Facilitators and barriers of breastfeeding late preterm infants according to mothers’ experiences

BMC Pediatrics, Nov 2016

Background Late preterm infants account for the majority of preterm births. They are at an increased risk of neonatal mortality and morbidity and are less likely to initiate breastfeeding and to be exclusively breastfed at discharge compared to infants born at term. The aim of this study was to identify the facilitators and barriers to breastfeeding during hospital stays according to the experiences of mothers of late preterm infants. Methods We conducted a cross-sectional questionnaire survey. Mothers who intended to breastfeed and had given birth to a newborn admitted to level I and II care, with a gestational age of 34 0/7 to 36 6/7 weeks, were enrolled. Sociodemographic data, neonatal variables, mode of feeding and feeding status at discharge were also collected. Results A total of 92 mothers who had given birth to 121 infants were enrolled. At discharge, any human milk was fed to 94 % of infants, with exclusively human milk being fed in 43 % of cases; exclusively formula was fed to 6 % of infants. In the multivariate analysis, having expressed breast milk was independently associated with an increased risk of being fed with either any human milk or formula only (OR = 2.73, 95 % CI 1.05–7.1, p = 0.039), whereas being encouraged to practice kangaroo mother care tended to have a protective effect (OR = 0.46, 95 % CI 0.2–1.06, p = 0.07). Conclusions Based on the present findings, health care professionals should strive to fully implement breastfeeding support for mothers of late preterm infants who intend to breastfeed, in particular optimizing breast milk expression and promoting kangaroo mother care. Further studies are needed to gain further insight into the complex interplay of the factors that modulate breastfeeding outcome in late preterm infants.

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Facilitators and barriers of breastfeeding late preterm infants according to mothers’ experiences

Giannì et al. BMC Pediatrics Facilitators and barriers of breastfeeding late preterm infants according to mothers' experiences Maria Lorella Giannì 0 Elena Bezze 2 Patrizio Sannino 2 Elena Stori 0 Laura Plevani 0 Paola Roggero 0 Massimo Agosti 1 Fabio Mosca 0 0 Fondazione I.R.C.C.S. Ca Granda Ospedale Maggiore Policlinico, Neonatal Intensive Care Unit Department of Clinical Science and Community Health, University of Milan , Via Commenda 12, 20122 Milan , Italy 1 Neonatologia e Terapia Intensiva Neonatale , Polo Universitario F. Del Ponte, Viale Borri 54, 21100 Varese , Italy 2 Fondazione I.R.C.C.S. Ca Granda Ospedale Maggiore Policlinico, S.I.T.R.A. Basic Education Sector , Via Francesco Sforza 28, 20122 Milan , Italy Background: Late preterm infants account for the majority of preterm births. They are at an increased risk of neonatal mortality and morbidity and are less likely to initiate breastfeeding and to be exclusively breastfed at discharge compared to infants born at term. The aim of this study was to identify the facilitators and barriers to breastfeeding during hospital stays according to the experiences of mothers of late preterm infants. Methods: We conducted a cross-sectional questionnaire survey. Mothers who intended to breastfeed and had given birth to a newborn admitted to level I and II care, with a gestational age of 34 0/7 to 36 6/7 weeks, were enrolled. Sociodemographic data, neonatal variables, mode of feeding and feeding status at discharge were also collected. Results: A total of 92 mothers who had given birth to 121 infants were enrolled. At discharge, any human milk was fed to 94 % of infants, with exclusively human milk being fed in 43 % of cases; exclusively formula was fed to 6 % of infants. In the multivariate analysis, having expressed breast milk was independently associated with an increased risk of being fed with either any human milk or formula only (OR = 2.73, 95 % CI 1.05-7.1, p = 0.039), whereas being encouraged to practice kangaroo mother care tended to have a protective effect (OR = 0.46, 95 % CI 0.2-1.06, p = 0.07). Conclusions: Based on the present findings, health care professionals should strive to fully implement breastfeeding support for mothers of late preterm infants who intend to breastfeed, in particular optimizing breast milk expression and promoting kangaroo mother care. Further studies are needed to gain further insight into the complex interplay of the factors that modulate breastfeeding outcome in late preterm infants. Late preterm infants; Breastfeeding; Facilitators; Barriers - Background Late preterm infants, classified as infants born from 34 0/7 to 36 6/7 weeks’ gestation, account for nearly three-quarters of preterm births and are at an increased risk of neonatal mortality and morbidity (i.e., jaundice, poor feeding, respiratory distress, hypoglycaemia and sepsis) [1]. In addition, long-term negative health outcomes, such as neurodevelopmental delays, have also been reported [2]. Given the health benefits that breast milk confers to both mothers and infants, breastfeeding is recommended as the normal and unequalled method for feeding infants, including preterm ones [3]. However, breastfeeding late preterm infants is challenging, as emphasized by the fact that mothers that had given birth to late preterm infants are less likely to initiate breastfeeding and to achieve exclusively breastfeeding at discharge compared to mothers that had given birth to infants born at term. In addition, mothers of late preterm infants who do © The Author(s). 2016 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. succeed in breastfeeding show a reduced duration of lactation [4, 5]. Although a growing body of evidence exists on the factors that have been identified to be negatively associated with successful breastfeeding in term infants, the factors affecting the feeding of late preterm infants appear to be complex but still relatively understudied [2, 5]. Within this context, a closer examination of breastfeeding outcomes accounting for neonatal factors, such as infants’ health status and the different degrees of their developmental maturity, physiological and psychological maternal factors and social and system factors has been advocated to develop a customized breastfeeding support strategy for the late preterm population [1, 6]. Specifically, of the individual determinants, intention to breastfeed has been demonstrated to be pre (...truncated)


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Maria Giannì, Elena Bezze, Patrizio Sannino, Elena Stori, Laura Plevani, Paola Roggero, Massimo Agosti, Fabio Mosca. Facilitators and barriers of breastfeeding late preterm infants according to mothers’ experiences, BMC Pediatrics, 2016, pp. 179, 16, DOI: 10.1186/s12887-016-0722-7