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Caregiving Factors Affecting Breastfeeding Duration Within a Neonatal Intensive Care Unit

Casavant, Sharon G. BSN, RN; McGrath, Jacqueline M. PhD, RN, FNAP, FAAN; Burke, Georgine PhD; Briere, Carrie-Ellen PhD, RN

Section Editor(s): Dowling, Donna

doi: 10.1097/ANC.0000000000000234
Original Research

Background: Increasingly, evidence supports oral feeding of very low birth-weight (VLBW) preterm infants exclusively at breast or with breast milk. Despite known breast milk benefits, outcomes related to exclusive breast milk provision are poor. Identifying factors that promote breast milk provision is critical.

Purpose: Breastfeeding practices of mothers of VLBW infants admitted to neonatal intensive care unit were explored to identify factors associated with mode of feeding at discharge.

Method: This retrospective study replicates previous work. Subjects were VLBW preterm infants consecutively admitted during a 24-month period. Primary outcomes included receiving any breast milk at discharge. Infant variables included gestational age, postmenstrual age of first direct breastfeeding, and comorbid conditions. Maternal variables included age and ethnicity. Nursing practice variables included first direct-to-breastfeeding, number of times to breast daily, and total direct-to-breastfeeding encounters 24 hours prior to discharge.

Results: A total of 96 VLBW infants (28.7 ± 2.8 weeks' gestational age) met inclusion criteria. Of these, 48% received breast milk at discharge. Controlling for significant effect of length of stay, infants receiving first oral feed at breast were more likely discharged home receiving breast milk (adjusted odds ratio = 8.7; 95% confidence interval, 2.9-32.3; P < .0001). There were both an independent effect of first oral feed at breast and an interaction where infants of nonmarried women also benefited from the first oral feed at breast.

Implications: Significant associations were found between first oral feeding at breast and infant receiving any breast milk at discharge. Targeting VLBW infants to receive first oral feeding at breast may yield the best outcome even among sickest and smallest infants.

University of Connecticut, School of Nursing, Storrs (Ms Casavant and Drs McGrath and Briere); Connecticut Children's Medical Center, Hartford (Drs McGrath, Burke, and Briere, and Ms Casavant); and University of Connecticut School of Medicine, Farmington (Dr Burke).

Correspondence: Sharon G. Casavant, BSN, RN, University of Connecticut, School of Nursing, 231 Glenbrook Rd, U-2026, Storrs, CT 06269 (

Funding graciously provided by the University of Connecticut, Office of Undergraduate Research, Summer Undergraduate Research Fund.

Jacqueline M. McGrath, PhD, RN, FNAP, FAAN, who is coeditor of Advances in Neonatal Care, was not involved in the editorial review or decision to publish this article. The entire process, from submission to referee assignment to editorial decisions, was handled by another member of the editorial team for the journal.

The authors declare no conflicts of interest.

© 2015 by The National Association of Neonatal Nurses