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. 2014 Sep 24;9(9):e108208.
doi: 10.1371/journal.pone.0108208. eCollection 2014.

Breastfeeding progression in preterm infants is influenced by factors in infants, mothers and clinical practice: the results of a national cohort study with high breastfeeding initiation rates

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

Breastfeeding progression in preterm infants is influenced by factors in infants, mothers and clinical practice: the results of a national cohort study with high breastfeeding initiation rates

Ragnhild Maastrup et al. PLoS One. .

Abstract

Background and aim: Many preterm infants are not capable of exclusive breastfeeding from birth. To guide mothers in breastfeeding, it is important to know when preterm infants can initiate breastfeeding and progress. The aim was to analyse postmenstrual age (PMA) at breastfeeding milestones in different preterm gestational age (GA) groups, to describe rates of breastfeeding duration at pre-defined times, as well as analyse factors associated with PMA at the establishment of exclusive breastfeeding.

Methods: The study was part of a prospective survey of a national Danish cohort of preterm infants based on questionnaires and structured telephone interviews, including 1,221 mothers and their 1,488 preterm infants with GA of 24-36 weeks.

Results: Of the preterm infants, 99% initiated breastfeeding and 68% were discharged exclusively breastfed. Breastfeeding milestones were generally reached at different PMAs for different GA groups, but preterm infants were able to initiate breastfeeding at early times, with some delay in infants less than GA 32 weeks. Very preterm infants had lowest mean PMA (35.5 weeks) at first complete breastfeed, and moderate preterm infants had lowest mean PMA at the establishment of exclusive breastfeeding (36.4 weeks). Admitting mothers to the NICU together with the infant and minimising the use of a pacifier during breastfeeding transition were associated with 1.6 (95% CI 0.4-2.8) and 1.2 days (95% CI 0.1-2.3) earlier establishment of exclusive breastfeeding respectively. Infants that were small for gestational age were associated with 5.6 days (95% CI 4.1-7.0) later establishment of exclusive breastfeeding.

Conclusion: Breastfeeding competence is not developed at a fixed PMA, but is influenced by multiple factors in infants, mothers and clinical practice. Admitting mothers together with their infants to the NICU and minimising the use of pacifiers may contribute to earlier establishment of exclusive breastfeeding.

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Conflict of interest statement

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

Figures

Figure 1
Figure 1. Flowchart.
BF  =  breastfeeding, M  =  mothers, NICU  =  Neonatal Intensive Care Unit, PI  =  preterm infants, Q  =  Questionnaire. *The four infants who died after inclusion were all twins; no mothers were lost due to infant death.
Figure 2
Figure 2. Breastfeeding milestones for various gestational groups.
BF  = breastfeeding, CI  =  confidence interval, GA groups  =  gestational age groups.
Figure 3
Figure 3. Postmenstrual age at establishment of exclusive breastfeeding compared to gestational age (GA) at birth.
Figure 4
Figure 4. Adjusted model of factors associated with PMA at establishment of exclusive breastfeeding.
BM  =  breast milk, GA  =  gestational age, MV  =  mechanical ventilation, NICU  =  neonatal intensive care unit, SGA  =  small for gestational age, sts  =  skin-to-skin contact
Figure 5
Figure 5. Feeding method at full oral feeding for various gestational age groups.
BF  =  Breastfeeding, excl  =  exclusive, GA  =  gestational age
See this image and copyright information in PMC

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