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Observational Study
. 2025 Jul 16;9(1):e003485.
doi: 10.1136/bmjpo-2025-003485.

Association of timing of initial breastfeeding and neonatal outcome in very preterm infants: a multicentre cohort study in China

Rong Lin #  1   2 , Zhihui Rong #  3 , Rong Zhang  4   5 , Zhi Zheng  1   2 , Ya Ding  6 , Chao Ning  7 , Yun Cao  4   5 , Chen Chao  4   5 , Jie Yang  8 , Xinzhu Lin  9   2 ; Chinese Neonatal Network
Collaborators, Affiliations
Observational Study

Association of timing of initial breastfeeding and neonatal outcome in very preterm infants: a multicentre cohort study in China

Rong Lin et al. BMJ Paediatr Open. .

Abstract

Objective: To evaluate the association between the timing of initial breastfeeding and the risk of necrotising enterocolitis (NEC) and other neonatal outcomes in very preterm infants (VPIs, <32 weeks' gestation).

Design: Multicentre observational cohort study.

Setting: Data were collected from 102 tertiary neonatal intensive care units (NICUs) in China between 2019 and 2023 through the Chinese Neonatal Network.

Patients: A total of 12 679 VPIs admitted to NICUs within 24 hours of birth and initially breastfed within 7 days were included.

Interventions: Infants were categorised into four groups based on initial breastfeeding timing: within 24 hours (n=2242), 24-48 hours (n=3657), 48-72 hours (n=1870) and after 72 hours (n=4910, reference group).

Main outcome measures: The primary outcome was NEC (stage ≥2). Secondary outcomes included mortality, bronchopulmonary dysplasia, severe neurological injury, severe retinopathy of prematurity, late-onset sepsis, NICU length of stay and intravenous nutrition duration.

Results: Early breastfeeding initiation (<24 hours) was associated with a higher incidence of NEC (7.5% vs 4.3%, OR 1.92, 95% CI 1.21 to 3.06). No significant NEC risk increase was observed for feeding initiation after 24 hours. Early breastfeeding was linked to a shorter duration of intravenous nutrition (median 15 days (IQR 10-27) vs 22 days (IQR 14-33), mean difference -3.93 days, 95% CI -6.57 to -1.3). Subgroup analysis revealed increased NEC risk in neonates delivered via caesarean section, those receiving blood transfusions and those born <28 weeks' gestation.

Conclusions: While early breastfeeding initiation (<24 hours) reduces intravenous nutrition duration, it may elevate NEC risk in specific high-risk subgroups. Feeding strategies should be individualised based on gestational age, delivery mode and transfusion status. Further randomised trials are needed to optimise early feeding protocols for VPIs.

Keywords: Child Health; Infant.

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Conflict of interest statement

Competing interests: No, there are no competing interests.

Figures

Figure 1
Figure 1. Flow chart of participants in this study. GA, gestational age.
Figure 2
Figure 2. Interaction and subgroup analysis for NEC. hsPDA, haemodynamically significant patent ductus arteriosus; NEC, necrotising enterocolitis; RDS, respiratory distress syndrome; SGA, small for gestational age; AGA, appropriate for gestational age.
See this image and copyright information in PMC

References

    1. Dimitroglou M, Iliodromiti Z, Christou E, et al. Human Breast Milk: The Key Role in the Maturation of Immune, Gastrointestinal and Central Nervous Systems: A Narrative Review. Diagnostics (Basel) 2022;12:2208. doi: 10.3390/diagnostics12092208. - DOI - PMC - PubMed
    1. Patel AL, Taylor SN. Dilemmas in initiation of very preterm infant enteral feeds-when, what, how? J Perinatol. 2023;43:108–13. doi: 10.1038/s41372-022-01564-6. - DOI - PubMed
    1. Quigley M, Embleton ND, McGuire W. Formula versus donor breast milk for feeding preterm or low birth weight infants. Cochrane Database Syst Rev. 2019;7:CD002971. doi: 10.1002/14651858.CD002971.pub5. - DOI - PMC - PubMed
    1. Belfort MB, Woodward LJ, Cherkerzian S, et al. Targeting human milk fortification to improve very preterm infant growth and brain development: study protocol for Nourish, a single-center randomized, controlled clinical trial. BMC Pediatr. 2021;21:167. doi: 10.1186/s12887-021-02635-x. - DOI - PMC - PubMed
    1. Nangia S, Maheshwari A, Valentine GC, et al. Advancement of Enteral Feeding in Very-low-birth-weight Infants: Global Issues and Challenges. Newborn. 2022;1:306–13. doi: 10.5005/jp-journals-11002-0038. - DOI

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