Abstract
Background and aimBoth breastfeeding and the use of human milk are strategies that provide better conformation to health throughout an individual’s life and bring countless short- and long- term benefits, which are well established in the scientific literature. For at-risk newborns (NBs), these strategies are crucial interventions to enable neonatal survival with better quality of life due to the distinctive and complex composition of human milk, which serves as personalized food-medicine-protection. However, there is limited knowledge about breastfeeding practices in high-risk NBs. The aim was to estimate the duration of EBF and to investigate the effect of risk at birth on EBF discontinuity in the first six months of life’.MethodsThis cohort study included 1,003 NBs from a high-risk referral center, followed up from birth to the sixth month of life, between 2017 and 2018. Correspondence and cluster analysis was used to identify neonatal risk clusters as the main exposure. The object of interest was the time until EBF discontinuity. The Kaplan-Meier methods and the Cox proportional hazards model were used to estimate the hazard ratio and 95% confidence intervals.ResultsThe prevalence and median duration of EBF decreased proportionally in the three groups. The multiple model revealed a gradient in EBF discontinuity, which was 40% higher in risk group 1 and 111% higher in risk group 2 compared to healthy full-term NBs. Additionally, EBF during hospitalization predicted a longer median duration of this practice for high-risk NBs.ConclusionThis study confirms a high proportion of high-risk NBs who have EBF discontinued before six months of life. The risk of EBF discontinuity is higher in risk groups, with a gradual effect even when adjusted by several factors. Effective interventions are needed to promote, protect, and support breastfeeding in different profiles of risk-at-birth groups.
Highlights
Several benefits of breastfeeding (BF) are well-established in the literature [1,2,3,4,5,6,7,8,9]
The multiple model revealed a gradient in exclusive breastfeeding (EBF) discontinuity, which was 40% higher in risk group 1 and 111% higher in risk group 2 compared to healthy full-term NBs
This study confirms a high proportion of high-risk NBs who have EBF discontinued before six months of life
Summary
Several benefits of breastfeeding (BF) are well-established in the literature [1,2,3,4,5,6,7,8,9]. For high-risk newborns (NBs), they range from protection against some diseases to neonatal survival with a higher quality of life [10,11,12,13,14,15,16,17,18,19,20] Considering that it is an intervention of great impact in the short, medium, and long term, exclusive breastfeeding (EBF) in the first six months and continued until two years of age is strongly recommended for every child [5, 16, 21], and its benefits extend to better health as a whole. Diverse behaviors are observed in underdeveloped countries with high BF prevalence at all ages, and BF rate and duration decreases as national wealth increases (except for early initiation) [5] Both breastfeeding and the use of human milk are strategies that provide better conformation to health throughout an individual’s life and bring countless short- and long- term benefits, which are well established in the scientific literature. The aim was to estimate the duration of EBF and to investigate the effect of risk at birth on EBF discontinuity in the first six months of life’
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