A shorter breastfeeding duration in late preterm infants than term infants during the first year

Breastfeeding Barriers for Preterm Infants in Neonatal Intensive Care Unit Environments: A Systematic Assessment and Meta-Analysis

Background: Breast milk is vital for the growth and development of preterm infants. However, in Neonatal Intensive Care Units (NICUs), mothers often encounter significant challenges in breastfeeding. Objective: This study aims to systematically evaluate the barriers to breastfeeding in NICUs, thereby providing evidence-based support for clinical practices. Methods: A comprehensive search was conducted in the Cochrane Library, PubMed, Web of Science, Embase, and Scopus databases, up to September 2023. Meta-analysis was performed using Stata 15.0, applying fixed or random effects models to calculate odds ratios (OR) and their 95% confidence intervals (CI). Study quality was assessed using the Newcastle-Ottawa Scale for cases and cohorts and the Agency for Healthcare Research and Quality standards for cross-sectional studies. Heterogeneity was evaluated using Cochran's chi-squared test (Cochran's Q) and I2 statistics, and publication bias was assessed through funnel plots and symmetry tests. Results: A total of 32 studies were included, encompassing 96,053 preterm infants. The main barriers to breastfeeding in preterm infants included: low gestational age (OR = 1.36, 95% CI: 1.06-1.75), lower maternal education (OR = 1.64, 95% CI: 1.39-1.93), insufficient breast milk (OR = 2.09, 95% CI: 1.39-1.93), multiple births (OR = 1.615, 95% CI: 1.18-2.210), smoking (OR = 2.906, 95% CI: 2.239-3.771), and single motherhood (OR = 1.439, 95% CI: 1.251-1.654). Conclusion: This study underscores the need for individualized breastfeeding support strategies in NICUs, taking into account the diverse backgrounds of mothers. Future research should focus on unraveling the underlying mechanisms affecting breastfeeding in preterm infants, with the goal of enhancing breastfeeding rates and improving developmental outcomes.

[Average prematurity: medical and developmental aspects]

Children born with moderate prematurity are at increased risk of neonatal morbidity, rehospitalization during the first year, and subsequent medical and neurodevelopmental disorders. Care in a specialized environment, at best without separation of mother and child, is necessary. Early developmental support, particularly through skin-to-skin contact, breastfeeding and couplet care, is recommended.

Parental smoking in the first two years of a child's life and its associations with breastfeeding

BACKGROUND

Exclusive breastfeeding for the first 6 months followed by ongoing breastfeeding to 12 months and beyond is associated with multiple benefits for both mother and child. Maternal smoking is associated with a reduction in breastfeeding. Little is known about the effect of partner smoking on breastfeeding.

AIMS

This study explores the smoking behaviour of mothers and their partners in the first two years of a child's life and its associations with breastfeeding practice.

MATERIALS AND METHODS

We performed a secondary data analysis using survey data on 1155 mothers from their third trimester of pregnancy and at six, 12 and 24 months after delivery. Survey questions included smoking status of both mother and partner and breastfeeding intention and practice. Logistic regression models were conducted at each time point.

FINDINGS

Where the mother or both parents smoke, babies were less likely to be breastfed at six months of age (adjusted odds ratio (aOR) 0.29, 95% CI: 0.13-0.66) compared with families where neither parent smoked. Non-smoking mothers with smoking partners were less likely to intend to breastfeed (aOR 0.29, 95% CI: 0.11-0.82) and their babies were less likely to be breastfed at six and 12 months of age (aOR 0.64, 95% CI: 0.42-0.98 and 0.64, 95% CI: 0.43-0.95 respectively). There was no difference in breastfeeding behaviour between smoking and non-smoking parents at 24 months.

CONCLUSION

Smoking parents are less likely to breastfeed their babies at ages six and 12 months. Breastfeeding promotion should target both smoking mothers and smoking partners.

Development of an exclusive breastfeeding intervention based on the theory of planned behavior for mothers with preterm infants: Study protocol for a mixed methods study

BACKGROUND

Despite the significance and benefits of exclusive breastfeeding, its rate among infants, especially preterm infants, is not optimal. Based on evidence, the mother's attitude toward breastfeeding, the subjective norm, and the mother's perceived behavioral control play a role in initiation and continuation of breastfeeding; so the interventions that consider these factors may be useful for breastfeeding premature infants. The aim of this study is to design and develop an exclusive breastfeeding intervention based on the theory of planned behavior for mothers with preterm infants.

