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Kelley L. Baumgartel Biography & Abstract
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Kelley L. Baumgartel, RN, PhD
Postdoctoral Scholar, Targeted Training and Academic Training for Nurses in Genomics (T32NR009759)
University of Pittsburgh School of Nursing

 

 

 

 

 

Biography

As a bedside nurse in a Level III NICU, Dr. Baumgartel witnessed the importance of breast milk for preterm infants. She also noticed great variability in milk volumes among new mothers, and that most were unable to pump enough milk to meet their infant’s needs. Dr. Baumgartel’s work in the NICU helped her to appreciate the stress NICU mothers experience, and the importance of providing appropriate support so they can gain confidence and provide breast milk for their babies.

Dr. Baumgartel’s research has examined molecular mechanisms for milk variability, and her dissertation uncovered an association between maternal interleukin polymorphisms and milk interleukin levels. She has also conducted a psychometric evaluation of the widely used Epworth Sleepiness Scale in a population of pregnant women. It was this experience that taught her that sleep among pregnant and postpartum women is often overlooked.

Her long term research interests involve the impact of environmental factors, particularly sleep, on breast milk volume and composition. She is also interested in how breast milk variability influences neonatal outcomes. Dr. Baumgartel is especially interested in how modifiable factors may optimize breast milk immunobiology for preterm infants with a specific interest in the provision of breast or donor milk that is immunologically personalized for vulnerable infants. NICU nurses are responsible for breast milk administration, and she sees a future where milk is both optimized and personalized to match infant needs.

Abstract

Background/Significance: The postpartum experience of mothers who have delivered preterm infants is unlike the biological norm. A new mother with a preterm infant experiences: separation from her infant, caring for a critically ill child, breast milk expression, and frequent Neonatal Intensive Care Unit (NICU) visits. Sleep, which·is essential for optimal health and associated with infant bonding, is well described among mothers with healthy infants. Unfortunately, little is known about postpartum sleep among mothers with hospitalized preterm infants, despite their unique needs. For example, mothers with preterm infants are encouraged to wake up at least once through the night to express breast milk, as maternal milk is the optimal first food for vulnerable preterm infants.

Despite these recommendations, little is known about whether mothers are expressing breast milk through the night, and how/if maternal sleep is associated with breast milk volume. Nearly 70% of women with preterm infants experience breast milk insufficiency, resulting in prescribed donor human milk supplementation. If maternal milk is unavailable, donor milk is now the standard of care; however, donor milk is pasteurized and contains no commensal bacteria, which are associated with positive neonatal outcomes. Despite the common experience of milk insufficiency, and the benefits of sleep to overall health, the relationship between objective maternal sleep measures and subsequent milk volume has never been explored.

 

Purpose: The purpose of this longitudinal, observational pilot study is to, in a population of breastfeeding mothers who have delivered infants before 32 6/7 weeks (n=20): 1) determine the feasibility of conducting a sleep study in a population of high-risk women who frequently experience low milk supply, 2) describe maternal sleep characteristics in the immediate postpartum period, and 3) explore if sleep characteristics are associated with breast milk volume.

 

Methods: Subjects will wear an Actiwatch 2 (Philips Respironics), and will also complete daily sleep and pumping logs. The sleep experience and milk volume will be described longitudinally. Group-based trajectory analyses will be applied to identify distinct short-term patterns of continuous measures. Given the exploratory nature of the study, we will also perform univariate analyses to measure associations, and will consider multivariate regression models. The estimation of effect sizes and summary statistics will be emphasized rather than hypotheses testing.

 

Implications: NICU nurses are directly involved in both: 1) emotional and physical support of new mothers (including sleep hygiene), and 2) breast milk administration to neonates. This study will inform future strategies related to sleep intervention strategies that may optimize maternal breast milk volume.

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