Clinical applicability of Nursing Outcomes related to breastfeeding establishment in the Neonatal Intensive Care Unit

Keywords: Breast Feeding; Nursing Process; Nursing Assessment; Validation Study.


Objective: to analyze clinical changes in the breastfeeding process in the Neonatal Intensive Unit Care using the Nursing Outcomes Classification. Methods: this longitudinal and prospective study was conducted in a public hospital at Neonatal Intensive Unit Care in Brazil. The sample consisted of 61 mother-infant dyads evaluated three times during breastfeeding by trained nurses who applied the Nursing Outcomes Classification scales. Statistical analysis was performed using Generalized Estimating Equation Models. Results: most indicators of the two Nursing Outcomes studied presented a similar frequency of scores of 4 and 5. It was observed that in most indicators, there were clinical changes throughout the evaluations over time; however, the indicators related to the mother presented a higher risk of scoring 4 and 5 on the Likert scale. Conclusion: the Nursing Outcomes Classification outcomes and indicators included successfully evaluated the clinical evolution of mother-infant dyads and proved to be applicable for use in Neonatal Intensive Unit Care. Contributions to practice: nurses can use the indicators to assess the quality of the proposed interventions.


Laborie S, Denis A, Horsch A, Occelli P, Margier J, Morisod Harari M, et al. Breastfeeding peer counselling for mothers of preterm neonates: protocol of a stepped-wedge cluster randomised controlled trial. BMJ Open. 2020;10(1):e032910. doi:

Yu G, Liu F, Zhao Y, Kong Y, Wei H. Promoting breastfeeding and lactation among mothers of premature newborns in a hospital in China. Nurs Womens Health. 2021;25(1):21-9. doi:

Li X, Wu Y, Zhong XY, Wang M, Huang L. Breastfeeding promotion strategies study on preterm infants in the neonatal intensive care unit. 2019. Beijing da Xue Xue Bao Yi Xue Ban. 2019;51(4):711-5. doi:

Moorhead S, Swanson E, Johnson M, Maas ML. Nursing Outcomes Classification (NOC): measurement of health outcomes. St Louis (MO): Elsevier; 2018.

Medronho AR, Carvalho DM, Bloch KV, Luiz RR, Werneck GL. Epidemiologia. São Paulo: Atheneu; 2011.

Emidio SCD, Moorhead S, Oliveira HC, Herdman TH, Oliveira-Kumakura ARS, Carmona EV. Validation of nursing outcomes related to breastfeeding establishment. Int J Nurs Knowl. 2020;31(2):134-44. doi:

Fernández-Gutiérrez M, Bas-Sarmiento P, Albar-Marín MJ, Paloma-Castro O, Romero-Sánchez JM. Health literacy interventions for immigrant populations: a systematic review. Int Nurs Rev. 2018;65(1):54-64. doi:

Bridges N, Howell G, Schmied V. Exploring breastfeeding support on social media. Int Breastfeed J. 2018;13:22. doi:

Barachetti R, Villa E, Barbarini M. Weaning and complementary feeding in preterm infants: management, timing and health outcome. Pediatr Med Chir. 2017;39(4):181. doi:

Lima APE, Castral TC, Leal LP, Javorski M, Sette GCS, Scochi CGS, et al. Exclusive breastfeeding of premature infants and reasons for discontinuation in the first month after hospital discharge. Rev Gaúcha Enferm. 2019;40(2):e20180406. doi:

Felice JP, Geraghty SR, Quaglieri CW, Yamada R, Wong AJ, Rasmussen KM. ‘Breastfeeding’ without baby: a longitudinal, qualitative investigation of how mothers perceive, feel about, and practice human milk expression. Matern Child Nutr. 2019;13(3):23-39. doi:

Wilson JC. Using social media for breastfeeding support. Nurs Womens Health. 2020;24(5):332-43. doi:

Betts RC, Johnson HM, Eglash A, Mitchell KB. It’s not yeast: retrospective cohort study of lactating women with persistent nipple and breast pain. Breastfeed Med. 2021;16(4):318-24. doi:

Galipeau R, Dumas L, Lepage M. Perception of not having enough milk and actual milk production of first-time breastfeeding mothers: is there a difference? Breastfeed Med. 2017;12(4):210-7. doi:

Mills N, Lydon AM, Davies-Payne D, Keesing M, Geddes DT, Mirjalili SA. Imaging the breastfeeding swallow: pilot study utilizing real-time MRI. Laryngoscope Investig Otolaryngol. 2020;5(3):572-9. doi:

Hernandez AM, Bianchini EMG. Swallowing analyses of neonates and infants in breastfeeding and bottle-feeding: impact on videofluoroscopy swallow studies. Int Arch Otorhinolaryngol. 2019;23(3):e343-e353. doi:

Boateng GO, Neilands TB, Frongillo EA, Melgar-Quiñonez HR, Young SL. Best practices for developing and validating scales for health, social, and behavioral research: a primer. Front Public Health. 2018;6:149. doi:

Niazi A, Rahimi VB, Soheili-Far S, Askari N, Rahmanian-Devin P, Sanei-Far Z, et al. A systematic review on prevention and treatment of nipple pain and fissure: are they curable? J Pharmacopuncture. 2018;21(3):139-50. doi:

Jackson KT, Dennis CL. Lanolin for the treatment of nipple pain in breastfeeding women: a randomized controlled trial. Matern Child Nutr. 2017;13(3):e12357. doi:

Puapornpong P, Paritakul P, Suksamarnwong M, Srisuwan S, Ketsuwan S. Nipple pain incidence, the predisposing factors, the recovery period after care management, and the exclusive breastfeeding outcome. Breastfeed Med. 2017;12(3):69-73. doi:

Loewenberg Weisband Y, Keim SA, Keder LM, Geraghty SR, Gallo MF. Early breast milk pumping intentions among postpartum women. Breastfeed Med. 2017;12(1):28-32. doi:

Kumari N, Jain A, Ramji S. Prediction of nutritive sucking in preterm babies (<34 weeks) and preterm sucking readiness scale. Matern Health Neonatol Perinatol. 2019;5:18. doi:

Fan HSL, Wong JYH, Fong DYT, Lok KYW, Tarrant M. Breastfeeding outcomes among early-term and full-term infants. Midwifery. 2019;71:71-6. doi:

Gianni ML, Bezze EN, Sannino P, Baro M, Roggero P, Muscolo S, Plevani L, Mosca F. Maternal views on facilitators of and barriers to breastfeeding preterm infants. BMC Pediatr. 2018;18(1):283. doi:

Kuhnly JE. Sustained breastfeeding and related factors for late preterm and early term infants. J Perinat Neonatal Nurs. 2018;32(2):175-88. doi:

Michels KA, Ghassabian A, Mumford SL, Sundaram R, Bell EM, Bello SC, Yeung EH. Breastfeeding and motor development in term and preterm infants in a longitudinal US cohort. Am J Clin Nutr. 2017;106(6):1456-62. doi:

Pires AUB, Lucena AF, Behenck A, Heldt E. Results of the Nursing Outcomes Classification/NOC for patients with obsessive-compulsive disorder. Rev Bras Enferm. 2020;10;73(1):e20180209. doi:

Bjorklund-Lima L, Müller-Staub M, Cardozo MCE, Bernardes DS, Rabelo-Silva ER. Clinical indicators of nursing outcomes classification for patient with risk for perioperative positioning injury: a cohort study. J Clin Nurs. 2019;28(23-24):4367-78. doi:

Osmarin VM, Boni FG, Bavaresco T, Lucena AF, Echer IC. Use of the Nursing Outcomes Classification - NOC to assess the knowledge of patients with venous ulcer. Rev Gaúcha Enferm. 2019;41(spe):e20190146. doi:

Luzia MF, Vidor ID, Silva ACFE, Lucena AF. Fall prevention in hospitalized patients: Evaluation through the nursing outcomes classification/NOC. Appl Nurs Res. 2020;54:151273. doi:

How to Cite
Emidio, S. C. D., Oliveira, H. C., Moorhead, S., Oliveira-Kumakura, A. R. de S., & Carmona, E. V. (2022). Clinical applicability of Nursing Outcomes related to breastfeeding establishment in the Neonatal Intensive Care Unit. Rev Rene, 23, e80535.
Research Article