MATERIALS AND METHODS

This exploratory, sequential, mixed methods study will be conducted in three phases. In the first phase, a qualitative study will be conducted based on the theory of planed behavior, to describe the exclusive breastfeeding beliefs of the mothers with preterm infants, the barriers to breastfeeding, and to explain the ways to overcome them. Moreover, the items of the Predictors Of Exclusive Breastfeeding Questionnaire are prepared based on the theory of planned behavior. In the second phase, the intervention plan is designed based on the literature review and the findings of the qualitative study, and it is approved by a panel of experts. Additionally, the psychometric properties of the questionnaire are evaluated and confirmed qualitatively and quantitatively. In the third phase, the developed intervention is implemented and evaluated.

CONCLUSION

Implementation of supportive educational interventions based on scientific theories can be a step toward improving the rate of onset and continuation of breastfeeding in mothers with preterm infants. Development of interventions based on evidence, identified beliefs, and perceived barriers of the mothers with preterm infants can provide the foundation for more effective interventions according to cultural, social, and religious contexts.

Standardizing Care of the Late Preterm Infant

BACKGROUND

Late preterm infants are infants born between 34 and 36 6/7 weeks gestation. Compared to term infants, late preterm infants are at increased risk for breastfeeding difficulties, hypoglycemia, hyperbilirubinemia, and hypothermia due to their relative physiologic and metabolic immaturity.

PROBLEM

Medical record reviews performed at a level III maternal and newborn hospital in central Illinois revealed only 64% of late preterm infants admitted to the newborn nursery received care per the unit late preterm infant policy. The aim of this quality improvement project was to increase nurse adherence to the policy to 80%.

METHODS

Between May 2022 and September 2022, several interventions were implemented for maternal-child nurses and support clinicians: an education offering, creation of a late preterm infant-specific breastfeeding log, and electronic medical record updates. Post-intervention medical record reviews measured policy adherence through documentation of feeding sessions, hypoglycemia, hypothermia, and hyperbilirubinemia. Descriptive statistics were performed to determine improvement.

RESULTS

Nurse adherence to the late preterm infant policy increased to 90% over the period of the project.

CLINICAL IMPLICATIONS

Late preterm infant care protocols should be in place in all newborn nurseries. Late preterm infant policy adherence can be supported through electronic medical record prompts, use of a late preterm infant-specific breastfeeding log, and continuing education.

The Current Status of Prolonged Breastfeeding and Its Related Factors in Korean Infants and Their Mothers: A Nationwide Cross-Sectional Study

BACKGROUND

International authorities recommend prolonged breastfeeding (PBF) for 12-24 months or more with 6 months of exclusive breastfeeding (EBF). Based on the Korean National Health and Nutrition Examination Survey (KNHANES) data, this study attempted to help encourage and educate breastfeeding (BF) over 1 year by investigating long-term BF trends and related factors in Korean infants and their mothers.

METHODS

This cross-sectional study was based on data on children aged 12-23 months and their mothers from 2010 to 2020. BF rates were compared between KNHANES V (2010-2012), KNHANES VI (2013-2015), KNHANES VII (2016-2018), and part of KNHANES VIII (2019-2020). In addition, data related to mothers and infants, including demographics, socioeconomic, educational, and health status, were collected, and their association with BF status was analyzed.

RESULTS

Of the 933 infants included in the study, the proportions achieving full BF at 6 months of age and PBF at 12 and 18 months were 34.8%, 33.7%, and 7.1%, respectively. Over the past 10 years, the trends of all three BF practices have significantly decreased since 2016 (P < 0.001). Of the 849 infants whose maternal data were available, multiple logistic regression analysis showed that EBF for 6 months (defined as full BF at 1, 3, and 6 months of age) positively correlated with maternal and infants' factors such as unemployed status, past BF experience, no history of drinking, and infants' birth weight of ≥ 2.5 kg. The mother's education level, particularly the nutrition label impact, current employment status, and smoking and drinking status, were significantly associated with PBF for ≥ 12 months but were not related to PBF for ≥ 18 months, except for drinking status.

