Breastfeeding Success Among Infants With Congenital Heart Disease

Kimberly H. Barbas; Deanne K. Kelleher


Pediatr Nurs. 2004;30(4) 

In This Article

Abstract and Introduction

It is a widespread misconception that infants with congenital heart disease (CHD) are not able to breastfeed. The purpose of this study was to describe breastfeeding duration and outcomes among a high-risk group of infants with CHD. Mothers of 68 infants at least 6 months of age, who had experienced cardiac surgery during the neonatal period, were surveyed regarding breastfeeding and milk expression habits. Results for this sample of infants were compared to a benchmark study conducted in 1993 at the same institution that described breastfeeding outcomes for 45 infants with CHD. Improved outcomes for the 1998-2000 sample are attributed to an active lactation consultation program instituted in 1998. These findings suggest that given support and education necessary to initiate and maintain lactation, mothers can successfully breastfeed their infants with CHD for durations recommended by the Healthy People 2010 initiative.

The ability of infants with congenital heart disease (CHD) to breastfeed successfully is not well documented in the literature. The incidence of CHD in the U.S. population is estimated at 8/1,000 live births, or approximately 30,000-35,000 children per year. In spite of a study by Marino, O'Brien, and LoRe (1995), indicating that oxygen saturations were maintained at higher and less variable levels during breastfeeding, it is a common misconception that breastfeeding is more difficult and requires more effort than bottle-feeding for infants with CHD. Another study by Combs and Marino (1993) demonstrated breastfed infants with CHD gained weight more quickly and had shorter hospital stays than bottle-fed infants with CHD. In spite of these studies, mothers of infants with CHD often are not encouraged to breastfeed. A survey by Lambert and Watters (1998) noted that mothers who were discouraged from breastfeeding were told, "The bottle is easier," "It's harder to breastfeed," "Formula has more calories," and "The baby would have better intake from a bottle." Respondents to the Lambert and Watters (1998) survey identified physicians and nurses as the primary source of breastfeeding information, yet ranked their assistance low (1.8-2.6) on a scale of 1 ("little help") to 5 ("much help"). Pantazi, Jaeger, and Lawson (1998) surveyed staff composed of pediatric and neonatal nurses and midwives regarding support for breastfeeding mothers and found that 53% of pediatric staff had no relevant training in breastfeeding. In addition, they demonstrated inadequate knowledge of lactation in spite of the frequency with which they assisted mothers to provide breastmilk to their infants.

The purpose of this study was to describe breastfeeding outcomes and breast pumping duration among a high-risk population of infants. Breastfeeding outcomes evaluated were: (a) the duration of breastfeeding in months or the length of time breastmilk was provided for feedings and (b) self-reported maternal satisfaction with the breastfeeding experience. This project asked mothers of infants with CHD to respond to a written survey when their infant was at least 6 months old, following cardiac surgery in the neonatal period. The survey addressed questions related to breastfeeding initiation, use of breast pumps and supplementation, and duration of breastfeeding/milk expression. Sources of breastfeeding support and education, perceived support or lack of support, and mother's level of satisfaction with her breastfeeding experience were evaluated. Factors that affected level of maternal satisfaction and duration of breastfeeding or provision of breastmilk were examined. Breastfeeding duration rates were compared with results from previous studies of infants with CHD conducted at the same institution, prior to the initiation of lactation support services.


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