Breastfeeding In Late Preterm Infants Research Articles

Impact of theory of planned behavior based intervention on breastfeeding patterns of the mothers with preterm infants: a randomized trial

BackgroundThe birth of a preterm infant is considered a crisis for the mother and the family. Given the significance of breastfeeding for these high-risk infants, failure to initiate and maintain exclusive breastfeeding in this group of infants is a prevalent and serious problem. The aim of this research was to investigate the impact of Theory of Planned Behavior based intervention on breastfeeding patterns of the mothers with preterm infants: a randomized trial.Materials and methodsThis study is a field trial conducted in Isfahan, Iran in 2021–2022. It included 72 mothers of late preterm infants, divided into the intervention (n = 36) and control (n = 36) groups. The intervention group received four training sessions focused on breastfeeding patterns based on the Theory of Planned Behavior. Before, immediately after, and two and four months after the intervention, the constructs of the Theory of Planned Behavior related to breastfeeding patterns were assessed using a researcher-made questionnaire, and the infant’s breastfeeding pattern was recorded. Statistical analysis was performed using SPSS version 19, g repeated measures ANCOVA, Bonferroni post hoc test, and chi-square test.ResultsThe results indicated that immediately after the intervention, as well as two and four months later, the mean scores for attitude (P < 0.001), subjective norms (P < 0.001), perceived behavioral control (P < 0.001), and behavioral intention (P < 0.001) were significantly higher in the intervention group than in the control group. Additionally, the results showed that, the rate of breastfeeding immediately, two months, and four months after the intervention was significantly higher in the intervention group than before the intervention (P < 0.001). However, in the control group, the rate of breastfeeding immediately, two months, and four months after the intervention was significantly lower than before the intervention (P < 0.001).ConclusionInterventions based on the Theory of Planned Behavior can improve exclusive breastfeeding in late preterm infants by changing the attitudes, subjective norms, perceived behavioral control and the behavioral intentions of the mothers of preterm infants.Trial registration“IRCTID: IRCT20210524051392N1”, 13/06/2021.

Late Preterm Newborns: Breastfeeding and Complementary Feeding Practices.

The aim of this study is to identify factors associated with successful breastfeeding in late preterm infants (LPIs) and explore the initiation of complementary feeding; Methods: Prospective cohort study was conducted of infants born at 34+0 to 36+6 weeks gestational age in the Hospital of the Lithuanian University of Health Sciences Kaunas Clinics during 2020-2021. Families were followed up until the infants reached 12 months of age. Average breastfeeding initial time, average breastfeeding duration time, prevalence of exclusive breastfeeding and average solid-food feeding initiation time were examined. The correlations among factors that might affect breastfeeding rates were calculated using the chi-square test (p < 0.05); Results: In our study with 222 eligible participants, we observed a statistically significant delay in breastfeeding initiation only in the 34+0+6 gestational age group (p < 0.001). At discharge, the 36+0+6 group exhibited a significantly higher exclusive breastfeeding rate (p < 0.001). Over the first year, breastfeeding rates varied, with no correlation found between duration of exclusive breastfeeding and gestational age. Initial solid-food feeding times were similar across groups, and all infants were introduced to vegetables first; Conclusions: Vaginal delivery, skin-to-skin contact after birth, early rooming-in, and breastfeeding within 2 h after birth statistically significantly causes earlier breastfeeding initiation and longer duration of breastfeeding in LPIs. All infants began solid-food feeding at an average age of 5 months, with vegetables being the primary food choice.

A prospective cohort study evaluating exclusive breastfeeding in late preterm infants.

