools including ‘Aim Statement,’
‘Key Driver Diaghram,’ ‘PDSA cycle,’ ‘Pareto Chart.’ Describe
how a multidisciplinary team can help to address ‘the gaps’ of
breastfeeding care from hospital to first visit. Delineate inter-
ventions to ‘‘close the gap’’ in breastfeeding support initiated
through a Quality Improvement Collaborative.
Materials/Methods: The aim of this project was to increase
the number of babies still receiving some of their mother’s milk
at the first visit by 5%. Key Drivers affecting early cessation were
identified and interventions developed to affect change through
PDSA (Plan-Do-Study-Act) cycles. Mothers identified as no
longer breastfeeding at the first visit were interviewed to learn the
reasons for cessation to help the team plan interventions.
Results: Baseline breastfeeding continuation at the newborn
visit was 88% from all area birth hospitals. Variation between birth
hospitals ranged from 82–92% still breastfeeding at the first visit.
Mothers identified the following reasons for their discontinuation
including: concerns about ‘‘not enough milk’’, difficult latch, baby
 A-18
not satisfied, stress, work, and mother’s habits not safe for the baby.
Early interventions included the addition of lactation support to the
Primary Care Clinics. Systematic procedures were developed,
launched, and implemented to improve identification of feeding
type at discharge and are now spread to all area birth hospitals for
more accurate classification of feeding. Community support re-
source guides were developed and shared with birth hospitals and
the community. A one page infographic is in development to share
guidance on the most common concerns of mothers during the
early days.
Conclusions: A quality improvement collaborative has suc-
Downloaded by FUNDAÇÃO UNIV. FEDERAL DE CIÊNCIAS DA SAÚDE DE PORTO ALEGRE from www.liebertpub.com at 09/30/21. For personal use only.
cessfully engaged partners from across institutions and disci-
plines to work on improving breastfeeding continuation at the
first visit with QI methodology.
37. BREASTFEEDING PRACTICE BEFORE BOTTLE
FEEDING INCREASES BREASTFEEDING RATES FOR
PRETERM INFANTS AT TIME OF NICU DISCHARGE
Raylene Phillips1, Dawn Van Natta1, Jenny Chu1,
Allison Best1, Pamela Bratton1, Tonya Oswalt1,
Dianne Wooldridge1, Elba Fayard1
1
Loma Linda University Children’s Hospital, Loma Linda,
California, USA
Category: Quality Improvement Advocacy
Background: In our NICU, efforts over several years have
resulted in improved rates of breast milk feeds for preterm infants
at time of NICU discharge, but rates of actual breastfeeding have
remained low.
Objective(s): To increase the rate of preterm infants who were
breastfeeding at the time of NICU discharge. To evaluate the
effects of breastfeeding before bottle feeding on time to full
oral feeding and corrected gestational gestational age at NICU
discharge.
Materials/Methods: We created a Preterm Breastfeeding
Pathway (PBP) algorithm for infants who were cleared for oral
feeding and whose mothers desired to breastfeed. If mothers
could be present for at least 3 feedings a day, we deferred in-
troduction of bottle feeding for 72 hours and gave full gavage
feedings during cue-based breastfeeding practice. After 72 hours
of breastfeeding practice, babies continued to practice breast-
feeding with full gavage support when mother was present
and practice bottle feeding with gavage support when mother
was absent. After 35 weeks corrected gestational age (CGA),
breastfeeding intake was estimated by pre/post weights or time/
quality of feeding and gavage volume was adjusted until baby
was weaned off gavage feeds. In addition to breast milk feeding
and breastfeeding at NICU discharge, we documented birth
gestational age and weight, gender, CGA at time of first oral feed
and full oral feeds, days from first to full oral feeds, as well as
days of life and CGA at NICU discharge.
Results: Seventy-five preterm infants (birth GA <33 weeks)
who had met criteria for the PBP were discharged from our 84-
bed Level 4B NICU between April and December 2019. By chart
review, we compared babies who received 72 hours of breast-
feeding practice before introducing a bottle (Group 1, n = 27)
with babies who were introduced to bottle feeding with or before
breastfeeding (Group 2, n = 15) and babies who were primarily
bottle fed (Group 3, n = 33). We found that babies in Group 1 had
significantly higher rates than those in Groups 2 or 3 for
breastfeeding (88.9%, 66.7%, 3% respectively, p < 0.001) and
breast milk feeding (100%, 86.7%, 39.4% respectively,
p < 0.001) at time of NICU discharge. A slight difference in
gestational age at birth among groups was found, but there were
POSTER ABSTRACTS
no statistical differences in CGA at first oral feed or full oral
feeds, days from first to full oral feeds, CGA or days of life at
NICU discharge.
Conclusions: Introducing breastfeeding practice before bottle
feeding may contribute to increased rates of breastfeeding by
supporting mothers who are already highly motivated to breast-
feed. Preterm infants may learn to breastfeed easier if allowed to
practice breastfeeding before bottles are introduced. Preterm ba-
bies and their mothers can be supported in direct breastfeeding
without increasing time to full oral feeds or length of NICU stay.
38. BREASTFEEDING INITIATION AND EXCLUSIVE
BREASTFEEDING RATES DURING THE DELIVERY
HOSPITALIZATION ARE LOWER IN SPANISH-
SPEAKING VS ENGLISH-SPEAKING WOMEN
IN A LARGE MEDICAL SYSTEM IN THE MIDWEST
UNITED STATES
Clara Chlon1, Laura Ward1, Scott Wexelblatt1, Larry Mayborg2
1
Cincinnati Children’s Hospital, Cincinnati, Ohio, USA
2
TriHealth Baldwin, Cincinnati, Ohio, USA
Category: Quality Improvement Advocacy
Background: Breast milk has been shown to provide the
optimal nutrition for newborn infants, and exclusive breast milk
feedings for the first six months of a newborn infant’s life is the
recommendation of many health organizations, including the
American Academy of Pediatrics (AAP) and World Health Or-
ganization (WHO). Exclusive breastfeeding (EBF) in the deliv-
ery hospitalization is associated with increased breastfeeding
rates within the first year of life. For this reason, we are inter-
ested in monitoring demographic and ethnic differences within
our patient population as they relate to breastfeeding rates and
success.
Objective(s): Determine if there are differences in the rates of
breastfeeding initiation between Spanish-speaking and English-
speaking mothers. Determine if there are differences in the rates
of EBF success within the newborn hospital stay according to
mothers’ primary language.
Materials/Methods: We extracted EPIC data from a large
hospital system in Cincinnati, Ohio throughout 16 months based
on chart documentation. This was achieved both manually and via
Tableau Data Analytics Software, and allowed us to report
breastfeeding initiation and percent success in meeting the goal of
EBF within the newborn stay, Perinatal Core Measure 5 (PC-05).
Results: We analyzed data from the period between 1/1/2019
and 4/28/2020, during which 83% of English speaking mothers
ever initiated breastfeeding, and 85% of all Spanish-speaking
mothers ever initiated breastfeeding. For primarily English-
speaking mothers whose expressed intent was to exclusively
breastfeed, EBF rates were 54.9% (n = 6,062). Primarily
Spanish-speaking mothers whose expressed intent was to ex-
clusively breastfeed had an EBF rate of 33.33% (n = 105),
P < 0.00001. Feeding preference aside, EBF rates were, 43.99%
(n = 8,613) in the primarily English-speaking dyads, vs. 20.41%
in the primarily Spanish-speaking dyads (n = 245), P < 0.00001.
Conclusions: Within a large health system in Cincinnati, OH,
we have found that mothers who identify Spanish as their pri-
mary language have a much lower incidence of exclusive
breastfeeding, regardless of their initial feeding goals. We hope
that exploring reasons for these disparities, as well as the im-
plementation of educational tools before, during, and after the
delivery hospitalization will allow us to improve the breast-
feeding rates in this vulnerable population.
 POSTER ABSTRACTS
39. EXCLUSIVE BREASTFEEDING RATES INCREASE
FOLLOWING IMPLEMENTATION OF STRICT
VISITOR RESTRICTIONS DURING COVID-19
PANDEMIC IN A LARGE MEDICAL SYSTEM
IN THE MIDWEST UNITED STATES
Clara Chlon1, Laura Ward1, Scott Wexelblatt1, Larry Mayborg2
1 feeding periods of induced lactation protocol for adoptive
Cincinnati Children’s Hospital, Cincinnati, Ohio, USA
2 breastfeeding dyads.
TriHealth Baldwin, Cincinnati, Ohio, USA
Category: Quality Improvement Advocacy
Downloaded by FUNDAÇÃO UNIV. FEDERAL DE CIÊNCIAS DA SAÚDE DE PORTO ALEGRE from www.liebertpub.com at 09/30/21. For personal use only.
Background: Exclusive breastfeeding (EBF) during the
newborn hospitalization helps predict overall breastfeeding
success. In the first few days after birth, breastfeeding dyads
need time, rest, and support to succeed in the crucial first days of
breastfeeding. In the birth hospital, there are often many bar-
riers to ensuring that mothers and babies can have the best start
possible. These include family members and other visitors
to the postpartum room. Beginning 3/16/20, such visitors were
limited to one per dyad due to Covid-19 precautions at a large
hospital system based in Cincinnati, OH. We explored
the potential link between this restriction and breastfeeding
success.
Objective(s): Compare exclusive breastfeeding rates before
and after the onset of visitor restrictions at a large delivery
hospital system in the Midwest United States. Explore how the
current climate of Covid-19 is affecting the rates of exclusive
breastfeeding (Perinatal Core Measure 5) at our medical center.
Materials/Methods: We extracted data from EPIC data from
a large medical center based in Cincinnati, Ohio throughout 16
months based on chart documentation. This was achieved via
Tableau Data Analytics Software, and allowed us to visualize
percent success in meeting the goal of EBF within the newborn
hospital stay, a.k.a Perinatal Core Measure 5 (PC-05).
Results: We analyzed data between the dates of 1/1/2019 and
4/28/2020. Over those dates, we found that pre-visitor restric-
tions (before 3/16/2020), 44% (n = 8779) of mothers were suc-
cessful in exclusively breastfeeding during the delivery
hospitalization in our large delivery center, vs. 47% (n = 826)
after the restrictions, with a P-value of 0.056.
Conclusions: Within a large health system based in Cin-
cinnati, OH, we have found that mothers had greater success
with exclusive breast milk feeding (PC-05) during the newborn
hospital stay following the implementation of strict visitor re-
strictions in the setting of the COVID-19 pandemic. We feel
that the reasons for this are worth exploring further and are
likely multifactorial. Limiting the number of postpartum visi-
tors leaves mothers with much more time to rest, latch their
infants, and receive valuable support from lactation consultants
and other support staff at the hospital. In the current climate,
mothers also may be more inclined to consider breastfeeding to
allow their newborns to benefit from the myriad benefits of
human milk during this time of uncertainty. Through the use of
our software interface, we will be able to track the rates in the
months to come and continue to explore if this hypothesis
persists.
40. INDUCED LACTATION FOR ADOPTIVE
BREASTFEEDING DYADS
Dyah Febriyanti1, Asti Praborini2
1
Kemang Medical Hospital, South Jakarta City, Jakarta, Indonesia
2
Permata Depok Hospital, Depok, Indonesia
Category: Research
A-19
Background: Breastfeeding has many benefits for both mo-
ther and baby, but not all mothers can have their own babies.
Here we used an induced lactation protocol to breastfeed adopted
babies.
Objective(s): Describe applicative induced lactation protocol
for adoptive breastfeeding dyads. Describe the length of breast-
Materials/Methods: We implement and describe an induced
lactation protocol for adoptive breastfeeding dyads at Kemang
Medical Care (KMC) Women and Children Hospital and Permata
Depok Hospital, Greater Jakarta, Indonesia. Participants included
32 of 48 breastfeeding dyads or subjects undergoing induced lac-
tation protocols and fulfilling the inclusion criteria. The induced
lactation protocol included the Praborini Method (hospitalization
for nipple confusion) to promote latching, pharmacologically in-
duced lactation, and at-breast supplementation.
Results: Nineteen babies (59.4%) were aged <1 month and
nine (28.1%) were aged 1–3 months at protocol initiation. Al-
most all (31 babies, 96.8%) were adopted after birth. At first
examination, 20 babies (62.5%) could not latch, but all dyads
could breastfeed after hospitalization for <1–2 days. Breast milk
was induced after one cycle of Yasmin in 24 cases (75%). All
mothers took domperidone and no side-effects were reported.
Average breastfeeding duration was 8.5 months, with weaning at
2–25 months of age, with working mothers weaning at £4 months.
At-breast supplementation was used until weaning.
Conclusions: Adopted babies can achieve long-term breast-
feeding through this multimodal protocol. Further prospective
studies are warranted.
41. DIFFERENCES IN THE EARLY BREASTFEEDING
EXPERIENCE IN WOMEN WITH AND WITHOUT
OBESITY
Ashley Schulz1, Laura Ward2, Laurie Rivers1
1
University of Cincinnati College of Medicine, Cincinnati,
Ohio, USA
2
Cincinnati Children’s Hospital, Cincinnati, Ohio, USA
Category: Research
Background: Due to numerous benefits for mother and baby,
six months of exclusive breastfeeding is recommended. Obesity
is associated with lower rates of exclusive breastfeeding, in-
cluding during the maternity stay. However, the specific drivers
of this disparity are not fully understood.
Objective(s): To determine the differences in the birth, early
postpartum, and breastfeeding experiences between obese and
non-obese women. To determine if there are differences in ex-
posure to Baby Friendly practices between obese and non-obese
women.
Materials/Methods: A single face-to-face structured interview
was conducted with mothers who initiated breastfeeding of their
singleton, term infant. Interviews typically occurred on weekdays
during a six week period during the summer of 2019 based on the
availability of the primary investigator. Exclusion criteria included
maternal transfer to the ICU or newborn transfer out of the mother-
baby unit, death, adoption, or entrance into foster care. Data col-
lected included: maternally reported demographics, obstetric
characteristics, infant feeding attitudes and intentions, and breast-
feeding practices, problems, and concern, including the seven
Baby Friendly patient care practices. Mothers were categorized as
obese based on early postpartum BMI> = 30.0kg/m2. Chi squared
 A-20
analysis and t-tests were used to identify statistically significant
differences between mothers with and without obesity (p < 0.05).
