latch assessment tool
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THE LATCH ASSESSMENT TOOL AS A PREDICTOR OF BREASTFEEDING
PATTERNS FOLLOWING CAESAREAN AND VAGINAL DELIVERY
Wiyarni Pambudi
Department of Child HealthSumber Waras Hospital
Medical School, Tarumanagara UniversityJakarta – Indonesia
It is unquestionable that breast milk is the best source of infant nutrition Studies have suggested that mode of delivery has influence on breastfeeding A practical & concrete tool to predict breastfeeding outcomes following different modes of delivery is needed The LATCH score provides a reliable, valid, and systematic method for gathering information about individual breastfeeding sessions (Riordan et al, 1997)
INTRODUCTION
2THE LATCH ASSESSMENT TOOL
This study aimed to explore the LATCH scoring system in predicting breastfeeding patterns following caesarean and vaginal
delivery.
OBJECTIVE
3THE LATCH ASSESSMENT TOOL
introduction
Design : Prospective cohort studyInstrument : The LATCH Assessment ToolPeriod : August 2009 - July 2010Location : 2 private hospitals in West JakartaStatistical analysis: Kruskal-Wallis test
Mantel Haenzel chi-square testSpearman correlation coefficient Relative Risk & CI 95% p<0.05 ~ significant (SPSS ver 16.0)
METHODS
4THE LATCH ASSESSMENT TOOL
Participants : Convenience sampling of mother-
baby dyads who had caesareansection or vaginal delivery
Eligibility criteria : First-time breastfeeding mother,
18 years or older, with healthy singletons
THE LATCH ASSESSMENT TOOL 5
C-section
or Vaginal deliver
y
Breastfeeding or not ?
LATCH score at hour-24
LATCH score at
day-7
LATCH score at week-6
methods
Assessment 0 1 2
Total
scores
L Latch on
Too sleepy or reluctant
No sustained latch or suck
achieved
Repeated attempts for sustained latch
or suckHold nipple in
mouthStimulate to suck
Grasps breastTongue downLips flangedRhythmical
sucking
AAudible swallowi
ngNone
A few with stimulation
Spontaneous and
intermittent/ frequent
T Type of nipple
Inverted Flat Averted
C Comfort
EngorgedCracked, bleed, large blisters or
bruisesSevere discomfort
FillingReddened/small
blisters or bruises
SoftNon tender
HHold
positioning
Full assist Minimal assist No assist6
methods
Table 1. The LATCH Breastfeeding Assessment Tool
Jenson D, Wallace S, Kelsay P (1994). LATCH : A Breastfeeding charting system and documentation tool. JOGNN, 23(1):29.
THE LATCH ASSESSMENT TOOL
A sample of 117 mother-baby dyads who had a normal vaginal delivery, 100 who with elective caesarean section and 162 with emergency caesarean section were recruited into this study
3346 newbo
rn
1011 primi mothe
rs
211 omitted
880 healthy singleto
ns
589 breastf
ed neonat
es
RESULTS & DISCUSSION
n=378
7THE LATCH ASSESSMENT TOOL
Vaginal delivery(n=117)
Elective c-
section (n=100
)
Emergency c-
section (n=162)
Maternal age, yrs (x SD) 240.6 240.2 250.4
Gestational age, wks (x SD) 390.3 390.5 390.7
Birth weight, g (x SD)
3,4900.4
3,5000.1
3,4750.7
Apgar score min-1(x ) 8.2 8.2 8.2
Apgar score min-5(x ) 8.9 8.9 8.9
Length of stay, d (x SD)* 10.1 30.3 20.2
8
Table 2.Characteristic of sample (n=378)
results & discussion
*p < 0.05
THE LATCH ASSESSMENT TOOL
Six weeks was chosen because it is a vulnerable time when breastfeeding is being established (Riordan et al, 2001)
Vaginal deliver
y(n=117
)
Elective c-section (n=100)
Emergency c-
section (n=162)
Initiation (%)* 76.6 24.3 13.3
Breastfed at hour-24 (%)* 62.9 59.6 41.4
Breastfed at day-7 (%)* 59.1 46.5 51.4
Breastfed at week-6 (%)* 47.6 21.9 31.6
LATCH score at hour-24 (x)* 9.1 8.7 6.4
LATCH score at day-7 (x)* 8.7 6.8 7.5
LATCH score at week-6 (x)* 6.7 4.2 5.1 9
Table 3. Breastfeeding Assessment among groups
results & discussion
*p < 0.05
THE LATCH ASSESSMENT TOOL
