Maternal Milk Provision in the Neonatal Intensive Care Unit and Mother-Infant Emotional Connection for Preterm Infants

Abstract

Maternal milk (MM) intake during neonatal intensive care unit (NICU) hospitalization is associated with improved neurodevelopment in preterm infants. Underlying mechanisms may include stronger mother-infant emotional connection. This paper examines associations between MM provision in the NICU with maternal connection to her infant using three factors validated in our sample: maternal sensitivity, emotional concern, and positive interaction/engagement. We studied 70 mothers of infants born <1500 g and/or <32 weeks' gestation. Associations between MM provision and mother-infant connection were modeled using median regression adjusted for clustering. Mothers who provided exclusive MM (i.e., 100% MM, no other milk) reported higher levels of maternal sensitivity by a median score of 2 units (β = 2.00, 95% CI: 0.76, 3.24, p = 0.002) than the mixed group (i.e., MM < 100% days, other milk ≥1 days), as well as greater emotional concern (β = 3.00, 95% CI: -0.002, 6.00, p = 0.05). Among mothers of very preterm infants, greater milk provision was associated with greater maternal sensitivity, but also with greater emotional concern about meeting the infant's needs. These findings highlight the importance of supporting MM provision and early infant care as an integrated part of lactation support. The findings may also provide insight into links between MM provision in the NICU and infant neurodevelopment.

Keywords: Neonatal Intensive Care Unit (NICU); breastfeeding; maternal milk; mother–infant connection; preterm.

Figure 1

Parenting in the NICU Study Recruitment Flowchart. BWH: Brigham and Women’s Hospital; BIDMC: Beth Israel Deaconess Medical Center. ¹ There were 370 offspring among 300 families (235 singletons, 120 twins, 15 triplets), 8 twins were not admitted to the NICU for a total of n = 362 study infants.

Figure 2

25-item Parenting in the NICU Study Survey [16,17,18]. ¹ Item “I don’t find my baby cute” from Nagata et al. excluded from factor analysis due to communalities >1; ¹. Reverse coded.