Feature ArticlesMaternal Milk and Relationships to Early Neurobehavioral Outcome in Preterm InfantsPineda, Roberta PhD, OTR/L; Muñoz, Rachel OT/S; Chrzastowski, Hayley OTD, OTR/L; Dunsirn-Baillie, Sonya OTD, OTR/L; Wallendorf, Michael PhD; Smith, Joan PhD, RN, NNP-BCAuthor Information Program in Occupational Therapy (Dr Pineda and Ms Muñoz) and Department of Pediatrics (Dr Pineda), Washington University School of Medicine, Saint Louis, Missouri; Spotsylvania Regional Medical Center, Fredericksburg, Virginia (Dr Chrzastowski); Children's Hospital of Wisconsin, Madison (Dr Dunsirn-Baillie); Division of Biostatistics, Washington University, Saint Louis, Missouri (Dr Wallendorf); and Department of Quality, Safety, and Practice Excellence, St Louis Children's Hospital, St Louis, Missouri (Dr Smith). Corresponding Author: Roberta Pineda, PhD, OTR/L, Program in Occupational Therapy and Department of Pediatrics, Washington University in St Louis School of Medicine, 4444 Forest Park Ave, Campus Box 8505, St Louis, MO 63108 ([email protected]). The authors express their appreciation to the following individuals who were part of the team that made this research possible: Karen Lukas, Sarah Oberle, Lauren Reynolds, Joy Bender, Laura Mazelis, Kelsey Melchior, Jessica Roussin, Felicia Foci, Justin Ryckman, Polly Durant, Rachel Harris, Elizabeth Heiny, Elaine Ward, Gabriel Blenden, Terrie Inder, Kelsey Dewey, Katie Ross, Lara Liszka, Maggie Crabtree, Maggie Kindra, Amy Jacobsen, Danielle Prince, Molly Grabill, Maddie Rolling, Anna Annecca, and Sarah Wolf. The authors also thank the families and infants who were participants and made this research possible.Disclosure: The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article.Each author has indicated that he or she has met the journal's requirements for Authorship.Submitted for publication: August 17, 2018; accepted for publication: November 12, 2019. The Journal of Perinatal & Neonatal Nursing: January/March 2020 - Volume 34 - Issue 1 - p 72-79 doi: 10.1097/JPN.0000000000000460 Buy Metrics Abstract The purpose of this study was to (1) define medical and sociodemographic factors related to maternal milk feedings and (2) explore relationships between maternal milk feeding and early neurobehavioral outcome. Ninety-two preterm infants born ≤ 32 weeks gestation had maternal milk feeding and breastfeeding tracked in this retrospective analysis. At 34 to 41 weeks postmenstrual age (PMA), neurobehavior was assessed with the NICU Network Neurobehavioral Scale. Maternal milk feeding was often delayed by the use of total parenteral nutrition, administered for a median of 11 (7-26) days, impacting the timing of gastric feeding initiation. Seventy-nine (86%) infants received some maternal milk during neonatal intensive care unit (NICU) hospitalization. Twenty-one (27%) infants continued to receive maternal milk at 34 to 41 weeks PMA, with 10 (48%) of those receiving maternal milk exclusively. Among mothers who initiated maternal milk feeds, 20 (25%) put their infants directly at the breast at least once during hospitalization. Mothers who were younger (P = .02), non-Caucasian (P < .001), or on public insurance (P < .001) were less likely to provide exclusive maternal milk feedings by 34 to 41 weeks PMA. Infants who received maternal milk at 34 to 41 weeks PMA demonstrated better orientation (P = .03), indicating they had better visual and auditory attention to people and objects in the environment. Our findings demonstrate a relationship between maternal milk feedings and better neurobehavior, which is evident before the infant is discharged home from the NICU. © 2020 Wolters Kluwer Health, Inc. All rights reserved.