Predictors of breastfeeding non‐initiation in the NICU

Abstract

This study compared predictors of breastfeeding non-initiation between infants who were and were not admitted to the NICU so that interventions can target high-risk mothers whose infants desperately need breastmilk. This was a population-based retrospective cohort study of singleton Ohio live births using birth certificates, 2006-2015. In babies who were and were not admitted to the NICU, a multivariable logistic regression model assessed the association between breastfeeding non-initiation and predictors relating to the mother, neonate, and labour and delivery events while adjusting for covariables. Of 1,463,506 births, 76,855 infants were admitted to the NICU (5.8% of study population), and breastfeeding was not initiated in 39.4% of them, compared with 31.5% of infants in the newborn nursery, p < 0.001. Apart from abnormal newborn conditions, smoking during pregnancy was the most significant risk factor for not breastfeeding in the NICU (RR 1.91 [95% CI 1.82-2.02]) and newborn nursery (RR 2.10 [95% CI 2.08-2.13]), followed by socioeconomic factors and multiparity. Limited prenatal visits (≤5) were a significantly higher risk factor in the NICU (RR 1.41 [95% CI 1.34-1.49]) than in the newborn nursery (RR 1.24 [95% CI 1.22-1.26]). Intentional home birth and use of infertility treatment were associated with breastfeeding initiation. The rate of breastfeeding initiation is lower in infants admitted to the NICU than those who are not, especially among mothers with limited prenatal care. Interventions should target mothers who smoke because they are least likely to breastfeed, and their babies, who are prone to serious health conditions, could especially benefit from breastmilk.

Factors associated with postmenstrual age at full oral feeding in very preterm infants

“…Better socio-economic status was associated with earlier FOF in the univariable model, although this result needs to be interpreted with caution, as multiple testing may impact the significance of some results. To our knowledge, this association has not been studied before, but the association of socioeconomic status with parental presence and skin to skin care [ 32 ], and breastfeeding during NICU [ 11 , 33 ], could have mediated this outcome. The association of socio-economic status with later feeding difficulties in preterm children has also been shown [ 34 ].…”

“…Different factors are known to be associated with age at tube weaning, such as gestational age, need for respiratory support and bronchopulmonary dysplasia (BPD) [8], as well as parental involvement [3]. The association of socio-economic status with several neurodevelopmental outcomes in preterm children has been demonstrated [9], but the association with feeding is underreported [10,11]. Moreover, studies of oral motor interventions to enhance feeding skills, such as non-nutritive sucking and oral stimulation, do not show unanimous results [12][13][14][15], which could be explained by the heterogeneity of the populations and of the interventions.…”

Feeding the critically ill child in intensive care units: a descriptive qualitative study in two tertiary hospitals in Ghana

“…Feeding at any stage of life is a basic need for survival (12). The newborn faces the reality of life to start feeding within half an hour from birth to transition to adopt to the extra uterine life in order to meet the physiological needs of the body (9,10,12,13).…”

“…Enteral feeding in itself may cause underfeeding and therefore need to be complemented with volume-based feeding (12). However, human milk still remains the main nourishment for children, therefore, mothers breastfeed and or express milk for feeding of their critically ill children in the ICU (8,13,16). Experts in nutrition and dietetics are sometimes required to estimate the number of micronutrients and mix-feeds for critically ill children in intensive care (5,22).…”

Socio-Economic Differences in Early Initiation of Breastfeeding Among Children in a Ugandan Cross-Sectional Study

“…The pathways through which household or maternal socio-economic status influence EIB are not clearly delineated, however it might follow earlier-on described models on social determinants of health inequalities and health [23,24]. er than socio-economic status at individual or household level, other factors that were found to influence EIB in developing and developed countries can be grouped into socio-demographic, medical, psycho-social, cultural and policy related factors [25][26][27][28][29]. Of interest to mention among others are those factors that are positively associated with EIB, which include but not limited to maternal-newborn skin-to-skin contact after birth, health facility based deliveries that are supervised by skilled attendants, maternal age above 30 years and normal vaginal delivery.…”