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Maryann Bozzette Biography and Abstract
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Maryann Bozzette, PhD, RN CLC

College of Nursing University of Missouri—St. Louis








I have a PhD in Nursing Science from the University of Washington. My clinical background is in pediatrics with an expertise in NICU.  I have been a neonatal clinical nurse specialist.  For the last several years I have had a full time faculty appointment and have practiced clinically.

Research Background
My research has focused on the social and perceptual development of premature infants as they receive life-sustaining medical care, through interventions to support their continued neurobehavioral development in the NICU.  I work with interdisciplinary teams to intervene while they are hospitalized to help prevent developmental delay. My primary interest is studying an intervention using mother’s voice to support sensory integration and early language development. My preliminary studies have shown decreased heart rate and respiratory rate, less body movement, and stable cerebral blood flow velocities when premature infants born between 28-34 weeks gestation are listening to recordings of their mother’s voice. A decrease in salivary cortisol levels and attending behaviors were also seen.

My interest in breastfeeding premature infants spans two decades. I am testing an intervention to transition premature infants from gavage feeds to direct exclusive breastfeeding prior to hospital discharge. By providing additional support for mothers and allowing the premature infants more time to learn to feed at the breast, it is hypothesized that the rate and duration of breastfeeding will increase. I am planning to follow this study with a larger intervention study to observe the growth of preterm infants during their first year of life as I partner with home care agencies to expand lactation services to families in the greater metropolitan area.



Transitioning Premature Infants to Direct Exclusive Breastfeeding Human milk is the preferred nutrition for premature infants. The American Academy of Pediatrics recommends exclusive breastfeeding for all infants for the first 6 months of life (AAP, 2012). Many mothers of premature infants pump breastmilk for several weeks to provide human milk for their babies. However, less than 30% of these mothers are reported to actually feed their infants at the breast consistently when discharged from the NICU, and many abandon breastfeeding altogether (Pineda, 2011). This is partially due to the practice of the majority of neonatal intensive care units in the United States that require efficient bottle feeding as a
criterion for discharge.

The purpose of this study is to examine a protocol that supports transitioning infants born at less than 34 weeks gestation to direct feeding at the breast, and continues lactation support after discharge from the hospital. Forty infants will be recruited for the study. Short term feeding and nutritional outcomes in breast fed infants, will be compared to a retrospective gestational age matched control group of premature infants who transitioned from gavage to bottle feedings. Progress for the premature infants feeding at the breast will be assessed with daily weights and with the Premature Infant Breastfeeding Behavior Scale (Nyqvist et al., 1996). Mothers of the study infants will also report their level of confidence in caring for their premature infant, and their breastfeeding self-efficacy. Home follow-up visits will be provided weekly after discharge from the NICU to support breastfeeding efforts for a period of 6 months, or until the mother stops breastfeeding. The effect of this additional support will be examined for the length of time the study infants are breastfed.

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