Do a Few Weeks Matter? Late Preterm Infants and Breastfeeding Issues

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.

Self-efficacy and breastfeeding outcomes in mothers of premature and term infants: a longitudinal study

PURPOSE

To analyze the breastfeeding self-efficacy in mothers of premature and full-term newborns, in the period of 180 days, and to know the social and obstetric factors that influence the practice of maintaining the exclusive breastfeeding in the period of exclusive recommendation.

METHODS

Cohort with 44 mothers admitted to a public maternity hospital between January and October 2018. The mothers were divided into two groups: Premature and Full-term Groups. The Breastfeeding Self-efficacy Scale was applied in the immediate postpartum period, in addition to a questionnaire elaborated by the authors to collect sociodemographic and obstetric variables. The follow-up was done on the 30th, 120th and 180th days of the newborn's life, by telephone. For the statistical analysis between the groups, the Statistical Package for the Social Sciences (SPSS) was used.

RESULTS

There was no difference in the self-efficacy score, nor in the obstetric and socioeconomic characteristics between the groups, except for family income (lower in the Premature Group - p = 0.031). The diet type was different on the 30th day after delivery (p = 0.023), with greater adherence to the exclusive breastfeeding in the Premature Group. No association was found between breastfeeding self-efficacy and exclusive breastfeeding practice in the 180-day period.

CONCLUSION

In this sample, the breastfeeding self-efficacy was not related to the exclusive breastfeeding practice in the period of 180 days, in both groups. The premature group showed lower family income and greater adherence to exclusive breastfeeding on the 30th day postpartum.

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.

Comparing the effects of breastfeeding in the laid-back and cradle position upon the experiences of primiparous women: a parallel randomized clinical trial

BACKGROUND AND AIM

Appropriate positioning is crucial to successful breastfeeding and its continuation. Positioning can create, prevent, or correct breastfeeding problems. This study aimed to determine and compare the effects of both the laid-back and cradle positions upon the breastfeeding experiences of primiparous (cisgender) women.

METHODS

A parallel randomized clinical trial was conducted with a sample of primiparous women (n = 168) with a gestational age of between 31 and 34 weeks, referring to the perinatal clinic of Shahid Gharazi Hospital in Malayer (Hamadan Province, Iran). Participants were recruited via convenience sampling and allocated to one of two groups: intervention (laid-back position) (n = 85) and control (cradle position) (n = 83) using the random block method. Breastfeeding education was given to both groups during two sessions (weeks 31-34 and 35--37 of pregnancy) by "baby-friendly" accredited hospitals in Iran. The intervention group was instructed on how to breastfeed using the laid-back position. The control group was instructed on how to breastfeed using the cradle position. In the immediate postnatal period, breastfeeding positions were assessed in both groups. Breastfeeding experiences were measured once at the time of participants returning home and again at both 1 week and 2 weeks following birth, using the breastfeeding experience scale. Data analysis was undertaken using the SPSS software version 21. A value of P < 0.05 was considered significant.

RESULTS

No statistically significant difference was observed between the two groups in terms of concerns relating to participants nor their breasts, milk insufficiency, neonate, process, or breastfeeding experience at any time point measured. The means (SDs) of breastfeeding experience at the time of discharge, 1 week, and 2 weeks after childbirth in intervention group were 26.07 (4.533), 26.85 (3.812), and 26.65 (4.632) respectively. The means (SDs) of breastfeeding experience at the time of discharge, 1 week, and 2 weeks after childbirth in control group were 25.42 (3.315), 26.68 (3.872), and 25.41 (4.05) respectively.

CONCLUSION

There is no difference in breastfeeding experiences whether the laid-back or cradle position is used. Thus, broader education on breastfeeding and the provision of comprehensive support may be more effective in optimizing one's experience of breastfeeding.

TRIAL REGISTRATION

Registration date: 2021 July 21, Code: IRCT20180427039436N10, https://irct.ir/user/trial/57054/view.

