Rooming in and Breast Feeding

Dr. Varsha Atul Shah

Rooming in and breast-feedingBy Dr. Varsha Atul Shah

A hospital arrangement where a mother/baby pair stay in the same room day and night, allowing unlimited contact between mother and infant

Slide 4.7.2

Rooming in

• Routine separation should be avoided.

• Separation should only occur for an individual clinical need.

• If separation of a mother and her infant is required because of a medical situation, document the reason for this separation in the mother/baby record

Rooming-in. Why?

• Helps establish and maintain breastfeeding

• Baby sleep better and cry less

• Reduced exposure to infection

• Helps mother to learn about her baby’s feeding and behavioral patterns

• Reduces costs

Slide 4.7.3

Helps establish and maintain breastfeeding

• Study on effects of Rooming in on breastfeeding frequency for first 24 hours.

• Findings: The frequency of breastfeeding per 24 hours was significantly higher in rooming-in than non-rooming-in infants from day 2 to day 7 (p<0.01).

• This study demonstrated that rooming-in infants had significantly higher breastfeeding frequencies than non-rooming-in infants during the first week of life.

Adapted from: Yamauchi Y, Yamanouchi I . The relationship between rooming-in/not rooming-in and breastfeeding variables. Acta Paediatr Scand, 1990, 79:1019.

Effect of rooming-in on frequency of breastfeeding per 24 hours

Adapted from: Yamauchi Y, Yamanouchi I . The relationship between rooming-in/not rooming-in and breastfeeding variables. Acta Paediatr Scand, 1990, 79:1019.

Slide 4.7.5

Determinants of lactation performance across time in an urban population from

MexicoMilk came in earlier in the hospital with rooming-in where formula was not allowed

Milk came in later in the hospital with nursery (p<0.05)

Breastfeeding was positively associated with early milk arrival and inversely associated with early introduction of supplementary bottles, maternal employment, maternal body mass index, and infant age.

Adapted from: Perez-Escamilla et al. Determinants of lactation performance across time in an urban population from Mexico. Soc Sci Med, 1993, (8):1069-78.

Effect of the maternity ward system on the lactation success

of low-income urban Mexican women

Slide 4.5.5

From: Perez-Escamilla R, Segura-Millan S, Pollitt E, Dewey KG. Effect of the maternity ward system on the lactation success of low-income urban Mexican women. Early Hum Dev., 1992, 31 (1): 25-40.

NUR, nursery, n-17

RI, rooming-in, n=15

RIBFG, rooming-in with breastfeeding guidance, n=22

NUR significantly different from RI (p<0.05) and RIBFG (p<0.05)

Baby is exposed to less infections

• Study on positive impact of rooming-in policy on prevention of infectious disease when infants rooming-in were compared to newborns not rooming-in with their mothers (Soetjiningsih et al.).

• Average length of newborn hospitalization after roomimg in is 1,8 days compared to 3.2 days for babies not roomed in

Average length of newborn hospitalization Sanglah Hospital, Indonesia

3.2

1.8

0

0.5

1

1.5

2

2.5

3

3.5

Before rooming-in After rooming-in

Day

s

Transparency 6.11

1.4 days

0.8 days

Adapted from:Soetjiningsih and Sudaryat Suraatmaja. The advantages of rooming-in. Paediatrica Indonesiana, 1986, 26:229-35.

Morbidity of newborn babies at Sanglah Hospital before and after rooming-in

Adapted from: Soetjiningsih, Suraatmaja S. The advantages of rooming-in. Pediatrica Indonesia, 1986, 26:231.

Slide 4.7.4

0%

2%

4%

6%

8%

10%

12%

Acute otitismedia

Diarrhoea Neonatal sepsis Meningitis

% o

f ne

wb

orn

bab

ies

6 months before rooming-in

6 months after rooming-in

n=205

n=17

n=77

n=11

n=61

n=17n=25

n=4

Morbidity of newborn babies at Sanglah Hospital before and after rooming-in

• Prospective study in Bali, Indonesia, over one year in which this study examined morbidity, mortality, amount of milk formula and IV fluid consumed, and length of hospital stay in the maternity ward and newborn nursery for the 6 months pre and post rooming in policy instituted

• Diarrhoeal diseases, otitis media, neonatal sepsis, and meningitis decreased in low-birthweight and normal full-term infants

• Mortality due to infection decreased (41 or 2.21% vs. 16 or 0.81%); whereas deaths due to other causes did not greatly change during this period (58 or 3.13 % versus 51 or 2.59%).