Breastfeeding can be challenging in neonates born between 34 0/7 and 36 6/7 weeks gestation (late preterm). This prospective cohort study aims to evaluate exclusive breastfeeding at discharge, at three and six months of life in late preterm infants, and to identify facilitators and challenges to it. We included late preterm neonates eligible for the rooming-in. Data about breastfeeding at discharge, at three and six months of life were collected. Two hundred and fourteen late preterm infants were included in the study. At discharge 70 infants (32.7%) were fed with human milk and 144 (67.2%) were not. Non-exclusive breastfeeding was more common in women who were primiparous, had hypertension, and who underwent cesarean sections. Non-exclusive breastfeeding was associated with a low birthweight (<2500 g), ≥2 blood glucose controls, weight loss >10%, and longer hospital stay. Early first latch-on and skin-to-skin contact were more frequently associated with exclusive human milk feeding (P<0.001). Late preterm neonates born at 35 weeks showed a significant increase in exclusive human milk feeding at 3 months compared to the rate at discharge (P=0.004). In this cohort, early first latch-on and immediate skin-to-skin contact resulted associated with exclusive human milk feeding. Despite formula-fed during hospitalization, infants born at ≥35 weeks gestation who were exclusively breastfed at follow-up increased.

A prospective cohort study evaluating exclusive breastfeeding in late preterm infants

A prospective cohort study evaluating exclusive breastfeeding in late preterm infants

544 Neonatal intensive care admission is associated with lower breastfeeding in late preterm infants

Breastfeeding is associated with improved maternal and infant outcomes. Infants who deliver during the late preterm period (34-0 to 36-6 weeks) represent over 70% of preterm births and have increased morbidity as compared to term infants. Whether NICU admission is associated with the likelihood of breastfeeding among late preterm infants is unknown. This is a secondary analysis of live births < 37 weeks in a Maternal Fetal Medicine Unit study of steroid use in the late preterm period. Prevalence of any breastfeeding in hospital was compared by infant NICU admission status. Chi square tests were used for bivariable analyses, and logistic regression was used to adjust for confounders. Median hours to first feed of any type (breast or bottle) was compared using Wilcoxon rank sum by NICU admission. Rate of breastfeeding was compared among infants who were fed within the first hour of life. Incidence of feeding problems, or inability to take all feeds by mouth, was compared by NICU admission among those breastfeeding. A total of 2329 subjects were included. The prevalence of any breastfeeding was 74.3% in infants not admitted to NICU and 65.8% in those admitted to the NICU (Table 1, p<0.001). NICU admission was independently associated with lower odds of any breastfeeding (adjusted odds ratio (aOR) 0.61, 95% CI 0.49, 0.77, p <0.001). NICU admission was associated with a significant delay to any first feed (Figure, p < 0.001). Analysis restricted to those with first feed within an hour revealed no difference in breastfeeding (70.6% admitted to NICU vs 77.4% not admitted to NICU p=0.08, aOR 0.62 95% CI 0.37- 1.02). Among breastfed infants, NICU admission was associated with higher odds of feeding problems (aOR 1.65, 95% CI 1.30 – 2.11, p<0.001). NICU admission is independently associated with decreased odds of any breastfeeding during delivery hospitalization in the late preterm infant. NICU admission is associated with longer time to any first feed. Among those infants who are fed in the first hour, there is no difference in breastfeeding rates by NICU admission.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Duration of Breastfeeding in Late Preterm Infants: Maternal and Infant Factors.

