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Jónsdóttir, R. B., Jónsdóttir, H., Skúladóttir, A., Thorkelsson, T. & Flacking, R. (2019). Breastfeeding progression in late preterm infants from birth to one month.. Maternal and Child Nutrition, Article ID e12893.
Open this publication in new window or tab >>Breastfeeding progression in late preterm infants from birth to one month.
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2019 (English)In: Maternal and Child Nutrition, ISSN 1740-8695, E-ISSN 1740-8709, article id e12893Article in journal (Refereed) Epub ahead of print
Abstract [en]

This study aimed to describe and compare breastfeeding progression, infants' feeding behaviours, maternal feeding difficulties, and mothers' usage of breastfeeding interventions for singleton late preterm (LPT) and term infants. A further aim was to identify associated factors for exclusive breastfeeding at breast at 1 month in LPT infants. This was a cohort study where mothers of LPT infants from a neonatal unit (n = 60), LPT infants from a maternity unit (n = 62), and term infants from a maternity unit (n = 269) answered a questionnaire approximately 1 month after delivery. Findings showed no significant differences in exclusive breastfeeding at breasts between LPT infants admitted to the neonatal unit compared with the maternity unit, during the first week at home (38% vs. 48%), or at 1 month of age (52% vs. 50%). Term infants were more likely to be exclusively breastfed at the breast (86% and 74%, p < 0.05) compared with LPT infants. Multiple regression analysis showed that usage of a nipple shield, not feeding breast milk exclusively during the first week at home, or feeding less than 10 times per day at 1 month were statistically significant for not exclusively breastfeed at the breast. A protective factor was the mothers' experience of having an abundance of milk during the first week at home. In conclusion, LPT infants are less likely to be exclusively breastfed at the breast than term infants, highlighting the need for further research to guide interventions aimed at optimising exclusive breastfeeding rates.

Keywords
breastfeeding pattern, exclusive breastfeeding, late preterm infants, maternity unit, neonatal intensive care unit, nipple shields
National Category
Nursing
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-30961 (URN)10.1111/mcn.12893 (DOI)000489120700001 ()31595692 (PubMedID)2-s2.0-85074047246 (Scopus ID)
Available from: 2019-10-16 Created: 2019-10-16 Last updated: 2019-11-07Bibliographically approved
Maastrup, R., Haiek, L. N., Lubbe, W., Meerkin, D. Y., Wolff, L., Hatasaki, K., . . . O'Donoghue, D. (2019). Compliance with the "Baby-friendly Hospital Initiative for Neonatal Wards" in 36 countries. Maternal and Child Nutrition, 15(2), Article ID e12690.
Open this publication in new window or tab >>Compliance with the "Baby-friendly Hospital Initiative for Neonatal Wards" in 36 countries
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2019 (English)In: Maternal and Child Nutrition, ISSN 1740-8695, E-ISSN 1740-8709, Vol. 15, no 2, article id e12690Article in journal (Refereed) Published
Abstract [en]

In 2012, the Baby-friendly Hospital Initiative for Neonatal Wards (Neo-BFHI) began providing recommendations to improve breastfeeding support for preterm and ill infants. This cross-sectional survey aimed to measure compliance on a global level with the Neo-BFHI's expanded Ten steps to Successful Breastfeeding and three Guiding Principles in neonatal wards. In 2017 the Neo-BFHI Self-Assessment questionnaire was used in 15 languages to collect data from neonatal wards of all levels of care. Answers were summarized into compliance scores ranging from 0 to 100 at the ward, country and international levels. A total of 917 neonatal wards from 36 low, middle and high-income countries from all continents participated. The median international overall score was 77, and median country overall scores ranged from 52 to 91. Guiding Principle 1 (respect for mothers), Step 5 (breastfeeding initiation and support), and Step 6 (human milk use) had the highest scores, 100, 88, and 88, respectively. Steps 3 (antenatal information) and 7 (rooming-in) had the lowest scores, 63 and 67, respectively. High-income countries had significantly higher scores for Guiding principle 2 (family-centered care), Step 4 (skin-to-skin contact) and Step 5. Neonatal wards in hospitals ever-designated Baby-friendly had significantly higher scores than those never designated. Sixty percent of managers stated they would like to obtain Neo-BFHI designation. Currently, Neo-BFHI recommendations are partly implemented in many countries. The high number of participating wards indicates international readiness to expand Baby-friendly standards to neonatal settings. Hospitals and governments should increase their efforts to better support breastfeeding in neonatal wards.