Results: Of the 79 mothers approached, 10 declined and 69
were interviewed, of which 40.6% were obese and 43.0% were
primiparous. Mothers with obesity were significantly more likely
to deliver at a lower gestational age, experience hypertension
during pregnancy, deliver by cesarean section and report a his-
tory of breastfeeding problems. Additionally, mothers with
obesity had significantly fewer breastfeeding episodes in the 24
hours prior to the interview and had longer delays before first
holding their babies after delivery. There was no significant
Downloaded by FUNDAÇÃO UNIV. FEDERAL DE CIÊNCIAS DA SAÚDE DE PORTO ALEGRE from www.liebertpub.com at 09/30/21. For personal use only.
difference between obese and non-obese mothers regarding any
of the seven Baby Friendly patient care practices; however, the
Baby Friendly steps least adhered to were mothers staying with
their newborn 24 hours per day, breastfeeding based upon infant
cues, exclusive breastfeeding unless medically indicated, and the
avoidance of artificial nipples.
Conclusions: The observed differences in the early postpar-
tum experience in mothers with obesity, coupled with a higher
prevalence of previous breastfeeding problems, may contribute
to shorter duration of exclusive breastfeeding in mothers with
obesity. Although obese women were more likely to deliver by
cesarean section, delivery mode did not explain their lower fre-
quency of breastfeeding. We did not observe a difference in Baby
Friendly patient care between obese and non-obese women,
suggesting that mothers with obesity may require additional
tailored breastfeeding support.
42. PERINATAL PSYCHIATRIC SYMPTOMS
AND THE CONTINUUM OF BREASTFEEDING
IN AFRICAN AMERICAN WOMEN
Swati Jain Goel1, Sindile Dlamini1,
Thomas Mellman1, Inez Reeves1
1
Howard University College of Medicine, Washington, DC, USA
Category: Research
Background: Breastfeeding has well-established public
health benefits; nevertheless, reduced rates for breastfeeding
remains an important health disparity in African American
communities. The burden of mental health disorders unique to
African American mothers has not been fully elucidated and
perinatal psychiatric disorders likely constitute important barri-
ers to achieving the established goals for initiation, duration,
continuation of breastfeeding. Of all the perinatal psychiatric
disorders, depression has been the best studied but there is lim-
ited literature that addresses screening of women for a wider
spectrum of perinatal psychiatric diagnoses. This study examines
the relationship between perinatal psychiatric disorders on Af-
rican American women’s plan, initiation and continuation of
breastfeeding.
Objective(s): To expand perinatal psychiatric health screen-
ing by utilizing the ’What’s my M-3 (My Mood Monitor)’ - a
validated 27-question checklist for mental health screening in
primary care settings. The M-3 screens for: major depressive
disorder (MDD), bipolar disorder, anxiety disorder, post-
traumatic stress disorder (PTSD), suicidal ideation and measures
of functional impairment. To determine the relationship between
screening positive for perinatal psychiatric disorders and its
impact on (i) planning to breastfeed, (ii) initiation of breast-
feeding and (iii) continuation of breastfeeding.
Materials/Methods: One hundred English speaking minority
pregnant women ‡18 years old were recruited from our academic
POSTER ABSTRACTS
health center in Washington D.C. and surveyed using the
‘‘What’s my M-3’’ psychiatric screening tool and breastfeeding
questionnaires in the second trimester of pregnancy (plan to
breastfeed), 2–3 days post-delivery (initiation of breastfeeding)
and in the postpartum period (continuation of breastfeeding).
Data was analyzed to establish the relationship of breastfeeding
to any positive M-3 screen (for major depressive disorder, bi-
polar, anxiety and post-traumatic stress syndrome) at corre-
sponding time points.
Results: Plan to breastfeed and initiation of breastfeeding
immediately postpartum was not different between women who
screened positively for perinatal psychiatric disorders as com-
pared to healthy women. However screening positive for peri-
natal psychiatric disorder(s) was associated with lower rates of
breastfeeding continuation (Chi-square = 7.32, p = 0.01). Among
the disorder categories, anxiety was significantly associated with
discontinuation of breastfeeding (Chi-square = 7.17, p < 0.008).
Conclusions: Women should be screened for the full spec-
trum of perinatal psychiatric disorders and provided with inter-
ventions designed to assist with treatment and support of the
mother-infant breastfeeding dyad. Special attention should be
paid to different ethnic groups with a focus on identifying and
managing maternal anxiety to support optimal breastfeeding
practices.
43. THE EFFECT OF INTRAPARTUM
COMPLICATIONS ON BREASTFEEDING SUCCESS
Stephanie Radke1, Shelby Green1,
Emily Anderson1, Kelli Ryckman1
1
University of Iowa, Iowa City, Iowa, USA
Category: Research
Background: Breastfeeding is the normative feeding mo-
dality for human infants. The American Academy of Pediatrics
(AAP) and the American College of Obstetricians and Gyne-
cologists (ACOG) both recommend exclusive breastfeeding for
the first six months of life with ongoing breastfeeding with ad-
dition of complementary foods through the first year of life.
Breastfeeding confers numerous health benefits for both mother
and baby, as well as societal and ecological benefits. Women
who achieve optimal breastfeeding duration experience a 28%
reduced rate of developing cardiovascular disease, as well as a
4% decrease in the risk of breast cancer per year of breastfeeding
[4]. Infants also greatly benefit from breastfeeding including
overall reduction of infectious morbidity in the first year of life,
reduced risk for Sudden Infant Death Syndrome, the promotion
of brain development, as well as lower risk of developing other
condition such as childhood leukemia and asthma, in addition to
decreased obesity and Type II Diabetes Mellitus later in life.
Breastfeeding is also shown to promote bonding and attachment
between mother-baby couplets, decrease risk for child abuse, and
improve a mother’s confidence in her caregiving abilities. The
benefits of breastfeeding for mother and baby appear to be well
understood by expectant women in the United States as over 80%
of women initiate breastfeeding following the birth of their baby.
However, many women fail to achieve their breastfeeding goals.
The CDC reported that in 2016 83.8% of women-initiated
breastfeeding, however by 6 months only 57.3% continued to
breastfeed in any capacity. These numbers are slightly better for
Iowa at 84.5% and 62.0%, respectively, but still indicate that
over a quarter of women are not able to maintain breastfeeding.
A study found that over 60% of mothers desired to exclusively
 POSTER ABSTRACTS
breastfeed, with 85% of this population intending to breastfeed
for more than 3 months and another 58% planned to continue
well after 5 months. Out of those women who had breastfeeding
as part of their plan, only 32.4% of the group were able to achieve
their goal. In addition to lost health benefits, inability to achieve a
breastfeeding goal is shown to be independently associated with
postpartum depression. There are many systemic challenges
faced by women in the United States who desire to breastfeed,
however there are also physiologic challenges that could be
recognized and addressed early in the breastfeeding journey.
One study looked at 1532 mother-infant dyads and the impact of
Downloaded by FUNDAÇÃO UNIV. FEDERAL DE CIÊNCIAS DA SAÚDE DE PORTO ALEGRE from www.liebertpub.com at 09/30/21. For personal use only.
postpartum anemia had on success with the initiation of
breastfeeding. It found that women with postpartum anemia
(hemoglobin levels of <11) were significantly less likely to be
successful with breastfeeding. Women who experience pre-
eclampsia are also found to cease breastfeeding at an earlier
stage than women without preeclampsia. This may be due to
delayed onset of lactogenesis in women with preeclampsia,
thought to be due to edema within the breast, but also may be
further exacerbated by stressful delivery, unit policies resulting
in separation from her newborn, and early perceptions of inef-
fective feeding. Successful breastfeeding requires optimal physi-
ologic functioning and psychologic well-being. Literature on the
impact of common intrapartum complications and their effect of
successful breastfeeding is sorely lacking. This study will attempt
to quantify the impact of various conditions on breastfeeding
success.
Objective(s): To determine the effect that experience of
various intrapartum complications (such as hemorrhage, pre-
eclampsia with severe features, ICU admission, uterine rupture,
prolonged labor, uterine infection) had on breastfeeding success
among women who expressed prior intention to breastfeed. To
examine interactions between complications when multiple
complications are experienced by one woman. To examine for
any protective effects, such as inpatient and outpatient lactation
support or prior breastfeeding experience, that mitigated the
harm of experience of intrapartum complications.
Materials/Methods: The study will involve a retrospective
cohort analysis of women with expressed intention to breastfeed
who delivered at the University of Iowa Hospitals and Clinics
(UIHC) and also brought their child to UIHC for well-child care
in the first year of life. We plan to examine the delivery records of
a cohort of women who meet our inclusion criteria and delivered
at UIHC between January 1, 2016 and December 31, 2019. The
study will utilize the Mother-Baby DataMart [IRB #201902830]
for automated data abstraction with additional manual data ab-
straction of infant feeding patterns as these data points are not all
documented in objective fields. To minimize confounding fac-
tors, the criteria for these mother-baby couplets will be inclusive
of full-term, singleton deliveries where the baby was admitted to
the Normal Newborn Nursery. Breastfeeding intention and ac-
tual feeding method will be assessed at multiple time points:
admission to Labor & Delivery, at hospital discharge, and at the
2-week and 2-month well child visits. Couplets with incomplete
records will be excluded. Our primary interest is in first-time
mothers to eliminate the confounding factor of prior breast-
feeding experience on our outcome. However, we are also in-
terested in determining any protective effect that prior
experience may carry and to this end we plan additional analyses
of women who delivered more than one baby in our study period
and experienced an intrapartum complication. Data abstraction
will be into a secure REDCaps database. Statistical analyses with
multinomial regression is planned.
Results: Pending at time of submission
A-21
Conclusions: Our hypothesis is that a range of common in-
trapartum complications will be found to have a deleterious ef-
fect on breastfeeding success. We anticipate, if this is confirmed,
that this study will provide the groundwork for future prospective
studies examining measures that can mitigate this impact and
improve breastfeeding rates among women who experience
complications during the labor and delivery course.
44. A QUALITATIVE ANALYSIS OF PROVIDING LOW-
INCOME, FIRST-TIME MOTHERS WITH A MANUAL
BREAST PUMP
Adrienne Hoyt-Austin1, Jessica Cheng1, Hana Moua1,
Caroline Chantry1, Daniel Tancredi1, Laura Kair1
1
UC Davis Medical Center, Sacramento, California, USA
Category: Research
Background: Low-income first-time mothers are known to
have suboptimal breastfeeding outcomes. One potential barrier is
access to a breast pump after birth.
Objective(s): To investigate attitudes and opinions regarding
the breastfeeding experience and use of manual pump in low
income primiparous women.
Materials/Methods: Data collection for this qualitative study
followed a clinical trial (clinicaltrials.gov NCT03192241) where
low-income (eligible for the US Special Supplemental Nutrition
Program for Women, Infants and Children (WIC)) participants
were randomized at discharge from newborn hospitalization to
receive a manual breast pump versus control intervention of a
children’s book. 60 participants enrolled in the study, of which
half received a breast pump. Three months following the inter-
vention, participants completed an interview regarding breast-
feeding experience. 31 women (52%) responded to the thirteen
open-ended questions which were then transcribed, coded, and
grouped into themes.
Results: Four themes regarding the breastfeeding experience,
need for additional support, pumping experience, and reasons to
stop breastfeeding were identified. Themes and example quota-
tions are noted below. In general, breastfeeding was described as
stressful, but participants also found it to be an amazing expe-
rience. A need for increased support in the immediate postpartum
day and ongoing medically accurate outpatient support was re-
ported. Manual pumps were well-received and noted as a con-
venient, but time-consuming, method to store milk. Those who
stopped breastfeeding reported a cyclical decrease in milk supply
with introduction of formula and/or desiring to prepare the infant
for extended separation from the mother. Themes and Selected
Quotations1. Breastfeeding experience: ‘‘.rewarding at first,
we have grown so close. My son knows me and feels safe.’’
(participant 8) ‘‘I had to give up on it because it was adding to my
anxiety a lot’’ (participant 12) ‘‘.very time consuming and
sacrificial, but great bonding experience. If I’m not breastfeed-
ing, then I was pumping, and it took too much time’’ (participant
34)2. Need for support: ‘‘I wish that I was still able to breastfeed
and that as soon as I was to feed my baby when she was born
someone would have been there to help. The hospital just left me
on my own for the first few feeds resulting in lots of pain and
discouragement’’ (participant 14) ‘‘When I was having a hard
time getting baby to latch the doctor said to supplement.I wish I
went to a lactation consultant instead’’ (participant 35)3.
Pumping experience ‘‘I have my manual pump if I only want to
take the pressure off, but not pump a full session. It is extremely
helpful.’’ (participant 51)‘‘yes, it [manual pump] was helpful so I
 A-22
didn’t have to get up every night to feed, so that dad can help.’’
(participant 34) ‘‘it [manual pump] was faster than setting up the
electric one.’’ (participant 25) 4. Reasons for stopping breast-
feeding ‘‘I wasn’t sure if baby was getting enough breast milk, so
I supplemented with formula. I lost the breast milk supply
because I didn’t maintain pumping.’’ (participant 13)‘‘I was
starting school and work and wanted to make sure he was used to
the formula if he needed it.’’ (participant 18)
Conclusions: While receipt of a manual breast pump did not
improve breastfeeding outcomes, women in our study univer-
sally felt that provision of a manual pump at discharge should be
Downloaded by FUNDAÇÃO UNIV. FEDERAL DE CIÊNCIAS DA SAÚDE DE PORTO ALEGRE from www.liebertpub.com at 09/30/21. For personal use only.
standard of care. In addition, women endorsed a need for earlier
and ongoing lactation support following discharge after birth
hospitalization to help with latch, supply, and infant weight loss.