More than 550,000 late preterm infants are born each year in Indonesia. These infants, born between 340/7-366/7 weeks, have more complications than term infants. Breastfeeding is considered the most optimal nutrition for newborn infants. Two groups of factors are important for successful breastfeeding: infant and maternal factors. The infant factors can be evaluated using the Infant Breastfeeding Assessment Tool and the maternal aspects with the Breastfeeding Self-Efficacy Scale-Short Form. To determine whether the Infant Breastfeeding Assessment Tool or the Breastfeeding Self-Efficacy Scale-Short Form was more predictive of successful breastfeeding among late preterm infants. This study was conducted in the Academic Teaching Hospital in Surabaya, Indonesia in March-July 2017. Mothers who delivered their infant between a gestational age of 340/7 and 366/7 weeks were included. Fifty-four single born participant mother-infant pairs were included. The mean total Breastfeeding Self-Efficacy Scale-Short Form score was 57.8 (SD = 8.9). The mean Infant Breastfeeding Assessment Tool score was 8.3 (SD = 1.8). There was a significant correlation between the total Breastfeeding Self-Efficacy Scale-Short Form score and the Infant Breastfeeding Assessment Tool score (p = .020, r = 0.316). The Breastfeeding Self-Efficacy Scale-Short Form was significantly higher in the participant (mothers) of the infants breastfed ≥ 4 months, compared to < 4 months, 61.59 (SD = 5.78) versus 51.78 (SD = 11.64; p = .001). No correlation was found between the duration of breastfeeding and Infant Breastfeeding Assessment Tool score (p = .087). Maternal factors were more important for successful breastfeeding in these late preterm infants than infant factors in our sample.

Intermittent kangaroo mother care and the practice of breastfeeding late preterm infants: results from four hospitals in different provinces of China

BackgroundChina has an extremely low exclusive breastfeeding rate. Kangaroo mother care (KMC) has been shown to increase the exclusive breastfeeding rate among infants born extremely or very preterm. However, there is limited evidence surrounding intermittent KMC and exclusive breastfeeding in late preterm infants. In our study we investigated the association between the provision of intermittent KMC and breastfeeding practice for late preterm infants in four hospitals in different provinces of China.MethodsIntermittent KMC was recommended to the mothers of all preterm infants admitted to the postnatal wards of participating hospitals between March 2018 and March 2019. Those who agreed to practice KMC were enrolled in the “KMC group”, those who did not were enrolled in the “No KMC group”. Basic maternal socio-demographic information was collected, feeding practice; outcome and method, were recorded daily whilst in hospital. A follow-up survey of feeding practice was conducted 42 days after discharge. Calculations for feeding practice were performed separately for both groups. Logistics regression was used to analyze the association between KMC and feeding outcome and method, adjusting for socio-demographic covariates.ResultsAmong the 844 mothers participating in the study, 627 (74.3%) chose to perform KMC. More of the mothers who provided KMC were exclusively breast milk feeding their infants in the 24 h before hospital discharge (54.6%) and at follow-up (57.3%), compared to mothers who did not provide KMC (34.6% at discharge and 33.2% at follow-up,). Mothers in the KMC group were more likely to be breastfeeding (method) than mothers in the No KMC group (65.3% vs. 52.1% at discharge, and 83.1% vs. 67.3% at follow up). Logistic regression indicated that compared with the No KMC group, mothers who provided KMC were twice as likely to be exclusively breast milk feeding their infants at discharge (OR = 2.15 (95% CI 1.53, 3.02)), use breastfeeding method at discharge as opposed to other means such as bottle or cup feeding (OR = 1.61 (95% CI 1.15, 2.25)), be exclusive breast milk feeding at follow-up (OR = 2.55 (95% CI 1.81, 3.61)), and use breastfeeding method at follow-up (OR = 2.09 (95% CI 1.44, 3.02)).ConclusionsIntermittent KMC was associated with a nearly doubled increase in exclusive breast milk feeding (outcome) and breastfeeding (method) at both discharge and 42 days after discharge for late preterm infants. This is especially important in China where exclusive breastfeeding rates are low, intermittent KMC provides a feasible means to increase the likelihood of these vulnerable infants receiving the benefits of exclusive breastmilk.

