Impacts des facteurs maternels sur l’allaitement maternel en réanimation néonatale

Factors associated with infants receiving their mother's own breast milk on discharge from hospital in a unit where pasteurised donor human milk is available

AIM

To determine the proportion of very preterm infants who were exclusively fed breast milk at the time of discharge home, before and after the availability of pasteurised donor human milk (PDHM).

METHODS

This was an observational retrospective cohort study with historical comparison, comparing two cohorts (<32 weeks gestational age or very low birthweight) before and after the availability of donor human milk. The main explanatory variable was the PDHM cohort: pre-PDHM or post-PDHM. The primary dichotomous outcome variable was defined as whether the baby was being fed with breast milk only at the time of discharge home, compared with those fed with artificial formula alone or mixed feeding (artificial formula and breast milk).

RESULTS

There were 1088 babies in the pre-PDHM cohort and 330 in the post-PDHM cohort (total n = 1418). Following the introduction of PDHM, 56% (185/330) were exclusively fed breast milk at the time of hospital discharge and 57% (620/1088) in the pre-PDHM cohort. The availability of PDHM is not a significant predictor of feeding outcome upon discharge (P = 0.45) when adjusted for maternal age, log-transformed post-natal age at discharge home and any congenital abnormality.

CONCLUSIONS

The availability of donor human milk in our unit is not associated with a decrease in the number of very preterm infants receiving mother's own breast milk at time of discharge home. Other factors that positively impact the successful establishment of breastfeeding in preterm babies were older maternal age, the absence of any congenital abnormality and a shorter duration of hospital stay.

[Maternal and neonatal factors associated with successful breastfeeding in very preterm infants]

OBJECTIVE

The main objective of this study was to evaluate the rate of breastfeeding at NICU discharge in a population of very preterm infants. The secondary objective was to identify maternal, gestational, and neonatal factors associated with successful breastfeeding at NICU discharge.

MATERIALS AND METHODS

This is a retrospective descriptive study. All live births before 32 weeks of gestational age (WGA) admitted to the NICU of the Amiens university hospital between 1 January 2009 and 30 June 2011 were included in the study, excluding infants who died during hospitalization or infants transferred to another hospital. Data on mothers and newborns were collected from the medical record. Statistical analysis was performed using the Chi(2) test for categorical variables and the Student t test for continuous variables. The significance threshold was set at P<0.05.

RESULTS

Seventy-seven infants were included in the study. While 66% of the mothers wished to breastfeed at birth, the success rate of breastfeeding at hospital discharge was only 38%. The proportion of married women was significantly higher in the "successful breastfeeding" group (P=0.029). No significant difference was demonstrated regarding maternal age, maternal profession, proportion of non-smoking mothers, parity, type of pregnancy, type of delivery, duration of invasive ventilation and oxygen dependency, and surgery during hospitalization.

CONCLUSION

The rate of breastfeeding of very preterm infants at hospital discharge is lower than the rates reported in the literature. The mother's marital status significantly influences the decision to breastfeed very preterm infants at discharge.