In-hospital direct breastfeeding is linked to improved oral feeding and human milk intake at discharge and beyond in neonates with CHD.

Abstract

Background: Feeding neonates with CHD is clinically and emotionally challenging. Although human milk improves outcomes-including reduced necrotising enterocolitis, sepsis, and neurodevelopmental delays-its use remains suboptimal. Prior studies have focused on clinical endpoints, with limited attention to modifiable maternal or prenatal influences on feeding.

Objective: To evaluate how maternal expectations, prenatal counselling, and early lactation behaviours affect feeding outcomes in infants with prenatally diagnosed CHD.

Methods: We conducted a prospective cohort study of 49 mother-infant dyads with prenatally diagnosed CHD in a tertiary neonatal ICU and paediatric cardiac ICU. Mothers completed structured surveys during hospitalisation. Feeding outcomes were assessed through chart review over six months post-discharge. Primary outcomes included human milk volume at day of life 14, feeding type at discharge, and direct breastfeeding. Multivariable logistic regression and CHD risk stratification were used for analysis.

Results: Direct breastfeeding during hospitalisation predicted oral feeding at discharge (77% vs. 28%, p = 0.0006) and ongoing human milk use. Early milk exposure (<72 hours) increased likelihood of human milk use at discharge (p = 0.0158). Strong maternal intent and prior breastfeeding experience were linked to sustained lactation. Prenatal counselling (reported by 68%) was not associated with outcomes. Higher Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery scores correlated with delayed achievement of 500 mL/day by day of life 14 (p = 0.0405).

Conclusions: Direct breastfeeding, early milk exposure, and maternal intent are key modifiable drivers of feeding success in neonates with CHD. Standard prenatal counselling alone is insufficient. Targeted, risk-informed lactation support is needed to optimise outcomes.