title: Effect of early-onset sepsis evaluations on in-hospital breastfeeding practices among asymptomatic term neonates.
abstract: OBJECTIVE
  To examine the effect of separation for early-onset sepsis (EOS) evaluations due to perinatal risk factors on breastfeeding practices among asymptomatic term newborns.
  
  
  METHODS
  This observational study included 692 nulliparous women with term, singleton uncomplicated pregnancies who intended to breastfeed and whose infants were well appearing at birth. We examined the rate of early breastfeeding initiation (within 2 hours of birth) and formula supplementation (in the first 24 hours) among this mother-infant cohort.
  
  
  RESULTS
  Asymptomatic infants separated for EOS evaluation within 2 hours of birth were more likely to have delayed initiation of breastfeeding (46.5% vs 12.5%; P<.001). This association remained significant when adjusted for potential confounders (adjusted odds ratio [aOR]: 5.5 [95% confidence interval (CI): 3.4-8.9]; P<.001). Among infants separated for EOS evaluation, mother-infant time together of ≤0.5 hour in the first 2 hours of life significantly delayed initiation (aOR: 8.9 [95% CI: 1.5-53.7]; P=.02) compared with infants spending >1.5 hours with their mothers. In bivariate analysis, both separation and initiation were associated with formula supplementation. After adjusting for confounders, only delayed initiation remained significantly associated with supplementation (aOR: 1.9 [95% CI: 1.1-3.5]; P=.03).
  
  
  CONCLUSIONS
  Early separation of asymptomatic infants from their mothers for EOS evaluation was significantly associated with delayed initiation of breastfeeding, which in turn was associated with increased formula supplementation in the first day of life. This unintended consequence of EOS evaluations among asymptomatic infants may be minimized by delaying early separation for performance of the evaluation, attempting breastfeeding initiation before separation, and/or applying more efficient criteria for identifying infants requiring evaluation.
authors.affiliation: Departments of Pediatric Newborn Medicine, and Harvard Medical School, Boston, Massachusetts; Section on Newborn Pediatrics, Children's Hospital of Philadelphia Newborn Care at Pennsylvania Hospital, Philadelphia, Pennsylvania; University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania; and MUKHOPADHS@EMAIL.CHOP.EDU.
authors.forename: Sagori
authors.initials: S
authors.lastname: Mukhopadhyay
authors.affiliation: Departments of Pediatric Newborn Medicine, and Harvard Medical School, Boston, Massachusetts; Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, Massachusetts;
authors.forename: Ellice S
authors.initials: ES
authors.lastname: Lieberman
authors.affiliation: Departments of Pediatric Newborn Medicine, and Harvard Medical School, Boston, Massachusetts; Section on Newborn Pediatrics, Children's Hospital of Philadelphia Newborn Care at Pennsylvania Hospital, Philadelphia, Pennsylvania; University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania; and.
authors.forename: Karen M
authors.initials: KM
authors.lastname: Puopolo
authors.affiliation: Harvard Medical School, Boston, Massachusetts; Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Laura E
authors.initials: LE
authors.lastname: Riley
authors.affiliation: Departments of Pediatric Newborn Medicine, and Harvard Medical School, Boston, Massachusetts;
authors.forename: Lise C
authors.initials: LC
authors.lastname: Johnson
mesh_terms: D000328:Adult; D058070:Asymptomatic Diseases; D001903:Bottle Feeding; D001942:Breast Feeding / Q000523:psychology*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006761:Hospitals; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D009034:Mother-Child Relations; D015997:Neonatal Screening; D012307:Risk Factors; D018805:Sepsis / Q000175:diagnosis*; D047929:Term Birth; D013997:Time Factors; D014481:United States
keywords: asymptomatic infection; breastfeeding; early-onset sepsis; neonatal screening; system-based practice