Barriers and facilitators to exclusive breastfeeding among Black mothers: A qualitative study utilizing a modified Barrier Analysis approach

Breastfeeding has health benefits for both infants and mothers, yet Black mothers and infants are less likely to receive these benefits. Despite research showing no difference in breastfeeding intentions by race or ethnicity, inequities in breastfeeding rates persist, suggesting that Black mothers face unique barriers to meeting their breastfeeding intentions. The aim of this study is to identify barriers and facilitators that Black women perceive as important determinants of exclusively breastfeeding their children for at least 3 months after birth. Utilizing a Barrier Analysis approach, we conducted six focus group discussions, hearing from Black mothers who exclusively breastfed for 3 months and those who did not. Transcripts were coded starting with a priori parent codes based on theory-derived determinants mapped onto the Socioecological Model; themes were analysed for differences between groups. Facilitators found to be important specifically for women who exclusively breastfed for 3 months include self-efficacy, lactation support, appropriate lactation supplies, support of mothers and partners, prior knowledge of breastfeeding, strong intention before birth and perceptions of breastfeeding as money-saving. Barriers that arose more often among those who did not exclusively breastfeed for 3 months include inaccessible lactation support and supplies, difficulties with pumping, latching issues and perceptions of breastfeeding as time-consuming. Lack of access to and knowledge of breastfeeding laws and policies, as well as negative cultural norms or stigma, were important barriers across groups. This study supports the use of the Socioecological Model to design multicomponent interventions to increase exclusive breastfeeding outcomes for Black women.

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.

Relationship Between Feeders and Exclusive Breastfeeding and Mixed Feeding During the First Month of Life

BACKGROUND

The critical time to continue or stop breastfeeding is during the first month after hospital discharge. Mothers receive lactation and physical support by fathers and others bottle-feeding human or formula milk to their infants.

PURPOSE

To describe the effect of feeders (mothers, fathers, and others) and different milk feeding on infants' weekly exclusive breastfeeding rates, from birth to 1 month after discharge.

METHODS

This study was a secondary analysis of a descriptive longitudinal study of mothers' (full-term: n = 77; late preterm: n = 39) breastfeeding experience, frequency of feeding, and infant feeding behaviors. Mothers completed a weekly questionnaire of who (mothers, fathers, and others) fed their infants human or formula milk by direct breastfeeding or bottle-feeding.

RESULTS

More than 60% of mothers reported fathers and others bottle-fed their infants. Exclusive breastfeeding rates were significantly higher when only mothers fed their infants at week 1 (P < .001), week 3 (P < .05), and week 4 (P < .05). Exclusive breastfeeding rates were negatively affected across time by bottle-feeding any human or formula milk for all feeders. When fathers bottle-fed their infants at week 1, the relative rates of exclusive breastfeeding at week 4 decreased to 52% (OR = 0.103; 95% CI, 0.26-0.404; P < .0001).

IMPLICATION FOR PRACTICE

Individuals providing early bottle-feeding adversely affect breastfeeding outcomes. Providers need to address maternal and paternal knowledge gaps about early breastfeeding practice.

IMPLICATIONS FOR RESEARCH

Further research is needed to explore clinical standard of care for management of infant weight loss, early supplementation, and support of exclusive breastfeeding outcomes.

A survey among healthcare professionals from seven countries reported diverse nutritional practices of late preterm infants

AIM

To gain insight into nutritional practices and expected growth outcomes of infants born between 34 and 36 gestational weeks defined as late preterm infants (LPT).

METHODS

An anonymous online survey among paediatricians and neonatologists from Bangladesh, Indonesia, Mexico, Nigeria, Malaysia, Singapore and Taiwan was conducted from March until October 2020. The questionnaire consisted of 40 questions on the nutritional management and expected growth outcomes of LPT in and after-hospital care.

RESULTS

Healthcare professionals from low to high Human Development (HDI) countries (n = 322) and very high HDI countries (n = 169) participated in the survey. Human milk was the preferred feeding, resulting in an adequate growth of LPT (weight, length and occipitofrontal circumference), according to a majority of respondents (low to high HDI, 179/265, 68% vs. very high HDI, 73/143, 51%; p = 0.002). The expected growth outcome was higher after-hospital discharge. Less than half of healthcare professionals started enteral feeding during the 1st hour of life. Lactation difficulties, limited access to human milk fortifiers and donor human milk, especially among low to high HDI countries, were reported as major hurdles.

CONCLUSION

Human milk is the first feeding choice for LPT. The diverse opinions on nutritional practices and expected growth outcomes among healthcare professionals indicate the necessity to develop general nutritional guidelines for LPT.

