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Using the Delphi Method to Develop Breastfeeding Quality Indicators for Very Preterm Infants
Anfeng Lu1, Li Zhu1, Peilu Huang1
1Department of Neonatology, Qinzhou Maternity and Child Health Care Hospital, Qinzhou, Guangxi, People's Republic of China.
Insights
This study developed 11 quality indicators for breastfeeding very preterm infants. These indicators provide a practical and reliable way to assess and enhance breastfeeding quality for this vulnerable group.
Area of Science:
- Neonatal care
- Infant nutrition
- Public health
Background:
- Human milk is vital for protecting very preterm infants from complications.
- Existing quality indicators for breastfeeding are insufficient for very preterm infants.
- There is a need for tailored indicators to evaluate breastfeeding quality in this population.
Purpose of the Study:
- To develop practical and reliable quality indicators for breastfeeding very preterm infants.
- To establish a framework for evaluating and improving breastfeeding practices in this vulnerable group.
Main Methods:
- A longitudinal, prospective survey using a two-round Delphi method.
- Systematic literature search across major databases (PubMed, Cochrane, Embase, Wanfang).
- Multidisciplinary expert panel evaluation of candidate indicators for relevance and feasibility.
Main Results:
- Eleven candidate quality indicators were identified and validated.
- Indicators cover breastfeeding outcomes, maternal lactation status, process, and balancing aspects.
- Expert consensus confirmed the relevance and feasibility of the selected indicators.
Conclusions:
- A set of 11 practical and reliable quality indicators for breastfeeding very preterm infants was successfully developed.
- These indicators can facilitate objective and quantitative assessment of breastfeeding quality.
- The developed indicators support improved care for very preterm infants through enhanced breastfeeding practices.
Background:
Human milk protects very preterm infants from many complications. While quality indicators are crucial for evaluating and improving breastfeeding practices, those specifically tailored for very preterm infants are lacking.
Research Aim:
To develop a set of practical and reliable indicators for evaluating and improving the quality of breastfeeding for very preterm infants.
Methods:
This study employed a longitudinal, prospective survey design utilizing a two-round Delphi method employing the RAND Corporation/University of California Los Angeles Appropriateness Method. A systematic search of the literature was performed across multiple databases, including PubMed, Cochrane, Embase, and Wanfang, to identify potential quality indicators for breastfeeding in very preterm infants. A multidisciplinary expert panel then evaluated these through two Delphi rounds to establish relevance and feasibility.
Results:
Twenty-two candidate quality indicators of breastfeeding were extracted for the Delphi process. The experts' authority coefficients for the two rounds were 0.84 and 0.83, respectively. Eleven indicators, encompassing breastfeeding outcome indicators (n = 1), mother's lactation status indicators (n = 3), the breastfeeding process indicators (n = 3), and balancing indicators (n = 4), were considered relevant and feasible and were incorporated into the set of quality indicators for breastfeeding.
Conclusions:
This study developed a set of practical and reliable indicators for evaluating and improving the quality of breastfeeding for very preterm infants, based on the collective opinion of content experts. These quality indicators may facilitate an objective and quantitative assessment of breastfeeding quality for this vulnerable population.
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