Abstract

Background: Increasingly, evidence supports oral feeding of very-low-birth-weight (VLBW) preterm infants exclusively at breast or with breastmilk. Despite known breastmilk benefits, outcomes related to exclusive breastmilk provision are poor. Identifying factors that promote breastmilk provision is critical.

Purpose: Breastfeeding practices of mothers of VLBW infants admitted to neonatal intensive care unit (NICU) were explored to identify factors associated with mode of feeding at discharge.

Method:

This retrospective study replicates previous work. Subjects were VLBW preterm infants consecutively admitted during a 24-month period. Primary outcomes included receiving any breastmilk at discharge. Infant variables included gestational age (GA), post-menstrual age (PMA) of first direct breastfeeding, and co-morbid conditions. Maternal variables included age and ethnicity. Nursing practices variables included first direct-to-breast feeding, number of times to breast daily and total direct-to-breast feeding encounters 24 hours prior to discharge.

Results: 96 VLBW infants (28.7 ± 2.8 weeks GA) met inclusion criteria. Of these, 48% received breastmilk at discharge. Controlling for significant effect of length of stay, infants receiving first oral feed at breast were more likely discharged home receiving breastmilk (adj OR 8.7, 95% CI 2.9-32.3, p<0.0001). There was both an independent effect of first oral feed at breast, and an interaction where infants of non-married women also benefited from the first oral feed at breast.

Implications: Significant associations were found between first oral feeding at breast and infant receiving any breastmilk at discharge. Targeting VLBW infants to receive first oral feeding at breast may yield the best outcome even among sickest and smallest infants.