Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Published:

Skilled lactation support using telemedicine in the neonatal intensive care unit

Journal of Perinatology volume 44, pages 687–693 (2024)Cite this article

Subjects

Abstract

Background

NICU mothers face unique challenges in initiating and sustaining breastfeeding, but previous studies have focused on outpatient breastfeeding support. We conducted a retrospective study of NICU breastfeeding outcomes before and after implementing telelactation.

Methods

Pre-Telemedicine mothers received in-person support by NICU lactation consultants, while Telemedicine mothers received solely telemedicine consults after maternal discharge.

Results

Exclusive breastmilk feeding at discharge increased in the Telemedicine group. Notably, babies in the Telemedicine cohort who were fed any formula on admission experienced significant improvement in exclusive breastmilk feeding at discharge, and those whose mothers received at least one NICU lactation consult had the greatest improvement in exclusive breastfeeding rates at discharge.

Conclusions

This study is the first to validate the use of telemedicine as a means of maintaining access to skilled lactation support in the NICU when in-person consults are not feasible. Incorporating telemedicine can ensure access and continuity of skilled lactation support, and sustain breastfeeding rates.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Fig. 1: Diagram of the derivation of the cohorts.

Similar content being viewed by others

Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

References

  1. Prevention CfDCa. Breastfeeding Report Card United States, 2020. National Center for Chronic Disease Prevention and Health Promotion; (2020).

  2. US Department of Health and Human Services OoDPaHP. Healthy People 2030: Infants [Available from: https://health.gov/healthypeople/objectives-and-data/browse-objectives/infants.

  3. Organization WH Infant and Young Child Feeding 2021 [updated June 9, 2021. Available from: https://www.who.int/news-room/fact-sheets/detail/infant-and-young-child-feeding.

  4. Meek JY, Noble L. Technical report: breastfeeding and the use of human milk. Pediatrics 2022;150:e2022057989.

    Article  PubMed  Google Scholar 

  5. Meek JY, Noble L, Section on B. Policy statement: breastfeeding and the use of human milk. Pediatrics 2022;150:e2022057988.

    Article  PubMed  Google Scholar 

  6. Haase B, Brennan E, Wagner CL. Effectiveness of the IBCLC: have we made an impact on the care of breastfeeding families over the past decade? J Hum Lact. 2019;35:441–52.

    Article  PubMed  Google Scholar 

  7. Kuan LW, Britto M, Decolongon J, Schoettker PJ, Atherton HD, Kotagal UR. Health system factors contributing to breastfeeding success. Pediatrics. 1999;104:e28.

    Article  CAS  PubMed  Google Scholar 

  8. Patel S, Patel S. The effectiveness of lactation consultants and lactation counselors on breastfeeding outcomes. J Hum Lact. 2016;32:530–41.

    Article  PubMed  Google Scholar 

  9. Dweck N, Augustine M, Pandya D, Valdes-Greene R, Visintainer P, Brumberg HL. NICU lactation consultant increases percentage of outborn versus inborn babies receiving human milk. J Perinatol. 2008;28:136–40.

    Article  CAS  PubMed  Google Scholar 

  10. The Surgeon General’s Call to Action to Support Breastfeeding. Publications and Reports of the Surgeon General. Rockville (MD) (2011).

  11. Patnode CD, Henninger ML, Senger CA, Perdue LA, Whitlock EP. Primary care interventions to support breastfeeding: updated evidence report and systematic review for the US Preventive Services Task Force. JAMA. 2016;316:1694–705.

    Article  PubMed  Google Scholar 

  12. Organization WH Infant and Young Child Feeding: Model Chapter for textbooks for medical students and allied health professionals. Switzerland: WHO Press; (2009).

  13. Gianni ML, Bettinelli ME, Manfra P, Sorrentino G, Bezze E, Plevani L, et al. Breastfeeding difficulties and risk for early breastfeeding cessation. Nutrients 2019;11:2266.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Gianni ML, Bezze EN, Sannino P, Baro M, Roggero P, Muscolo S, et al. Maternal views on facilitators of and barriers to breastfeeding preterm infants. BMC Pediatr. 2018;18:283.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Ikonen R, Paavilainen E, Kaunonen M. Preterm infants’ mothers’ experiences with milk expression and breastfeeding: an integrative review. Adv Neonatal Care. 2015;15:394–406.

    Article  PubMed  Google Scholar 

  16. Spatz DL, Davanzo R, Muller JA, Powell R, Rigourd V, Yates A, et al. Promoting and protecting human milk and breastfeeding in a COVID-19 World. Front Pediatr. 2020;8:633700.