CONCLUSIONS

In Korea, the long-term BF rate of ≥ 12 months has declined in the past 10 years, and BF becomes rare after 18 months. Higher maternal interest in nutrition information appears to be driving access to PBF over 12 months than EBF for 6 months or PBF over 18 months. To promote PBF over 12 months in Korea, it may be helpful to strengthen nutrition education that specifically emphasizes the benefits of PBF along with EBF, especially during infant health examinations.

Exclusive breastfeeding: Relation to gestational age, birth weight, and early neonatal ward admission. A nationwide cohort study of children born after 35 weeks of gestation

OBJECTIVES

Prematurity, being small for gestational age and early neonatal ward admission are the major neonatal conditions that may interfere with breastfeeding supportive practices in infants born at gestational age ≥35+0 weeks. We aimed to investigate the associations between gestational age, small for gestational age, early neonatal ward admission and exclusive breastfeeding at one and four months.

METHODS

A register-based cohort-study of all Danish singletons with gestational age ≥35+0 weeks born in 2014-2015. In Denmark, health visitors routinely conduct free home visits throughout infants' first year and thereby report breastfeeding data to The Danish National Child Health Register. These data were linked with data from other national registers. Logistic regression models estimated the odds ratio for exclusive breastfeeding at one and four months, adjusted for confounding variables.

RESULTS

The study population comprised 106,670 infants. Compared to gestational age 40 weeks, the adjusted odds ratio for exclusive breastfeeding at one month showed a decreasing tendency from gestational age ≥42 (n = 2,282) (1.07; 95% confidence interval (CI) 0.97-1.17) to 36 weeks (n = 2,062) (0.80; 95% CI 0.73-0.88). Small for gestational age (n = 2,342) was associated with decreased adjusted odds ratio for exclusive breastfeeding at one month (0.84; 95% CI 0.77-0.92). Neonatal ward admission was associated with increased adjusted odds ratio for exclusive breastfeeding at one month among late preterm infants (gestational age 35-36 weeks; n = 3,139) (1.31; 95% CI 1.12-1.54), as opposed to among early term (gestational age 37-38 weeks; n = 19,171) (0.84; 95% CI 0.77-0.92) and term infants (gestational age >38 weeks; n = 84,360) (0.89; 95% CI 0.83-0.94). The associations seemed to persist at four months.

CONCLUSIONS

Decreasing gestational age and small for gestational age were associated with decreased exclusive breastfeeding rates. Neonatal ward admission was associated with increased exclusive breastfeeding rates among late preterm infants, whereas the opposite was observed among early term and term infants.

Feeding Difficulties in Late Preterm Infants and Their Impact on Maternal Mental Health and the Mother-Infant Relationship: A Literature Review

Late preterm infants constitute the largest subset of premature infants and are more likely to experience feeding issues leading to delayed oral feeding independence and low breastfeeding rates. Considering the increased parental concern about their infants' nutrition and growth, we performed a literature review to provide an update on the feeding challenges faced by late preterm infants and the impact of these issues on maternal mental health and the mother-infant relationship. Based on our findings, late preterm infants have a high prevalence of feeding difficulties which need to be addressed by targeted support interventions to promote breastfeeding success and the establishment of a harmonious dyadic interaction between the mother and her infant, all of which contribute to the prevention of altered feeding behavior later in life. There is still a need for additional research to develop a standardized and shared strategy that can be proven to be effective. Should this be accomplished, it will be possible to offer appropriate support for mothers, encourage the oral skills and maturation of late preterm infants, and improve the relationship quality within the dyad.

Correlates of early initiation of breast feeding and prelacteal feeding: a cross-sectional study in Sindh province of Pakistan

OBJECTIVES

The objective of this study was to determine the prevalence and correlates of early initiation of breast feeding and prelacteal feeding in highly disadvantaged districts in Pakistan.

DESIGN

This cross-sectional study design.

SETTINGS

This study was carried out in twelve districts of the Sindh province of Pakistan.