45. BREASTFEEDING CONTINUATION RATES
FOLLOWING GESTATIONAL DIABETES
Martha Kole1, Laurie Griffin1, Jia Jennifer Ding1, Nina Ayala1,
Phinnara Has1, Erika Werner1
1
Women & Infants Hospital, Providence, Rhode Island, USA
Category: Research
Background: Breastfeeding is known to have a positive im-
pact on both maternal and neonatal health. It has been demon-
strated that mothers with gestational diabetes mellitus (GDM)
have lower breastfeeding rates compared to mothers without
diabetes but it is less clear how breastfeeding success compares
between mothers who have diet controlled (A1) GDM compared
to those who require medication for glucose control (A2).
Objective(s): Compare breastfeeding initiation rates between
mothers with A1 and A2 GDM. Compare exclusive breastfeed-
ing continuation rates between mothers with A1 and A2 GDM.
Materials/Methods: This is a secondary analysis of a pro-
spective cohort study of 600 women with GDM funded by the
American Diabetes Association. Eligible women were diagnosed
with GDM by either a 1-hour glucose challenge test value
>200 mg/dl or by the Carpenter-Coustan criteria using the 3-hour
100 gram glucose tolerance test and enrolled during their de-
livery hospitalization. Baseline demographic, antepartum and
detailed neonatal information were recorded in addition to mode
of infant feeding at hospital discharge and 3 months postpartum.
Breastfeeding was classified as any or exclusive breastfeeding.
Women with A1 GDM were compared to women with A2 GDM
using Fischer’s exact test.
Results: Of the 600 women consented to participate 301 had
A1 and 299 had A2 GDM. Mothers with A1 and A2 GDM had
similar rates of any breastfeeding at hospital discharge (242
(80.4%) vs 228 (76.4%); p = 0.24); however, exclusive breast-
feeding rates at hospital discharge were lower in A2 GDM
mothers compared to A1 GDM (28.9% vs. 38.2%; p = 0.02).
Similar findings were noted at three months; no difference in any
breastfeeding (84.3% vs 87.5%; p = 0.28), but a difference in
exclusive breastfeeding (13.9% vs 26.6%; p = <0.001). Among
women who were exclusively breastfeeding at hospital dis-
charge, exclusive breastfeeding continuation at 3 months post-
partum was decreased in women with A2 compared to A1 GDM
(53.3% vs 74.8%; p = 0.004).
Conclusions: Mothers with A2 GDM had decreased rates of
both initiating and continuing exclusive breastfeeding postpar-
tum compared to mothers with A1 GDM. Further investigation is
needed to determine additional barriers that mothers with A2
GDM may face when attempting to exclusively breastfeed.
POSTER ABSTRACTS
46. CONTRACEPTIVE CHOICES AND FERTILITY
INTENTION AMONG WOMEN ON EXCLUSIVE
BREASTFEEDING IN SOUTH WEST NIGERIA
Kolade Afolayan Afolabi1, Adebukunola Olajumoke2
1
Obafemi Awolowo University, Ife, Nigeria
2
O.A.U. Teaching Hospitals, Ife, Nigeria
Category: Research
Background: Exclusive breastfeeding has been recognized to
offer significant contraceptive protection due to associated Lac-
tational Amenorrhea. Several women of reproductive age would
have preferred to postpone or even stop further childbearing but
eventually ended with unplanned pregnancies thereby contribut-
ing to high incidence of unplanned births and associated sequalae
in developing countries including Nigeria where low contracep-
tive uptake has been reported. The increasingly high incidence of
unplanned births could be attributed to widespread non-use or in-
effective contraceptive use among these category of women de-
spite widespread awareness. Previous research findings on reasons
for low contraceptive use in Nigeria identified women’s low
perception on risk of pregnancy, women’s perceived lack of need
for contraception, opposition to contraceptive use base on cultural
or religious reasons among others. There is however a dearth of
information on the interplay between contraceptive choices and
fertility preference among women practicing exclusive breast-
feeding in this region; hence this study.
Objective(s): This study explored perception of women on
exclusive breastfeeding about contraceptive choices and fertility
intention; assessed the pattern of contraceptive uptake post-
partum; and identified factors associated with contraceptive
choices among these women.
Materials/Methods: Study was a cross-sectional study, em-
ployed sequential explanatory mixed method design using quan-
titative and qualitative data collection methods. Quantitative data
were collected from 396 exclusive breastfeeding women selected
through multi-stage sampling technique. Semi structured ques-
tionnaire was used to collect quantitative data while Focus Group
Discussion guide was used to conduct qualitative study. Quanti-
tative data was analyzed using IBM SPSS software version 22 with
level of significance taken at P < 0.05. Qualitative responses were
analyzed and findings presented thematically.
Results: Result showed that majority of the women on exclu-
sive breastfeeding retorted their intention to delay their next
pregnancies. The women also opined that active contraception
may be optional in the first six months post-partum in view of
anticipated protection offered by exclusive breastfeeding. Sig-
nificant proportion of the women (69.7%) relied on Lactational
amenorrhea for contraception, 20.3% used barrier method, 4.7%
used intrauterine contraceptive device, 2.3% hormonal method of
contraception, 0.5% used traditional methods of contraception,
1.7% calendar method and 0.8% had bilateral tubal ligation. Fifty
six percent of the women solely made their contraceptive choices,
25.0% jointly made their choice with their spouse or partner, 7.8%
of the women attributed their choice to previous convenience of
the method, 1.4% of the women were influenced by their friends
while 9.8% gave cultural and religious reasons. Women’s marital
status (p = 0.004, OR = 10.67, CI = 2.09–54.64), highest level of
education (p = 0.04, OR = 13.8. CI = 2.33–81.38), parity (p = 0.03,
OR = 0.42, CI = 0.19–0.93) and age (p = 0.01, OR = 0.25,
CI = 0.10–0.66) were main predators of contraceptive use among
this category of women.
Conclusions: Significant proportion of women on exclusive
breastfeeding in South-West Nigeria relied on Lactational
Amenorrhea for contraception. A high level of autonomy and
 POSTER ABSTRACTS
informed decision making about contraceptive choices and fer-
tility intention were observed among this category of women.
47. ROLE OF NUTRITIONAL SUPPORT AND
BREASTFEEDING IN NEONATAL INTENSIVE CARE
UNITS (NICUS), AS INDICATED BY DECREASED
MORBIDITY, MORTALITY, AND LENGTH OF STAY
Shereen Abd elghani1
1 and pain. Both ointments were reported to be effective. Skin irri-
Faculty of Medicine, Cairo University, Giza, Egypt
Downloaded by FUNDAÇÃO UNIV. FEDERAL DE CIÊNCIAS DA SAÚDE DE PORTO ALEGRE from www.liebertpub.com at 09/30/21. For personal use only.
Category: Research
Background: Breastfeeding has crucial role in lessening
morbidity, mortality, and length of hospital stay in neonatal in-
tensive care units (NICUs).
Objective(s): To assess the benefits of nutritional support and
breastfeeding in full term infants in NICU to lessen morbidity.
To assess the benefits of nutritional support and breastfeeding in
full term infants in NICU to lessen mortality. To assess the
benefits of nutritional support and breastfeeding in full term in-
fants in NICU to shorten length of hospital stay.
Materials/Methods: This is a systematic review performed
according to PRISMA guidelines for reporting on systematic
reviews. Medline, Pubmed, Web of Science Citation Index and
Cochrane Central Register of Controlled Trials Registry, were
searched electronically in January 2019, using key words ‘‘Nu-
tritional support’’, ‘‘breastfeeding’’ and ‘‘NICU’’. The inclusion
criteria were studies written in English which evaluated benefits
of nutritional support and breastfeeding in full term infants in
NICU and their impacts on the outcomes, as indicated by de-
creased morbidity, mortality, and length of stay.
Results: Breastfeeding and STS lessen morbidity; indicated
by increased weight gain, decreased the incidence of NEC, in-
creased immunity reflected by decreased the nosocomial infec-
tion and neonatal septicemia, lessens mortality, and the length of
stay in the NICU
Conclusions: Breastfeeding and STS lessen morbidity, mor-
tality, and the length of stay in the NICU.
48. USE OF NIPPLE OINTMENTS AND OUTCOMES
FOR MANAGING BREASTFEEDING PAIN
Shereen Abd elghani1
1
Faculty of Medicine, Cairo University, Giza, Egypt
Category: Research
Background: Exclusive breast milk feeding for the first six
months of life is recommended by multiple public health and
medical organizations. Nipple pain is commonly cited as a reason
woman discontinue breastfeeding. Multiple ointments are com-
mercially marketed to soothe nipple pain, yet studies are lacking
on the use of nipple ointments and adverse effects encountered.
Objective(s): 1) Identify ointments used and perceived ef-
fectiveness to soothe nipple pain and/or skin damage during
breastfeeding. 2) Differentiate maternal and infant side effects
that occurred with use of nipple ointments.
Materials/Methods: This is a quantitative descriptive study,
women at least 18 years of age residing in the United States who
breastfed at least one child within the previous 5 years were
eligible to participate in the study. Data were collected using an
online survey developed by the research team. Qualtrics survey
software was used to design, send, and analyze data. A message
including the link to the online survey was posted on breast-
feeding and women’s health social media sites. No incentives
A-23
were provided to complete the survey. Data were analyzed using
descriptive and chi-square statistics.
Results: Over a 4-week period, 1,866 women completed the
survey. The majority of participants were white (65%), 25–34 years
old (57%), and currently breastfeeding (68%). Of the total number
of children reported, 92% were born full-term. Nipple pain was the
most commonly reported problem during breastfeeding with 88%
women using a nipple ointment. Lanolin (71%) and coconut oil
(35%) were the most frequently used ointments for cracked nipples
tation was the most common maternal side effect for both lanolin
(2%) and coconut oil (<1%). Rash (1%) and refusing to nurse (1%)
were common infant side effects reported by women using lanolin
with only 1 report of infant rash when using coconut oil. Being a
first-time mother was significantly associated with use of any
nipple ointment during breastfeeding (?2 = 15.32, p < .001).
Conclusions: Breastfeeding women routinely use nipple
ointments for managing nipple pain. Both lanolin and coconut oil
were reported to be effective in treating cracked nipples and pain.
No significant maternal or infant side effects were reported.
49. THE ASSOCIATION BETWEEN BREASTFEEDING
AND ABNORMAL GLUCOSE METABOLISM AT
1 YEAR POSTPARTUM FOLLOWING GESTATIONAL
DIABETES
Jia Jennifer Ding1, Martha Kole1, Laurie Griffin1, Nina Ayala1,
Phinnara Has1, Erika Werner1
1
Brown/Women and Infants Hospital, Providence, Rhode Island,
USA
Category: Research
Background: Previous studies have suggested that increased
length and intensity of breastfeeding in women with gestational
diabetes (GDM) are associated with decreased risk of developing
diabetes within two years of delivery.
Objective(s): We sought to investigate whether breastfeeding
was associated with lower rates of abnormal glucose metabolism
at 1 year postpartum in women with GDM.
Materials/Methods: Prospective cohort study which enrolled
postpartum women who delivered at a single tertiary care hos-
pital from Jan 2017 - June 2018. Participants were eligible if they
had GDM, spoke English or Spanish, and were >18 years of age.
Consented women were surveyed immediately postpartum and at
3 months postpartum about infant feeding. They also underwent
glucose tolerance testing at 4–12 weeks and had a glycosylated
hemoglobin (HgbA1c) obtained at 1 year postpartum. Breast-
feeding status was classified as never breastfed, any breastfeed-
ing, or exclusive breastfeeding. Rates of abnormal glucose
metabolism at 1 year postpartum (HgbA1c >5.7%) were com-
pared between women with any or exclusive breastfeeding at 3
months postpartum compared to those who never breastfed.
Results: Women who were exclusively breastfeeding at 3
months postpartum (44/186, 24%) were more likely to be parous,
college educated, thin, and had private insurance. When rates of
abnormal glucose metabolism at one year postpartum were
compared by breastfeeding status (HgbA1c >5.7%: 36% for no
breastfeeding, 34% for any breastfeeding, p = 0.81, and 27% for
exclusive breastfeeding, p = 0.57), no difference was found, even
after adjusting for differences between the never breastfed and
exclusively breastfed groups.
Conclusions: Women who report breastfeeding their infants at
3 months postpartum have similar rates of impaired glucose me-
tabolism at 1 year postpartum as women who did not breastfeed at
all.
 A-24
50. TESTOSTERONE IMPACTS ON MILK AND INFANT
IN A LACTATING TRANSGENDER INDIVIDUAL,
A CASE REPORT
Sara Oberhelman1, Alice Chang1, Andrew Braith1,
Natalie Erbs1, Aida Lteif1, Cesar Gonzalez1, Ravinder Singh1
1 tients at our institution). Four days after initiating testosterone
Mayo Clinic, Rochester, Minnesota, USA
Category: Research
Background: Pregnancy and lactation are becoming more
common among transgender men. There is limited data to support
Downloaded by FUNDAÇÃO UNIV. FEDERAL DE CIÊNCIAS DA SAÚDE DE PORTO ALEGRE from www.liebertpub.com at 09/30/21. For personal use only.
the safety or danger of testosterone use during lactation, making it
difficult for clinicians to make evidence-based recommendations.
There is a descriptive paper with mention of a case-report for an
individual who restarted testosterone therapy when his infant was
21 months old. The individual self-reported that over 15 months of
continued lactation, blood testosterone levels in his child remained
normal and milk supply did not subjectively decrease. (MacDo-
nald T, Noel-Weiss J, West D et al. Transmasculine individuals’
experiences with lactation, chestfeeding, and gender identity: a
qualitative study. BMC Pregnancy and Childbirth. 16:106.) A
study of cis-gender lactating women who administered testoster-
one therapy vial vaginal cream, sublingual drops or subcutaneous
pellet implant did not show measureable excretion of testosterone
into breast milk and showed low levels of testosterone in infant
blood samples with no adverse events for the seven months of the
study. (Glaser RL, Newman M, Parsons M et al. Safety of maternal
testosterone therapy during breast feeding. Int J Pharm Compd.
