Lactation Practices in Critically Ill Patients

CHEST critical care Pub Date : 2024-12-26 DOI:10.1016/j.chstcc.2024.100123

Kayla J. Kolbe MD , Virginia Sheffield MD , Katerina Castillo MD , Kriya S. Patel MD , Jessica A. Blank MD , Melissa H. Ross MD , Thomas S. Valley MD , Rommel Sagana MD

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Abstract

Background

Most birthing people in the United States initiate lactation, but little is known about lactation practices in patients who are critically ill.

Research Question

What are the lactation rates and practices in adult patients in the ICU and what are potential barriers to lactation and resource use?

Study Design and Methods

We performed a retrospective chart review of immediately postpartum patients in the ICU at an academic medical center between January 2018 and January 2024. Information regarding initiation, cessation, communication, and lactation consultant (LC) services were extracted and bivariate tests of association were conducted.

Results

Most immediately postpartum patients in the ICU initiated lactation (85% [87 of 102]), but only 70% (72 of 102) continued until hospital discharge. Documented lactation plans were present before delivery for 60% of patients, and a documented plan to initiate lactation before delivery was associated with increased odds of initiating lactation after delivery (OR, 9.21; 95% CI, 1.96-43.3; P = .005). Although most patients (75%) saw LCs, less than 30% of patients saw LCs within 24 hours of delivery. An association between seeing an LC and continuing lactation until hospital discharge was found (OR, 4.74; 95% CI, 1.77-12.7; P = .002). More than one-half of lactating patients received mechanical ventilation (55%), but nearly 20% of these intubated patients did not undergo milk expression while ventilated.

Interpretation

Most postpartum patients who are critically ill initiate lactation, but not all continue until hospital discharge. Having documented plans to lactate before delivery and seeing LCs were protective of lactation in the ICU, but many patients did not see LCs promptly. Additional gaps in care included lack of documentation and delays in lactation initiation in intubated patients. We hypothesize that these gaps may hinder patients who are critically ill from achieving their personal lactation goals, and steps should be taken to address and mitigate these challenges.

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