Keywords
Baby-friendly Hospital Initiative, breastfeeding, compliance, lactation, monitoring, neonatal, preterm
National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-28487 (URN)10.1111/mcn.12690 (DOI)000461886000007 ()30198645 (PubMedID)
Available from: 2018-09-17 Created: 2018-09-17 Last updated: 2019-04-11Bibliographically approved
Flacking, R., Breili C, C. & Eriksson, M. (2019). Facilities for presence and provision of support to parents and significant others in neonatal units. Acta Paediatrica, 108(12), 2186-2191
Open this publication in new window or tab >>Facilities for presence and provision of support to parents and significant others in neonatal units
2019 (English)In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 108, no 12, p. 2186-2191Article in journal (Refereed) Published
Abstract [en]

AIM: To describe parental facilities for staying in neonatal units, visiting policies, and access to emotional support during hospitalization.

METHODS: A cross-sectional design was used in which a survey was presented to all neonatal units in Sweden; 34 out of 38 units participated (89%).

RESULTS: The findings showed that in 50% of the units, parents could stay 24/7 for the infant's entire hospital stay. In 32% of the units, siblings could stay the night with their parents. Units had policies on restrictions for visits by siblings (80%), grandparents (59%), friends and relatives (71%). All units offered counselling to parents, and some units offered peer-to-peer groups (24%), diaries (35%), relaxation techniques (6%) or internet parental forums (6%). All units enabled parents to be at home with their infant and to visit the unit for check-ups (35%) or to have staff visits at home (65%).

CONCLUSION: Facilities for parents to stay with their infant during hospitalization and to have significant others visit are good, but there is room for improvement. During the transitional phase to being at home, parents are facilitated in being at home before the infant is discharged and are supported by the unit, which must be considered beneficial for parents. This article is protected by copyright. All rights reserved.

National Category
Nursing
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-30593 (URN)10.1111/apa.14948 (DOI)000484771100001 ()31350769 (PubMedID)2-s2.0-85071867917 (Scopus ID)
Note

Open Access APC beslut nr 13/2019

Available from: 2019-08-06 Created: 2019-08-06 Last updated: 2019-11-25Bibliographically approved
Tandberg, B. S., Flacking, R., Markestad, T., Grundt, H. & Moen, A. (2019). Parent psychological wellbeing in a single-family room versus an open bay neonatal intensive care unit.. PLoS ONE, 14(11), Article ID e0224488.
Open this publication in new window or tab >>Parent psychological wellbeing in a single-family room versus an open bay neonatal intensive care unit.
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2019 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 14, no 11, article id e0224488Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Studies of parents' psychological well-being in single-family rooms in neonatal intensive care units have shown conflicting results.

AIMS: To compare emotional distress in the form of depression, anxiety, stress and attachment scores among parents of very preterm infants cared for in a single-family rooms unit vs an open bay unit.

STUDY DESIGN: Prospective survey design.

SUBJECT: Parents (132) of 77 infants born at 28 0/7-32 0/7 weeks of gestation in the two units.

OUTCOME MEASURES: Duration of parental presence was recorded. Scores for depression (The Edinburgh Postnatal Depression Scale), anxiety (The State-Trait-Anxiety Inventory, Short Form Y), stress (The Parent Stressor Scale: neonatal intensive care unit questionnaire and The Parenting Stress Index-short form) and attachment (Maternal Postnatal Attachment Scale) measured 14 days after delivery, at discharge, expected term date and four months post-term.

