A quality improvement intervention to improve medium-term breastfeeding in moderate- and late-preterm infants
Katarina Berndt1, Sabrina Holzapfel2, Annika Dietz1
1Department of Neonatology, University Children's Hospital Regensburg (KUNO), Hospital St. Hedwig of the Order of St. John, University of Regensburg, Regensburg, Germany.
Insights
A quality improvement initiative significantly increased breastfeeding rates in moderate and late preterm (MLPT) infants by four months. Key success factors included higher socioeconomic status and maternal self-efficacy, while C-section delivery posed a barrier.
Area of Science:
- Neonatal care
- Public health
- Maternal-infant health
Background:
- Moderate and late preterm (MLPT) infants (32-36 weeks gestation) represent 80% of premature births and face increased health risks.
- Breastfeeding is crucial for mitigating these risks, yet data on MLPT infant breastfeeding rates and success factors remain limited.
Purpose of the Study:
- To evaluate the effectiveness of a quality improvement (QI) initiative on breastfeeding rates in MLPT infants.
- To identify predictors of breastfeeding success in this population.
Main Methods:
- A prospective intervention trial compared a QI initiative (staff training, parent education via Neo-MILK app) with standard care.
- Data on maternal and infant clinical parameters, including breastfeeding at four months, were collected.
- Univariate logistic regression analyzed predictors of breastfeeding success.
Main Results:
- The intervention group showed a significantly higher breastfeeding rate at four months (75%) compared to the control group (48%).
- Maternal socioeconomic status, exclusive breast milk feeding at 14 days, and maternal self-efficacy were positive predictors.
- Cesarean section delivery was negatively associated with breastfeeding success.
Conclusions:
- A QI initiative incorporating education and support significantly enhances breastfeeding success in MLPT infants.
- Early interventions are vital, but cesarean section delivery presents a persistent challenge to breastfeeding.
Background:
Despite medical advancements, the rate of premature births remains at one in ten babies worldwide. Moderate and late preterm (MLPT, gestational age 32-36 weeks) infants constitute 80% of all preterm births and are at higher risk of short- and long-term complications compared to term infants. Breastfeeding helps to reduce these risks, but evidence on breastfeeding rates and success factors in MLPT infants is limited.
Methods:
A prospective intervention trial included a pre-intervention phase from June to September 2022 (comparison) and a post-intervention phase from June to October 2023 (intervention) at one tertiary academic hospital. Clinical parameters from pregnancy, delivery, and postnatal care were collected from MPLT infants and their mothers, including mid-term breastfeeding at infant´s four-month health check-up. Intervention was a quality improvement (QI) initiative involving staff training and parent education using an information platform (Neo-MILK app) with breastfeeding content. Primary outcome was breastfeeding rate at the age of four months after birth. Various secondary outcomes were defined, including growth sufficient exclusive breast milk feeding at 14 days after birth. Relative risks (RR) and 95% confidence intervals approximated from odds ratios obtained through univariate logistic regression to identify predictors of breastfeeding success.
Results:
Out of 170 eligible mothers of MLPT infants, 69 participated (36 intervention, 33 comparison group) with similar baseline characteristics. At four months of age (primary endpoint), 75% of the intervention group were breastfeeding compared to 48% of the comparison group (p = 0.023). Significant independent predictors of medium-term breastfeeding success were higher socioeconomic status (RR 1.16; 95% CI 1.01, 1.31), growth sufficient exclusive breast milk feeding and maternal self-efficacy, both measured at 14 days postpartum (RR 1.84; 95% CI 1.37, 2.01 and RR 1.04; 95% CI 1.02, 1.06, respectively). In contrast, delivery by cesarean section was associated with lower medium-term breastfeeding success (RR 0.21; 95% CI 0.07, 0.52).
Conclusions:
The implementation of a QI initiative, including breastfeeding education, early postpartum milk pumping and lactation support based on a common information platform for staff and parents was associated with increased medium-term breastfeeding success in MLPT infants. Despite early interventions, caesarean section remains a barrier to breastfeeding.
Trial Registration:
The study is registered in the German Clinical Trials Register (DRKS00034762).
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