Breastfeeding Difficulties and Exclusivity Among Late Preterm and Term Infants: Results From the All Our Babies Study

Abstract

reterm birth is defined as delivery of a live born infant before 37 weeks of completed gestation. 1 Worldwide, about 15 million babies (more than 10% of all births) are born preterm. 1 There are three commonly used or established categories of preterm birth based on gestational age: very early (<32 weeks), early (32 0/7 -33 6/7 weeks), and late preterm (LP; 34 0/7 -36 6/7 weeks). "Late preterm" was introduced to replace the "near term" descriptor to differentiate this group as more similar to preterm infants and more vulnerable compared to term infants. 2 The increase in preterm birth rates in recent years can be largely attributed to increases in LP births. 3 The Canadian preterm birth rate was approximately 8.1% in 2006 to 2007 and almost three quarters (74.0%) of these births were late preterm. 4 Indeed, LPs are the largest and fastest growing subgroup of preterm births, a trend that constitutes a growing public health concern given its increased risk of morbidity compared to longer gestations. 5 Despite assumptions that LP infants are similar to term infants, LPs are physiologically and metabolically immature. 5 LP infants are more likely to be diagnosed with temperature instability, hypoglycemia, respiratory distress, apnea, jaundice, and feeding difficulties during birth and in the first month of life. 5 Although less is known about long-term outcomes for LPs and their families, recent reports suggest that there are subtle developmental delays that present as poor school outcomes, 6 cognitive impairments, and behavioural and emotional problems. 7 In addition, mothers of LPs tend to report both short-term and long lasting distress, including breastfeeding difficulties, anxiety and depression, and post-traumatic stress. 5,[8][9][10][11][12] Given the large population attributable risk associated with the LP gestation category, such findings may have major implications for health and education services.Although the benefits associated with breastfeeding for infants and mothers are well documented, 13 the rates of exclusive breastfeeding at 4 to 6 months are far from optimal in many countries, 14 including Canada, 15 which fail to meet WHO's recommendation of exclusive breastfeeding for the first six months of life. 16 In Canada, the rate of breastfeeding initiation is promising at 90.3%, however only 14.4% of mothers surveyed reported exclusively breastfeeding at 6 months. 15 Preterm birth is a risk factor for early discontinuation of breastfeeding, along with other known factors such as maternal age,

Establishing Breastfeeding with the Late Preterm Infant in the NICU

“…In regards to duration, these researchers also found that mothers of LPIs were more likely to discontinue breastfeeding by 4‐months postpartum. The risk of early breastfeeding cessation in the late preterm population was also supported by Nagulesapillai et al () who found that LPIs are at increased risk of exclusive breastfeeding cessation by 4‐months postpartum compared to term infants. Mothers identified the most significant breastfeeding difficulties related to infant issues, such as a sleepy infant.…”

Preterm feeding recommendations are achievable in large-scale research studies

“…The rates of exclusive or predominant breastfeeding were lower in this study than in WHO MGRS (MGRS -approximately 80 and 63 %; PPFS -65.3 and 56.5 % at 4 weeks and 3 months, respectively) [19]. These results are not unexpected as breastfeeding rates are generally lower in preterm compared to term infants [9,[20][21][22], and establishing and maintaining breastfeeding in preterms requires considerable support. Factors that may impact upon the ability of preterms to breastfeed are clinical conditions related to prematurity, extended hospitalization, increased sleepiness and maternal illness.…”

Breastfeeding the late preterm infant: experiences of mothers and perceptions of public health nurses

“…Nagulesapillai and colleagues found that 55% of mothers of LPIs exclusively breastfed at 4 months in Calgary [12]. The discrepancies may be attributed to the fact that the difficulties encountered during the early breastfeeding experience may have been overcome by the time the LPIs were 4 months of age.…”