Mother And late Preterm Lactation Study (MAPLeS): a randomised controlled trial testing the use of a breastfeeding meditation by mothers of late preterm infants on maternal psychological state, breast milk composition and volume, and infant behaviour and growth

BackgroundLate preterm infants suffer from more complications and are less likely to be breastfed compared to term infants and their mothers experience higher levels of stress than mothers with term infants. The physiological or hormonal responses that influence milk ejection, milk production, and/or maternal behaviour are possible mechanisms by which maternal distress could negatively influence breastfeeding success. Maternal mood might also affect infant behaviour (feeding, sleeping, and crying) through changes in milk volume and composition, and consequently breastfeeding success and infant growth. Previous research, using relaxation therapy in 64 Malaysian first-time mothers breastfeeding their full-term infants, demonstrated that the therapy was effective in reducing maternal stress and improving infant growth. We hypothesise that expected benefits are even greater in a more vulnerable population where additional breastfeeding support is especially needed, such as in mothers of late preterm infants.Methods/designThis protocol describes our randomised controlled trial that tests whether a breastfeeding meditation audio reduces maternal stress in mothers of late preterm infants in London. Home visits will be conducted at 2–3 and 6–8 weeks post-delivery. Participants will be randomised to a control group or an intervention group, where mothers will be asked to listen to a meditation tape on a daily basis while breastfeeding. The main outcomes of the intervention will be maternal stress markers and infant weight Z-score. Potential mediators will be the secondary outcomes and include breast milk macronutrient and hormone levels (ghrelin, leptin, cortisol, and adiponectin), milk volume assessed by 48-h test-weighing, and maternal engagement with the infant. Infant behaviour, including crying and sleeping, and infant appetite will be evaluated. Data about other mediators such as maternal perception of milk supply and salivary oxytocin will be collected.DiscussionWe hypothesise that the use of the breastfeeding meditation will reduce maternal stress and consequently improve infant growth mediated by changes in milk composition and volume and maternal behaviour. This study will allow us to understand the mother–infant factors that influence breastfeeding in late preterm infants and potentially identify a method that could improve mother, infant, and breastfeeding outcomes.Trial registrationClinicalTrials.gov, NCT03791749. Registered 1 January 2019.

Effects of a Breastfeeding Support Program on the Prevalence of Exclusive Breastfeeding and Growth in Late Preterm Infants

PurposeThe purpose of this study was to investigate the effects of a breastfeeding support program (BSP) on the prevalence of exclusive breastfeeding and growth in late-preterm infants.MethodsA quasi-experimental study was conducted. The participants were 40 late preterm infants (LPIs), of whom 20 were assigned to the experimental group and 20 to the control group. For the mothers in the experimental group, a BSP was provided prior to the LPIs’ discharge and reinforced once a week for 4 weeks. Information on the feeding type was collected by observation and the LPIs’ body weight was measured.ResultsThere were significant differences in feeding type by group and time. Exclusive breastfeeding was 5.18 times more common in the experimental group than in the control group (odds ratio=5.18, 95% confidence interval=1.11~16.70). However, weekly weight gain did not show a significant relationship with group and time (F=0.40, p=.712).ConclusionThe BSP was helpful for increasing the rate of exclusive breastfeeding in LPIs. Furthermore, the LPIs in the experimental group, which had a higher likelihood of being exclusively breastfed, showed an equivalent amount of weight gain as the LPIs in the control group, in which infants were more likely to be formula-fed.

Are there interventions that improve breastfeeding and the use of breast milk in late preterm infants?

To answer the clinical question 'Among late preterm infants are there any interventions that improve the rates of breastfeeding and the use of breast milk compared with current practice?'. MEDLINE via Ovid, Embase via Ovid, the Maternity and Infant Care Database and the Cochrane Library were searched for relevant articles. Articles were excluded if they did not discuss specific interventions to improve breastfeeding, for example, if they only commented on factors such as age, race and education. Articles were also excluded if they were not specific to the late preterm infant population. A total of 516 articles were found and screened by title and abstract independently by two reviewers. The full text of 17 articles was independently reviewed. The reference lists of these full-text articles were screened, and 14 abstracts were subsequently reviewed. The final analysis included three studies. There is limited high-quality research evidence for interventions to improve breastfeeding in late preterm infants. In the absence of robust academic research, clinical practice should be guided by clinical expertise and involve a multidisciplinary team, including qualified lactation consultants. While it seems reasonable for hospitals to support interventions that improve breastfeeding in term infants, managing late preterm infants as healthy term infants without additional specialist support may result in high breastfeeding failure rates among late preterm infants.