PARTICIPANTS

A total of 4800 mothers with children under 2 years, selected through a multistage random sampling method.

DATA ANALYSIS

Bivariate association, survival analysis (Kaplan-Meier and Cox proportional hazard techniques), multivariate linear regression and the ordinary least square model were used.

RESULTS

The results show that the prevalence of early initiation of breast feeding was 68% and prelacteal feeding was 32%. Adequate treatment, proper guidance at antenatal care visits, postpartum health check, normal birth with skilled birth attendants, institutional birth, skin-to-skin contact at birth and birth size were all associated with early breastfeeding initiation (p<0.001). The odds of early initiation of breast feeding after birth are higher if the respondents received proper guidance (OR 2.05; 95% CI 1.02 to 4.11) or made skin-to-skin contact (OR 10.65; 95% CI 6.82 to 16.65). Bivariate association between the prelacteal feeding and a set of correlates suggests that all variables under study were significantly associated with the outcome variable of interest at a 95% or higher significance level. The factors which significantly reduced the odds of prelacteal feeding were adequate treatment (OR 0.29; 95% CI 0.23 to 0.37) and postpartum health check (OR 0.65; 95% CI 0.53 to 0.80).

CONCLUSION

Sudy concludes that the correlates like adequate treatment of mothers during labour, postpartum health check-up, normal birth with skilled birth attendants, institutional births and skin-to-skin contact between mother and the baby determine the early initiation of breast feeding and prelecteal feeding. Early initiation of breast feeding needs to be encouraged, and communities must be educated against the use of prelacteal feeding.

Postnatal growth of small for gestational age late preterm infants: determinants of catch-up growth

BACKGROUND

Failure to recover growth is a risk reported in late preterm population. This study aimed to evaluate the auxological outcome of late preterm infants and identify factors associated with failure to recover growth.

METHODS

We enrolled late preterm infants with birth weight ≤10th percentile, followed up at High-Risk Infant Follow-up Service. We collected data at birth and at follow-up visits. A logistic regression analysis was performed to assess variables independently associated with growth failure.

RESULTS

The population consisted of 175 preterms. The percentage of children showing no weight recovery was 34% at 36 months. At logistic regression analysis, infants who had not regained weight at 12 months had a higher risk of not regaining weight even at 36 months. The same risk factor was highlighted for length catch-up growth. Moreover, infants fed any human milk at discharge were protected from not achieving both weight and length catch-up growth at 36 months.

CONCLUSION

These results indicate that children born late preterm and small for gestational age could fail to recover weight and stature growth in the first 36 months. The protective effect of human milk on failure to thrive highlights the importance of promoting breastfeeding in this population.

IMPACT

A significant number of SGA late preterms show a failure to recover weight and statural growth. Having experienced intrauterine growth restriction is associated with a greater chance of achieving statural catch-up growth. Being born singleton represents a risk factor for slower weight and height growth velocity. Breastmilk has a protective effect on failure to recover adequate weight and length in preterm SGA infants. This finding highlights the importance of promoting breastfeeding in this population.

Feeding Patterns of Healthy Term Newborns in the First 5 Days-The Glucose in Well Babies Study (GLOW)

BACKGROUND

The feeding patterns of healthy newborns have been poorly described.

RESEARCH AIM

To determine the feeding patterns of healthy term newborns soon after birth, and if these differed with sex, gestation, and mode of birth.

METHODS

This study was a prospective, longitudinal observational cohort study. Term, appropriately grown newborns (N = 66) were fed according to maternal choice and details were recorded. Data were analyzed using generalized Poisson regression for feeding frequencies, and mixed model regression of log-transformed data for durations.

RESULTS

The participants completing the study had a M = 3589 g (SD = 348 g) birthweight, with a gestation age of M = 40.1 (1.2) weeks. All participants were breastfed; 23 (35%) also received expressed human milk and 10 (15%) received formula. Participants had fewer feeding sessions on Day 1, (M = 7.3 [1.9] sessions/day) increasing to (M = 9.4 [2.4] sessions/day) by Day 3, then reducing to (M = 9.0 [2.2] sessions/day) on Day 5, p < .001. The overall duration of breastfeeding sessions varied widely (Mdn = 29 [range = 1-447] min). Feed frequency but not duration was higher in males than females (M = 8.9, SE = 0.2 vs. 8.1, 02, sessions/day, p = .03), in newborns born ≥ 40 weeks' gestation (M = 8.9, SE = 0.3 vs. 8.2, 02, sessions/day, p = .04), and in newborns born by Caesarean section (M = 9.4, SE = 0.3 vs. 8.4, 02, sessions/day, for vaginal birth, p = .003).

