The paradox of breastfeeding-associated morbidity among late preterm infants
1School of Nursing, University of Pittsburgh, 3500 Victoria Street, Pittsburgh, PA 15261, USA. jvr5@pitt.edu
Insights
Breastfeeding initiation is common for late preterm infants, but duration and exclusivity are lower than for term infants. These infants face higher rehospitalization risks due to feeding issues.
Area of Science:
- Neonatal care
- Lactation science
- Pediatric health outcomes
Background:
- Late preterm infants (born 34-36 weeks gestation) present unique challenges for breastfeeding.
- Existing research often extrapolates findings from younger preterm infants.
Purpose of the Study:
- To synthesize current research on breastfeeding establishment and outcomes in late preterm infants.
- To identify gaps in the scientific understanding of breastfeeding in this population.
Main Methods:
- Systematic review of nine data-based research articles.
- Searched Ovid MEDLINE, CINAHL, PubMed, and reference lists.
- Extracted data on breastfeeding initiation, duration, exclusivity, and health outcomes.
Main Results:
- Breastfeeding initiation rates range from 59-70% in the U.S.
- Sustained and exclusive breastfeeding is significantly lower than in term infants.
- Late preterm infants have nearly double the rehospitalization rate, often for jaundice or poor feeding.
Conclusions:
- Late preterm infants are at increased risk for breastfeeding difficulties and rehospitalization.
- Evidence-based guidelines and systematic investigation of contributing factors are needed.
Objective:
To synthesize the published research pertaining to breastfeeding establishment and outcomes among late preterm infants and to describe the state of the science on breastfeeding within this population.
Data Sources:
Online databases Ovid MEDLINE, CINAHL, PubMed, and reference lists of reviewed articles.
Study Selection:
Nine data-based research articles examining breastfeeding patterns and outcomes among infants born between 34 0/7 and 36 6/7 weeks gestation or overlapping with this time period by at least 2 weeks.
Data Extraction:
Effect sizes and descriptive statistics pertaining to breastfeeding initiation, duration, exclusivity, and health outcomes among late preterm breastfed infants.
Data Synthesis:
Among late preterm mother/infant dyads, breastfeeding initiation appears to be approximately 59% to 70% (U.S.), whereas the odds of breastfeeding beyond 4 weeks or to the recommended 6 months (exclusive breastfeeding) appears to be significantly less than for term infants, and possibly less than infants ≤34 to 35 weeks gestation. Breastfeeding exclusivity is not routinely reported. Rehospitalization, often related to "jaundice" and "poor feeding," is nearly twice as common among late preterm breastfed infants as breastfed term or nonbreastfed late preterm infants. Barriers to optimal breastfeeding in this population are often inferred from research on younger preterm infants, and evidence-based breastfeeding guidelines are lacking.
Conclusions:
Late preterm infants are at greater risk for breastfeeding-associated rehospitalization and poor breastfeeding establishment compared to their term (and possibly early preterm) counterparts. Contributing factors have yet to be investigated systematically.
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