Associations Between Single-Family Room Care and Breastfeeding Rates in Preterm Infants

Abstract

Background Hospitalization in neonatal intensive care units with a single-family room design enables continuous maternal presence, but less is known regarding the association with milk production and breastfeeding. Research aim To compare maternal milk production, breastfeeding self-efficacy, the extent to which infants received mother’s milk, and rate of direct breastfeeding in a single-family room to an open bay neonatal intensive care unit. Methods A longitudinal, prospective observational study comparing 77 infants born at 28– 32° weeks gestational age and their 66 mothers ( n = 35 infants of n = 30 mothers in single family room and n = 42 infants of n = 36 mothers in open bay). Comparisons were made on milk volume produced, the extent to which infants were fed mother’s milk, and rate of direct breastfeeding from birth to 4 months’ corrected infant age. Breastfeeding self-efficacy was compared across mothers who directly breastfed at discharge ( n = 45). Results First expression (6 hr vs. 30 hr, p < .001) and first attempt at breastfeeding (48 hr vs. 109 hr, p < .001) occurred significantly earlier, infants were fed a greater amount of mother’s milk ( p < .04), and significantly more infants having single-family room care were exclusively directly breastfed from discharge until 4 months’ corrected age; OR 6.8 (95% CI [2.4, 19.1]). Volumes of milk produced and breastfeeding self-efficacy did not differ significantly between participants in either units. Conclusion To increase the extent to which infants are fed mother’s own milk and are exclusively directly breastfed, the design of neonatal intensive care units should facilitate continuous maternal presence and privacy for the mother–infant dyad.

Positive breastfeeding experiences and facilitators in mothers of preterm and low birthweight infants: a meta-ethnographic review

“…Further, mothers need to be empowered by staff to be ‘in charge’ of breastfeeding and not become passive recipients of care and support [ 69 ]. Within settings where mothers are separated from their infants, it is hard for mothers to take active control to act freely and to gain trust in their capabilities [ 15 ]; this is contrary to units where the mother-infant dyad can spend unending time in close physical proximity [ 5 ]. However, regardless of the environmental features, staff support is crucial for breastfeeding preterm/LBW infants [ 70 , 71 ].…”

“…Although a broad definition of breastfeeding was used during the literature search and selection of papers, positive experiences of feeding the infant were only described when the mother breastfed at breast in all papers. One reason for this could be that in many settings the norm and goal is to feed the infant directly at breast [ 5 , 8 ]. When mothers do not achieve this goal but instead feed the infant by alternative means, i.e., a bottle, the overall experience becomes negative.…”

“…It has been suggested that even small changes in the prevalence of breast milk feeding may result in significant changes in health, healthcare costs, and economic productivity for preterm infants and their mothers [ 2 ]. Despite the overwhelming evidence of the value of breast milk for mothers and their preterm and/or LBW infants, there are wide variations in the initiation and duration rates of feeding breast milk [ 3 – 5 ], where preterm infants have shown to have a shorter breast milk feeding duration compared to term infants [ 6 – 8 ].…”

Privacy, Early Colostrum, and Gestational Age are Associated with Exclusive Breastfeeding in Preterm and Sick Term Infants

“…This was shown to have a major impact on breastfeeding success of preterm infants born at 28-32 weeks of gestation. Exclusive breastfeeding at discharge occurred in 65.7 % of dyads in single-family rooms compared to 9.5 % in standard open-bay care [ 33 ] .…”

Factors associated with post NICU discharge exclusive breastfeeding rate and duration amongst first time mothers of preterm infants in Shanghai: a longitudinal cohort study

“…However, the breastfeeding rate of premature infants in China is far lower than that of in developed countries. Although China has implemented related measures to promote the breastfeeding rate of preterm infants [ 20 ], the breastfeeding rate of preterm infants in the NICU is still only 15% [ 21 ].…”