Breastfeeding trajectories for preterm infants over the first 6 months of life in England 2010-2020: surveys using large representative birth samples
Ilana Levene1, Sian Harrison1, Fiona Alderdice1
1National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
Insights
Late preterm infants experienced worse breastfeeding outcomes compared to term infants, especially during the COVID-19 pandemic. These infants require targeted support during emergencies to improve breastfeeding success.
Area of Science:
- Neonatal nutrition and infant feeding practices.
- Public health and epidemiology of infant health.
- Perinatal and neonatal care.
Background:
- Breast milk is the optimal nutrition for infants, especially preterm infants who face unique feeding challenges.
- The SARS-CoV-2 (COVID-19) pandemic may have impacted feeding outcomes differently for preterm versus term infants.
- Understanding feeding trajectories is crucial for optimizing infant nutrition and care.
Purpose of the Study:
- To describe feeding trajectories of preterm infants in their first six months of life.
- To compare feeding outcomes between preterm and term infants.
- To analyze feeding outcomes across pre-pandemic and pandemic periods.
Main Methods:
- Utilized data from the 2010 UK Infant Feeding Survey and 2018/2020 English National Maternity Surveys.
- Classified infants into term (37-42 weeks), late preterm (34-36 weeks), and lower gestation (<34 weeks) groups.
- Employed modified Poisson regression, log-rank tests, and survival curves for feeding outcome analysis by gestational age.
Main Results:
- Late preterm infants showed a lower adjusted relative risk (aRR) of exclusive breastfeeding at 6 weeks in 2010 (aRR=0.47) and 2020 (aRR=0.57) compared to term infants.
- No significant difference in feeding outcomes was observed between infants born <34 weeks gestation and term infants.
- Breastfeeding inequity for late preterm infants re-emerged in 2020 during the early SARS-CoV-2 pandemic.
Conclusions:
- Late preterm infants faced breastfeeding challenges, with inequities observed in 2010 and a resurgence in 2020.
- The gap in breastfeeding outcomes between late preterm and term infants narrowed in 2018 but widened again during the pandemic.
- Late preterm infants are a vulnerable group requiring focused support for breastfeeding, particularly during public health crises.
Background:
Breastmilk is the optimal source of nutrition for infants, particularly preterm infants. Preterm infants face unique feeding challenges and these change with the birth gestation of the infant. Preterm infants' feeding outcomes may have been affected differently than term infants by the SARS-CoV-2 pandemic. The objective of this study was to describe the feeding trajectories of preterm infants in the first 6 months of life compared with term infants and compare these across prepandemic and pandemic periods.
Methods:
Data were extracted from the 2010 UK Infant Feeding Survey and the English National Maternity Surveys of 2018 and 2020. Original survey weights were used. Infants were divided by gestation into term (37+0 to 42+6 weeks' postmenstrual age), late preterm (34+0 to 36+6 weeks' postmenstrual age) and a lower gestation group (23+0 to 33+6 weeks' postmenstrual age). Modified Poisson regression, log-rank tests and survival curves were used to analyse feeding outcomes by gestational age.
Results:
Late preterm infants had lower adjusted relative risk (aRR) of exclusive breastmilk at 6 weeks of age compared with term infants in 2010 and 2020 but not in 2018. In 2010, aRR was 0.47 (95% CI 0.29 to 0.74), in 2018 aRR was 0.86 (95% CI 0.67 to 1.10) and in 2020 aRR was 0.57 (95% CI 0.41 to 0.81). There was no evidence of differences in feeding outcomes between infants born less than 34 weeks' postmenstrual age and term infants.
Conclusion:
Late preterm infants had worse breastfeeding outcomes than term infants in 2010, but the inequity was reduced or eliminated in 2018. In 2020, during the early SARS-CoV-2 pandemic, the inequity had re-emerged. Late preterm infants appear to be a particularly vulnerable population in relation to breast feeding. In future emergencies and natural disasters, late preterm infants should receive additional focus and resources to support breastfeeding establishment.
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