CONCLUSION

Feeding patterns of healthy term newborns vary widely, but frequency increases during the first 3 days, and is greater in males, newborns born late term, and born by Caesarean section.

CLINICAL TRIAL REGISTRATION

The Australian and New Zealand Clinical Trials Registry Ref: ACTRN12615000986572. The study protocol is available online: http://hdl.handle.net/2292/32066.

Breastfeeding in Neonates Admitted to an NICU: 18-Month Follow-Up

Introduction: The admission of neonates to Neonatal Intensive Care Units (NICUs) has been identified as a primary inhibiting factor in the establishment of breastfeeding. The aims of this study were to (1) estimate the prevalence and duration of breastfeeding in infants/toddlers who had been admitted to an NICU in Greece and (2) to investigate factors, associated with the NICU stay, which affected the establishment and maintenance of breastfeeding in infants/toddlers previously admitted to the NICU. Materials and methods: Data for this cohort study were retrieved from interviews with mothers of infants/toddlers who had been admitted to our NICU as neonates during the period of 2017−2019. Interviews were conducted based on a questionnaire regarding the child’s nutrition from birth to the day of the interview, including previous maternal experience with breastfeeding. Information related to the prenatal period, gestation age, delivery mode, duration of NICU stay, and neonatal feeding strategies during their hospital stay were recorded. Results: The response rate to the telephone interviews was 57%, resulting in 279 mother−infant pairs being included in this study. The results showed that 78.1% of children received maternal milk during their first days of life. Of all infants, 58.1% were exclusively breastfed during their first month, with a gradual decrease to 36.9% and 19.4% by the end of the third and sixth months of life, respectively. The prevalence of breastfed children reached 14.7% and 7.5% at the ages of twelve and eighteen months, respectively. In the multivariate analysis, prematurity emerged as an independent prognostic factor for the duration of exclusive and any breastfeeding (aHR 1.64, 95% CI: 1.03−2.62; and 1.69, 95% CI: 1.05−2.72, respectively; p < 0.05). Additionally, the nationality of the mother, NICU breastfeeding experience, the administration of maternal milk during neonatal hospital stay, and previous breastfeeding experience of the mother were independent prognostic factors for the duration of breastfeeding. Conclusions: Although breastfeeding is a top priority in our NICU, the exclusive-breastfeeding rates at 6 months were quite low for the hospitalized neonates, not reaching World Health Organization (WHO) recommendations. Mothers/families of hospitalized neonates should receive integrated psychological and practical breastfeeding support and guidance.

Breastfeeding initiation, duration, and experiences of mothers of late preterm twins: a mixed-methods study

Background

Twins and late preterm (LPT) infants are at an increased risk of being breastfed to a lesser extent than term singletons. This study aimed to describe the initiation and duration of any and exclusive breastfeeding at the breast for mothers of LPT twins and term twins during the first 4 months and to explore the breastfeeding experiences of mothers of LPT twins.

Methods

A sequential two-sample quantitative–qualitative explanatory mixed-methods design was used. The quantitative data were derived from a longitudinal cohort study in which 22 mothers of LPT twins and 41 mothers of term twins answered questionnaires at one and four months after birth (2015–2017). The qualitative data were obtained from semi-structured interviews with 14 mothers of LPT twins (2020–2021), based on results from the quantitative study and literature. Analysis included descriptive statistics of quantitative data and deductive content analysis of the qualitative data, followed by condensation and synthesis.