2009;13(4):314-7.). The World Health Organization recommends
avoiding breastfeeding with testosterone use (Anon: Breastfeeding
and Maternal Medication. World Health Organization, Geneva,
Switzerland, 2002.). Infant Risk categorizes testosterone as ‘‘L4 –
limited data – possibly hazardous.’’ Micromedex states ‘‘infant
risk has been demonstrated’’ but does not cite any literature.
Objective(s): Identify the concentration of testosterone in
human milk samples before and after subcutaneous testosterone
supplementation has been initiated. Evaluate for the presence of
testosterone in the serum of an infant receiving human milk from
a lactating parent who has initiated testosterone therapy.
Materials/Methods: This patient self-identified as wishing to
initiate testosterone therapy while continuing to lactate. After
discussing the current limited data and potential risks, he wished
to proceed. We recommended safety monitoring by checking his
and his son’s serum testosterone values and his son’s growth and
development periodically. We also offered measuring milk val-
ues via a study as this is not a routine lab available for clinician
ordering. Evaluating milk specimens was approved by our IRB.
The patient self-expressed milk on the same day as their blood
draws. He provided the milk specimens to the study team for
analysis. Blood specimens were collected and evaluated for
parent total testosterone, parent bioavailable testosterone and
infant total testosterone. Milk samples were evaluated by mass
spectroscopy using the routine testosterone acquisition method.
Each sample along with routine testosterone standards and
quality control and an internal standard were all run twice.
Routine control and internal standards showed good accuracy
and precision; the two sample values were all within 1 ng/dL of
each other. Samples were collected at baseline, 4 days after
initiation of testosterone (which is when peak is expected after
subcutaneous administration), 14 days after initiation of testos-
terone and 28 days after initiation of testosterone. Samples will
continue to be obtained as long as the patient continues to lactate.
Results: The patient initiated gender-affirming testosterone
therapy by subcutaneous administration of 50 mcg testosterone
cypionate weekly when his infant was 13 months and 3 weeks old
POSTER ABSTRACTS
and continuing to receive human milk directly ad lib. At baseline,
parent serum total testosterone was 14 ng/dL, parent serum bio-
available testosterone was 1.5 ng/dL, milk total testosterone
(average of 2 runs) was 0.462 ng/dL and infant serum total tes-
tosterone was <7 ng/dL (lowest reported value for pediatric pa-
therapy, parent serum total testosterone was 171 ng/dL, parent
serum bioavailable testosterone was 29 ng/dL, milk total tes-
tosterone was 8.395 ng/dL and infant serum total testosterone
was <7 ng/dL. Fourteen days after initiating testosterone therapy,
parent serum total testosterone was 300 ng/dL, parent serum
bioavailable testosterone was 66 ng/dL, milk total testosterone
was 20.85 ng/dL and infant serum total testosterone was
<7 ng/dL. Twenty eight days after initiating testosterone therapy,
parent serum total testosterone was 340 ng/dL, parent serum
bioavailable testosterone was 85 ng/dL, milk total testosterone
was 12.36 ng/dL and infant serum total testosterone was
<7 ng/dL. Testosterone measurements will continue as long as
the patient continues to lactate. Nine months’ worth of data will
be available at the time of the conference.
Conclusions: This single patient case report showed that over
the first month of gender-affirming subcutaneous testosterone
therapy in a transgender man lactating for his 13 month old child,
testosterone did cross into the milk but was not measureable in
infant serum. Interestingly, while the milk values increased over
the first two weeks, the 28 day milk value decreased despite the
parent serum value continuing to increase. The infant’s serum
testosterone values remained undetectable throughout this study
period, likely secondary to the poor oral bio-availability of tes-
tosterone. By the time of the conference, we will have an addi-
tional 8 months’ worth of data to present which will help
demonstrate whether the milk testosterone values change or
stabilize over time. While this study has many limitations (single
patient report, initiation of testosterone was not until infant was
13 months old, unmeasured quantity of milk the child receives
each day), it will certainly help clinicians and patients interested
in simultaneous lactation and gender-affirming therapy make
decisions.
51. IMPACT OF LACTATION CONSULTATION
ON BREASTFEEDING RATES IN WOMEN
WITH GESTATIONAL DIABETES
Laurie Griffin1, Martha Kole1, Jia Jennifer Ding1, Megan Lord1,
Phinnara Has1, Erika Werner1
1
Women and Infants Hospital, Providence, Rhode Island, USA
Category: Research
Background: In patients with gestational diabetes (GDM),
breastfeeding decreases the lifetime risk of type II diabetes by as
much as 50%. Patients with GDM face many barriers to breast-
feeding success. Lactation consultations may help to address
these barriers. We sought to determine if lactation consultation
during postpartum hospitalization was associated with any or
exclusive breastfeeding success in women with GDM.
Objective(s): To determine if women with GDM who receive
lactation consults were more likely to report any breastfeeding
attempts or exclusive breastfeeding at hospital discharge com-
pared to women who did not receive lactation consultation. To
determine if women with GDM who receive lactation consults
were more likely to report any breastfeeding attempts or exclu-
sive breastfeeding at 3 months and one year compared to women
who did not receive lactation consultation.
 POSTER ABSTRACTS
Materials/Methods: Six hundred patients diagnosed with
GDM by either the Carpenter-Coustan criteria or a 1-hour glu-
cose challenge result over 200mg/dl were prospectively enrolled.
Patients completed surveys during delivery hospitalization and at
three month follow-up visits including questions about infant
feeding. For this secondary analysis, data regarding lactation
consultations were retrospectively extracted from the electronic
medical record. Demographics and self-reported breastfeeding
rates were compared between women with GDM who did and
did not receive lactation consultations during their postpartum
hospitalization.
Downloaded by FUNDAÇÃO UNIV. FEDERAL DE CIÊNCIAS DA SAÚDE DE PORTO ALEGRE from www.liebertpub.com at 09/30/21. For personal use only.
Results: Complete data were available for 575 pregnancies.
Inpatient lactation consultations were completed for 444 (77%).
Women who received lactation consults were more likely to
report any breastfeeding attempts post-partum (82.2% vs 69.5%,
p = 0.002) or exclusive breastfeeding at hospital discharge
(37.7% vs 21.4%, p = 0.001) compared to women who did not
receive lactation consultation. Similarly, at three months post-
partum, women who had lactation consultations were more likely
to have continued any breastfeeding (87.8% vs 78.2%, p = 0.01)
or exclusive breastfeeding (22.5 vs 13.5%, p = 0.03).
Conclusions: Inpatient lactation consultations during the
immediate postpartum period are associated with improved rates
of breastfeeding in women with GDM. Future work should focus
on specific educational interventions to further improve breast-
feeding rates.
52. IMPACT OF EXCLUSIVE BREASTFEEDING
ON MATERNAL BODY COMPOSITION AT 6 MONTHS
POSTPARTUM
Nicole Marshall1, Katherine Au1,
Kent Thornburg1, Jonathan Purnell1
1
Oregon Health & Science University, Portland, Oregon, USA
Category: Research
Background: Exclusive breastfeeding (EBF) is often re-
commended to help facilitate restoration of pre-pregnancy
weight. However, few studies have examined the impact of EBF
compared to non-EBF on postpartum maternal weight retention
or fat mass.
Objective(s): 1) Determine body composition in early preg-
nancy (pre-pregnancy BMI, fat mass, body fat percent (%body
fat)) and changes in body composition across pregnancy (ges-
tational weight gain, change in fat mass, change in percent body
fat) according to later EBF status. 2) Determine postpartum body
composition changes (weight loss, return to pre-pregnancy
weight, change in fat mass, change in body fat percent) during the
first 6 months postpartum based on EBF status.
Materials/Methods: This was a cross-sectional study of 57
healthy mother-baby pairs over a range of maternal pre-
pregnancy BMI enrolled at Oregon Health & Science University
from October 2015 to January 2018. Women were either early
enrollers (12–16 weeks gestation, n = 32) or late enrollers (>37
weeks gestation, n = 25). Weight and fat mass via air displace-
ment plethysmography were assessed at enrollment, 37 weeks
gestation, and 6 months postpartum. Modified Infant Feeding
Practices II surveys were completed at 6 weeks and 6 months
postpartum. Descriptive statistics were used to characterize the
demographic profile of the cross-sectional sample. Unadjusted
associations between EBF and maternal body composition were
analyzed.
Results: Pre-pregnancy BMI’s and demographics were simi-
lar in women who did and did not breastfeed exclusively at 6
A-25
months postpartum. However, compared to non-EBF mothers,
%body fat (and fat mass) in EBF mothers was lower in early
pregnancy. This lower %body fat remained lower in the EBF
mothers in later pregnancy and out to 6 months postpartum such
that the change in %body fat from early pregnancy to 6 months
postpartum declined in EBF mothers and increased in non-EBF
mothers (-2.0% vs. 1.3%, p-value 0.035). EBF and non-EBF
mothers otherwise showed no differences in gestational weight
gain, postpartum weight loss, or return to pre-pregnancy
weight.
Conclusions: Our data do not support recommending EBF as
a means of facilitating postpartum weight loss or restoration of
pre-pregnancy weight. Instead, we find that despite similarities in
pre-pregnancy BMI, GWG, and 6 month BMI, the body com-
position in women who successfully EBF differs from non-EBF
women. Lower %body fat and fat mass are already evident by
early pregnancy and women who EBF experienced a greater
reduction in %body fat 6 months postpartum than non-EBF
mothers. This finding suggests that, even in early pregnancy,
EBF mothers may be more efficient at mobilizing fat stores and
retaining lean mass than non-EBF mothers. This might be missed
when only weight and BMI measurements are utilized.
53. MOTHER’S MILK MESSAGINGb (MMM):
MIXED METHODS EVALUATION OF BILINGUAL
APP AND TEXTING PROGRAM TO SUPPORT
BREASTFEEDING (BF)
Maya Bunik1, Andrea Jimenez-Zambrano1, Brenda Beaty1,
Xuhong Zhang2, Susan Moore2, Sheana Bull2, Jenn Leiferman2
1
University of Colorado, Aurora, Colorado, USA
2
Colorado School of Public Health, Aurora, Colorado, USA
Category: Research
Background: Breastfeeding (BF) provides optimal health
benefits for mothers and their infants. Most new mothers expe-
rience BF challenges but evidence-based support online and
through mobile apps is limited. We developed and evaluated an
app (MMM) in English and Spanish to help mothers from late
third trimester through 2 months postpartum meet their BF goals.
Objective(s): To describe engagement with the app. To de-
termine if using the app improved aspects of breastfeeding and
breastfeeding rates.
Materials/Methods: We recruited online a national sample of
primiparous, singleton mothers with uncomplicated pregnancy,
interested in BF, through ads and listservs. We randomized the
mothers to one of three arms: 1) BF text messages plus app
access; 2) BF text messages, app access, and physician-
moderated private Facebook (FB) group; and 3) Attention con-
trol group who received injury prevention texts not related to BF.
We determined engagement through analysis of app usage
metrics. We conducted and content coded using Atlas Ti 60
qualitative interviews with participants to learn more about app
usage and BF experience. Attitude, confidence, social support
and BF outcomes were determined from comparing baseline and
3-month post-intervention responses to a survey with validated
questions. We combined 2 intervention arms because of minimal
FB activity and similar outcomes.
Results: Total participants included n = 311 with the Inter-
vention n = 201 and Control n = 110. Demographics are shown in
Table 1. Greater than 80% registered the app, 40% interacted
with the app on some level with greater app use after baby’s birth.
Mothers reported positively to receiving text messages and to
reliability of information. Discontinuation of app use was
 A-26 POSTER ABSTRACTS

common among mothers reporting early problems and no
problems with BF. Women in the intervention arm reported
significantly higher confidence and social support compared to
the control group.
Conclusions: Highly motivated, white married women were
the highest utilizers of the new MMM app despite a national
online recruitment mode and the bilingual and culturally en-
hanced option. Mothers perceived MMM as useful and reported
increased confidence and supports with breastfeeding.
Downloaded by FUNDAÇÃO UNIV. FEDERAL DE CIÊNCIAS DA SAÚDE DE PORTO ALEGRE from www.liebertpub.com at 09/30/21. For personal use only.
55. IS THE NEWBORN WEIGHT LOSS TOOL
CLINICALLY USEFUL FOR PREDICTING EXCESS
NEWBORN WEIGHT LOSS AT DAY 4 OF LIFE?
Anna Smith1, Laura Ward2, Jane Heinig3,
Kathryn Dewey3, Laurie Nommsen-Rivers1
1
University of Cincinnati, Cincinnati, Ohio, USA
2
Cincinnati Children’s Hospital, Cincinnati, Ohio, USA
3
University of California Davis, Davis, California, USA
Category: Research

Background: Breast milk provides powerful benefits for in-

54. MOTHER’S MILK MESSAGINGb (MMM): fants. However, some newborns experience excess weight loss
MOTHERS FAVOR DAILY TEXTING while breastfeeding is being established.
AND RELIABILITY OF APP CONTENT Objective(s): Evaluate the validity of the Newborn Weight
IN QUALITATIVE EVALUATION Loss Tool (NEWT) in early identification of exclusively
breastfed newborns who will eventually lose >10% of birth-
Maya Bunik1, Andrea Jimenez-Zambrano1, weight once discharged to home.
Sheana Bull2, Jenn Leiferman2 Materials/Methods: We conducted a secondary analysis of
1
University of Colorado, Aurora, Colorado, USA prospective data from mother-infant dyads screened during the
2
Colorado School of Public Health, Aurora, Colorado, USA birth hospitalization for inclusion in the Davis, CA site of the
WHO Growth Reference Study. Infant feeding and weight data
Category: Research
were collected from birth through day of life (DoL) 4 and beyond.
Background: Although the benefits and advantages of
For our analysis, we excluded records where: newborn received
breastfeeding (BF) are known, disparities exist in BF practices
>60 mL formula prior to the DoL4 home visit, relevant data were
from different ethnic/racial groups. We developed and evaluated
missing, or NEWT exclusion criteria were met (newborn admis-
an app (MMM) in English and Spanish to help mothers from late
sion to Level II or Level III care, birthweight <2000 g or >5000 g,
trimester through 2 months postpartum meet their BF goals.
or biologically implausible weight value recorded). We examined
MMM includes theoretical-based text messaging with social
the sensitivity and specificity of in-hospital newborn NEWT status
support features, videos and evidence-based written content to
in predicting newborn weight loss >10% by DoL4. We defined
encourage BF exclusivity and duration among first time mothers.
