Preterm infants' first breastfeeding attempt: Early initiation and performance: A large multicentre questionnaire
Ragnhild Maastrup1,2, Sisse Walloee3, Hanne Kronborg4
1Department of Neonatology, Knowledge Centre for Breastfeeding Infants with Special Needs, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.
Plos One
|July 18, 2025
Summary
Stable preterm infants can initiate breastfeeding early, even with nasal-CPAP support. Mechanical ventilation delays this, but early attempts show breastfeeding behaviors, though swallowing may not occur initially.
Area of Science:
- Neonatal care
- Pediatric nutrition
- Lactation science
Background:
- Global health organizations recommend early breastfeeding for stable preterm infants.
- Current practices often fall short of these recommendations.
- Limited data exists on the timing and factors influencing first breastfeeding attempts in preterm infants.
Purpose of the Study:
- To determine the postmenstrual age (PMA) at first breastfeeding attempt in stable preterm infants.
- To identify factors delaying breastfeeding initiation.
- To analyze breastfeeding performance across different gestational ages and in infants using nasal-CPAP.
Main Methods:
- Danish multicentre cohort study involving 992 mothers of preterm infants (gestational age 23-36 weeks).
- Data collected via questionnaires.
- Statistical analysis included One-way ANOVA and linear regression models.
Main Results:
- The earliest postmenstrual age (PMA) for a first breastfeeding attempt was 27.57 weeks.
- 61% of extremely preterm and 46% of very preterm infants attempted breastfeeding before 32 weeks PMA.
- Mechanical ventilation delayed the first attempt by 7 days (p < 0.0001).
- 78% of first attempts showed no swallowing; 29% occurred with nasal-CPAP, which did not significantly affect performance.
Conclusions:
- Early breastfeeding initiation is feasible for preterm infants, even at low PMA and with nasal-CPAP.
- Nasal-CPAP should not be a contraindication for initiating breastfeeding.
- Preterm infants exhibit breastfeeding behaviors early, but require time to develop effective swallowing.
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