Unit policies and breast milk feeding at discharge of very preterm infants: The EPIPAGE‐2 cohort study

Abstract

Background Facilitating factors and barriers to breast milk feeding (BMF) very preterm (VP) infants have been widely studied at the individual level. We aimed to describe and analyse factors associated with BMF at discharge for VP infants, with a special focus on unit policies aiming to support BMF. Methods We described BMF at discharge in 3108 VP infants enrolled in EPIPAGE‐2, a French national cohort. Variables of interest were kangaroo care during the 1st week of life (KC); unit's policies supporting BMF initiation (BMF information systematically given to mothers hospitalised for threatened preterm delivery and breast milk expression proposed within 6 hours after birth) and BMF maintenance (availability of protocols for BMF and a special room for mothers to pump milk); the presence in units of a professional trained in human lactation and regional BMF initiation rates in the general population. Associations were investigated by multilevel logistic regression analysis, with adjustment on individual factors. Results In total, 47.2% of VP infants received BMF at discharge (range among units 21.1%‐84.0%). Unit policies partly explained this variation, regardless of individual factors. BMF at discharge was associated with KC (adjusted odds ratio (aOR) 2.26 (95% confidence interval (CI) 1.40, 3.65)), with policies supporting BMF initiation (aOR 2.19 (95% CI 1.27, 3.77)) and maintenance (aOR 2.03 (95% CI 1.17, 3.55)), but not with BMF initiation rates in the general population. Conclusion Adopting policies of higher performing units could be an effective strategy for increasing BMF rates at discharge among VP infants.

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

“…These mothers could beneficiate of targeted information and support to help them BMF their preterm baby. Unlike very preterm infants included in EPIPAGE‐2 (Mitha et al, ), infant characteristics were not associated with BMF at discharge in this population of moderate preterm infants. Most of these infants stayed in the same unit until discharge, which strengthens the role of unit policies to support BMF (Campbell & Miranda, ; Colaizy et al, ; Herich et al, ; Mitha et al, ; Rayfield et al, ; Rodrigues, Severo, Zeitlin, & Barros, ; Wilson et al, ).…”

“…Multifactorial determinants are involved in BMF rate, particularly societal attitudes (Rollins et al, ). In this population of moderate preterm infants, unlike very preterm infants (Mitha et al, ), BMF rates at initiation and discharge were associated with BMF rates in the general population. Even if most variables associated with BMF at discharge were common for very and moderate preterm infants, the fact that the regional BMF initiation rates in the general population may have different effects deserves attention.…”

“…Breast milk banks, known to positively affect BMF (Parker, Burnham, Mao, Philipp, & Merewood, ; Wilson et al, ), are also well distributed in France and contribute to the diffusion of facilities (Human milk bank French association, ). Nevertheless, the rate of first enteral feeding with human milk was lower in these moderately preterm infants compared with very preterm infants (38% vs. 80%; Mitha et al, ). Using donor milk for infants born after 32 WG when the mother's milk is not available was not recommended in France in 2011 because of insufficient reserves.…”

“…Nevertheless, the rate of first enteral feeding with human milk was lower in these moderately preterm infants compared with very preterm infants (38% vs. 80%; Mitha et al, 2019). Using donor milk for infants born after 32 WG when the mother's milk is not available was not recommended in France in 2011 because of insufficient reserves.…”

“…Facilitating factors and barriers to BMF in preterm infants has been mainly studied in very preterm and late preterm infants (Bonet et al, 2015;Gianni et al, 2016;Kair, Flaherman, Newby, & Colaizy, 2015;Meier, Patel, Wright, & Engstrom, 2013;Mitha et al, 2019;Rayfield et al, 2015;Wilson et al, 2018). Recent cohort studies have emphasized the great variability among neonatal intensive care units (NICUs) in rates of BMF at discharge for very preterm infants (Lee & Gould, 2009;Mitha et al, 2019;Powers, Bloom, Peabody, & Clark, 2003;Wilson et al, 2018). However, data are lacking for moderate preterm infants, who account for a large proportion of preterm infants (Ananth, Friedman, & Gyamfi-Bannerman, 2013;Blencowe et al, 2012).…”