Associations between gestational age at birth and infection-related hospital admission rates during childhood in England: Population-based record linkage study

BACKGROUND

Children born preterm (<37 completed weeks' gestation) have a higher risk of infection-related morbidity than those born at term. However, few large, population-based studies have investigated the risk of infection in childhood across the full spectrum of gestational age. The objectives of this study were to explore the association between gestational age at birth and infection-related hospital admissions up to the age of 10 years, how infection-related hospital admission rates change throughout childhood, and whether being born small for gestational age (SGA) modifies this relationship.

METHODS AND FINDINGS

Using a population-based, record-linkage cohort study design, birth registrations, birth notifications and hospital admissions were linked using a deterministic algorithm. The study population included all live, singleton births occurring in NHS hospitals in England from January 2005 to December 2006 (n = 1,018,136). The primary outcome was all infection-related inpatient hospital admissions from birth to 10 years of age, death or study end (March 2015). The secondary outcome was the type of infection-related hospital admission, grouped into broad categories. Generalised estimating equations were used to estimate adjusted rate ratios (aRRs) with 95% confidence intervals (CIs) for each gestational age category (<28, 28-29, 30-31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41 and 42 weeks) and the models were repeated by age at admission (<1, 1-2, 3-4, 5-6, and 7-10 years). An interaction term was included in the model to test whether SGA status modified the relationship between gestational age and infection-related hospital admissions. Gestational age was strongly associated with rates of infection-related hospital admissions throughout childhood. Whilst the relationship attenuated over time, at 7-10 years of age those born before 40 weeks gestation were still significantly higher in comparison to those born at 40 weeks. Children born <28 weeks had an aRR of 6.53 (5.91-7.22) during infancy, declining to 3.16 (2.50-3.99) at ages 7-10 years, in comparison to those born at 40 weeks; whilst in children born at 38 weeks, the aRRs were 1·24 (1.21-1.27) and 1·18 (1.13-1.23), during infancy and aged 7-10 years, respectively. SGA status modified the effect of gestational age (interaction P<0.0001), with the highest rate among the children born at <28 weeks and SGA. Finally, study findings indicated that the associations with gestational age varied by subgroup of infection. Whilst upper respiratory tract infections were the most common type of infection experienced by children in this cohort, lower respiratory tract infections (LRTIs) (<28 weeks, aRR = 10.61(9.55-11.79)) and invasive bacterial infections (<28 weeks, aRR = 6.02 (4.56-7.95)) were the most strongly associated with gestational age at birth. Of LRTIs experienced, bronchiolitis (<28 weeks, aRR = 11.86 (10.20-13.80)), and pneumonia (<28 weeks, aRR = 9.49 (7.95-11.32)) were the most common causes.

CONCLUSIONS

Gestational age at birth was strongly associated with rates of infection-related hospital admissions during childhood and even children born a few weeks early remained at higher risk at 7-10 years of age. There was variation between clinical subgroups in the strength of relationships with gestational age. Effective infection prevention strategies should include focus on reducing the number and severity of LRTIs during early childhood.

Correlation of facial anthropometry data of late preterm newborns and oral feeding readiness

OBJECTIVE

To correlate nine facial anthropometric measurements with the readiness for oral feeding of late preterm newborns using an orogastric tube.

METHODS

Observational study, carried out in two institutions in Maceió, Alagoas. Fifty-two newborns participated. A single measuring of nine facial measurements and daily measuring of the interface area for fixing the tube was performed. For readiness assessment, the Premature Oral Feeding Readiness Assessment Scale was used.

RESULTS

An average readiness of 28.81 (± 3.18) was observed in the first evaluation and 30.65 (± 3.23) in the second. Most facial measurements are correlated with weight. There was a positive and slight correlation between glabella-subnasale distance and readiness. No correlation was observed between the area of the tube fixation interface and facial measurements.

CONCLUSION

It is concluded that the glabella-subnasale measurement is positively correlated with the readiness for oral feeding in late preterm newborns who used an orogastric tube for feeding.

