Breastfeeding and risk for ceasing in mothers of preterm infants-Long-term follow-up

Jenny Ericson, Mats Eriksson, Pat Hoddinott, Lena Hellström-Westas, Renée Flacking, Jenny Ericson, Mats Eriksson, Pat Hoddinott, Lena Hellström-Westas, Renée Flacking

Abstract

Breastfeeding is challenging for mothers of preterm infants. The aim of this paper is to describe risk factors for ceasing breastfeeding and methods of feeding until 12 months postnatal age in mothers who breastfed their preterm infants at discharge from neonatal intensive care units (NICUs). The data come from a randomised controlled trial, which evaluated the effectiveness on exclusive breastfeeding at 8 weeks of proactive telephone support compared with reactive support offered to mothers of preterm infants following discharge from NICU. Six NICUs across Sweden randomised a total of 493 mothers. We used regression and survival analyses to assess the risk factors for ceasing breastfeeding and the long-term outcomes of the intervention. The results showed that 305 (64%) of the infants were breastfed at 6 months and 49 (21%) at 12 months. Partial breastfeeding at discharge, low maternal educational level, and longer length of stay in the NICU increased the risk for ceasing breastfeeding during the first 12 months. Furthermore, the Kaplan-Meier analysis showed that the proportion of mothers who ceased breastfeeding did not differ between the intervention (n = 231) and controls (n = 262) during the first 12 months (log-rank test p = .68). No difference was found between groups on method of feeding. More than 85% of the infants were fed directly at the breast. These findings provide important insights for health professionals who are supporting mothers of preterm infants to breastfeed long term. Registered in www.clinicaltrials.gov (NCT01806480).

Keywords: RCT; bottle; breast milk; feeding; mother; neonatal.

Conflict of interest statement

The authors declare that they have no conflicts of interest.

© 2018 The Authors. Maternal and Child Nutrition Published by John Wiley & Sons, Ltd.

Figures

Figure 1
Figure 1
Flowchart showing the randomisation, allocation, and analysis stages in the study
Figure 2
Figure 2
Kaplan–Meier curve over event rate of ceasing breastfeeding between the proactive and reactive group (log‐rank test p = .68) during the first 12 months postnatal age