RESULTS: Parents were present 21 hours/day in the single-family room unit vs 7 hours/day in the Open bay unit. Ninety-three percent of the fathers in the single-family rooms unit were present more than 12 hours per day during the first week. Mothers in the single-family rooms had a significantly lower depression score -1.9 (95% CI: -3.6, -0.1) points from birth to four months corrected age compared to mothers in the Open bay unit, and 14% vs 52% scored above a cut-off point considered being at high risk for depression (p<0.005). Both mothers and fathers in the single-family rooms reported significantly lower stress levels during hospitalization. There were no differences between the groups for anxiety, stress or attachment scores after discharge.

CONCLUSION: The lower depression scores by the mothers and lower parental stress scores during hospitalization for both parents supports that single-family rooms care contribute to parents' psychological wellbeing.

National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-31126 (URN)10.1371/journal.pone.0224488 (DOI)31689307 (PubMedID)2-s2.0-85074515724 (Scopus ID)
Available from: 2019-11-22 Created: 2019-11-22 Last updated: 2019-12-06
Osman, F., Flacking, R., Klingberg-Allvin, M. & Schön, U.-K. (2019). Qualitative study showed that a culturally tailored parenting programme improved the confidence and skills of Somali immigrants. Acta Paediatrica, 108(8), 1482-1490
Open this publication in new window or tab >>Qualitative study showed that a culturally tailored parenting programme improved the confidence and skills of Somali immigrants
2019 (English)In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 108, no 8, p. 1482-1490Article in journal (Refereed) Published
Abstract [en]

AIM: Parenting programmes tailored to immigrant parents have been reported to improve the mental health of the children and parents, as well as parents' sense of competence in parenting. However, research on parents' experiences of programmes tailored to their needs is scarce. This qualitative study aimed to describe Somali parents' experiences of how a culturally sensitive programme affected their parenting.

METHODS: The study was conducted in a middle-sized city in Sweden in 2015. Data were collected through semi-structured interviews with 50 participants two months after they took part in a parenting support programme. Inductive and deductive qualitative content analyses were used.

RESULTS: A light has been shed was a metaphor that emerged from the analysis and that captured the knowledge the parents gained from the parenting system in Sweden. Parents gained confidence in their parenting role and became emotionally aware of their child's social and emotional needs and how to respond to them. Holding the sessions in the participant's native language was important for the parents' participation and acceptance of the programme.

CONCLUSION: Parenting programmes should be tailored to the specific needs of the participants and cultural sensitivity should be factored into programmes to attract immigrant parents. This article is protected by copyright. All rights reserved.

Keywords
cultural sensitivity, effective parenting, family relationships, immigrants, parenting programmes
National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-29761 (URN)10.1111/apa.14788 (DOI)000474935600019 ()30896042 (PubMedID)2-s2.0-85064519588 (Scopus ID)
Available from: 2019-03-26 Created: 2019-03-26 Last updated: 2019-07-29Bibliographically approved
Joffer, J., Flacking, R., Bergström, E., Randell, E. & Jerdén, L. (2019). Self-rated health, subjective social status in school and socioeconomic status in adolescents: a cross-sectional study. BMC Public Health, 19, Article ID 785.
Open this publication in new window or tab >>Self-rated health, subjective social status in school and socioeconomic status in adolescents: a cross-sectional study
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2019 (English)In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 19, article id 785Article in journal (Refereed) Published
Abstract [en]

Background: Social position, traditionally measured by objective data on socioeconomic status (SES), is linked to health status in adults. In adolescents, the association is more uncertain and there are some studies suggesting that subjective social status (SSS) might be more adequate in relation to health. This study aimed to examine associations between SSS in school, SES and self-rated health (SRH) in adolescent boys and girls.

Methods: A descriptive cross-sectional research design with quantitative survey data was used. The study involved 705 Swedish adolescents in upper secondary school (17–18-year-olds). SRH was measured with a single-item question and SSS by a question where adolescents were asked to assess their social position within their school. Formal education level of the parents was used as a proxy for objective SES. Univariable and multivariable ordinal regression analyses were conducted to assess the associations between SRH and SSS in school and SES.

