Factors affecting continuation of mother's-own-(breast)milk feeding until discharge from the NICU for infants born preterm less than 32 weeks: A cohort study.

Objectives: To quantify the feeding volumes and factors associated with feeding mothers-own-(breast) milk until discharge for preterm neonates born less than 32 weeks.

Methods: This was a retrospective cohort study (2010-2020). Neonates born <32 weeks and admitted to NICU with stored feeding records were eligible for inclusion. Information about daily feeding patterns (volume and sources), maternal demographics, birth data, and postnatal conditions were abstracted using standard data collection forms. Descriptive and inferential statistics were used to analyze results and compare groups.

Results: Of 436 newborns born <32 weeks, 372 met the inclusion criteria for the final analysis. While 87.9% of neonates had fed with mother's-own-milk initiated, only 53.5% continued these feeds until discharge from NICU. Over the study period, there was a significant decline in both initiation (P = 0.002) and continuation of feeds with mother's-own-milk (P < 0.0001). Factors positively associated with the continuation of mother's-own-milk to hospital discharge included older maternal age (P = 0.0002) and primiparity (P = 0.002). Continuation of mother's-own-milk was also associated with an earlier date of first feed with mother's-own-milk and higher volumes of breast milk production (P < 0.004). Volume of mother's-own-milk fed on Day 7 of admission was significant in predicting continuation to discharge. Factors negatively associated with continuation of feeds to discharge included high BMI (P = 0.009), cigarette smoking (P = 0.004), substance abuse (P = 0.0001), multiples (P = 0.038), and remote residence (P = 0.002).

Conclusions: Early initiation of mother's-own-(breast)milk improves continuation throughout NICU admission until discharge. Investigation into barriers to breastfeeding and targeted support for mothers (particularly those that are younger, multiparous, and/or from remote locations) are urgently needed.