Barriers and Facilitators to Breastfeeding in Moderate and Late Preterm Infants: A Systematic Review

Rationale: Most of the preterm infants are born between 32 and 36 weeks of gestation (moderate to late preterm infants [MLPIs]). This comes with significant short- and long-term risks. Breastfeeding reduces many of these risks, but breastfeeding rates in MLPIs are lower than those in full-term infants. We performed a systematic review of studies identifying factors associated with successful breastfeeding in MLPIs and interventions to improve breastfeeding. Methods: Systematic search performed using PubMed April 24, 2020. In total, 11 articles describing barriers to breastfeeding in MLPIs and 6 articles about interventions to improve breastfeeding were included. Interventions were categorized according to different outcomes: breastfeeding initiation, continuation for 5 days to 6 weeks, and continuation ≥3 months. Because of heterogeneity in study characteristics, no meta-analysis was performed. Results: Breastfeeding rates were lower in those with lower socioeconomic status and single-parent households. Providing parents with more information and direct health care support significantly improved breastfeeding initiation. Cup feeding instead of bottle feeding had inconsistent effects on breastfeeding initiation and continuation. Continuous skin-to-skin contact did not affect breastfeeding initiation or continuation. Discussion: Risk groups for lower breastfeeding rates of MLPIs include mothers with lower socioeconomic status and single mothers. Interventions that may improve breastfeeding include cup feeding and providing parents with more information and health care support. Key limitations of included studies are lack of adequate adjustment for confounders and lack of blinding. However, this is the first systematic review identifying both risk groups and interventions to improve breastfeeding in MLPIs.

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.

An Observational Cohort Study and Nested Randomized Controlled Trial on Nutrition and Growth Outcomes in Moderate and Late Preterm Infants (FLAMINGO)

Background: Over the past decades, the preterm birth rate has increased, mostly due to a rise in late and moderate preterm (LMPT, 32–36 weeks gestation) births. LMPT birth affects 6–7% of all births in the United Kingdom and is associated with increased morbidity risk after birth in infancy as well as in adulthood. Early life nutrition has a critical role in determining infant growth and development, but there are limited data specifically addressing LMPT infants, which was the rationale for the design of the current study.

Objective: The Feeding Late and Moderate Infants and Growth Outcomes (FLAMINGO) study aims to improve understanding of the longitudinal growth, nutritional needs, and body composition of LMPT infants as well as their microbiome development and neurodevelopment. In addition, having a nested non-inferiority trial enables evaluation of the nutritional adequacy of a concept IMF with large milk phospholipid-coated lipid droplets comprising dairy and vegetable lipids. The primary outcome of this RCT is daily weight gain until 3 months corrected age.

Methods: A total of 250 healthy LMPT infants (32+0–36+6 weeks gestational age) with birth weight 1.25–3.0 kg will be recruited to the cohort, of which 140 infants are anticipated to be enrolled in the RCT. During six visits over the first 2 years of life, anthropometry, body composition (using dual energy X-Ray absorptiometry), feeding behavior, and developmental outcomes will be measured. Saliva and stool samples will be collected for oral and gut microbiota assessment.

Discussion: The FLAMINGO study will improve understanding of the longitudinal growth, body composition development, and feeding characteristics of LMPT infants and gain insights into their microbiome and neurodevelopment.

Study Registration:www.isrctn.com; Identifier ISRCTN15469594.

The Relationship of Previous Breastfeeding Experiences and Factors Affecting Breastfeeding Rates: A Follow-Up Study

Background/Objective: Many studies have focused on the effects of previous breastfeeding experience (PBE) on subsequent breastfeeding, but few have explored their specific relationships. To explain the relationship between PBE and subsequent breastfeeding behavior based on a follow-up study. Materials and Methods: After delivery, 394 participants who had no PBE completed a demographic questionnaire, breastfeeding knowledge questionnaire, the breastfeeding self-efficacy short-form scale (BSES-SF), and the Iowa infant feeding attitudes scale (IIFAS). Multiparas with PBE also completed the maternal breastfeeding evaluation scale (MBFES) in addition to the aforementioned four questionnaires. On the 42nd day after delivery, participants completed the breastfeeding experience scale (BES) through social networking platforms (QQ, WeChat: both are Chinese social medias). At 4 and 6 months postpartum, researchers contacted participants by phone or a social network regarding their exclusive and partial breastfeeding experiences. Results: In this study, exclusive breastfeeding rates were 58.6% and 30.5% at 4 and 6 months. PBE affected breastfeeding attitudes (p < 0.05), self-efficacy (p < 0.01), and difficulties (p < 0.05). Breastfeeding knowledge, attitude, self-efficacy, and difficulties were relevant to exclusive and partial breastfeeding at 4 and 6 months (p < 0.05). Multivariate logistic regression analysis showed that compared with women without PBE, the probability of exclusive breastfeeding of multiparas with PBE at 4 and 6 months increased by 275% and 369%, respectively. Conclusions: The rate of breastfeeding remains low among Chinese women, but PBE is associated with a higher probability of breastfeeding at 4 and 6 months postpartum. Multiparas, especially those having PBE were more likely to breastfeed for an extended period based on their knowledge, attitude, self-efficacy, and ability to manage difficulties.