    Article  PubMed  Google Scholar 

  17. UNICEF. Breastfeeding when sick [Available from: https://www.unicef.org/parenting/health/breastfeeding-when-sick.

  18. UNICEF Navigating pregnancy during the COVID-19 pandemic 2022 [updated October 21, 2022]. Available from: https://www.unicef.org/coronavirus/navigating-pregnancy-during-coronavirus-disease-covid-19-pandemic#covid-breastfeeding.

  19. Organization WH Home care for patients with suspected or confirmed COVID-19 and management of their contacts: Interim guidance. 2020 August 12, (2020).

  20. ABM Statement on Coronavirus 2019 (COVID-19) [press release]. (2020).

  21. UNFPA statement on novel coronavirus (COVID-19) and pregnancy [press release]. March 5, 2020 (2020).

  22. Continuing to Nurse Your Baby Through Coronavirus (2019-nCoV; COVID-19) and Other Respiratory Infections [press release]. February 19, 2020 (2020).

  23. ILCA Statement on Breastfeeding and Lactation Support During the COVID-19 Pandemic [press release]. March 18, 2020 (2020).

  24. Pace RM, Williams JE, Jarvinen KM, Belfort MB, Pace CDW, Lackey KA, et al. Characterization of SARS-CoV-2 RNA, Antibodies, and Neutralizing Capacity in Milk Produced by Women with COVID-19. mBio. 2021;12:e03192–20.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Ismail S, Unger S, Budylowski P, Poutanen S, Yau Y, Jenkins C, et al. SARS-CoV-2 antibodies and their neutralizing capacity against live virus in human milk after COVID-19 infection and vaccination: prospective cohort studies. Am J Clin Nutr. 2023;119:485–95.

  26. Telehealth Claim Lines Increase 8,336 Percent Nationally from April 2019 to April 2020 [press release].

  27. Glassman ME, Sarakki AP, Katz-Feigenbaum D, Zitaner J, Thind P, Stockwell MS. The Use of a Medical Center-Based Outpatient Breastfeeding Support Program with Telelactation to Provide Ongoing Breastfeeding Support to a Diverse Patient Population. Breastfeed Med. 2023;18:362–9.

    Article  PubMed  Google Scholar 

  28. Walker K, Green J, Petty J, Whiting L, Staff L, Bromley P, et al. Breastfeeding in the context of the COVID-19 pandemic: A discussion paper. J Neonatal Nurs. 2022;28:9–15.

    Article  PubMed  Google Scholar 

  29. Badr H, Alghamdi S. Breastfeeding Experience among Mothers during the COVID-19 Pandemic. Int J Environ Res Public Health. 2022;19:4535.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Siwik E, Larose S, Peres D, Jackson KT, Burke SM, Mantler T. Experiences of At-Risk Women in Accessing Breastfeeding Social Support During the Covid-19 Pandemic. J Hum Lact. 2022;38:422–32.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Lubbe W, Niela-Vilen H, Thomson G, Botha E. Impact of the COVID-19 Pandemic on Breastfeeding Support Services and Women’s Experiences of Breastfeeding: A Review. Int J Women’s Health. 2022;14:1447–57.

    Article  Google Scholar 

  32. Pacheco F, Sobral M, Guiomar R, de la Torre-Luque A, Caparros-Gonzalez RA, Ganho-Avila A. Breastfeeding during COVID-19: A Narrative Review of the Psychological Impact on Mothers. Behav Sci (Basel). 2021;11:34.

    Article  PubMed  Google Scholar 

  33. Broom M, Youseman ME, Kent AL. Impact of introducing a lactation consultant into a neonatal unit. J Paediatr Child Health. 2022;58:636–40.

    Article  PubMed  Google Scholar 

  34. Hoban R, McLean L, Sullivan S, Currie C. Proactive Lactation Care is Associated With Improved Outcomes in a Referral NICU. J Hum Lact. 2022;38:148–55.

    Article  PubMed  Google Scholar 

  35. Mercado K, Vittner D, McGrath J. What Is the Impact of NICU-Dedicated Lactation Consultants? An Evidence-Based Practice Brief. Adv Neonatal Care. 2019;19:383–93.

    Article  PubMed  Google Scholar 

  36. Graham EQ, e ROPCG. Telemedicine approaches to evaluating acute-phase retinopathy of prematurity: study design. Ophthalmic Epidemiol. 2014;21:256–67.