NEWT test-positive status as in-hospital newborn weight falling at
Objective(s): To understand the perspectives of first-time
or below the NEWT trajectory intersecting with eventual 10%
mothers using an evidence-based BF app. To obtain qualitative
weight loss. We defined cases as having actual weight loss >10%
information to understand RCT outcomes as well as inform fu-
between birth and the DoL4 home visit.
ture engagement and dissemination of the app.
Results: Of 280 records in the original dataset, 60 were excluded
Materials/Methods: We conducted 60 telephone interviews
(27 did not meet NEWT inclusion criteria, 15 were missing DoL4
with a subgroup from a total of 311 participants completing a
data, and 18 newborns received >60 mL formula). Among n = 220
randomized controlled trial of the breastfeeding app. We aimed
eligible records, in-hospital newborn weight was recorded at 17+/-
questions at obtaining reactions to the app content, understanding
8 h, and DoL4 weight was recorded at 84+/-8 h. NEWT correctly
engagement and how the app influenced their BF experience.
identified 6 of 28 cases of excess newborn weight loss (21% sensi-
We also explored other sources of support (providers, family,
tivity [95% CI: 8–34%]), and 158 of 192 non-cases (82% specificity
friends) on BF for these mothers. We content coded the tran-
[95% CI: 75–89%]). NEWT test-positive status was significantly
scripts of focused interviews and analyzed for thematic do-
associated with the following DoL4 outcomes (P < 0.05): greater
mains using Atlas Ti and then performed comparisons for
newborn weight loss, maternal perception of less breastfeeding
concurrence and differences. Three of the four domains ‘Use of
support, and less frequent infant feeding interest. In post hoc anal-
app’, ‘BF experience/journey’ and ’Timing of app content’ are
ysis, formula use exclusions did not explain the low sensitivity, as
presented here.
only 3 of those 18 newborns were NEWT test-positive.
Results: Demographics included mothers with mean age 29
Conclusions: The Newborn Weight Loss Tool, when applied
years, 23% Hispanic, 80% White, 68% married and 90% with
to a single in-hospital newborn weight at about DoL1, demon-
some post high school education. These subgroup mothers were
strated poor sensitivity in identifying exclusively breastfeeding
similar to the larger trial population. Participants who accessed
newborns who develop excessive weight loss; however, NEWT
and engaged with the app had positive attitudes towards the
test-positive status was associated with less favorable breast-
usefulness of the app during their BF journey. Most participants
feeding outcomes at DoL4. Further research is needed to deter-
preferred receiving the app’s BF text messages as well as the
mine the clinical usefulness of NEWT when used later in the
texts with bidirectional quizzes. Mothers also appreciated the
birth hospitalization.
reliability of the information on the app. Engagement of the app
varied by each individual’s BF experiences. We learned that
discontinuation of app use was common among mothers re-
56. PREDICTORS OF THE PROVISION OF MOTHER’S
porting early problems and also no problems with BF. Most
MILK FEEDINGS IN NEWBORNS ADMITTED
mothers engaged in the app once the baby was born.
TO THE NICU
Conclusions: Perceptions of MMM text messages, content
and structure were positive. Mothers struggling with breast- Lisa Marie Piwoszkin1, Megan Corley2,
feeding early on may need focused direction toward in person Karthikeyan Meganathan2, Vivek Narendran1,
lactation support. This qualitative information provides per- Laurie Rivers2, Laura Ward1
1
spectives for the RCT outcomes as well as assists in improving Cincinnati Children’s Hospital, Cincinnati, Ohio, USA
2
future engagement and dissemination of MMM. University of Cincinnati, Cincinnati, Ohio, USA
 POSTER ABSTRACTS
Category: Research
Background: Breast milk has been shown to improve mor-
bidity and mortality in NICU-admitted infants. Most infants
admitted to the NICU are reliant on expressed mother’s own milk
(MOM) and vulnerable to decreased maternal milk availability
and sustainability. We sought to determine predictors of the
provision of MOM in infants admitted to the NICU.
Objective(s): Determine predictors of initiation of milk
expression among mothers of NICU-admitted infants (MOM-
initiation). Determine predictors of NICU-admitted infants
receiving MOM as their first enteral feeding (MOM-First). De-
Downloaded by FUNDAÇÃO UNIV. FEDERAL DE CIÊNCIAS DA SAÚDE DE PORTO ALEGRE from www.liebertpub.com at 09/30/21. For personal use only.
termine predictors of the provision of MOM at 21 days of life or
discharge (MOM-21/DC), whichever occurred first.
Materials/Methods: We performed a retrospective chart
review of inborn NICU admissions at UCMC from June 1, 2018-
May 31, 2019 and examined a comprehensive set of socio-
demographic, maternal, infant, and hospital variables to determine
potential predictors of MOM-Initiation, MOM-First, and MOM-
21/DC. We excluded infants not directly admitted to the NICU,
those never enterally fed, multiple gestation if not the first to be
discharged, and infants discharged to a non-biological caregiver.
We used chi-square analysis to examine unadjusted associations
between independent variables and MOM outcomes and then used
logistic regression to determine the adjusted odds ratio and 95%
Confidence Interval (AOR [95%CI]) for predictors of MOM
outcomes.
Results: There were 341 mother-infant dyads who met in-
clusion criteria and 71% of these mothers initiated milk ex-
pression. Adjusted odds of MOM-Initiation were significantly
lower for mothers who smoked (0.16 [95% CI 0.07–0.39]), were
multiparous, (0.55 [0.31–0.95]), or with shorter antepartum stays
(0.41 [0.22–0.76]); and significantly higher for mothers who
delivered at 28–32 weeks versus > = 33 weeks (2.35 [1.14–
4.84]). Adjusted odds of MOM-First were significantly lower for
infants of mothers with gestational diabetes (0.30 [0.15–0.64]).
Adjusted odds of MOM-21/DC were significantly lower for in-
fants of mothers with Hepatitis C (0.28 [0.10–0.75]) and sig-
nificantly higher for infants with birthweight <1500 grams versus
1500–2500 grams (7.92 [1.70–36.87]).
Conclusions: In the context of a NICU setting, we identified
characteristics of mothers and infants at risk for poor breast-
feeding outcomes that can inform future interventions. While
many NICUs have policies to ensure strong counseling regarding
the benefits of MOM for very low birthweight infants, our
analysis suggests that lactation support should also be prioritized
for more mature infants in the NICU. Furthermore, mothers with
gestational diabetes or Hepatitis C could benefit from targeted
support ensuring best lactation practices should their infants re-
quire NICU admission.
57. HAND EXPRESSION SIMULATION: A STAFF
EDUCATION INTERVENTION TO IMPROVE
THE PROVISION OF MATERNAL BREAST MILK
FOR INFANTS ADMITTED TO THE NICU
Lisa Marie Piwoszkin1, Karthikeyan Meganathan2,
Divya Denduluri2, Vivek Narendran1,
Laurie Rivers2, Laura Ward1
1
Cincinnati Children’s Hospital, Cincinnati, Ohio, USA
2
University of Cincinnati, Cincinnati, Ohio, USA
Category: Research
Background: Maternal breast milk (MOM) improves several
outcomes related to infant morbidity and mortality. Many infants
A-27
admitted to the Neonatal Intensive Care Unit (NICU) are reliant
on pumped MOM and vulnerable to decreased milk availability
and sustainability. Early initiation of hand expression is shown to
increase immediate and long-term milk supply. An assessment of
lactation support knowledge gaps among NICU, labor and de-
livery (L&D), and postpartum (PP) nurses at the University of
Cincinnati Medical Center (UCMC) revealed low confidence in
instructing mothers how to perform hand expression.
Objective(s): Evaluate the effect of a targeted hand expres-
sion simulation curriculum for NICU, L&D, and PP nurses on
confidence in instructing mothers to perform hand expression.
Evaluate the effect of a targeted hand expression simulation
curriculum on MOM outcomes in the NICU.
Materials/Methods: We implemented a hand expression
workshop for nurses using a hands-on simulator model. We
compared pre and post-training self-assessment surveys with the
Wilcoxon signed-rank test. We used interrupted time series
analysis to compare the trends for initiation of MOM expression
(MOM-initiation), first MOM expression within 6 hours post-
partum (MOM-hour), infants receiving MOM as their first en-
teral feeding (MOM-first), non-orally feeding infants receiving
colostrum for oral care within 36 hours of life (COC36), and
proportion of infants receiving any MOM at 21 days of life or
discharge (MOM-DC/21). We excluded outborn infants, those
not directly admitted to the NICU, never enterally fed, dis-
charged to non-biological caregiver(s), and multiple gestations if
not the first to be discharged.
Results: 105 nurses (50.5% NICU, 25.7% L&D, and 23.8%
PP) were included in the analysis. There was significant im-
provement in confidence ratings for teaching hand expression
following training, p < 0.0001. For MOM outcomes, 341 (pre
n = 182, inter+post n = 159) dyads met initial inclusion criteria.
Although there wasn’t a significant change in pre- versus post-
intervention linear trends for any outcome over time, there was a
significant increase in the average prevalence of MOM-initiation
(17.3% increase, p = 0.03) and MOM-first (41.8% increase,
p = 0.02) following the intervention.
Conclusions: Simulated hand expression training for nurses is
a useful educational approach. There was a significant increase in
initiation of milk expression and in infants receiving MOM as
their first feed. Targeted training may improve hand expression
skills and outcomes related to breastfeeding support in the NICU.
Additional research is needed to target other MOM outcomes.
58. EFFECTS OF A DONOR HUMAN MILK PROGRAM
ON MATERNAL BREAST MILK RATES
Smrithy Jacob1, Philip Roth1, Amanda Rahman1, Jonathan Blau1
1
Staten Island University Hospital, Staten Island, New York, USA
Category: Research
Background: Human milk is the optimal source of nutrition
for premature neonates and is associated with significantly de-
creased rates of late-onset sepsis (LOS) and necrotizing entero-
colitis (NEC). In 2017, the AAP recommended the use of donor
human milk (DHM) for the very low birth weight (VLBW,
£1500 grams) population. As more neonatal intensive care units
begin utilizing DHM, it is unclear if this new practice has an
effect on maternal pumping and exclusive maternal breast milk
(EBM) rates in the neonatal intensive care unit (NICU).
Objective(s): To compare the rates of maternal breast feed-
ing/EBM feeding among VLBW infants before and after the
implementation of a DHM program in the Level 3 NICU at
Staten Island University Hospital in 01/2017. To compare the
 A-28
rates of NEC pre- and post- implementation of the DHM Pro-
gram in these patients.
Materials/Methods: A retrospective chart review was con-
ducted for newborns with a gestational age £32 weeks and/or
birth weight £1500 grams admitted to the NICU. The pre-
intervention cohort (N = 80) was admitted from 03/2014 – 12/
2016 and the post-intervention cohort (N = 79) from 07/2017 –
06/2019. A six month ‘‘wash-out’’ period occurred after the
program began in 01/2017 to allow for adequate staff education
and culture change after the implementation of the new program.
Chart review examined the type of enteral feeding the infant
Downloaded by FUNDAÇÃO UNIV. FEDERAL DE CIÊNCIAS DA SAÚDE DE PORTO ALEGRE from www.liebertpub.com at 09/30/21. For personal use only.
received on DOL 7, 28 and day of discharge. Feeds were re-
corded as EBM, DHM or formula. Proportions of the types of
enteral feeds were also noted.
Results: The demographics of the pre- and post-intervention
cohorts were similar. In the pre-intervention group (n = 80), there
was a high use of EBM on day of life (DOL) 7 (78%), and
remained high on DOL 28 (70%). This was in comparison to
formula. There was a lower use of maternal breast milk in the
post-intervention group (58% on DOL 7 and 28), suggesting that
mothers who initially committing to providing breast milk con-
tinued to do so but that many mothers were also relying on DHM.
At time of discharge, only 28% of mothers pre-intervention were
providing exclusive breast milk, while 45% were in the post-
intervention group. We found a trend in the increased rates of
NEC from pre- to post-intervention (4% to 9%). Of note, during
the post-intervtuion group, there was a cluster of NEC in a few
month period significantly outside normal rates. This appears to
have skewed the post-intervention data, as there have been no
NEC incidents reported since this cluster.
Conclusions: After the initiation of a DHM program, we
found that the use of exclusive human milk increased (with the
access to DHM) but that the rates of exclusive EBM declined on
DOL 7 and DOL 28 compared to when DHM was not an option.
This may be due to decreased maternal pressure, knowing that
DHM is available to the infant if EBM is not available. There is
concern however, that this could also be due to a subconscious
drop in emphasis on the importance of breast milk or education
on the ICU team. Further investigation of potential causes is
ongoing, and emphasis of maternal education, ensuring access to
lactation and early access to a breast pump. We were reassured
that there was an increase in EBM usage at time of discharge,
suggesting that the use of the DHM program has helped parents
to understand the importance of breast milk for the preterm
infant.
59. IMPACT OF A NOVEL SMARTPHONE APP
ON LOW-INCOME, FIRST-TIME MOTHERS’
BREASTFEEDING RATES: A RANDOMIZED
CONTROLLED TRIAL
Adam Lewkowitz1, Julia Lopez2, Ebony Carter2,
Hillary Duckham2, Tianta’ Strickland2,
George Macones3, Alison Cahill3
1 WOMEN?
Women and Infants Hospital, Providence, Rhode Island, USA
2
Washington University in St. Louis, St. Louis, Missouri, USA
3
University of Texas at Austin, Austin, Texas, USA
Category: Research
Background: Low-income women are less likely to exclu-
sively breastfeed on postpartum day two compared to high-
income women, but focus groups of low-income women have
suggested that on-demand videos on breastfeeding and infant
behavior would support exclusive breastfeeding beyond post-
POSTER ABSTRACTS
partum day two. Smartphone applications (apps) provide on-
demand video.