Results: In the multivariable analysis, SSS in school was positively associated with SRH, whereas no significant association between SES and SRH was found. The proportion of adolescents with high SRH increased with higher steps on the SSS ladder. Significant gender differences were found in that boys rated their SRH and SSS in school higher than girls did.

Conclusions: The study shows that self-rated health in adolescents is related to perceived social position in school. Subjective social status in school seems to be a useful health-related measure of social position in adolescents.

Keywords
Adolescents, Gender Health status, Self-rated health, Socioeconomic status, Subjective social status
National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-30374 (URN)10.1186/s12889-019-7140-3 (DOI)000472845800005 ()31221114 (PubMedID)2-s2.0-85067561580 (Scopus ID)
Available from: 2019-06-24 Created: 2019-06-24 Last updated: 2019-07-23Bibliographically approved
Tandberg, B. S., Frøslie, K. F., Markestad, T., Flacking, R., Grundt, H. & Moen, A. (2019). Single-family room design in the neonatal intensive care unit did not improve growth. Acta Paediatrica, 108(6), 1028-1035
Open this publication in new window or tab >>Single-family room design in the neonatal intensive care unit did not improve growth
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2019 (English)In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 108, no 6, p. 1028-1035Article in journal (Refereed) Published
Abstract [en]

AIM: The aim was to compare growth in very premature infants cared for in a single-family room and an open-bay unit. We recorded duration of parental presence and skin-to-skin contact as proxies for parental involvement in care of their infants.

METHODS: We consecutively included infants with gestational ages 28+0 through 32+0 weeks at two hospitals in Norway, one single-family room unit (n=35) and one open-bay unit (n=42). Weight, length, and head circumference were followed from birth to four months after term date. Both units adhered to the same nutritional protocol and methods of recording events.

RESULTS: The single-family room mothers spent a mean (standard deviation) of 111 (38) hours and the open bay mothers 33 (13) hours with their infants during the first week and 21 (5) versus 7 (3) hours per day later. The respective duration of skin-to-skin care was 21 (10) versus 12 (8) hours during the first week and 4.2 (2) versus 3.0 (2) hours per day later. The differences were similar, but less pronounced for the fathers. The growth trajectories did not differ between the groups.

CONCLUSION: Single-family room care was associated with more parental involvement, but not with better growth. This article is protected by copyright. All rights reserved.

Keywords
Family-centred care, Growth, Single-family room, Skin-to-skin contact, Very premature infant
National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-29461 (URN)10.1111/apa.14746 (DOI)000467867900010 ()30729563 (PubMedID)2-s2.0-85062990829 (Scopus ID)
Available from: 2019-02-11 Created: 2019-02-11 Last updated: 2019-06-03Bibliographically approved
Ahrne, M., Adan, A., Schytt, E., Andersson, E., Small, R., Flacking, R. & Byrskog, U. (2018). Antenatal care for Somali born women in Sweden – perspectives from mothers, fathers and midwives. In: European Journal of Public Health, Volume 28, Issue suppl_1, May 2018: . Paper presented at 1st World Congress on Migration, Ethnicity, Race and Health, 17-19 May 2018, Edinburgh. , 28
Open this publication in new window or tab >>Antenatal care for Somali born women in Sweden – perspectives from mothers, fathers and midwives
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2018 (English)In: European Journal of Public Health, Volume 28, Issue suppl_1, May 2018, 2018, Vol. 28Conference paper, Oral presentation with published abstract (Refereed)
Series
European Journal of Public Health, ISSN 1101-1262
National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-30423 (URN)10.1093/eurpub/cky047.252 (DOI)
Conference
1st World Congress on Migration, Ethnicity, Race and Health, 17-19 May 2018, Edinburgh
Available from: 2019-06-26 Created: 2019-06-26 Last updated: 2019-06-26Bibliographically approved
Ericson, J., Eriksson, M., Hoddinott, P., Hellström-Westas, L. & Flacking, R. (2018). Breastfeeding and risk for ceasing in mothers of preterm infants - long-term follow-up. Maternal and Child Nutrition, 14(4), Article ID e12618.
Open this publication in new window or tab >>Breastfeeding and risk for ceasing in mothers of preterm infants - long-term follow-up
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2018 (English)In: Maternal and Child Nutrition, ISSN 1740-8695, E-ISSN 1740-8709, Vol. 14, no 4, article id e12618Article in journal (Refereed) Published
Abstract [en]