10Figure 1. Breastfeeding Assessment among groups
results & discussion
Total LATCH score were higher among mother who were still breastfeeding at 6 weeks (8.2±0.9 vs 5.3±0.1, p=0.003)Total LATCH scores positively correlated with duration of breast-feeding (n=126, r=0.26, p=0.001) and mode of delivery (n=378, r=0.22, p=0.002)
THE LATCH ASSESSMENT TOOL 11
results & discussion
Mothers who had low score at day-7 were less likely to be breastfeeding at 6 weeks
THE LATCH ASSESSMENT TOOL 12
results & discussion
Relative Risk (95% CI)
LATCH ScoreVaginal delivery(n=117)
Elective c-section (n=100)
Emergency c-
section (n=162)
At hour-24 3.8 (0.8-4.6)
2.6 (0.5-3.1)
3.2 (1.3-3.9)
At day-7* 4.1 (1.6-4.9)
5.1 (2.0-6.1)
4.8 (1.9-5.7)
At week-6 3.7 (1.6-4.5)
3.8 (1-5-4.6)
4.4 (0.8-5.3)
7-10 (low risk)
1.7 (0.7-2.1)
3.3 (0.8-3.9)
2.7 (0.6-3.2)
3-6 (medium risk)
2.6 (0.9-3.2)
4.7 (1.9-5.7)
4.0 (1.6-4.8)
0-2 (high risk)*
3.4 (1.4-4.1)
6.2 (2.5-7.6)
5.4 (2.2-6.5)
Table . Determinant fo breastfeeding duration
*p < 0.05
LATCH score below 2 at day-7 was the most discriminate of the 3 time periods examinedLATCH scores predict whether or not the mother would breastfed for up to 6 weeks aid for health professionals in identifying those who potentially will stop breastfeeding prematurely & might need interventions to continue to breastfed
THE LATCH ASSESSMENT TOOL 13
results & discussion
The LATCH assessment tool identifies as a predictor
for the duration of breastfeeding followed caesarean and vaginal delivery
CONCLUSION
14THE LATCH ASSESSMENT TOOL
THE LATCH ASSESSMENT TOOL 15
Aims Tools Study
Assess subjective
perspective of the
mother
Maternal Breastfeeding Evaluation Scale (56 item)
Leff et al, 1994
Lactation Assessment Tool Blair et al, 2003
Assess objective factors of
breastfeeding
Systemic Assessment of the Infant at Breast (4 items)
Shrago, 1990
Breastfeeding Assessment Tool (3 items) Bono, 1992
Assess the risk of early
weaning
The Potential Early Breastfeeding Problem Tool (23 items)
Kearney et al, 1990
Breastfeeding Attrition Prediction Tool Janke, 1944
Hill & Humenick Lactation Scale (30 items) Hill et al, 1996
Breastfeeding Self Efficacy Scale Dennis, 2002
Assess effectiveness
of breastfeedin
g
Breastfeeding Assessment Score (107 items)Hall et al,
2002
LATCH Assessment Tool (5 items)Jensen et al,
1994
Infants Breastfeeding Assessment Tool (6 items)
Matthews, 1988
Mother-Baby Assessment (5 items) Mulford, 1992
Via Christi Breastfeeding Assessment Tool (4 items)
Riordan, 2005
16
Table 5. Tools to measure breastfeeding
Taha R (2009). Breastfeeding case study. http://digitalcommons.uconn.edu/srhonors.theses/74
results & discussion
THE LATCH ASSESSMENT TOOL
Assessment of breastfeeding effectiveness is most comprehensive when it includes :
Objective observations of maternal & infant factorsIndicators of milk intake Subjective maternal evaluation
BAS was shown to be highly significant in predicting breastfeeding cessation (Hall et al,
2002) consisted of 107 detailed questionnaires about pregnancy, medication & experience with breastfeeding
THE LATCH ASSESSMENT TOOL 17
results & discussion
The LATCH Assessment Tool measures 5 breast-feeding indicators (latch-on, audible swallowing, type & shape of the nipple, comfort level, hold positioning); assigns a score of 0-1-2 for maximum total score of 10 (Jensen et al, 1994) relationship was supported between higher scores & fewer breastfeeding problems (Schomer et al, 1999)
LATCH 5 components of breastfeeding :Lack predictive capacity to breastfeeding outcomes (Hemelim et al, 2000)
Correlates positively with breastfeeding duration (Riordan et al, 2001; Kumar et al, 2006)
18
results & discussion
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