Results

All mothers of LPT twins (100%) and most mothers of term twins (96%) initiated breastfeeding. There was no difference in any breastfeeding during the first week at home (98% versus 95%) and at 1 month (88% versus 85%). However, at 4 months, the difference was significant (44% versus 75%). The qualitative data highlighted that mothers of LPT twins experienced breastfeeding as complex and strenuous. Key factors influencing mothers’ experiences and decisions were their infants’ immature breastfeeding behaviors requiring them to express breast milk alongside breastfeeding, the burden of following task-oriented feeding regimes, and the lack of guidance from healthcare professionals. As a result, mothers started to question the worth of their breastfeeding efforts, leading to changes in breastfeeding management with diverse results. Support from fathers and grandparents positively influenced sustained breastfeeding.

Conclusions

Mothers of LPT twins want to breastfeed, but they face many challenges in breastfeeding during the first month, leading to more LPT twins’ mothers than term twins’ mothers ceasing breastfeeding during the following months. To promote and safeguard breastfeeding in this vulnerable group, care must be differentiated from routine term infant services, and healthcare professionals need to receive proper education and training.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13006-022-00507-3.

Factors associated with post NICU discharge exclusive breastfeeding rate and duration amongst first time mothers of preterm infants in Shanghai: a longitudinal cohort study

BACKGROUND

Breastfeeding is crucial for the preterm infants. Breast milk is not only food but also medicine. Few studies have focused on the longitudinal effects of exclusive breastfeeding outcome of preterm infants separated from their mothers after discharge, especially in Shanghai. We aimed to examine the exclusive breastfeeding rate and duration amongst first time mothers of preterm infants after discharge and its determinants.

METHODS

Analyses were based on 500 preterm infants separated from their mothers in a tertiary maternity and infant-specialized hospital in Shanghai from September 2018 to September 2019.The Socio-demographic characteristics, breastfeeding knowledge questionnaire, breastfeeding self-efficacy short form scale, Edinburgh postpartum depression scale and breastfeeding family support scale were used for the investigation and the exclusive breastfeeding rate of premature infants was followed up on 1 month, 3 months and 6 months after discharge. The changing trend of breastfeeding knowledge, breastfeeding self-efficacy, postpartum depression and family support were measured by ANOVA at different stages. Using the chi-square test and multiple logistic regression, factors impacting the breastfeeding rate of preterm infants at three time intervals after discharge were investigated. The Kaplan Meier survival curve and cox regression model were used to analyze the determinants of exclusive breastfeeding duration of premature infants after discharge.

RESULTS

Exclusive breastfeeding rates were 19.0, 17.2 and 10.4% at 1 month, 3 months and 6 months after discharge of preterm infants, respectively. The average length of exclusive breastfeeding duration was(3.69 ± 1.80)months. Finally, type of delivery (adjusted odds ratio [AOR] 1.564; 95% confidence interval [CI] 0.513,3.116), gestational age(AOR 0.612, 95% CI 0.236, 3.418), maternal family support (AOR 6.125,95% CI 6.359, 98.452) were discovered to be independent predictors on the exclusive breastfeeding rate at 6 months after preterm infants were discharged. Through the cox regression model, we found that a maternal planned pregnancy (HR 0.681, 95%CI 0.531,0.873), delivering breast milk during hospitalization (HR 0.797, 95%CI 0.412,2.288), NICU feeding mode during hospitalization (HR 1.221, 95%CI 0.128,1.381) and family support (HR 0.561, 95%CI 0.004,2.428) were significantly associated with the exclusive breastfeeding duration after discharge.

CONCLUSIONS

The exclusive breastfeeding outcome of premature infants was affected by many factors, so we should focus on the three levels of individual, family, society and design targeted intervention measures to increase the exclusive breastfeeding rate and prolong exclusive breastfeeding duration.

Positive breastfeeding experiences and facilitators in mothers of preterm and low birthweight infants: a meta-ethnographic review

Background

Most qualitative research on breastfeeding the preterm or low-birthweight (LBW) infant has focused on negative insights; there are no comprehensive insights into how, when and why mothers experience positive breastfeeding experiences. We aimed to address this knowledge gap by exploring what characterizes and facilitates a positive breastfeeding experience in mothers of preterm and/or LBW infants.

Methods

A systematic review using meta-ethnographic methods was conducted. Search strategies involved a comprehensive search strategy on six bibliographic databases, citation tracking and reference checking. The analysis involved a reciprocal level of translation and a line of argument synthesis.

