The impact of neonatal unit policies on breast milk feeding at discharge of moderate preterm infants: The EPIPAGE‐2 cohort study

Abstract

Facilitating factors and barriers to breast milk feeding (BMF) for preterm infants have been mainly studied in very preterm populations, but little is known about moderate preterm infants. We aimed to analyze hospital unit characteristics and BMF policies associated with BMF at discharge for infants born at 32 to 34 weeks' gestation. EPIPAGE‐2, a French national cohort of preterm births, included 883 infants born at 32 to 34 weeks' gestation. We investigated kangaroo care in the first 24 hr, early involvement of parents in feeding support, volume of the unit, BMF information given to mothers hospitalized for threatened preterm delivery, protocols for BMF, presence of a professional trained in human lactation, unit training in neurodevelopmental care, and regional BMF initiation rates in the general population. Multilevel logistic regression analysis was used to investigate associations between unit policies and BMF at discharge, adjusted for individual characteristics and estimating odds ratios (ORs) and 95% confidence intervals (CIs). Overall, 59% (490/828) of infants received BMF at discharge (27% to 87% between units). Rates of BMF at discharge were higher with kangaroo care (adjusted OR 2.03 [95% CI 1.01, 4.10]), early involvement of parents in feeding support (1.94 [1.23, 3.04]), unit training in a neurodevelopmental care programme (2.57 [1.18, 5.60]), and in regions with a high level of BMF initiation in the general population (1.85 [1.05, 3.28]). Creating synergies by interventions at the unit and population level may reduce the variability in BMF rates at discharge for moderate preterm infants.

Breastfeeding in Hospitals: Factors Influencing Maternal Choice in Italy

“…It is very important that breastfeeding start within 24 h of delivery. We observed that 85% of children were attached to their mothers' breasts within the first 24 h. Those who do not take the breast within the first day of life will very rarely do so in the future, and the first three hours are essential to ensure the continuation of exclusive breastfeeding [22,30,33,34].…”

Breastfeeding progression in late preterm infants from birth to one month

“…On the other hand, 33% of the LPT NICU mothers initiated breastfeeding within 6 h compared with 92% of the LPT MU mothers. These discrepancies can not only be explained by infant illness or lower gestational age among the LPT NICU infants but may also be attributed to different strategies and unit policies (e.g., separation of mother and infant, kangaroo care, parental involvement, breastfeeding within an hour, and use of a breast pump), which has recently been highlighted as important for breast milk feeding in moderate preterm infants (Mitha et al, ). In the Icelandic NICU, there was a strong emphasis on early expression and milk production and in the maternity unit an emphasis on methods to assure at breastfeeds (i.e., breast, finger feeding, and supplemental system).…”

Nutritional Management of Moderate- and Late-Preterm Infants Commenced on Intravenous Fluids Pending Mother's Own Milk: Cohort Analysis From the DIAMOND Trial

“…Rates of breastfeeding, the ability to exclusively breastfeed, and breastmilk production are well documented to be challenging to mothers of MP and LP babies ( 41 – 43 ). However, supportive care programs to encourage and support breastfeeding have been shown to improve breastmilk provision during admission, decrease the use of formula, and increase the rates of exclusive breastfeeding in moderate to late preterm infants ( 44 – 46 ). Therefore, there may be an opportunity for quality initiatives to increase breastmilk provision, particularly in the first week after birth in this high-risk group.…”