Breastfeeding abandonment causes and success factors in relactation

Objective: To identify the causes of breastfeeding abandonment and the success factors associated with relactation in mothers with children attended in a specialised health institution. Methodology: Descriptive transversal design through non-probabilistic convenience sampling, with 100 mothers and their children. A structured survey was used and central tendency measurements and frequencies were analysed. The study was approved by the Ethics committee of the School of Health Sciences at the University Pontificia Bolivariana. Results: The average age was 26.8 years; 73 % had a low socioeconomic level; 59 % were cohabitating; 46 % were housewives; 32 % had a high school degree; 57 % were first-time mothers; 74 % had a high obstetric risk; and 59 % had children by caesarean section. Causes of breastfeeding abandonment were newborn hospitalization (79 %) and low birth weight (52 %). Health professionals suggested substitutes for hypogalactia in 18 % of the mothers. Incorrect maternal posture: 66.1 and 61 % with no previous experience. Relactation success factors were: chronological age under one month (48 %); effective newborn breast sucking (89 %); good newborn breast grasping (71 %). During the non-breastfeeding period, 72 % received mixed milk, 82 % did not breastfeed between 8 and 30 days, 98 % of the mothers were willing to relactate, 91 % considered the support of their families and health professionals as good. Conclusion: Children hospitalization was the main cause of breastfeeding abandonment and the main success factors for relactation were effective breast sucking, mothers’ readiness and support.

Exclusively Breastfeeding Modifies the Adverse Association of Late Preterm Birth and Gastrointestinal Infection: A Nationwide Birth Cohort Study

Introduction: Late preterm infants (LPIs) are at greater risk for short- and long-term morbidity compared with term infants. However, little is known about whether breastfeeding can reduce the adverse effect of late preterm (LP) birth on various diseases. Therefore, we examined the association of LP birth with the risk of hospitalizations from 6 to 18 months of age, then explored the possible modification of this effect by breastfeeding. Materials and Methods: Data were extracted from a nationwide population-based longitudinal survey in Japan. We restricted our analysis to term and LPIs with information on hospitalization (n = 31,578). Multivariate adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were estimated to evaluate the association between LP birth and hospitalization using term birth as the reference. We then examined whether breastfeeding status modified the potential adverse effects of LP birth on each health outcome. Results: LPIs were more likely to be hospitalized for all-cause (aOR, 1.58; 95% CI, 1.35-1.86), respiratory (aOR, 1.52; 95% CI, 1.21-1.92) and gastrointestinal infections (aOR, 1.73; 95% CI, 1.14-2.62) than term infants. While LPIs had a higher risk of hospitalization for all-cause and respiratory infection regardless of breastfeeding status, we did not observe an increased risk of hospitalization for gastrointestinal infection among the exclusively breastfed LPIs, in contrast with increased risk among the non-exclusively breastfed LPIs. Conclusions: We found that LPIs had a higher risk of all-cause and cause-specific hospitalization compared with term infants. Moreover, exclusive breastfeeding probably reduced the adverse effect of LP birth on gastrointestinal infection.

Does breastfeeding self-efficacy theory apply to mothers of moderate and late preterm infants? A qualitative exploration

BACKGROUND

Breastmilk feeding reduces morbidities and improves outcomes related to prematurity. However, breastmilk feeding rates in preterm infants are substantially lower than those in term infants. Breastfeeding self-efficacy theory is a social change theory, which is predictive of exclusive breastmilk feeding at 2 months postpartum in mothers of full-term infants. However, this theory has not been well explored in mothers of moderate and late preterm infants.

AIMS AND OBJECTIVES

To explore maternal experiences with feeding moderate (32^0/7 - 33^6/7  weeks' gestational age) and late preterm infants (34^0/7 - 36^6/7  weeks' GA) in neonatal intensive care units and assess applicability of breastfeeding self-efficacy theory.