References

    1. Akerstrom, S. , Asplund, I. , & Norman, M. (2007). Successful breastfeeding after discharge of preterm and sick newborn infants. Acta Paediatrica, 96(10), 1450–1454. 10.1111/j.1651-2227.2007.00502.x
    1. American Academy of Pediatrics Committee on Fetus and Newborn (2012). Levels of neonatal care. Pediatrics, 130(3), 587–597. 10.1542/peds.2012-1999
    1. Briere, C. E. (2015). Breastfed or bottle‐fed: Who goes home sooner? Advances in Neonatal Care, 15(1), 65–69. 10.1097/anc.0000000000000159
    1. Briere, C. E. , McGrath, J. M. , Cong, X. , Brownell, E. , & Cusson, R. (2016). Direct‐breastfeeding in the neonatal intensive care unit and breastfeeding duration for premature infants. Applied Nursing Research, 32, 47–51. 10.1016/j.apnr.2016.04.004
    1. Chen, E. , & Miller, G. E. (2013). Socioeconomic status and health: Mediating and moderating factors. Annual Review of Clinical Psychology, 9, 723–749. 10.1146/annurev-clinpsy-050212-185634
    1. Collins, C. T. , Gillis, J. , McPhee, A. J. , Suganuma, H. , & Makrides, M. (2016). Avoidance of bottles during the establishment of breast feeds in preterm infants. Cochrane Database Syst Rev, 10 Cd005252. 10.1002/14651858.CD005252.pub4
    1. Dosani, A. , Hemraj, J. , Premji, S. S. , Currie, G. , Reilly, S. M. , Lodha, A. K. , … Hall, M. (2016). Breastfeeding the late preterm infant: Experiences of mothers and perceptions of public health nurses. International Breastfeeding Journal, 12, 23 10.1186/s13006-017-0114-0
    1. Ericson, J. , Eriksson, M. , Hellstrom‐Westas, L. , Hagberg, L. , Hoddinott, P. , & Flacking, R. (2013). The effectiveness of proactive telephone support provided to breastfeeding mothers of preterm infants: study protocol for a randomized controlled trial. BMC Pediatrics, 13, 73 10.1186/1471-2431-13-73
    1. Ericson, J. , Eriksson, M. , Hellstrom‐Westas, L. , Hoddinott, P. , & Flacking, R. (2018). Proactive telephone support provided to breastfeeding mothers of preterm infants after discharge: A randomised controlled trial. Acta Paediatrica. 10.1111/apa.14257
    1. Ericson, J. , & Flacking, R. (2013). Estimated breastfeeding to support breastfeeding in the neonatal intensive care unit. Journal of Obstetric, Gynecologic, and Neonatal Nursing, 42(1), 29–37. 10.1111/j.1552-6909.2012.01423.x
    1. Ericson, J. , Flacking, R. , Hellstrom‐Westas, L. , & Eriksson, M. (2016). Changes in the prevalence of breast feeding in preterm infants discharged from neonatal units: A register study over 10 years. BMJ Open, 6(12), e012900 10.1136/bmjopen-2016-012900
    1. Flacking, R. , & Dykes, F. (2013). 'Being in a womb' or 'playing musical chairs': The impact of place and space on infant feeding in NICUs. BMC Pregnancy and Childbirth, 13, 179 10.1186/1471-2393-13-179
    1. Flacking, R. , Ewald, U. , Nyqvist, K. H. , & Starrin, B. (2006). Trustful bonds: A key to "becoming a mother" and to reciprocal breastfeeding. Stories of mothers of very preterm infants at a neonatal unit. Social Science & Medicine, 62(1), 70–80. 10.1016/j.socscimed.2005.05.026
    1. Flacking, R. , Ewald, U. , & Starrin, B. (2007a). "I wanted to do a good job": Experiences of 'becoming a mother' and breastfeeding in mothers of very preterm infants after discharge from a neonatal unit. Social Science & Medicine , 64(12), 2405–2416. 10.1016/j.socscimed.2007.03.008
    1. Flacking, R. , Nyqvist, K. H. , & Ewald, U. (2007b). Effects of socioeconomic status on breastfeeding duration in mothers of preterm and term infants. European Journal of Public Health , 17(6), 579–584. 10.1093/eurpub/ckm019
    1. Flacking, R. , Ewald, U. , & Wallin, L. (2011). Positive effect of kangaroo mother care on long‐term breastfeeding in very preterm infants. Journal of Obstetric, Gynecologic, and Neonatal Nursing, 40(2), 190–197. 10.1111/j.1552-6909.2011.01226.x
    1. Gu, Y. , Zhu, Y. , Zhang, Z. , & Wan, H. (2016). Effectiveness of a theory‐based breastfeeding promotion intervention on exclusive breastfeeding in China: A randomised controlled trial. Midwifery, 42, 93–99. 10.1016/j.midw.2016.09.010
    1. Hair, A. B. , Peluso, A. M. , Hawthorne, K. M. , Perez, J. , Smith, D. P. , Khan, J. Y. , … A, S. (2016). Beyond necrotizing enterocolitis prevention: Improving outcomes with an exclusive human milk‐based diet. Breastfeeding Medicine, 11(2), 70–74. 10.1089/bfm.2015.0134
