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. 2014 Feb 19;9(2):e89077.
doi: 10.1371/journal.pone.0089077. eCollection 2014.

Factors associated with exclusive breastfeeding of preterm infants. Results from a prospective national cohort study

Ragnhild Maastrup  1 , Bo Moelholm Hansen  2 , Hanne Kronborg  3 , Susanne Norby Bojesen  4 , Karin Hallum  5 , Annemi Frandsen  6 , Anne Kyhnaeb  7 , Inge Svarer  8 , Inger Hallström  9
Affiliations

Factors associated with exclusive breastfeeding of preterm infants. Results from a prospective national cohort study

Ragnhild Maastrup et al. PLoS One. .

Abstract

Background and aim: Evidence-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.

Methods: A 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.

Results: At 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)).

Conclusion: Early 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.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Flow chart.
BF  =  breastfeeding, M  =  mothers, NICU  =  Neonatal Intensive Care Unit, PI  =  preterm infants, Q1  =  Questionnaire 1, Q2  =  Questionnaire 2. *The four infants who died after inclusion were all twins, no mothers were lost due to infant death.
Figure 2
Figure 2. Forest plot.
BM expres.  =  Breast milk expression, h  =  hours, NICU  =  Neonatal Intensive Care Unit, pp  =  postpartum, ref  =  reference.
Figure 3
Figure 3. Forest plot.
BM expres.  =  Breast milk expression, h  =  hours, NICU  =  Neonatal Intensive Care Unit, pp  =  postpartum, ref  =  reference.
See this image and copyright information in PMC

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