Breastfeeding Characteristics of Late-Preterm Infants in a Kangaroo Mother Care Unit.

To describe the breastfeeding characteristics of late-preterm infants (LPIs) in a kangaroo mother care (KMC) unit. In a 20-bed KMC unit, the breastfeeding of 73 purposively-selected LPIs' (mean gestational age: 34.8 weeks) was observed once-off, using the Preterm Infant Breastfeeding Behavior Scale. Participants' mean age was 9.5 days, mean number of days in the unit was 3.1 days, and mean number of days breastfeeding was 7.5 on observation. Only 13.7% of participants were directly breastfeeding without supplementary naso- or orogastric feeding/cup-feeding and 86.3% received supplementary cup-feeding of expressed breast milk. Most participants did not exhibit obvious rooting (83.5%) and although most latched-on (97.3%), those who did, latched shallowly (93%). The mean longest sucking burst was 18.8 (standard deviation: 10.5) and approximately half the participants swallowed repeatedly (53.4%). The mean breastfeeding session duration was 17.8 minutes, but most participants breastfed for less than 10 minutes (76.7%). No statistically significant differences in breastfeeding characteristics were detected between participants of different chronological ages. A general trend toward more mature behaviors in participants' breastfeeding for more days was present for many breastfeeding characteristics. More infants exhibited the most mature behavior for each breastfeeding characteristic when the environment was quiet, rather than noisy and disturbing, except for depth of latching (quiet: 0%, disturbance: 15.2%). LPIs in this sample presented with subtle breastfeeding difficulties, highlighting their need for breastfeeding support. Further research is required to examine the effect of KMC on breastfeeding in LPIs.

Prevalence and Predictors of Exclusive Breastfeeding in Late Preterm Infants at 12 Weeks

Purpose: The purpose of this study was to identify breastfeeding practice with late preterm infants (LPIs), and to determine predictors of exclusive breastfeeding at the 12th week after discharge. Methods: The participants were 106 mothers of LPIs hospitalized in neonatal intensive care units at two university hospitals. Data were collected between February and October, 2013. Questionnaires included characteristics of LPIs, their mothers, and feeding-related characteristics. Feeding methods were exclusive breastfeeding, mixed feeding, and formula feeding. Results: Exclusive breastfeeding steadily increased from 5.7% at the 1st week to 19.8% at the 12th week, as did formula feeding from 27.3% to 67.9%. Contrarily, mixed feeding decreased from 67.0% at the 1st week to 12.3% at the 12th week. The ratio of formula feeding was higher than that of exclusive breastfeeding over time. Predictors for exclusive breastfeeding were the following: type of delivery (OR=2.96, 95%CI=1.07-8.14), feeding intolerance (OR=3.03, 95%CI=1.26-7.25) and feeding method during hospitalization (OR=7.84, 95%CI=3.15-19.53). Conclusion: In order to increase breastfeeding opportunities for LPIs, educational programs for gestational age-appropriate breastfeeding should be developed. The focus of breastfeeding education needs to be on mothers who delivered their LPIs through Cesarean-section and LPIs who had feeding intolerance or were fed only formula during hospitalization.

Comparing Factors Associated with Breastfeeding in Late Preterm Infants of Different Gestational Ages

