Perinatal factors associated with initiation of breastfeeding following very preterm birth < 29 weeks

Abstract

To determine feeding trends and perinatal characteristics associated with breastfeeding amongst neonates < 29 weeks of gestation. This was a retrospective cohort study using a national neonatal database. Extremely preterm neonates delivered < 29 weeks’ and admitted to two tertiary-care NICUs from January 1, 2015 to December 31, 2018 were eligible for inclusion. Maternal demographics, pregnancy complications, birth events, and postnatal course were entered in the database by trained abstractors using standardized definitions. Our primary outcome was initiation and continuation rates of feeding with mother’s-own-(breast)-milk (“MOM”). The secondary outcome was to determine the perinatal factors associated with non-initiation of MOM feeds and/or discontinuation prior to hospital discharge. Descriptive and inferential statistics (student t-, chi-square, and Wilcoxon rank-sum tests) were used to present results and compare outcomes between groups. Prevalence of feeding trends were calculated for the total study period and annually. Of 302 eligible neonates, 84.1% initiated feeding of MOM but only 40.4% continued to discharge. There was no change in the rates of discontinuation of MOM in the study period, but a significant reduction in initiation rates (p < 0.0001; Figure 1). The only perinatal factors negatively associated with initiation of MOM were multiparity (p=0.0001) and cigarette smoking (p=0.0011). Discontinuation of MOM prior to hospital discharge was significantly associated with earlier gestational age at birth (p=0.0002) as well as maternal characteristics including multiparity (p=0.0003), younger age (p=0.0195), and cigarette smoking (p=0.0002). While initiation of MOM was high amongst very preterm neonates, over half stopped breastfeeding during the NICU admission. Enhanced understanding of the key perinatal factors associated with non-initiation and discontinuation will improve targeted supports and quality improvement strategies promoting breastfeeding in this high-risk group.