Factors Associated with Exclusive Breastfeeding of Preterm Infants. Results from a Prospective National Cohort Study

Abstract

Background and AimEvidence-based knowledge of how to guide the mothers of preterm infants in breastfeeding establishment is contradictive or sparse. The aim was to investigate the associations between pre-specified clinical practices for facilitating breastfeeding, and exclusive breastfeeding at discharge as well as adequate duration thereof.MethodsA prospective survey based on questionnaires was conducted with a Danish national cohort, comprised of 1,221 mothers and their 1,488 preterm infants with a gestational age of 24–36 weeks. Adjusted for covariates, the pre-specified clinical practices were analysed by multiple logistic regression analyses.ResultsAt discharge 68% of the preterm infants were exclusively breastfed and 17% partially. Test-weighing the infant, and minimizing the use of a pacifier, showed a protective effect to exclusive breastfeeding at discharge (OR 0.6 (95% CI 0.4–0.8) and 0.4 (95% CI 0.3–0.6), respectively). The use of nipple shields (OR 2.3 (95% CI 1.6–3.2)) and the initiation of breast milk expression later than 48 hours postpartum (OR 4.9 (95% CI 1.9–12.6)) were associated with failure of exclusive breastfeeding at discharge. The clinical practices associated with an inadequate breastfeeding duration were the initiation of breast milk expression at 12–24 hours (OR 1.6 (95% CI 1.0–2.4)) and 24–48 hours (OR 1.8 (95% CI 1.0–3.1)) vs. before six hours postpartum, and the use of nipple shields (OR 1.4 (95% CI 1.1–1.9)).ConclusionEarly initiation of breast milk pumping before 12 hours postpartum may increase breastfeeding rates, and it seems that the use of nipple shields should be restricted. The use of test-weighing and minimizing the use of a pacifier may promote the establishment of exclusive breastfeeding, but more research is needed regarding adequate support to the mother when test-weighing is ceased, as more of these mothers ceased exclusive breastfeeding at an early stage after discharge.

Why do mothers fail to breastfeed successfully? A descriptive study done at selected lactation management centres in Sri Lanka

“…Incorrect feeding practices like feeding formula milk or anything other than breast milk and bottle feeding were shown to be significantly associated which must have been due to the poor knowledge on the importance of exclusive BF and the adverse outcomes of formula or other feeds which also showed significant association with difficulties in BF in this study. Two community based study showed similar results 14,17 .…”

“…Neonatal birth weight less than 2500g or more than 3500g and the period of amenorrhoea less than 37 weeks were also not associated with BF status which could also be due to the fact that some of the extreme premature and extreme low birth weight babies are admitted to the SCBU. A Danish study also revealed that 68% of premature babies exclusively breast fed on discharge 17 .…”

Breastfeeding Progression in Preterm Infants Is Influenced by Factors in Infants, Mothers and Clinical Practice: The Results of a National Cohort Study with High Breastfeeding Initiation Rates

“…This article is the second from the cohort; the first article analysed factors associated with exclusive breastfeeding at discharge and adequate duration [14].…”

Experiência de amamentação de mulheres após mamoplastia

“…Certainly the speeches describing sadness, frustration and guilt reflect negative feelings of failure in breastfeeding, which are part of the repertoire of so many other testimonies of women who desire and try hard to maintain breastfeeding, regardless of the biological conditions associated with surgery (16)(17) . However, among women who undergo breast surgeries, these emotions collide with the desire and persistence for maintaining breastfeeding with relactation and formula.…”