This study aims to identify factors influencing breastfeeding non-initiation among NICU infants, compared to non-NICU infants, and inform tailored educational/support interventions.
We performed a population-based, retrospective cohort study of singleton live births using Ohio birth certificates between 2006 and 2015. Univariate analyses assessed the association between NICU breastfeeding non-initiation and predictors relating to the mother, neonate, and delivery events. A multivariate logistic regression model evaluated highly significant predictors, adjusting for socioeconomic, demographic, and neonatal covariates.
Of 76,855 live births, 5.83% reported NICU admission, 39.4% of which reported non-initiation of breastfeeding, compared with 31.5% of newborn nursery infants (P<.001). Among NICU infants, congenital anomalies and abnormal newborn conditions were the most significant risk factor for non-initiation of breastfeeding, while gastroschisis, low birth weight and very low birth weight were protective for breastfeeding initiation. The most significant maternal risk factors for non-initiation included: smoking during pregnancy (RR 1.91 [95% CI 1.82–2.02]), multiparity (RR 1.72 [95% CI 1.64–1.79]), unmarried (RR 1.68 [95% CI 1.60–1.77]), Medicaid recipient (RR 1.51 [95% CI 1.44–1.58]), no high school diploma (RR 1.48 [95% CI 1.40–1.57]), ≤5 prenatal visits (RR 1.41 [95% CI 1.34–1.49]), age <20 years (RR 1.30 [95% CI 1.21–1.40]), and BMI ≥40.0 (RR 1.26 [95% CI 1.16–1.37]).
Socioeconomically disadvantaged mothers and mothers who smoke are the least likely to initiate breastfeeding for their NICU infants. Maternal-targeted, NICU breastfeeding intervention efforts present an opportunity to reduce infant deaths and improve outcomes.