Early Fresh Mother's Own Milk Feeding in 917 Very-Low-Birth-Weight Infants: Current Status and Nursing Implications

This study aimed to analyze the initiation, intake, proportion, and continuity of fresh mother's own milk (MOM) feeding during the first 14 days of life in hospitalized very-low-birth-weight (VLBW) infants, identify weaknesses in neonatal intensive care unit (NICU) breastfeeding care, and provide evidence for optimizing nursing protocols.

This retrospective study enrolled 917 VLBW infants admitted to a tertiary hospital NICU from January 2020 to December 2023. Clinical data and daily feeding records during the first 14 days of life were collected from electronic medical records. Descriptive statistics, Mann-Whitney U tests, and repeated measures analysis of variance (ANOVA) were used for data analysis.

The fresh MOM feeding rate within 14 days was 55.94%. The median time to first feeding was 24.0 hours, predominantly with donor human milk (92.0%). The median postnatal day of first fresh MOM feeding was 4.0 days, and the median duration was 1.0 day; only 0.11% received fresh MOM continuously through day 14. Feeding rates, intake volumes, and energy contributions peaked on days 4 and 5 and declined sharply thereafter, with mean energy contribution from fresh MOM over 14 days at only 4.24% ± 7.65%. Subgroup analyses showed that infants with gestational age <28 weeks had significantly lower cumulative intake and energy supply; vaginal delivery, uncomplicated pregnancy, and multiparity correlated with earlier first fresh MOM exposure; and cesarean-delivered infants had higher cumulative intake and longer duration, likely attributable to prolonged hospitalization.

Early fresh MOM feeding in VLBW infants is characterized by delayed initiation, short duration, and low intake and energy contribution. The sharp decline after days 4 and 5 suggests fragmentation between in-hospital and postdischarge lactation support. Standardized early initiation protocols, integrated support systems, and stratified care for high-risk infants are urgently needed.

There is an urgent need to establish standardized early initiation protocols, develop integrated in-hospital and postdischarge lactation support systems, and implement stratified care for high-risk infants to improve the timeliness, adequacy, and continuity of fresh MOM feeding in the NICU setting.