    1. Herich, L. C. , Cuttini, M. , Croci, I. , Franco, F. , Di Lallo, D. , Baronciani, D. , … Zeitlin, J. (2017). Maternal education is associated with disparities in breastfeeding at time of discharge but not at initiation of enteral feeding in the neonatal intensive care unit. J Pediatr, 182, 59–65.e57. 10.1016/j.jpeds.2016.10.046
    1. Hoddinott, P. , Craig, L. , Maclennan, G. , Boyers, D. , & Vale, L. (2012). The FEeding Support Team (FEST) randomised, controlled feasibility trial of proactive and reactive telephone support for breastfeeding women living in disadvantaged areas. BMJ Open, 2(2), e000652 10.1136/bmjopen-2011-000652
    1. Ikonen, R. , Paavilainen, E. , & Kaunonen, M. (2015). Preterm infants' mothers' experiences with milk expression and breastfeeding: An integrative review. Advances in Neonatal Care, 15(6), 394–406. 10.1097/anc.0000000000000232
    1. de Jersey, S. J. , Mallan, K. , Forster, J. , & Daniels, L. A. (2017). A prospective study of breastfeeding intentions of healthy weight and overweight women as predictors of breastfeeding outcomes. Midwifery, 53, 20–27. 10.1016/j.midw.2017.07.002
    1. Kair, L. R. , Flaherman, V. J. , Newby, K. A. , & Colaizy, T. T. (2015). The experience of breastfeeding the late preterm infant: A qualitative study. Breastfeeding Medicine, 10(2), 102–106. 10.1089/bfm.2014.0121
    1. Karall, D. , Ndayisaba, J. P. , Heichlinger, A. , Kiechl‐Kohlendorfer, U. , Stojakovic, S. , Leitner, H. , & Scholl‐Burgi, S. (2015). Breast‐feeding duration: Early weaning‐do we sufficiently consider the risk factors? J Pediatr Gastroenterol Nutr, 61(5), 577–582. 10.1097/mpg.0000000000000873
    1. Lavender, T. , Richens, Y. , Milan, S. J. , Smyth, R. M. , & Dowswell, T. (2013). Telephone support for women during pregnancy and the first six weeks postpartum. Cochrane Database Syst Rev, 7 Cd009338. 10.1002/14651858.CD009338.pub2
    1. Lechner, B. E. , & Vohr, B. R. (2017). Neurodevelopmental outcomes of preterm infants fed human milk: A systematic review. Clin Perinatol, 44(1), 69–83. 10.1016/j.clp.2016.11.004
    1. Lee, S. , & Kelleher, S. L. (2016). Biological underpinnings of breastfeeding challenges: The role of genetics, diet, and environment on lactation physiology. American Journal of Physiology. Endocrinology and Metabolism, 311(2), E405–E422. 10.1152/ajpendo.00495.2015
    1. Maastrup, R. , Hansen, B. M. , Kronborg, H. , Bojesen, S. N. , Hallum, K. , Frandsen, A. , … Hallstrom, I. (2014). Breastfeeding progression in preterm infants is influenced by factors in infants, mothers and clinical practice: The results of a national cohort study with high breastfeeding initiation rates. PLoS One, 9(9), e108208 10.1371/journal.pone.0108208
    1. McFadden, A. , Gavine, A. , Renfrew, M. J. , Wade, A. , Buchanan, P. , Taylor, J. L. , … MacGillivray, S. (2017). Support for healthy breastfeeding mothers with healthy term babies. Cochrane Database Syst Rev, 2 Cd001141. 10.1002/14651858.CD001141.pub5
    1. Moher, D. , Hopewell, S. , Schulz, K. F. , Montori, V. , Gotzsche, P. C. , Devereaux, P. J. , … Altman, D. G. (2010). CONSORT 2010 explanation and elaboration: updated guidelines for reporting parallel group randomised trials. BMJ, 340, c869 10.1136/bmj.c869
    1. Niela‐Vilen, H. , Axelin, A. , Melender, H. L. , & Salantera, S. (2015). Aiming to be a breastfeeding mother in a neonatal intensive care unit and at home: A thematic analysis of peer‐support group discussion in social media. Maternal & Child Nutrition, 11(4), 712–726. 10.1111/mcn.12108
    1. Nommsen‐Rivers, L. A. (2016). Does insulin explain the relation between maternal obesity and poor lactation outcomes? An overview of the literature. Advances in Nutrition, 7(2), 407–414. 10.3945/an.115.011007
    1. Nyqvist, K. H. (2008). Early attainment of breastfeeding competence in very preterm infants. Acta Paediatrica, 97(6), 776–781. 10.1111/j.1651-2227.2008.00810.x
    1. Victora, C. G. , Bahl, R. , Barros, A. J. D. , França, G. V. A. , Horton, S. , Krasevec, J. , … Rollins, N. C. (2016). Breastfeeding in the 21st century: Epidemiology, mechanisms, and lifelong effect. The Lancet, 387(10017), 475–490. 10.1016/S0140-6736(15)01024-7
    1. World Health Organization . (2001). Global strategy on infant and young child feeding. Retrieved 10/03/2016, from

Source: PubMed

Sponsors en medewerkers

Medische omstandigheden

Geneesmiddelinterventies

3
Abonneren