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Jill Demirci Biography & Abstract
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Jill Demirci, PhD, RN, IBCLC

Postdoctoral Associate at the University of Pittsburgh School of Medicine, Department of Pediatrics

 

 

 

 

Biography

Jill Demirci, PhD, RN, IBCLC is a Postdoctoral Associate at the University of Pittsburgh School of Medicine, Department of Pediatrics. In September 2016, she will transition to a tenure-stream faculty position as Assistant Professor at the University of Pittsburgh School of Nursing Department of Health Promotion & Development.  Dr. Demirci is a PhD-prepared nurse researcher, practicing internationally board-certified lactation consultant, and recent NIH K99/R00 career development award recipient. Her research focuses on clinical breastfeeding support, specifically psychological and perceptual barriers to extended, exclusive breastfeeding, breastfeeding messaging and impact of clinician communication on infant feeding decisions, breastfeeding management in vulnerable populations, and etiology and management of perceived insufficient breast milk supply.

 

 

Abstract

Antenatal milk expression (AME) is a simple, cost-effective technique that capitalizes on milk production beginning in mid-pregnancy by teaching women how to hand-express, collect and store milk beginning at 36 weeks gestation. Milk can be used if needed in the postpartum period, and women also develop confidence in handling breasts and expressing milk prior to delivery, when they may be more receptive to learning. There is some evidence suggesting AME can lead to a larger postpartum milk supply and improved breastfeeding duration and exclusivity. AME has demonstrated safety, acceptability, and some improvement in breastfeeding outcomes among diabetic women. It has not yet been examined in other populations at-risk for poor milk supply and premature breastfeeding cessation. In the current study, we will examine the feasibility and acceptability of AME in an at-risk population—mothers of infants with congenital anomalies requiring surgical correction shortly after birth (i.e., surgical infants). These mothers are at heightened risk for poor breastfeeding outcomes due to their infants’ statuses after birth prohibiting oral feeds and subsequent dependence on a breast pump to establish a milk supply. As such, we hypothesize that surgical infants will have low rates of breastfeeding (or receiving their mother’s own milk (MOM)) and thus a need for AME, that infants with certain surgical anomalies and characteristics will be at greater risk than others of not receiving MOM, and that mothers of surgical infants will be receptive to an intervention designed to increase provision of MOM. To test these hypotheses, we propose the following two specific aims: 1)
explore the need for AME in the surgical infant population and determine sub-groups most likely to
benefit from AME; and 2) determine the acceptability of AME to mothers of surgical infants. Aim 1 will be accomplished through a retrospective 12-month chart review to examine the timing and volume of mother’s own milk (MOM), formula, and donor breast milk use amongst infants admitted to Children’s Hospital of Pittsburgh neonatal intensive care unit (CHP NICU) with specific surgical anomalies. Infants with greater use of formula or donor milk versus MOM, controlling for various confounders (e.g., breastfeeding intention), will be deemed most likely to benefit from AME. To address Aim 2, we will interview 15-30 mothers during their infants’ surgical hospitalization at CHP NICU to ascertain awareness of, interest in, and potential barriers to AME. This will inform the practicality of an AME intervention for mothers of surgical infants and allow us to modify our proposed AME clinical protocol and recruitment methods for such an intervention. If we demonstrate that AME is a needed and acceptable intervention, our next step is a RCT examining the effect of AME on breastfeeding and
infant health outcomes in the surgical infant population. Through the potential of AME to increase provision of MOM, reduce the need for formula supplementation, and extend the natural duration of breastfeeding, this line of research has health and economic implications for mothers, NICU infants, their families, and the healthcare system.

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