    Article  Google Scholar 

  37. Fang JL, Campbell MS, Weaver AL, Mara KC, Schuning VS, Carey WA, et al. The impact of telemedicine on the quality of newborn resuscitation: A retrospective study. Resuscitation. 2018;125:48–55.

    Article  PubMed  Google Scholar 

  38. Sable CA, Cummings SD, Pearson GD, Schratz LM, Cross RC, Quivers ES, et al. Impact of telemedicine on the practice of pediatric cardiology in community hospitals. Pediatrics. 2002;109:E3.

    Article  PubMed  Google Scholar 

  39. Makkar A, McCoy M, Hallford G, Foulks A, Anderson M, Milam J, et al. Evaluation of Neonatal Services Provided in a Level II NICU Utilizing Hybrid Telemedicine: A Prospective Study. Telemed J E Health. 2020;26:176–83.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Hoffman AM, Lapcharoensap W, Huynh T, Lund K. Historical Perspectives: Telemedicine in Neonatology. Neoreviews. 2019;20:e113–e23.

    Article  PubMed  Google Scholar 

  41. Nandula PS, Hudak ML. Remote Lactation Support in the COVID-19 Era. Neoreviews. 2021;22:e392–e7.

    Article  PubMed  Google Scholar 

  42. Uscher-Pines L, Ghosh-Dastidar B, Bogen DL, Ray KN, Demirci JR, Mehrotra A, et al. Feasibility and Effectiveness of Telelactation Among Rural Breastfeeding Women. Acad Pediatr. 2020;20:652–9.

    Article  PubMed  Google Scholar 

  43. Demirci J, Kotzias V, Bogen DL, Ray KN, Uscher-Pines L. Telelactation via Mobile App: Perspectives of Rural Mothers, Their Care Providers, and Lactation Consultants. Telemed J E Health. 2019;25:853–8.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Habibi MF, Springer CM, Spence ML, Hansen-Petrik MB, Kavanagh KF. Use of Videoconferencing for Lactation Consultation: An Online Cross-Sectional Survey of Mothers’ Acceptance in the United States. J Hum Lact. 2018;34:313–21.

    Article  PubMed  Google Scholar 

  45. Feinstein JSE, Bernstein HH. Telehealth Can Promote Breastfeeding During the COVID-19 Pandemic. New Engl J Med Catalyst. 2021;1–11.

  46. Flacking R, Nyqvist KH, Ewald U. Effects of socioeconomic status on breastfeeding duration in mothers of preterm and term infants. Eur J Public Health. 2007;17:579–84.

    Article  PubMed  Google Scholar 

  47. Dhillon S, Dhillon PS. Telelactation: A Necessary Skill With Puppet Adjuncts During the COVID-19 Pandemic. J Hum Lact. 2020;36:619–21.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

We appreciate the hard work of Jitzy Marrero, Administrative Assistant and Billing Coordinator, for her meticulous bookkeeping and for providing access to submitted bills.

Funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. The authors have no financial relationships relevant to this article to disclose.

Author information

Authors and Affiliations

  1. Division of Neonatology, Maria Fareri Children’s Hospital, Valhalla, New York, USA

    Melanie Leong, Maria Obaid, Maria Cristina Fernandez Ramos & Boriana Parvez

  2. Westchester Medical Center, Valhalla, New York, USA

    Melanie Leong, Maria Obaid, Maria Cristina Fernandez Ramos, Regina Eichenberger, Annamma John, Patricia Krumholtz-Belkin, Tina Roeder & Boriana Parvez

  3. Department of Pediatrics, New York Medical College, Valhalla, New York, USA

    Melanie Leong & Boriana Parvez

Authors
  1. Melanie Leong
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Maria Obaid
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Maria Cristina Fernandez Ramos
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Regina Eichenberger
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Annamma John
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Patricia Krumholtz-Belkin
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Tina Roeder
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Boriana Parvez
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

ML collected and reviewed data, interpreted results, and revised several versions of the manuscript. MO collected data and contributed to the initial draft. MCFR contributed to the initial draft. RE performed lactation consults and contributed to the initial draft. AJ and PKB performed lactation consults. TR collected data. BP designed the study, and critically reviewed and revised the manuscript. All authors reviewed the results and approved the final version of the manuscript.

Corresponding author

Correspondence to Melanie Leong.

Ethics declarations

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Leong, M., Obaid, M., Fernandez Ramos, M.C. et al. Skilled lactation support using telemedicine in the neonatal intensive care unit. J Perinatol 44, 687–693 (2024). https://doi.org/10.1038/s41372-024-01894-7

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41372-024-01894-7

Search

Advanced search

Quick links