Rates and Determinants of Mother’s Own Milk Feeding in Infants Born Very Preterm

Abstract

on behalf of the Canadian Neonatal Network (CNN) and Canadian Preterm Birth Network (CPTBN) Investigators* Objectives To examine rates and determinants of mother's own milk (MOM) feeding at hospital discharge in a cohort of infants born very preterm within the Canadian Neonatal Network (CNN).Study design This was a population-based cohort study of infants born at <33 weeks of gestation and admitted to neonatal intensive care units (NICUs) participating in the CNN between January 1, 2015, and December 31, 2018. We examined the rates and determinants of MOM use at discharge home among the participating NICUs. We used multivariable logistic regression analysis to identify independent determinants of MOM feeding.Results Among the 6404 infants born very preterm and discharged home during the study period, 4457 (70%) received MOM or MOM supplemented with formula. Rates of MOM feeding at discharge varied from 49% to 87% across NICUs. Determinants associated with MOM feeding at discharge were gestational age 29-32 weeks compared with <26 weeks (aOR 1.56, 95% CI 1.25-1.93), primipara mothers (aOR 2.12, 95% CI 1.86-2.42), maternal diabetes (aOR 0.79, 95% CI 0.66-0.93), and maternal smoking (aOR 0.27, 95% CI 0.19-0.38). Receipt of MOM by day 3 of age was the major predictor of breast milk feeding at discharge (aOR 3.61,.Conclusions Approximately two-thirds of infants born very preterm received MOM at hospital discharge, and rates varied across NICUs. Supporting mothers to provide breast milk in the first 3 days after birth may be associated with improved MOM feeding rates at discharge.

Trend and Predictors of Breastmilk Feeding among Very-Low-Birth-Weight Infants in NICU and at Discharge

“…The percentages of feeding with MOM of 69.5% recorded in our NICU are not satisfactory but better than the European [22][23][24][25][26] (France 49%, Germany 47-60%, 44% in Portugal, 53.6-78% in Greece, 49% in Sweden) and Chinese [27] data (58%) and in line with those of the United States [28][29][30] (70-75%); our values have improved over the years, except for 2020, the year of the COVID-19 pandemic. This trend is common to other countries that recorded a 10-20% increase over the years [22].…”

Associations of Maternal Milk Feeding With Neurodevelopmental Outcomes at 7 Years of Age in Former Preterm Infants

“…The main outcome variables were WASI full-scale, verbal, and performance IQ scores; WRAT-4 reading standard, spelling, and math computation scores; ADHD symptoms (Conners Third Edition ADHD Index T score); BRIEF global executive composite score; and SDQ total difficulties score. To estimate the association of the human milk intake with neurodevelopmental outcomes at 7 years of age, we fitted linear models using generalized estimating equations with an independence working correlation structure to account for nonindependence of multiple births and repeated pregnancies and adjusting for clinical and social variables that we conceptualized as potential confounders . Confounders adjusted for in the models included maternal educational level, maternal occupation, number of adults and children living in the home, maternal smoking, maternal alcohol use, parity, race, birth weight (continuous), gestational age (continuous), plurality, exposure to antenatal steroids, treatment group (high vs standard docosahexaenoic acid), and center.…”

Monitoring the Use of Human Milk, the Ideal Food for Very Low-Birth-Weight Infants—A Narrative Review

“…Then, at the Boston Medical Center in early 2015, the rate of breast milk initiation among infants at <34 weeks of gestation was >80%, but <60% of them continued breastfeeding until the time of discharge [ 61 ]. In a population-based cohort study [ 62 ] of 6404 children born at <33 weeks GA included in a Collaborative National Network between 2015 and 2018, 4457 (70%) received exclusive MOM or MOM supplemented with formula. MOM feeding rates at discharge ranged from 49% to 87% among NICUs.…”

“…In another study [ 62 ], the MOM feeding rates at discharge were associated with a higher gestational age at birth, with better outcomes among those born at 29–32 weeks GA compared to those <26 weeks GA. Other determinants associated with a poorer MOM feeding rate at discharge were birth to primiparous mothers or birth to mothers with diabetes.…”

“…These findings are summarized in Table 2. Long hospitalization [78,79,97,98] MOM at discharge [99] Lack of communication, counseling Lack of breastfeeding support [110,111] Lack of mother's proximity [66] Dedicated spaces [48,111] Free access of parents [12,13] MOM within day 3 of age [62] High intake of MOM during the first postnatal week [68] Breastfeeding at discharge [108,109] Availability of DM [67,118] Active breastfeeding promotion/support of staff [51,69,76,78,[80][81][82][83] Baby-Friendly Hospital accreditation [67,76] Support of partner and family [66,116] KMC [51,[112][113][114]117]…”