Results

Searches identified 1774 hits and 17 articles from 14 studies were included, representing the views of 697 mothers. A positive breastfeeding experience was identified as being ‘attuned’. Three themes and eight sub-themes were developed to describe what characterizes attuned breastfeeding. ‘Trusting the body and what it can do’, concerned how attuned breastfeeding was facilitated through understanding the bodily responses and capacity and feeling comfortable with holding the infant and to breastfeed. ‘Being emotionally present – in the here and now’ described the importance of feeling relaxed and reassured. ‘Experiencing mutual positive responses’, illuminated how attunement was related to feelings of mutuality - when the mother recognises the infant’s cues, responds to these signals and receives a positive response from the infant. The key factors to facilitate attuned breastfeeding were opportunities for prolonged close physical contact with the infant, positive relationships with and support from staff and peers, and being facilitated to breastfeed when the infant showed feeding cues.

Conclusions

This study provides new insights into what characterizes a positive breastfeeding experience and how staff can facilitate and enable mothers to achieve attuned breastfeeding. Improvements in units’ design, such as for rooming-in and having prolonged skin-to-skin contact, and care provided by knowledgeable, supportive and encouraging staff and peers, are crucial. The mother’s physical and emotional states and the infant’s behavioural responses and physiological signals should guide the process towards positive breastfeeding practices.

Supporting Feeding of Late Preterm Infants in the Hospital: A Quality Improvement Project

BACKGROUND

Feeding difficulty is the most common cause of delayed hospital discharge and readmission of late preterm infants. Frequent and adequate feedings from birth are protective against dehydration, hypoglycemia, and jaundice. The National Perinatal Association's feeding guidelines provide the foundation for late preterm infant standards of care. Feeding at least every 3 hours promotes nutritional status and neurologic development. One feeding assessment every 12 hours during the hospital stay can ensure quality of infant feeding.

PROBLEM

At a large urban hospital, medical record reviews were completed to evaluate nursing care practices consistent with the hospital's late preterm infant care standard policy. Feeding frequency and nurse assessment of feeding effectiveness were far below acceptable targets. A quality improvement team was formed to address inconsistency with expected practice.

METHODS

The project included an investigation using the define, design, implement, and sustain method of quality improvement. Parent education, nurse education, and visual cues were developed to sustain enhanced nursing practice.

RESULTS

Late preterm infants who received feedings at least every 3 hours increased from 2.5% (1 of 40) to 27% (11 of 40); (M = 0.275, SD = 0.446), p = 0.001. Documented breastfeeding assessments increased from 2% (5 of 264) to 8% (10 of 126), p = 0.001. Documented bottle-feeding assessments increased from 15% (39 of 264) to 31% (53 of 172), p < 0.001. Intervention time was cut short due to reprioritization of efforts in response to the COVID-19 pandemic.

CONCLUSION

Interventions and implementation of this process improvement is easy to replicate through attainable and sustainable goals directed toward improved outcomes for late preterm infants.

A shorter breastfeeding duration in late preterm infants than term infants during the first year

AIM

Little attention has been paid to breastfeeding late preterm (LPT) infants. This study compared breastfeeding, worries, depression and stress in mothers of LPT and term-born infants throughout the first year. We also described factors associated with shorter breastfeeding duration of LPT infants.

METHODS

This longitudinal cohort study of the mothers of singleton infants-129 born LPT and 277 born at term-was conducted at Landspitali-The National University Hospital of Iceland, which has the country's only neonatal intensive care unit. The mothers answered questionnaires when their infants were 1, 4, 8 and 12 months of age.

RESULTS

Mothers breastfed LPT infants for a significantly shorter time than term infants: a median of 7 months (95% confidence interval 5.53-8.48) vs 9 months (95% confidence interval 8.39-9.61) (P < .05). Starting solids at up to 4 months was the strongest risk factor for LPT breastfeeding cessation during the first year, after adjusting for confounders (P < .001). Their mothers reported more worries about their infants' health and behaviour during the first year and were more likely to experience depression at 4 months.

CONCLUSION

Mothers with LPT infants are vulnerable and need greater practical breastfeeding and emotional support in hospital and at home.