• Need for milk formula decreased from 105.6 tins to 25.6 tins per month (400 g tin of powdered milk formula).

• Need for IV fluid dropped from 135.8 bottles to 74.1 bottles per month (500 cc/bottle).

• Number of days in the hospital was reduced from 4.2 to 1.8 days

Babies sleep better and cry less

• A study to compare the state behavior of newborns who roomed-in with their mothers at night with those who were cared for by the traditional nursery-at-night method.

• Infants in the mother's room had significantly, p less than.001, more quiet sleep (33% vs. 25.4%), less indeterminate (4.8% vs. 11.2%), and less crying (0.6% vs. 7.5%) states than infants who remained in the nursery.

• Adapted from:Keefe MR,Nursing Research (1987,36(3):140-144

Cost savings of rooming-in compared to separate recovery rooms at the Clinical Hospital of the Catholic University of

Chile13.5

$3.57 $3.57

9

$2.35 $3.05

0

2

4

6

8

10

12

14

16

Full-time nursesand aides

Personnel cost perpatient per day

Personnel + capitalcosts* per patient

per day

Separate recovery

Rooming-in

Transparency 6.15

14% savings34% savings

Adapted from Valdes et al. The impact of a hospital and clinic-based breastfeeding promotion programme in a middle class urban environment. Journal of Tropical Pediatrics. 1993, 39:142-151.

Cost analysis of maintaining a newborn nursery at the Dr. Jose Fabella Memorial Hospital

Transparency 6.16

Hospital Statistics:

Average daily deliveries: 100 babies

Daily newborn census: 320 babies

Adapted from: Gonzales R. Cost Analysis of Maintaining a Newborn Nursery at Dr. Jose Fabella Memorial Hospital, Manila. (Transparencies presented in meeting in Manila, Philippines), 1990.

Summary of costs for maintaining a newborn nursery

Transparency 6.17

Feeding bottle sets/year124,800 x 20 P = 2,496,000 P

Milk formula cans/year17,521 x 36 P = 630,720 P

Salary of nursing staff/year900 x 3,000 P x 12 = 3,240,000 P

Salary of formula room staff/year6 x 2,000 P x 12 = 144,000 P

________________________________________

Total 6,510,720 P (310,037 USD)

The impact of infant rooming-in on maternal sleep at night.

• A two-group comparison study was designed to investigate differences in sleep patterns for a group of mothers who roomed-in with their infants at night as compared with a group who was separated from their infants at night.

• The data collected from the mothers in the study indicated that mothers did not sleep longer or better when their infants were returned to the nursery during the night.

• Keefe MR ,Children's Hospital, Denver, CO 80218-1088.Journal of Obstetric,Gynecologic and Neonatal Nursing(1988,17(2):122-126)

Mothers ask for their babies to be taken to Nursery

• Explain to the mother why the hospital encourages rooming-in

• Discuss the reason why the mother wants the baby taken to the nursery

• Address the benefits of rooming-in during antenatal contacts.

References• Keefe M. R. Comparison of neonatal nighttime sleep-wake patterns in nursery versus

rooming-in environments. Nursing Research. 1987;36(3):140–144. [PubMed]

• Keefe M. R. The impact of infant rooming-in on maternal sleep at night. Journal of Obstetric, Gynecologic, and Neonatal Nursing. 1988;17(2):122–126.

• Flores-Huerta S, Cisneros-Silva I. Mother-infant rooming-in and exclusive breast feeding. Salud Publica de Mexico. 1997;39(2):110–116. [PubMed]

• O'Connor S, Vietze P. M, Sherrod K, Sandler H. M, Altemeier W. A. Reduced incidence of parenting inadequacy following rooming-in. Pediatrics. 1980;66(2):176–182. [PubMed]

• Yamauchi Y, Yamanouchi I.Acta Paediatr Scand. 1990 Nov;79(11):1017-22. PMID: 2267917 [PubMed - indexed for MEDLINE]

• Reference: Soetjiningsih and Suraatmaja S. The advantages of rooming-in. Pediatrica Indonesia,1986, 26:229-23

• Yamauchi Y, Yamanouchi L.Breastfeeding frequency during the first 24 hours after birth in full term neonates.Paediareics 1990,86(2):171-175