A prospective cohort study on lactation status and breastfeeding challenges in mothers giving birth to preterm infants

Abstract

Background Mothers of preterm infants face many challenges in breastfeeding, especially regarding lactation. This study aimed to investigate the lactation status and challenges in breastfeeding faced by preterm infants’ mothers. Methods We approached 124 mothers who gave birth to preterm infants between 26 May and 31 October 2018 in a tertiary hospital in China. Lactation status and challenges in breastfeeding on day 7 postpartum, at discharge of infants, 2 weeks post-discharge, and 3 months of corrected age were collected using questionnaires. The area under the receiver operating characteristic (ROC) curve for expressed milk volume on day 7 postpartum for predicting expressed milk volume ≥ 300 mL/d at discharge was calculated. Logistic regression analyses were performed to identify factors associated with delayed lactogenesis II onset and continuation of breastfeeding at 3 months of corrected age. Results Seventy mothers were enrolled, and 51.4% had delayed lactogenesis II. Multivariate logistic regression analysis revealed that older maternal age (aOR = 1.19; 95% CI: 1.01, 1.40) and first live birth (aOR = 4.81; 95% CI 1.43, 16.18) were significant independent predictors of delayed lactogenesis II. Mothers with delayed lactogenesis II had significantly lower expressed milk volume (day 7 postpartum: 160.0 mL vs. 300.0 mL, U = 328.50, p = 0.001; at discharge: 425.0 mL vs. 612.5 mL, U = 372.00, p = 0.005), with a lower proportion of exclusive breastfeeding in their infants (at discharge: 33.3% vs. 69.8%, χ2 = 12.39, df = 1, p < 0.001; 3 months of corrected age: 17.8% vs. 52.8%, χ2 = 11.03, df = 1, p = 0.001). The ROC showed that expressed milk volume > 190 mL/d on day 7 postpartum significantly predicted expressed milk volume ≥ 300 mL/d at discharge. Insufficient human milk was the main reason for breastfeeding discontinuation at 3 months of corrected age. Twins were less likely to continue breastfeeding at 3 months of corrected age (aOR = 0.27; 95% CI 0.09, 0.86). In singleton infants, mother’s own milk ≥50% of total milk uptake at 2 weeks post-discharge (aOR = 32.66; 95% CI 3.00, 355.25) was an independent predictor of continuous breastfeeding at 3 months of corrected age. Feeding complications in infants, poor breastfeeding technique, and low milk output are the main challenges in breastfeeding. Conclusion Interventions to improve early postpartum lactation and breastfeeding techniques may increase breastfeeding adoption in mothers of preterm infants.

Effects of a WeChat Mini-Program on Human Milk Feeding Rates in a Neonatal Intensive Care Unit During the COVID-19 Pandemic

“…Some studies also use special categorical indicators derived from the above-mentioned quantitative indicators. It is suggested that cumulative HM-PCT ≥ 50% within 14 days reduces the incidence of NEC in VLBWI by six-fold ( 46 ), while cumulative MOM-PCT ≥ 50% within 14 days was predictive of continued breastfeeding at 3 months corrected gestational age in preterm mothers ( 47 ). Furthermore, HM-DD ≥ 50 ml/kg/day within 28 days reduces the incidence of sepsis in VLBWI while reducing hospitalization costs ( 48 ).…”

Pilot Feasibility Study of a Hospital-Based Post-Natal Educational Intervention on New Mothers in a BFHI-Compliant Tertiary Referral Center for Neonatal Care

“…Likewise, the present study did not analyze mothers who underwent operative vaginal deliveries and/or delivered prematurely. Those dyads usually need extra support and encounter more difficulties in breastfeeding [ 41 , 42 ]. Said populations, hereby not considered due to the preliminary nature of our study, shall be included in future studies analyzing the impact of the Diary on perceived maternal support and exclusive breastfeeding rates.…”

Determinants of delayed onset of lactogenesis II among women who delivered via Cesarean section at a tertiary hospital in China: a prospective cohort study

“…For the analyses presented in this article, we calculated the sample size based on the formula n = Z 2 1 − α/2 × pq / d 2 . According to a study conducted in the USA in 2010, the prevalence of DOLII among Cesarean section mothers (estimated p ) was 59.2% [ 6 ]. Based on an allowable deviation of 0.05, statistical power of 90%, and two-tailed significance level of 5%, the minimum required sample size was 300 participants.…”

“…We selected the variables from potential confounders of the onset of lactogenesis identified in prior studies from other countries [ 4 , 6 , 20 – 25 ]. Demographic, medical, and breastfeeding factors for the mother and infant were included in the current analysis.…”

“…However, the onset of lactogenesis II is closely related to the changes in the physiological structure of the mammary epithelial cells, which can be interrupted or delayed by internal and external factors, such as premature delivery or surgical delivery. If the onset of lactogenesis II occurs ≥ 72 h postpartum it is defined as delayed [ 4 , 6 ]. Delayed onset of lactogenesis II (DOLII) is relatively common, with a prevalence of 12 – 55% among all mothers [ 5 – 7 ].…”