Objective(s): To determine whether a novel app—
BreastFeeding Friend (BFF)—increases the rate of exclusive
breastfeeding on postpartum day two for low-income first-time
mothers. To determine whether BFF increases the rate of ex-
clusive or non-exclusive breastfeeding up to six months post-
partum among low-income first-time mothers. To determine
what low-income first-time mothers reported providing the most
breastfeeding support at various postpartum intervals.
Materials/Methods: This double-blinded randomized trial
recruited low-income first-time mothers at 36 weeks gestation.
Consenting women received a complimentary Android smart-
phone and internet service before 1:1 randomization to BFF or
a control app. BFF was created by a multidisciplinary team
of perinatologists, neonatologists, lactation consultants, and a
middle-school teacher and was refined by end-user focus groups.
BFF contained on-demand education and videos on breastfeed-
ing and newborn behavior, tailored to a 5th-grade reading level.
The control app contained digital breastfeeding handouts. The
primary outcome was exclusive breastfeeding on postpartum day
two; secondary outcomes were breastfeeding rates until 6 months
postpartum and patient-reported best breastfeeding resource.
Primary statistical analyses compared outcomes between study
groups via intention-to-treat; pre-specified secondary analyses
did so per-protocol. 170 women (85 per arm) were needed to
detect whether BFF increased exclusive breastfeeding at post-
partum day two from 34% (known baseline) to 56%. The study
was registered on clinicaltrials.gov (NCT03167073).
Results: 253 women were approached; 170 women enrolled.
Most participants were Black, and more than half reported annual
household incomes <$25,000. Exclusive breastfeeding rates on
postpartum day two were low and similar among BFF and con-
trol app users (n = 30 (36.6%) vs n = 30 (35.7%); relative risk
(RR) 1.02 (95% Confidence Interval (CI) .068 – 1.53)). Breast-
feeding rates until six months postpartum were also similar be-
tween study groups: the rate of exclusive breastfeeding was 8.3%
(n = 5) and 10.4%) (n = 7) in the BFF and control app group,
respectively (RR 0.8 (95% CI 0.27 – 2.38)). At six weeks post-
partum, the majority of BFF users (n = 34 (52.3%)) rated their
app as providing the best breastfeeding support. Excluding wo-
men who did not utilize their study app (BFF n = 18 (21.4%);
control app n = 9 (10.6%)) did not affect outcomes.
Conclusions: Neither app improved breastfeeding rates among
low-income first-time mothers above the known baseline rates,
despite user perception that BFF was the best breastfeeding re-
source at six weeks postpartum. By demonstrating the feasibility
of app-based interventions within a particularly high-needs pop-
ulation, our research supports efforts in obstetrics to examining
whether mobile health improves peripartum health outcomes.
60. DOES INCREASED USE OF BREASTFEEDING
SMARTPHONE APPLICATIONS IMPROVE
BREASTFEEDING RATES AMONG LOW-INCOME
Laurie Griffin1, Julia López2, George Macones2,
Alison Cahill2, Adam Lewkowitz1
1
Women and Infants Hospital/Brown University, Providence,
Rhode Island, USA
2
Washington University in St. Louis, St. Louis, Missouri, USA
Category: Research
Background: Low-income women are less likely to breast-
feed compared to high-income women. Complex and simple
 POSTER ABSTRACTS
technology-based interventions have both shown promise in
decreasing postpartum health disparities. We aimed to determine
whether increased use of breastfeeding smartphone applications
(apps) impacts breastfeeding rates for low-income women.
Objective(s): To determine if breastfeeding initiation differed
between the highest and lowest quartiles of breastfeeding app users.
To determine if use of the breastfeeding app improved exclusive
and sustained breastfeeding until 6 months postpartum between the
highest and lowest quartiles of breastfeeding app users.
Materials/Methods: This is a planned secondary analysis of
an RCT including nulliparous, low-income English-speaking
Downloaded by FUNDAÇÃO UNIV. FEDERAL DE CIÊNCIAS DA SAÚDE DE PORTO ALEGRE from www.liebertpub.com at 09/30/21. For personal use only.
women at 36 weeks. In the parent trial, consenting women were
randomized to one of two apps: a skeleton app containing digital
breastfeeding handouts and BreastFeeding Friend(BFF), an app
designed to provide postpartum support via on-demand educa-
tional and video content. A secure website tracked app usage. For
this study, women were stratified into usage quartiles by app. The
highest quartile of BFF and skeleton app users were combined
into one group. The lowest quartile of each app’s users were
combined into another group. Outcomes were compared between
the highest and lowest quartiles of breastfeeding app users.
Results: Among 169 women in the parent study, usage was
similar in both apps (median 15 uses (Interquartile Range (IQR)
15 – 50 for BFF vs 19 uses (IQR 9 – 30) for skeleton app; p = 0.1).
This study included 44 women and 41 women in the highest and
lowest app-usage quartiles, respectively. Breastfeeding initiation
did not differ with app usage (84.1% (n = 37) in highest quartile
vs 78.2% (n = 32) for lowest quartile; p = 0.5). Rates of sustained
and exclusive breastfeeding from two days postpartum until six
months postpartum were similar in the two groups.
Conclusions: Increased usage of breastfeeding smartphone
applications did not improve breastfeeding rates among low-
income women. In this high-needs population, complex post-
partum environmental factors may decrease the effectiveness of
technology-based interventions attempting to increase breast-
feeding equity.
61. FOUR YEARS AFTER DONOR MILK
IMPLEMENTATION IN OUR MOTHER-BABY UNIT:
HOW ARE WE DOING?
Rana Alissa1, Patty Williams1, Erika Baker1,
Anuta Ciurte1, Carmen Smotherman1
1
University of Florida Jacksonville, Jacksonville, Florida, USA
Category: Research
Background: The World Health Organization (WHO) and the
American Academy of Pediatrics (AAP) recommend exclusive
breastfeeding for the first 6 months of life minimum. Many
studies showed that in-hospital exclusive breastfeeding after
birth is the key for a successful 6 months and beyond duration of
exclusive breastfeeding. Neonatal hypoglycemia, physiologic
neonatal jaundice, physiologic delay in colostrum production,
weight loss, and maternal exhaustion are some of the causes that
necessitate formula supplementation; which interrupts the nu-
merous benefits of exclusive breastfeeding and fall against WHO
and AAP recommendation. Replacing formula with donor milk
offers a bridge to balance the neonatal need for feeding supple-
mentation without interrupting exclusive breastfeeding.
Objective(s): Study the effect of donor milk’s supplementa-
tion on the rates of exclusive breastfeeding at the time of dis-
charge from the Mother-Baby Unit. Compare the exclusive
breastfeeding rate at the time of discharge from the Mother- Baby
unit before and after donor milk implementation.
A-29
Materials/Methods: This project was conducted at the Uni-
versity of Florida in Jacksonville, and it was approved by the
Institutional Review Board. Donor milk was implemented in our
Mother-Baby unit in October 2015. We collected the exclusive
breastfeeding rates at the time of discharge from the hospital four
years before and four years after donor milk implementation. The
monthly breastfeeding rates were used to calculate the average
rate of breastfeeding and its 95% confidence interval (CI) for
each time period. The averages breastfeeding rate between the
before- and after-implementation were compared using the
Wilcoxon rank sum test.
Results: On average, the breastfeeding rate was higher post-
implementation (average 45.9%, 95%CI 44.3%, 47.6%) com-
pared to pre-implementation (average 25.0%, 95%CI 23.5%,
26.49%, p < .0001).
Conclusions: The donor milk increased exclusive breast-
feeding rates during the four years after its implementation.
62. PRELIMINARY RESULTS FROM A SURVEY
OF THE PHARMACOLOGIC, HERBAL, AND
NUTRITIONAL GALACTAGOGUE PRESCRIBING
PRACTICES OF PHYSICIANS IN THE UNITED STATES
AND CANADA
Anna Sadovnikova1, Jane Sommers2, Sara Oberhelman3
1
University of California, Davis, Davis, California, USA
2
Dalhousie University, Nova Scotia, Canada
3
Mayo Clinic, Rochester, Minnesota, USA
Category: Research
Background: One of the most common reasons for premature
cessation of breastfeeding is insufficient milk production.
Healthcare providers and mothers often turn to medications,
foods, vitamins, and herbs to increase milk production; however,
there is limited evidence regarding the efficacy and safety of any
potential galactagogue. The United States (US) Food and Drug
Administration (FDA) has issued a black box warning regarding
the pharmacologic galactagogue, domperidone. To build the
evidence-base for the utilization of galactagogues, it is important
to characterize and compare the current state of galactagogue
knowledge, beliefs, and prescribing practices of physicians in the
US and Canada.
Objective(s): 1) Characterize the current state of pharmaco-
logic, herbal, and nutritional galactagogue knowledge, beliefs,
and prescribing practices of physicians in the US and Canada. 2)
Compare the galactagogue knowledge, beliefs, and prescribing
practices between physicians in the US and Canada. 3) Describe
the association between a physicians’ breastfeeding experience
and their likelihood to discuss, recommend, or prescribe various
potential galactagogues.
Materials/Methods: The Mayo Clinic Institutional Review
Board approved the study design and instrument (RedCap).
Study participants were physicians recruited from the Dr. MILK
(Doctor Mothers Interested in Lactation Knowledge) Facebook
group. The survey consisted of 5 sections with questions about
demographic information and prior breastfeeding experience and
practice patterns related to potential galactagogues: pharmaco-
logic agents, herbal supplements, vitamins and minerals, and
foods. Participants were asked to report on whether and why they
had ever discussed, recommended, or prescribed various ga-
lactagogues, how certain conditions (eg. poor access, lack of
research) may limit their practice, and which conditions (eg.
more education, quality control) would encourage them to in-
corporate galactagogues into their clinical practice. The
 A-30
association (odds ratio, OR) between a study participant’s geo-
graphic location (Canada or US) and their likelihood to discuss,
recommend, or prescribe a galactagogue was determined using
Fisher’s Exact Test, with ‘never’ as the reference group.
Results: A total of 314 study participants completed the
pharmacologic galactagogue section, with 263 physicians from
the US and 43 from Canada. Physicians in the US were more likely
to discuss (OR 7.45, P = .002) and prescribe (OR 6.8, P = .03)
metoclopramide. Canadian physicians were more likely to discuss
(OR 9.6, P < .0001), recommend (OR 28.3, P < .0001), and pre-
scribe (OR 67.8, P < .0001) domperidone. Canadian physicians
Downloaded by FUNDAÇÃO UNIV. FEDERAL DE CIÊNCIAS DA SAÚDE DE PORTO ALEGRE from www.liebertpub.com at 09/30/21. For personal use only.
were also more likely to prescribe levothyroxine (OR 5.5, P = .003)
and metformin (OR 4, P = .01) to increase milk supply.
Conclusions: Given the US FDA’s ban on the use of dom-
peridone for increasing milk production, it is not surprising that
physicians in the US are more likely to utilize metoclopramide
while Canadian physicians prescribe domperidone. Next steps in
data analysis are to define the association between a study par-
ticipant’s geographic location or breastfeeding experience and
their likelihood to discuss, recommend, or prescribe various
galactagogues.
63. QUALITATIVE STUDY EXPLORING THE LGBTQI
PARENTAL EXPERIENCE WITH INFANT NUTRITION
IN THE SETTING OF CURRENT BREASTFEEDING
GUIDELINES
Jason Jackson1, Lissette Moreno1, Rita Dadiz1
1
University of Rochester, Rochester, Minnesota, USA
Category: Research
Background: Nationally, 4.5% of the population identifies as
Lesbian, Gay, Bisexual, Transgender, Queer or Intersex
(LGBTQI), with 29% raising children. However, healthcare
providers are ill-equipped to adequately support LGBTQI par-
ents on infant nutrition and alternative feeding methods. Cur-
rently available research remains very limited from both the
healthcare provider and parental perspective.
Objective(s): To explore resources sought after and provided
to LGBTQI parents regarding feeding options and alternative
feeding methods during the prenatal, perinatal and early post-
partum periods. To identify challenges, both universal and un-
ique, that LGBTQI parents face in attempts to successfully meet
their infant feeding goals. To identify areas in which healthcare
providers have the opportunity to more fully support LGBTQI
parents in their infant nutrition decision making.
Materials/Methods: We conducted a qualitative study of
semi-structured interviews of LGBTQI parents with a <1-year-
old infant. Using convenience sampling, we recruited parents
in-person, via Facebook and from a Clinical and Translation
Science Institute research database. Interview questions were
iteratively revised, focusing on parental support, resources, de-
cisions and overall experience around infant nutrition during the
prenatal to neonatal period. We interviewed parents primarily via
Zoom videoconferencing, though face-to-face interviews were
offered when available based on the family’s location. Inter-
views were audio recorded, de-identified, and transcribed ver-
batim. We inductively analyzed transcripts using grounded
theory, applying immersion and crystallization cycles to iden-
tify and verify emergent themes. During this process, they de-
veloped visual aids to conceptualize the relationship between
themes and subthemes. To support the trustworthiness of data
analysis, a third party reviewed the codes for >75% of the
transcripts and participated in group discussions regarding
POSTER ABSTRACTS
emerging themes and subthemes. The investigators maintained
an audit trail of the coding process. Interviews continued until
thematic saturation was met, which was determined by agree-
ment between co-investigators.