METHODS

We conducted a qualitative descriptive exploration of maternal experiences with infant feeding in neonatal intensive care units. Using purposive, maximum variation sampling, we selected mothers of preterm infants born at 32^0/7 - 34^6/7  weeks, who experienced high mean differences in their BSE scores between admission and discharge. Fourteen mothers participated in semi-structured telephone interviews. Data were examined using thematic analysis. To explore and describe breastfeeding self-efficacy within the context of neonatal intensive care units, we super-imposed the four sources of information from breastfeeding self-efficacy theory onto the defined themes.

RESULTS

Three main themes emerged: (a) institutional influences, (b) relationship with the pump and (c) establishing breastfeeding, with an emphasis on the importance of direct breastfeeding at discharge. Overlaying the four sources of information from breastfeeding self-efficacy highlighted the presence of three sources of information: verbal persuasion, performance accomplishment and physiologic/affective responses. Vicarious experience was not identified in maternal experiences with infant feeding.

CONCLUSION

Our findings indicate that breastfeeding self-efficacy is an applicable theory for mothers of preterm infants.

RELEVANCE TO CLINICAL PRACTICE

Healthcare providers need to be aware of the influence that institutional culture and policies may have on maternal breastfeeding self-efficacy and breastfeeding outcomes.

Evidence-Based Updates on the First Week of Exclusive Breastfeeding Among Infants ≥35 Weeks

The nutritional and immunologic properties of human milk, along with clear evidence of dose-dependent optimal health outcomes for both mothers and infants, provide a compelling rationale to support exclusive breastfeeding. US women increasingly intend to breastfeed exclusively for 6 months. Because establishing lactation can be challenging, exclusivity is often compromised in hopes of preventing feeding-related neonatal complications, potentially affecting the continuation and duration of breastfeeding. Risk factors for impaired lactogenesis are identifiable and common. Clinicians must be able to recognize normative patterns of exclusive breastfeeding in the first week while proactively identifying potential challenges. In this review, we provide new evidence from the past 10 years on the following topics relevant to exclusive breastfeeding: milk production and transfer, neonatal weight and output assessment, management of glucose and bilirubin, immune development and the microbiome, supplementation, and health system factors. We focus on the early days of exclusive breastfeeding in healthy newborns ≥35 weeks' gestation managed in the routine postpartum unit. With this evidence-based clinical review, we provide detailed guidance in identifying medical indications for early supplementation and can inform best practices for both birthing facilities and providers.

Human Milk and Lactation

Human milk is uniquely tailored to meet infants’ specific nutritional requirements [...]

Supplementation of Mother's Own Milk with Donor Milk in Infants with Gastroschisis or Intestinal Atresia: A Retrospective Study

BACKGROUND

Mother's own milk (MOM) improves in-hospital outcomes for preterm infants. If unavailable, donor milk (DM) is often substituted. It is unclear if DM vs. formula to supplement MOM is associated with improved in-hospital outcomes in term/late preterm surgical infants with gastroschisis or intestinal atresia.

METHODS

This retrospective study included infants born ≥33 weeks gestational age (GA) with a birth weight of >1500 g who were admitted to a quaternary neonatal intensive care unit (NICU). Using Chi square and Mann-Whitney u testing, we compared hospital outcomes (length of stay, parenteral nutrition and central line days) before and after a clinical practice change to offer DM instead of formula in this surgical population.

RESULTS

Baseline characteristics were similar between eras for the 140 infants (median GA 37 weeks). Fewer infants in DM era were receiving formula at discharge (50.0% vs. 31.4%, p = 0.03). In sub-analyses including only small bowel atresia and gastroschisis infants, the median length of stay (35 vs. 25, p < 0.01) and the central line days (28 vs. 20, p < 0.01) were lower in the DM era.

CONCLUSION

In this retrospective study, offering DM instead of formula was associated with less formula feeding at discharge, and in infants with gastroschisis or small bowel atresia, shorter length of stay and central line days.

A Guide to Feeding Term and Preterm Newborns

The management of feeding term and preterm newborns encompasses knowing the physiologic mechanics of nutritive feeding and requirements for good somatic and neurodevelopmental growth. Feeding in newborns can be fraught with challenges that each individual infant-family unit presents. Management is multifactorial and requires fluidity as the infant progresses. Pediatricians are tasked with one of the most important responsibilities in the newborn period-partnering with families to ensure optimal feeding regimen and infant growth. This article's aim is to outline general recommendations on evidence-based feeding practices in term and preterm infants with a goal to help guide pediatricians create an optimal individualized feeding regimen and address some known hurdles. [Pediatr Ann. 2020;49(2):e71-e76.].