Among infants born weighing <1250 g and exclusively fed human milk, the use of HMBF did not improve feeding tolerance or reduce mortality and morbidity compared with BMBF. This trial was registered at clinicaltrials.gov as NCT02137473.

The Canada Prenatal Nutrition Program (CPNP) provides a variety of health and nutrition supports to vulnerable mothers and strongly promotes breastfeeding but does not have a formal framework for postnatal lactation support. Breastfeeding duration and exclusivity rates in Canada fall well below global recommendations, particularly among socially and economically vulnerable women. We aimed to explore CPNP participant experiences with breastfeeding and with a novel community lactation support program in Toronto, Canada that included access to certified lactation consultants and an electric breast pump, if needed. Four semistructured focus groups and 21 individual interviews (n = 46 women) were conducted between September and December 2017. Data were analysed using inductive thematic analysis. Study participants reported a strong desire to breastfeed but a lack of preparation for breastfeeding‐associated challenges. Three main challenges were identified by study participants: physical (e.g., pain and low milk supply), practical (e.g., cost of breastfeeding support and maternal time pressures), and breastfeeding self‐efficacy (e.g., concern about milk supply and conflicting information). Mothers reported that the free lactation support helped to address breastfeeding challenges. In their view, the key element of success with the new program was the in‐home visit by the lactation consultant, who was highly skilled and provided care in a non‐judgmental manner. They reported this support would have been otherwise unavailable due to cost or travel logistics. This study suggests value in exploring the addition of postnatal lactation support to the well‐established national CPNP as a means to improve breastfeeding duration and exclusivity among vulnerable women.

Background Data on how baseline characteristics, acuity, morbidity, and nutrition work in combination to affect the growth of very-low-birth-weight (VLBW, &lt;1500 g) infants are limited. Objective We aimed to determine factors associated with in-hospital weight, length, and head circumference (HC) trajectories of VLBW infants. Methods VLBW infants (n = 316) from the GTA-DoMINO trial were included. Linear mixed-effects models assessed relations of baseline characteristics, acuity (at birth, across hospitalization), major morbidities, and nutrition (enteral feeding type, macronutrient/energy intakes) with changes in anthropometrics over hospitalization (days 1–8, 9–29, 30–75). Results Specific factors and the strength of their associations with growth depended on in-hospital time interval. Small-for-gestational-age infants experienced weight gain (4.3   g · kg−1 · d−1; 95% CI: 2.0, 6.5   g · kg−1 · d−1) during days 1–8, versus weight loss (−4.6     g · kg−1 · d−1; 95% CI: −5.6, −3.7     g · kg−1 · d−1) among appropriate-for-gestational-age infants (P &lt; 0.001). Positive-pressure ventilation (versus oxygen/room air) was associated with slower weight (−1.8    g · kg−1 · d−1) and HC (−0.25 cm/wk) gain during days 9–29 (P &lt; 0.001). Morbidities were negatively associated with growth after days 1–8, with patent ductus arteriosus (PDA) showing negative associations with weight (−2.7     g · kg−1 · d−1), length (−0.11 cm/wk), and HC (−0.21 cm/wk) gain during days 9–29 (P &lt; 0.001). Macronutrient/energy intakes were associated with weight across hospitalization (P ≤ 0.01), with greater weight gain (1.3–3.0 g  ·  kg−1  ·  d−1) among infants achieving macronutrient/energy recommendations during days 9–29 and 30–75. Macronutrient/energy intakes were associated with HC during the first month (P = 0.013–0.003), with greater HC gain (0.07–0.12 cm/wk) among infants achieving protein, lipid, and energy recommendations during days 9–29. Conclusions Baseline characteristics, acuity, morbidity, and nutrition factors were independently associated with VLBW infant growth. A focus on achieving macronutrient/energy recommendations and improving nutrient delivery to PDA-diagnosed infants may yield improvements to their growth. This trial was registered at www.isrctn.com as ISRCTN35317141.