Results: We conducted 12 interviews with families, with a
mixture of parental dyads together and only one parent, for a total
of 17 participants. Of the individuals interviewed, all were
married and Caucasian and non-Hispanic. The majority of the
participants were cis-gender females (80%) and identified as
homosexual (70%) which is typical of prior studies involving
LGBTQI parents. Uniquely we also had 10% of male respon-
dents and 10% gender non-binary/gender-queer participants. No
infant was hospitalized for more than a week. Respondents re-
sided in New York, Connecticut, Vermont, North Carolina,
Maine, and Washington State. Preliminary results revealed the
following themes:- Sources of nutrition support: Parents shifted
their primary sources of information from the internet prenatally
to counseling by nurses after delivery. Counseling did not in-
clude LGBTQI-specific information. - Traditional versus alter-
native feeding methods: Limited information about alternative
feeding methods such as induced lactation and simulated nursing
systems was available. Parents generally believed their options
consisted of breastfeeding by the gestational parent or formula
feeding. - Unexpected challenges; universal versus unique:
Limited support left many parents feeling unprepared for unex-
pected challenges when breastfeeding at home. - Inclusion of the
non-gestational parent: Level of involvement of the non-
gestational parent in the perinatal period to a greater extent than
during the early prenatal period had a greater influence on the non-
gestational parent’s feeling of inclusion and ability to bond with the
infant. - Implicit biases: Perceptions of normative feeding plans
and the environment in which families live influenced parental
attitudes and decisions. - Need for open communication: A com-
mon thread throughout all themes was that much of the work self-
guided research being done by the parents was not being shared
with the health care team and the health care providers in general
did not ask questions regarding parental feeding wishes. This is a
primary area of focus where future opportunities to improve could
be explored in the support of LGBTQI parents.
Conclusions: LGBTQI parents faced challenges obtaining
infant nutrition options and support. Opportunities exist for
healthcare providers to increase their knowledge of feeding op-
tions and challenges faced by LGBTQI parents to better help
them. These opportunities, though diverse among the LGBTQI
community, share a commonality in the reliance on open and
bias-free communication between the parents and all members of
the health care team.
64. BREASTFEEDING ATTITUDES AND PRACTICE
AMONGST MOTHERS WITH NEONATES
WITH CONGENITAL HEART DISEASE
Hanano Watanabe1, Leonardo Liberman1, Lauren Walzer1
1
Columbia University Medical Center, New York City,
New York, USA
Category: Research
Background: The health advantages of breastfeeding in the
general population are well-documented. Breastfeeding may play
an important role in infants with congenital heart disease (CHD).
To our knowledge, attitudes regarding breastfeeding in mothers
with infants with CHD (CHD mothers) have not been previously
assessed. A better understanding of breastfeeding determinants
may improve nutritional practices for infants with CHD.
 POSTER ABSTRACTS
Objective(s): We aimed to assess attitudes towards breast-
feeding in CHD mothers using the Iowa Infant Feeding Attitude
Scale (IIFAS). We sought to identify modifiable barriers to
breastmilk consumption in infants with CHD.
Materials/Methods: This is a prospective observational pilot
study. English-speaking mothers of well-babies and CHD infants
were enrolled. IIFAS was used to assess maternal attitudes to-
ward infant feeding and the Edinburgh Postnatal Depression
Scale was used to assess for postnatal depression. We collected
demographic data, information about mothers’ prior feeding
experiences and ideal feeding plans, and CHD medical data.
Downloaded by FUNDAÇÃO UNIV. FEDERAL DE CIÊNCIAS DA SAÚDE DE PORTO ALEGRE from www.liebertpub.com at 09/30/21. For personal use only.
Mothers completed surveys and questionnaires after birth and at
3 months.
Results: We enrolled 59 well-baby and 25 CHD mother-infant
dyads. Follow-up data were available on 33 dyads from the well-
baby and 24 from the CHD group; 6 patients from the CHD group
remained hospitalized at follow-up. Compared to the well-baby
group (63.7 – 7.3), the CHD mothers scored higher on the atti-
tude survey at birth (67.3 – 6.6) (p = 0.04). At follow-up, 22/33
(67%) well babies and 17/24 (71%) CHD babies were consuming
breastmilk (p = 0.12). Of the CHD babies discharged by the time
of follow-up, there was a non-significant difference noted in
hospital length of stay (days) between those consuming only
formula (n = 5) (median 13, IQR 13–19) compared to any amount
of breastmilk (n = 13) (median 33, IQR 15–52) (p = 0.17). Of the
CHD babies who were consuming only formula vs any breast-
milk at follow-up, the mothers’ Iowa Infant Feeding Attitude
Scores were significantly different at birth (60.85 – 5.64 vs
70 – 5.02; p = 0.0007) and at follow-up (57.5 – 4.37 vs
67.75 – 5.66; p = 0.0013).
Conclusions: CHD mothers scored higher on the breastfeed-
ing attitude survey than the nursery mothers. Mothers of CHD
infants may be more interested in breastfeeding their babies
compared to mothers of children without CHD. Most CHD
mothers had prior breastfeeding experience and were perhaps
more motivated to continue providing a diet consisting of any
amount of breastmilk for their infants. Interestingly, within the
CHD group, we noted significantly lower breastfeeding attitude
scores in mothers that provided an only-formula diet compared to
mothers that provided a diet containing some amount of breast-
milk. The IIFAS breast feeding attitude score may be helpful for
identifying mothers who may need interventions to increase
breastmilk consumption in their CHD infant. Future research
should devise interventions to support mothers who want to
breastfeed their infants with CHD.
65. LACK OF PERMANENCE IN MEASURES
OF SECRETORY ACTIVATION IN BREAST PUMP
DEPENDENT MOTHERS OF PREMATURE INFANTS
IN THE FIRST 14 DAYS POSTPARTUM
Clarisa Medina Poeliniz1, Judy Janes1, Maryan Arrieta1,
Abbey Mastroianni1, Aloka Patel1, Paula Meier1
1 66. PERCEPTIONS OF LACTATION-RELATED
Rush University Medical Center, Chicago, Illinois, USA
Category: Research
Background: Breast pump-dependent mothers who give birth
to premature infants cared for in the newborn intensive care unit
(NICU) experience delayed or impaired secretory activation
(SA) and achievement of coming to volume (pumping ‡500 mL
daily by postpartum day 14). Little is known about the rela-
tionship among pumping behaviors, pumped milk volume and
the permanence of SA as measured by milk Na: K ratios (Na: K
ratio <1.0).
A-31
Objective(s): To describe the lack of permanence in initial
achievement of SA and subsequent re-achievement of SA in 3
breast pump dependent mothers of premature infants during the
first 14 days postpartum, using precise measures of pumping
behaviors, pumped milk volume, and milk Na: K ratio.
Materials/Methods: This ongoing prospective observational
study measures pumping behaviors (daily pumping frequency
and total minutes pumped), pumped milk volume (nearest
0.1 mL) and daily maternal milk Na and K concentrations (LA-
QUA Twin Sodium and Potassium Meters; Horiba, Ltd, Kyoto,
Japan) during the first 14 days postpartum in breast pump-
dependent mothers of premature infants (<33 weeks gestation).
Pumping behaviors and pumped milk volume were measured
electronically using an adapted Symphony Breast Pump (Me-
dela, AG, Switzerland) with implanted microchip technology to
capture these measures. Of an anticipated sample of 30 mothers,
10 mothers have completed all study requirements. Of these 10
mothers, the data for 3 mothers revealed achievement and re-
achievement of SA over the first 14 days postpartum. These data
were graphed over the 14-day study period to examine the re-
lationships among the variables of interest.
Results: Of the 10 subjects (50% Black, 40 % White, 10%
other), the mean maternal age and infant gestational age were
30 – 5.7 years and 29.8 – 2.3 weeks, respectively, and maternal
pre-pregnancy BMI was 32.8 – 7. Nine of the ten mothers
achieved SA, all between days 3 and 6. However, data from 3 of
these 9 mothers revealed that 2 achieved SA on postpartum day
4, and 1 on postpartum day 6. For the 3 mothers, achievement of
SA was not permanent (Na: K ratio ‡1) over the 14 days. In each
case, the reversal preceded a brief interval (1–2 days) of de-
creased daily pumping frequency and total minutes pumped, but
without an abrupt decrease in pumped milk volume. Each mother
attributed the brief interruption in pumping to common clinical
scenarios for this population: a lengthy doctor’s visit for preg-
nancy complications that resulted in 2 missed pumping sessions;
a single day caring for children in the home when pumping
frequency decreased from 5 to 1; and the decision to stop
pumping entirely after having pumped >1300 mL only 5 days
earlier. In each instance a NICU nurse intervened, the mothers’
improved pumping behaviors and Na: K ratios returned to <1.0
within 1 day of the nurse’s intervention.
Conclusions: For the first time we report the lack of perma-
nence in achievement and reversal of SA during the first 14 days
postpartum in 3 breast pump-dependent mothers of premature
infants. Once achieving SA, brief interruptions in pumping be-
haviors resulted in a reversal of SA, which was re-achieved
within one day following timely, targeted interventions. These
data contribute critical information to the importance of estab-
lishing lactation in the first 14 days postpartum in this vulnerable
population and highlight the potential utility of using Na: K ratios
as point-of-care intervention in the clinical setting.
DISCRIMINATION EXPERIENCED BY PHYSICIAN
MOTHER TRAINEES
Caitlin Billingham1, Jessica Gold1, Caroline Rassbach1
1
Stanford Children’s Health, Stanford, California, USA
Category: Research
Background: There is growing recognition in the medical
literature of female physicians as a particularly at-risk breast-
feeding group. Due to a variety of unique barriers in the work-
place, physician mothers are less likely to meet their desired
 A-32
breastfeeding goals, despite federal, state, and local policies that
may exist to protect them. In addition, aggregate survey data
suggests that instances of maternal bias and discrimination in the
workplace are high, often directly related to pregnancy, mater-
nity leave, and breastfeeding practices. Female physician train-
ees have reported even more pronounced barriers than their
faculty counterparts. Our study aims to complement existing
quantitative data by describing the lived experience of trainees
who are pumping/breastfeeding at work.
Objective(s): Explore the experience of female trainees as
they navigate lactation at work while fulfilling clinical duties,
Downloaded by FUNDAÇÃO UNIV. FEDERAL DE CIÊNCIAS DA SAÚDE DE PORTO ALEGRE from www.liebertpub.com at 09/30/21. For personal use only.
and better understand workplace culture as it relates to lactation.
Describe perceptions of lactation-related bias or discrimination
witnessed or experienced. Summarize barriers and strategies for
improving the institutional environment surrounding lactation.
Materials/Methods: This is an IRB-approved, exploratory
study using qualitative methods with a phenomenological
framework. Data will be analyzed through the lens of Cruess
et al.’s conceptual model of professional identity formation in
medicine, with particular focus on factors that impact sociali-
zation in the workplace. We are conducting semi-structured fo-
cus groups of physician mother trainees (residents and fellows)
across disciplines within the Stanford housestaff community be-
tween January and May 2020. To meet inclusion criteria, partic-
ipants must self-report breastfeeding (includes pumping) at some
time during their current residency or fellowship training. Ques-
tions were developed using extensive literature review and con-
sensus of experts in both medical education and lactation to
appropriately address study objectives. Sessions are audio re-
corded and transcribed verbatim. Two authors will independently
code transcripts, with validation by a third author for consensus of
thematic analysis and by member checking for accuracy.
Results: To date, no prior studies have explored the collective
experience of breastfeeding trainees across disciplines at Stan-
ford. We anticipate that female resident and fellow trainees will
describe their personal experiences navigating lactation and
work, including any instances of maternal bias and discrimina-
tion they have encountered. Three focus groups have been con-
ducted thus far, with a fourth in progress. Data analysis is
expected to be completed by the end of June 2020. We hope our
study will highlight opportunities to promote workplace culture
change and help inform ways institutions can enhance their
support of physician mothers.
Conclusions: This study remains in-progress. Based on re-
sults, we will summarize the collective lived experience of
physician trainee mothers and use their voice to directly identify
opportunities to better support breastfeeding women in medicine
moving forward.
67. COMPARISON OF GROWTH AND MORBIDITIES
IN EXTREMELY LOW GESTATIONAL AGE INFANTS
FED STERILIZED SHELF-STABLE VERSUS HOLDER
PASTEURIZED DONOR HUMAN MILK
Sarah Jordan-Crowe1, Melindy Dorcin2, Cheryl Thompson2,
Deanne Wilson-Costello1, Jessica Madden1
1 1
Rainbow Babies and Children’s Hospital, Cleveland, Ohio, USA
2
Case Western Reserve University, Cleveland, Ohio, USA
Category: Research
Background: Preterm infants are known to be at increased
risk of poor growth and other morbidities, including sepsis and
retinopathy of prematurity (ROP), which is partly mitigated with
human milk. The protective role of human milk is especially
POSTER ABSTRACTS
important in the smallest neonates who are at highest risk.
However, it is unknown whether these benefits extend to donor
human milk (DM), especially when processed using retort
methods (involving a higher temperature and pressure to make
the product shelf-stable). Retort sterilization (used in commer-
cially available DM products) has been shown to significantly
reduce levels of protein, human milk oligosaccharides, antimi-
crobial proteins, and antibodies compared to milk which has been
processed using the Holder pasteurization method (utilized by
the Human Milk Banking Association of North America). To
date, there is not any published data comparing neonatal out-
comes of patients fed Holder pasteurized DM versus DM ster-
ilized via retort methods.
Objective(s): Compare growth in infants less than 27 weeks
gestational age (GA) fed sterilized vs pasteurized donor milk
products. Compare sepsis and development of severe ROP in
infants less than 27 weeks GA fed sterilized vs pasteurized donor
milk products.
Materials/Methods: We performed a retrospective cohort
study of all infants less than 27 weeks GA admitted to our urban
Level 4 NICU (Cleveland, OH) from January 2014 – December
2018 who were being fed DM at 28 days of life. There was an
institutional change in DM in June 2016 (from pasteurized to
sterilized). Infants were grouped according to the type of DM
they received. Those with congenital malformations were ex-
cluded. Severe ROP defined as ROP requiring anti-VEGF
treatment or laser surgery. Sepsis defined in accordance with the
neonatal Vermont-Oxford Network (VON). Statistical signifi-
cance assessed using a t-test or Fisher exact test.
Results: There were 51 infants who met inclusion criteria and
2 were excluded due to congenital anomalies. Of the remaining
49 infants, 31 were fed sterilized DM and 18 were fed pasteur-
ized DM. The infants had a mean GA of 25.1 weeks and birth-
weight of 790g (neither of which differed significantly between
the two groups). Infants in both groups had the same rate of daily
weight gain (22.9g for both, p = 0.98). The infants fed sterilized
DM had a significantly decreased rate of weekly head growth
(70mm) compared to those who received Holder pasteurized DM
(77mm, p = 0.03). There was also a trend (although statistically
insignificant) toward increased rates of both sepsis (10% vs 0%,
p = 0.29) and severe ROP (17% vs 11%, p = 0.7) in the retort
sterilized group compared to pasteurized.