Purpose: The purpose of this study was to compare the rate of breastfeeding and factors which affect late preterm infants’ (LPIs) breastfeeding according to gestational age. Methods: Participants were LPIs of 34 weeks (n=70), 35 weeks (n=75), and 36 weeks (n=88). Data were collected from July to December, 2011 from four university hospitals in D city. Descriptive statistics and odds ratio were used to compare three groups. Results: The rate of breastfeeding at 1 week after LPIs’ discharge was 32.9%, 37.3%, 23.9% at 34, 35 and 36 weeks, respectively. The tendency to breastfeed in LPIs of 34 weeks was lower for LPIs born by Cesarean-section, while it was higher for LPIs with a longer period of breastfeeding during hospitalization and higher body weight at the first day of feeding. The prevalence of breastfeeding in LPIs of 35 weeks and 36 weeks was higher for infants with a history of more frequent breastfeeding during hospitalization. Conclusion: The rate of breastfeeding in LPIs of 36 weeks was the lowest. This study suggests that nurses should give more customized education to mothers with LPIs of 36 weeks during their stay in hospitals.

Management of breastefeeding for late preterm infants

Breast milk is the preferred feeding for all infants. Unfortunately, late preterm infants (LPIs) have a lower rate of feeding at-breast and lower expressed breast milk intake than other infants. [1] In fact, literature documents an increased risk of morbidity and even mortality of LPIs, often related to feeding problems, possibly due to an inadequate support of the breastfeeding. [2] Born with low energy stores and high energy demands, LPIs may be sleepier and have more difficulty with latch, suck, and swallow. They are at risk for hypothermia, hypoglycemia, excessive weight loss, dehydration, failure to thrive, kernicterus, and breastfeeding failure. Establishing breastfeeding in LPIs is problematic, due to neonatal physiological, neurological immaturity and due to maternal risk factors leading to delayed lactogenesis II. Mothers may be obese, experienced a cesarean delivery, have pregnancy induced hypertension, diabetes, or been treated for preterm labor. They easily experience anxiety about milk insufficiency and about separation from their babies for medical problems. Sanitary staff has to encourage the immediate and extended skin-to-skin contact to improve postpartum stabilization of heart rate, respiratory effort, temperature control, metabolic stability, and early breastfeeding, possibly within 1 hour after birth. If the infant is healthy, it’s important to allow rooming in and free access to the breast. It may be necessary to wake the baby up if he/she does not indicate hunger cues, which is not unusual in LPIs. The infant should be breastfed (even with expressed milk) 8 to 12 times/day. It is important observing the baby feeding at breast and showing the mother techniques to facilitate effective latch and adequate support of the neonate’s head. A nipple shield could be recommended. Pre- post-feeding weight may be helpful to assess milk transfer, because a supplementation with small quantities of maternal expressed milk, donor human milk, or formula may be necessary. If supplementing, the mother should pump milk after breastfeeding, 6 to 8 times/day to establish and maintain milk supply. [3] LPIs developing complications are often discharged early, after successful transition to extra-uterine environment, but before lactogenesis II is fully established. Before discharge, adequate milk intake should be documented by feeding volume or by thriving. One/2 days after discharge, a follow up to check weight, feeding ability and jaundice is recommended. In conclusion we may say that breastfeeding LPIs is possible, but to achieve this target, an adequate maternal support and a regular neonatal monitoring is required. [4]

