Acute Flaccid Paralysis Accompanying West Nile Meningitis Ahmed ...

Lactation Assessment Standardized Tool (LAST)
Barus, K, D.O., Butani, V, M.D., Abrell, A, D.O., Griffin, C, D.O, Gibbon, D. D.O,
Saad, D. D.O., Stevens, M. D.O., Moss. B. D.O., Adams, C
Maine Dartmouth Family Medicine Residency; Augusta, ME
Introduction: The benefits of breastfeeding are well supported by evidence. A
standardized, validated latch and breastfeeding assessment tool utilized by
trained lactation consultants would help to identify babies which might benefit
from interventions to improve breastfeeding success rates and measure the
success of such interventions. Our hypothesis is that this lactation assessment
tool will provide a reproducible method for evaluating lactation in neonates,
independent of operator, among board certified lactation consultants.
Methods: The LAST study is an ongoing randomized, blinded pilot study
approved by the MaineGeneral Medical Center IRB. In a rural community
hospital setting, board certified lactation consultants independently use a latch
assessment tool to evaluate breast feeding success. Mother baby pairs are
chosen who meet the following inclusion criteria: term infants (38 to 42 weeks),
12-96 hours old, with well mothers (no illness that would interfere with
breastfeeding), who desire to breastfeed. Exclusion criteria include: any infant
with orofacial deformity (including short frenulum), any infant on the Neonatal
Abstinence Scoring Protocol, and any maternal breast deformity or previous
breast surgery. The tool obtains ratings on six metrics derived from existing
International Lactation Consultant Association Guidelines. Kappa values were
applied to these metrics for statistical analysis. To date 15 mother baby pairs
have been assessed with a goal of 20 pairs.
Results: Preliminary results of inter-rater reliability were obtained from three
lactation consultants’ observations of 15 mother-infant dyads. Kappa values from
12 of the 15 dyads based on on six measures were as follows: Feeding Cues
(0.55, moderate agreement by Landis and Koch criteria); Latch Time (0.75,
Substantial agreement); Latch Quality (0.61, substantial agreement); Suck
Swallow Pattern (0.63 substantial agreement); Type of Nipple (0.77, substantial
agreement); and Nipple Appearance (0.52, moderate agreement).
Conclusions: This pilot study suggests to date that the Latch Assessment Tool
can be used to assess latch in a standardized fashion. It could then be used to
measure success of interventions such as osteopathic manipulation of neonates.
Continued study is needed to better characterize this tool.