Conclusions: The decreased head growth in neonates who
received sterilized shelf-stable DM rather than pasteurized DM is
clinically significant. It may have implications for worsened
neurodevelopmental outcomes given the known association be-
tween the two. The trend toward increasing rates of sepsis and
severe ROP in infants fed sterilized DM is also concerning. It
suggests the need for studies with increased sample sizes for
additional power to detect statistical differences.
68. US WOMEN’S AWARENESS THAT
BREASTFEEDING REDUCES BREAST CANCER RISK
Adrienne Hoyt-Austin1, Laura Kair1, Melanie Dove1,
Renata RA. Abrahao1, E. Bimla Schwarz1
UC Davis Medical Center, Sacramento, California, USA
Category: Research
Background: It is widely accepted in the medical community
that mothers who breastfeed their infants are less likely to de-
velop breast cancer. However, it is not known if US women have
awareness that breastfeeding is a modifiable protective factor in
the prevention of breast cancer.
 POSTER ABSTRACTS
Objective(s): To estimate the prevalence of US women’s
awareness that breastfeeding protects against the development of
breast cancer. To estimate differences in awareness that breast-
feeding protects against the development of breast cancer among
women with and without a personal history of breast cancer.
Materials/Methods: We conducted a population based cross-
sectional study using a weighted sample of 5554 female partic-
ipants of the National Survey for Family Growth aged 15–49,
years 2015–2017. Multivariable logistic regression was used to
examine associations between age, parity, breastfeeding history,
race, ethnicity, US birth, education, income, prior mammogram,
Downloaded by FUNDAÇÃO UNIV. FEDERAL DE CIÊNCIAS DA SAÚDE DE PORTO ALEGRE from www.liebertpub.com at 09/30/21. For personal use only.
family history of breast cancer, personal history of breast cancer,
and tobacco and alcohol use and women’s awareness of this
modifiable risk factor.
Results: Only 38.5% of US women were aware that breast-
feeding reduces risk of breast cancer. In women without a history
of breast cancer (N = 5519), nulliparous women (29% vs 46%,
aOR = 0.52, 95% CI = 0.37–0.71), parous women who never
breastfed (29% vs 55.1%, aOR = 0.43, CI = 0.31–0.58), those
with a high school education or less (34% vs 46%, aOR = 0.64,
95% CI = 0.53–0.77), and US born Hispanic women (33% versus
39%, aOR = 0.68, 95% CI = 0.52 – 0.89) were less likely to be
aware that breastfeeding reduces risk of breast cancer. Black
(46% vs 39%, aOR 2.72, 95% CI = 1.28 – 5.77), and Hispanic
(55% vs 39%, aOR 1.88, 95% CI = 1.39–2.54) women born out-
side of the US were more likely to have awareness of the pro-
tective effect of breastfeeding. In women with history of breast
cancer who had not breastfed, none (0 or 6 participants) were
aware that breastfeeding reduces risk. Awareness of this modifi-
able risk factor did not vary by family history of breast cancer,
prior receipt of mammogram, alcohol use, or smoking status.
Conclusions: Almost two-thirds of US women remain un-
aware that breastfeeding reduces risk for breast cancer. When
providing preconception counseling and lactation support, it is of
vital importance that clinicians mention to women the dose-
dependent breast cancer risk reduction that breastfeeding provides.
69. PARENTAL PERCEPTIONS AND PATTERNS
OF CANNABIS USE DURING PREGNANCY AND
BREASTFEEDING AT A CANADIAN TERTIARY
OBSTETRICS CENTRE
Anne Drover1, Sarah Manning1
1
Memorial University of Newfoundland, St. John’s,
Newfoundland and Labrador, Canada
Category: Research
Background: On October 17th, 2018, recreational cannabis
use became legalized in Canada. Tetrahydrocannabinol (THC) is
the main psychoactive compound in cannabis. It has the ability to
cross the placenta and enter fetal tissues during pregnancy and
accumulate in breast milk postpartum. There is limited research
on the long-term effects of cannabis use, particularly on the
developing brain. Canadian guidelines recommend that women
who are thinking about becoming pregnant, pregnant, or
breastfeeding should abstain from using cannabis.
Objective(s): The objective of this study was to investigate
parental perceptions of cannabis use during the pre- and post-natal
periods. The objective of this study was to investigate parental
patterns of cannabis use during the pre- and post-natal periods.
Materials/Methods: Participants were recruited from the
women’s health unit at a tertiary care centre; 103 patients or
partners of patients who were currently pregnant or less than
6 months post-partum were enrolled in the study. Participants
A-33
consented to complete an anonymous, online questionnaire in-
cluding previously validated demographic questions and newly
developed questions on cannabis use during pregnancy and
breastfeeding. Descriptive statistics and chi-square tests were
used for data analysis.
Results: Overall, 5.0% of pregnant women and 6.3% of
breastfeeding women used cannabis daily or weekly. Cannabis
use during pregnancy was found to be significantly associated
with lower level of education (p < 0.0001), cannabis use prior to
pregnancy (p < 0.05), and smoking or vaping tobacco during
pregnancy (p < 0.001; p < 0.0001). Among all participants, 22.3%
and 30.0% believed there was no harm or were unsure of the harm
associated with cannabis use during pregnancy and breastfeeding,
respectively. All of the women who used cannabis during preg-
nancy or breastfeeding indicated that knowledge of the possible
effects on the fetus or child would decrease their cannabis use. The
majority of participants reported obtaining their information on
cannabis use during breastfeeding from the internet (51.5%); while
only 12.9% reported receiving information from a family doctor,
7.9% from an OBGYN, and 3.0% from a pediatrician. Legalization
of cannabis had no reported effect on cannabis use during preg-
nancy and breastfeeding for the majority of participants.
Conclusions: It is clear that parents lack information about the
safety of cannabis use during pregnancy and breastfeeding.
Perinatal counselling should put an emphasis on educating par-
ents on the risks associated with cannabis use during fetal de-
velopment. In addition, given the overwhelming benefits of
breastfeeding, harm reduction approaches to cannabis use while
breastfeeding should be investigated.
70. SHORT-TERM NEONATAL OUTCOMES
OF COLOCATING AND BREASTFEEDING INFANTS
OF MOTHERS WHO TESTED POSITIVE
FOR SARS-COV-2
Parvathy Krishnan1, Lawrence Noble1, Uday Patil1
1
Icahn School of Medicine at Mount Sinai, New York City,
New York, USA
Category: Research
Background: There is a paucity of data on the neonatal out-
comes of maternal SARS-COV2 infection which has emerged as
a pandemic spreading rapidly across the world. Further, conflicts
in current guidelines exist on whether to routinely separate in-
fants from infected mothers in the hospital, to utilize shared
decision-making to regulate care or to encourage exclusive
breastfeeding and standard feeding guidelines for these infants.
At our hospital in New York City which has been the epicenter of
the infection in the US, shared decision-making between the
mother and clinical team was utilized. Mothers who elected to
room-in were encouraged to initiate skin-to-skin care and follow
routine breast-feeding practices while following strict hand
washing and use of masks. Infected mothers who were restricted
from NICU and mothers of isolated infants were encouraged to
provide pumped breastmilk. We aimed to elucidate the outcomes
of the infants born to mothers with COVID-19 infection fol-
lowing these practices.
Objective(s): To assess the outcomes of the infants born to
mothers with COVID-19 infection. To assess the rates of direct
breast feeding in the infants born to mothers with COVID-19
infection.
Materials/Methods: We identified all neonates born to
mothers who were tested positive for SARS-CoV-2 from March
19 to April 22, 2020 at Elmhurst Hospital Center. All infants
 A-34
were tested by nasopharyngeal PCR swabs. Data regarding de-
mographic, epidemiologic, clinical features, breastfeeding
practices and short-term outcomes including outpatient follow
up through tele-medicine or in-person visits were obtained by
retrospective chart review of medical records.
Results: Among 118 mothers tested during the study period,
45 (38%) of mothers tested positive of which 18(40%) was
asymptomatic. All the infants were screened for SARS-CoV-2
and none were positive. 3 infants initially tested positive for
SARS-CoV-2 on a screen at <24 hours of age, but tested negative
on 2 repeated screens and were considered false positives. All the
Downloaded by FUNDAÇÃO UNIV. FEDERAL DE CIÊNCIAS DA SAÚDE DE PORTO ALEGRE from www.liebertpub.com at 09/30/21. For personal use only.
infants were asymptomatic for COVID-19 in the hospital. De-
mographic characteristics are described in Table 1. 33 babies
were roomed with the mother while 7 required NICU admission.
5 newborns were isolated from the mother at birth due to ma-
ternal request. 31 infants were breastfed directly, 9 received
expressed breastmilk and 5 did not receive any breastmilk. 41
babies were discharged to the same household as mother, one is
still in the hospital and 3 were discharged to a different household
(Table 2). During follow up, there was a 93% adherence to the
initial in-person newborn visit while there was a 100 % com-
pliance to the tele-medicine visit around 14 days. All infants
were asymptomatic at follow up visits and none had COVID-19
related emergency department visits or subsequent hospital
admissions.
Conclusions: We report no short term adverse neonatal out-
comes to skin-to-skin care, rooming-in or breastfeeding in in-
fants of SARS-CoV-2 positive mothers in our population.
Although this data is preliminary, it could help decide best
practices for these infants.
71. HELPING EARLY BLOOMERS: EVALUATION
OF A LATE PRETERM BREASTFEEDING SUPPORT
PROGRAM
Katherine Standish1, Ginny Combs2, Lisa Zani2,
Cheryl Slater2, Barbara Philipp1
1
Boston University, Boston, Massachusetts, USA
2
Boston Medical Center, Boston, Massachusetts, USA
Category: Research
Background: Late preterm infants (LPI) have lower breast-
feeding rates than term infants, yet few studies have evaluated
LPI breastfeeding interventions. In April 2019, Boston Medical
Center, a Baby-Friendly designated hospital since 1999, im-
plemented the Early Bloomer Program, an interdisciplinary,
hospital-based breastfeeding support program among LPI not
requiring intensive care.
Objective(s): Measure differences in feeding outcomes
among LPI who did and did not receive the Early Bloomer
Program. Measure differences in neonatal outcomes among LPI
who did and did not receive the Early Bloomer Program.
Materials/Methods: The Early Bloomer Program includes an
order set applied at birth, immediate lactation consult, avail-
ability of donor milk, hand expression teaching and kit including
spoon and video link, and daily interdisciplinary team huddles.
We collected data from medical records of singleton infants born
at 36.0–36.6 weeks gestational age in the 24 months before and
12 months after program implementation. Exclusion criteria in-
cluded NICU admission, maternal HIV or active substance use
contraindicating breastfeeding, or significant social issues in-
cluding state custody of infant. We performed chi square and
t-tests to assess for significant differences between groups.
POSTER ABSTRACTS
Results: Among eligible infants born in the study period, 89
received the Early Bloomer Program order set (EBP) and 112 did
not (non-EBP). There were no significant differences in mean
birth weight, gestational age, Apgar scores, delivery mode, or
race/ethnicity. Maternal age was higher in the EBP group (mean
32.3 – 6.3 vs 30.5 – 6.0, p = 0.04). EBP and non-EBP infants had
similar rates of receiving any breastmilk (89.9% vs 90.2%
p = 0.9454). EBP infants were significantly more likely to receive
donor milk (23.6% vs 12.5%, p = 0.0394) and showed a trend
toward fewer one-year readmissions (11.2% vs 20.5%,
p = 0.0771).
Conclusions: Late preterm infants receiving the Early Bloo-
mer Program were more likely to receive donor milk and had
fewer one-year readmission rates. Future studies and interven-
tions are needed to further tailor breastfeeding support to late
preterm infants and their mothers.
72. BREASTFEEDING COUNSELING BASED
ON FORMATIVE RESEARCH AT PRIMARY CARE
HEALTH SERVICES IN MEXICO
Diana Bueno1, Uriel Romero1
1
Universidad Autonoma de Baja California, Baja California,
Mexico
Category: Research
Background: Breastfeeding rates in Mexico are one of the
lowest of Latin America with 14.4% of exclusive breastfeeding
under six months. There are even lower rates in the North of
Mexico (10.6%). Evidence shows that an effective way to im-
prove breastfeeding practices is by using culturally appropriate
counseling based on formative research.
Objective(s): The objective of this study was to evaluate the
effect of counseling at improving exclusive breastfeeding (EBF)
in primary care health services in Tijuana, México. The objective
of this study was to evaluate the effect of counseling at improving
exclusive breastfeeding (EBF) in primary care health services in
Tijuana, México.
Materials/Methods: This study is a randomized, controlled
trial pilot, where a convenience sampling of mothers received
breastfeeding counseling at an immunization service within a
Primary Care Health Center. Mothers of infants under 4 months
were randomized to a 1) Control Group, receiving counseling
about immunizations as well as routine infant feeding informa-
tion, and 2) Intervention Group, receiving breastfeeding coun-
seling based on previous formative research conducted in this
region (3). We evaluated changes in breastfeeding attitudes, self-
efficacy and EBF at 2 months post-intervention.
Results: Eighty mothers were included in the study (40 in
each group). The mean age was 26.4 years for mothers and 1.4
months for infants. Main breastfeeding obstacles reported were
breastfeeding in public (23%), pain (19%), insufficient milk
(15%) and returning to work (8%). We observed a significant
improvement in breastfeeding attitudes (P = 0.0001), self-
efficacy (P = 0.018) and EBF (P = 0.001). There was a 30% in-
crease in EBF in the intervention group and 15% decrease in the
control group, at 2 months post-intervention.
Conclusions: This pilot intervention based on formative re-
search in this population was successful to improve breastfeeding
attitudes, self-efficacy and practices. We are planning the ex-
pansion of this project to 10 health care centers. Breastfeeding
counseling integrated to the immunization program can be a
sustainable way to increase breastfeeding in this population,