Formula feeding for late-preterm infants

Preterm birth interrupts physiological foetal development, leading to various degrees of immaturity according to the gestational age at which the infant is born [1]. Since 2005, the imprecise definition of “near-term” infants has been replaced with “late-preterm”, which includes infants born between 340/7 and 366/7 weeks of gestation [2]. Late-preterm infants are at higher risk than term infants of developing medical complications that result in higher rates of mortality and morbidity [3], including thermal instability, respiratory problems, hypoglycaemia, jaundice, and feeding problems. Breastfeeding is the first nutritional choice for all infants, especially for those born preterm. The establishment of successful breastfeeding in late-preterm infants is usually problematic, as late-preterm infants can be sleepier, have less muscular strength and more difficulty with latch, suck and swallow than term infants [4]. For this reason, health-care providers should implement specific strategies aimed at anticipate, identify promptly, and manage breastfeeding problems that the late-preterm infant and mother can experience. However, when exclusive breastfeeding does not guarantee adequate nutrition, supplements might be advisable. Nutritional requirements of late-preterm infants are currently derived from speculations on foetal growth and requirements of preterm and term infants, while specific data on nutritional needs of this population are scarce. There is currently no consensus on whether late-preterm infants would benefit most of a high-protein diet, such as that proposed for “micropreterm” infants [5], or of a low-protein diet, such as that recommended for full-term infants. Some studies suggest that the provision of extra protein and energy could reduce weight loss and increase growth velocity [6], thus decreasing the risk for dehydration and hospital readmission. However, it is important to note that growth rate during late gestation decreases dramatically, and it is likely that protein and energy requirements for infants born during this period wouldn’t be as high as those of very preterm infants [7]. Current guidelines recommend the supplementation with essential nutrients also for late-preterm infants. Actually, it has been shown that supplementation with LC-PUFAs improves visual acuity and cognitive development in infants 30-37 weeks gestation [8]. The best nutritional approach to late-preterm infants still needs to be determined. Human milk’s benefits are undoubted; however, caregivers have to adequately support the establishment of successful breastfeeding and also identify those cases where some supplementation is needed. Further studies will have to clarify whether all late-preterm infants, or only a subgroup such as small-for-gestational-age infants, could benefit from formulas with high energy and protein content.

Effect of Cup Feeding and Bottle Feeding on Breastfeeding in Late Preterm Infants

Cup feeding has been used as an alternative feeding method for preterm infants. The purpose of this study was to determine the effect of bottle and cup feeding on exclusive breastfeeding rates at hospital discharge and 3 and 6 months post-discharge in late preterm infants. Included in the study were preterm infants of 32 to 35 weeks' gestation fed only by intermittent gastric tube at the time of recruitment; 522 infants were randomly assigned to 2 groups: the cup-fed group (n = 254) and bottle-fed group (n = 268). Main outcomes were prevalence of exclusive breastfeeding at discharge and 3 and 6 months after discharge, and length of hospital stay. Infants randomized to cup versus bottle feeding were more likely to be exclusively breastfed at discharge home (relative risk [RR], 1.58; 95% confidence interval [CI], 1.36-1.83), 3 months after discharge (RR, 1.64; 95% CI, 1.42-1.89), and 6 months after discharge (RR, 1.36; 95% CI, 1.14-1.63). There was no significant difference between groups for length of hospital stay. The mean hospital stay was 25.96 ± 2.20 days in the bottle-fed group and 25.68 ± 2.22 days in the cup-fed group. There was no significant difference between groups for time spent feeding, feeding problems, or weight gain in hospital. Cup feeding significantly increased the likelihood of late preterm infants being exclusively breastfed at discharge and 3 and 6 months after discharge, and cup feeding did not increase the length of hospital stay. Overall, we recommend cup feeding as a transitional method prior to breastfeeding for late preterm infants during hospitalization.

Role of the Pediatric Nurse Practitioner in Promoting Breastfeeding for Late Preterm Infants in Primary Care Settings

The preterm birth rate has been increasing steadily during the past two decades. Up to two thirds of this increase has been attributed to the increasing rate of late preterm births (34 to < 37 gestational weeks). The advantages of breastfeeding for premature infants appear to be even greater than for term infants; however, establishing breastfeeding in late-preterm infants is frequently more problematic. Because of their immaturity, late preterm infants may have less stamina; difficulty with latch, suck, and swallow; temperature instability; increased vulnerability to infection; hyperbilirubinemia, and more respiratory problems than the full-term infant. Late preterm infants usually are treated as full term and discharged within 48 hours of birth, so pediatric nurse practitioners in primary care settings play a critical role in promoting breastfeeding through early assessment and detection of breastfeeding difficulties and by providing anticipatory guidance related to breastfeeding and follow-up. The purpose of this article is to describe the developmental and physiologic immaturity of late preterm infants and to highlight the role of pediatric nurse practitioners in primary care settings in supporting and promoting breastfeeding for late preterm infants.