BACKGROUND AND SIGNIFICANCELactation often plays a dominant role in how motherhood is experienced during the early postnatal period. 1 However, for mothers of premature infants (about 10% of infants worldwide), lactation and breastfeeding can be extremely challenging. 2,3 Premature infants are fragile due to their early birth (less than 37 weeks of gestational age), and they often require treatment and care at a neonatal intensive care unit (NICU). 4 A review from 2015 revealed that stable premature infants exposed to the breast as early as 27 to 28 weeks postconceptional age (PCA) maintain their physiological status. Furthermore, some infants exposed to the breast before 30 weeks PCA were exclusively breastfeed at 32 weeks PCA. 5 According to the World Health Organization, exclusive breastfeeding is the optimal nutrition for all infants during their first 6 months due to its nutritional, gastrointestinal, immunological, developmental, and psychological benefits. 6 Early breastfeeding (before 32 weeks PCA) has also been found to be less stressful to the premature infant than bottle-feeding. 7,8 Nevertheless, research has revealed a lower incidence and a shorter duration of

Aim Although exclusive breastfeeding is recommended for all newborn in the first 6 months of life, only 13% of Danish premature infants complies with this. This trial aimed to examine whether oral stimulation prolonged exclusive breastfeeding in premature infants. Method A randomised controlled trial was conducted at the Neonatal Intensive Care Unit, Hvidovre Hospital, Denmark between 2016 and 2018. Systematic oral stimulation was performed by the parents after training by occupational therapists. Primary outcome was exclusive breastfeeding duration with 6 months' follow‐up, analysed by intention‐to‐treat. Results Included were 211 infants (53% boys) with a mean gestational age of 231 days, allocated in ratio 1:1 to oral stimulation or standard care. There was no difference in exclusive breastfeeding duration between infants orally stimulated and control infants. Thus, for orally stimulated infants, median duration was 122 days (interquartile range 40‐183) in contrast to 154 days (interquartile range 61‐183) for the controls, P value .16. At 6 months of age, 27% of orally stimulated infants were exclusively breastfed compared with 25% of controls. Conclusion In healthy premature infants, oral stimulation performed by parents has no long‐lasting effect on breastfeeding duration. Attention should be directed to parental education and involvement.

Purpose: Maternal concerns for health and growth in prematurely born infants affect the breastfeeding duration. Method:This prospective observational study evaluated whether maternal concerns regarding insufficient milk supply were supported by inadequate nutrients in human milk or low infant growth. The study followed mothers of 211 premature born infants for 6 months after delivery. Results: Of the 211 infants, 156 were not exclusively breastfed for the recommended 6 months after delivery.

Aim Exclusive breastfeeding is recommended for the first 6 months of life, but the breastfeeding rate in premature infants is low. We examined the effect of oral stimulation on infant's strength of suction and the relation between this intra‐oral vacuum and breastfeeding duration. Method Between 2016 and 2018, 211 infants in a Danish neonatal unit were randomised 1:1 and of these 108 to oral stimulation intervention and 103 to control. Suction was measured as peak vacuum at enrolment and a corrected age of 6 weeks. Breastfeeding duration was registered. Results Vacuum increased from enrolment to a corrected age of 6 weeks in all infants, and no effect of oral stimulation intervention was demonstrated P = .08. Infants born ≤32 gestational weeks had lower vacuum compared with infants born after, 350 vs 398 mbar P < .001. For infants born after 32 gestational weeks, the odds ratio for exclusive breastfeeding at 6 months was 1.99 per 100 mbar increase in vacuum P = .01. Conclusion In our study, infant's intra‐oral vacuum increased with age and was not affected by the oral stimulation intervention. For infants born after 32 gestational weeks, the exclusive breastfeeding rate was positively associated with a strong vacuum.