Rong Lin, Zhihui Rong, Rong Zhang, Zhi Zheng, Ya Ding, Chao Ning, Yun Cao, Chen Chao, Jie Yang, Xinzhu Lin
{"title":"Association of timing of initial breastfeeding and neonatal outcome in very preterm infants: a multicentre cohort study in China.","authors":"Rong Lin, Zhihui Rong, Rong Zhang, Zhi Zheng, Ya Ding, Chao Ning, Yun Cao, Chen Chao, Jie Yang, Xinzhu Lin","doi":"10.1136/bmjpo-2025-003485","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the association between the timing of initial breastfeeding and the risk of necrotising enterocolitis (NEC) and other neonatal outcomes in very preterm infants (VPIs, <32 weeks' gestation).</p><p><strong>Design: </strong>Multicentre observational cohort study.</p><p><strong>Setting: </strong>Data were collected from 102 tertiary neonatal intensive care units (NICUs) in China between 2019 and 2023 through the Chinese Neonatal Network.</p><p><strong>Patients: </strong>A total of 12 679 VPIs admitted to NICUs within 24 hours of birth and initially breastfed within 7 days were included.</p><p><strong>Interventions: </strong>Infants were categorised into four groups based on initial breastfeeding timing: within 24 hours (n=2242), 24-48 hours (n=3657), 48-72 hours (n=1870) and after 72 hours (n=4910, reference group).</p><p><strong>Main outcome measures: </strong>The primary outcome was NEC (stage ≥2). Secondary outcomes included mortality, bronchopulmonary dysplasia, severe neurological injury, severe retinopathy of prematurity, late-onset sepsis, NICU length of stay and intravenous nutrition duration.</p><p><strong>Results: </strong>Early breastfeeding initiation (<24 hours) was associated with a higher incidence of NEC (7.5% vs 4.3%, OR 1.92, 95% CI 1.21 to 3.06). No significant NEC risk increase was observed for feeding initiation after 24 hours. Early breastfeeding was linked to a shorter duration of intravenous nutrition (median 15 days (IQR 10-27) vs 22 days (IQR 14-33), mean difference -3.93 days, 95% CI -6.57 to -1.3). Subgroup analysis revealed increased NEC risk in neonates delivered via caesarean section, those receiving blood transfusions and those born <28 weeks' gestation.</p><p><strong>Conclusions: </strong>While early breastfeeding initiation (<24 hours) reduces intravenous nutrition duration, it may elevate NEC risk in specific high-risk subgroups. Feeding strategies should be individualised based on gestational age, delivery mode and transfusion status. Further randomised trials are needed to optimise early feeding protocols for VPIs.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"9 1","pages":""},"PeriodicalIF":2.3000,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12273134/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"BMJ Paediatrics Open","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1136/bmjpo-2025-003485","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"PEDIATRICS","Score":null,"Total":0}
引用次数: 0
Abstract
Objective: To evaluate the association between the timing of initial breastfeeding and the risk of necrotising enterocolitis (NEC) and other neonatal outcomes in very preterm infants (VPIs, <32 weeks' gestation).
Design: Multicentre observational cohort study.
Setting: Data were collected from 102 tertiary neonatal intensive care units (NICUs) in China between 2019 and 2023 through the Chinese Neonatal Network.
Patients: A total of 12 679 VPIs admitted to NICUs within 24 hours of birth and initially breastfed within 7 days were included.
Interventions: Infants were categorised into four groups based on initial breastfeeding timing: within 24 hours (n=2242), 24-48 hours (n=3657), 48-72 hours (n=1870) and after 72 hours (n=4910, reference group).
Main outcome measures: The primary outcome was NEC (stage ≥2). Secondary outcomes included mortality, bronchopulmonary dysplasia, severe neurological injury, severe retinopathy of prematurity, late-onset sepsis, NICU length of stay and intravenous nutrition duration.
Results: Early breastfeeding initiation (<24 hours) was associated with a higher incidence of NEC (7.5% vs 4.3%, OR 1.92, 95% CI 1.21 to 3.06). No significant NEC risk increase was observed for feeding initiation after 24 hours. Early breastfeeding was linked to a shorter duration of intravenous nutrition (median 15 days (IQR 10-27) vs 22 days (IQR 14-33), mean difference -3.93 days, 95% CI -6.57 to -1.3). Subgroup analysis revealed increased NEC risk in neonates delivered via caesarean section, those receiving blood transfusions and those born <28 weeks' gestation.
Conclusions: While early breastfeeding initiation (<24 hours) reduces intravenous nutrition duration, it may elevate NEC risk in specific high-risk subgroups. Feeding strategies should be individualised based on gestational age, delivery mode and transfusion status. Further randomised trials are needed to optimise early feeding protocols for VPIs.