Determinants of Successful Direct Breastfeeding at Hospital Discharge in High-Risk Premature Infants

Background: Despite a mother's intention to breastfeed, there are many barriers to feeding preterm infants that decrease breastfeeding rates. Objective: The objective of this research was to determine factors associated with successful direct breastfeeding (DBF) of the preterm infant at hospital discharge. Materials and Methods: A retrospective chart review of 69 preterm (<34 weeks' gestational age) infants in the neonatal intensive care unit, whose mothers intended to breastfeed, was conducted. Infant-, mother-, and feeding-related factors were examined by chi-square or t test for their relationship with breastfeeding success, and by multiple logistic regression to identify predictive factors. Results: Successful DBF at discharge occurred in 64%. Mothers of infants who were breastfed were older (p<0.0001); had less psychiatric illness (p=0.03); and were less likely to smoke (p<0.0001) and use recreational drugs (p=0.04). The infants had higher birth weights (p=0.03) and lower incidence of bronchopulmonary dysplasia (p=0.04). A higher proportion of infants received DBF at their first oral feed (p<0.001), and were discharged earlier (p=0.03). Reduced milk supply was cited for breastfeeding failure in 36%. Older maternal age (odds ratio [OR]=1.24, 95% confidence interval [CI] 1.02-1.51) and DBF at the first oral feed (OR=7.72, 95% CI 1.37-43.6) were associated with successful DBF at discharge. Conclusion: Maternal age and method of first oral feed are critical predictors of breastfeeding success in preterm infants. Mothers should be encouraged to breastfeed at the infant's first oral attempt and strategic breastfeeding support should be provided before initiation of oral feeding.