Breastfeeding is challenging for mothers of preterm infants. The aim of this paper is to describe risk factors for ceasing breastfeeding and methods of feeding until 12 months postnatal age in mothers who breastfed their preterm infants at discharge from neonatal intensive care units (NICUs). The data come from a randomised controlled trial, which evaluated the effectiveness on exclusive breastfeeding at 8 weeks of proactive telephone support compared with reactive support offered to mothers of preterm infants following discharge from NICU. Six NICUs across Sweden randomised a total of 493 mothers. We used regression and survival analyses to assess the risk factors for ceasing breastfeeding and the long-term outcomes of the intervention. The results showed that 305 (64%) of the infants were breastfed at 6 months and 49 (21%) at 12 months. Partial breastfeeding at discharge, low maternal educational level, and longer length of stay in the NICU increased the risk for ceasing breastfeeding during the first 12 months. Furthermore, the Kaplan-Meier analysis showed that the proportion of mothers who ceased breastfeeding did not differ between the intervention (n = 231) and controls (n = 262) during the first 12 months (log-rank test p = .68). No difference was found between groups on method of feeding. More than 85% of the infants were fed directly at the breast. These findings provide important insights for health professionals who are supporting mothers of preterm infants to breastfeed long term.

Registered in www.clinicaltrials.gov (NCT01806480).

Keywords
RCT, bottle, breast milk, feeding, mother, neonatal
National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-27651 (URN)10.1111/mcn.12618 (DOI)000448900800013 ()29733102 (PubMedID)2-s2.0-85046532136 (Scopus ID)
Note

Open Access APC beslut 11/2018

Available from: 2018-05-09 Created: 2018-05-09 Last updated: 2018-11-15Bibliographically approved
Tandberg, B. S., Frøslie, K. F., Flacking, R., Grundt, H., Lehtonen, L. & Moen, A. (2018). Parent-infant closeness, parents' participation, and nursing support in single-family room and open bay NICUs. Journal of Perinatal & Neonatal Nursing, 32(4), E22-E32
Open this publication in new window or tab >>Parent-infant closeness, parents' participation, and nursing support in single-family room and open bay NICUs
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2018 (English)In: Journal of Perinatal & Neonatal Nursing, ISSN 0893-2190, E-ISSN 1550-5073, Vol. 32, no 4, p. E22-E32Article in journal (Refereed) Published
Abstract [en]

This was a prospective survey study, comparing parent-infant closeness, parents' perceptions of nursing support, and participation in medical rounds in single-family room (SFR) and an open bay (OB) neonatal intensive care units. Nurses' assessments of provided support were also measured. In total, 115 parents of 64 preterm infants less than 35 weeks' gestational age and 129 nurses participated. Parents recorded the presence and skin-to-skin care. Parents were sent 9 text message questions in random order. Nurses answered corresponding Internet-based questions. SFR mothers were more present, 20 hours daily (median) versus 7 hours (P < .001), initiated skin-to-skin contact (SSC) at 4 versus 12 hours (P = .03), and preformed SSC 180 min/24 h versus 120 min/24 h for mothers in the OB unit (P = .02). SFR fathers were also more present, 8 versus 4 hours (P < .001), initiated SSC at 3 versus 40 hours (P = .004), and performed SSC 67 min/24 h versus 31 min/24 h (P = .05). SFR parents rated participation in medical rounds and emotional support higher than OB parents. Parental trust was rated higher by nurses in the OB unit (P = .02). SFR facilitated parent-infant closeness, parents' participation in medical rounds, and increased support from nurses.

National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-28848 (URN)10.1097/JPN.0000000000000359 (DOI)000450894700003 ()30358674 (PubMedID)2-s2.0-85055610909 (Scopus ID)
Available from: 2018-10-29 Created: 2018-10-29 Last updated: 2019-02-19Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-4013-1553

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