Long-term breastfeeding outcomes in very preterm infants: predictors and challenges

Breastfeeding is considered the gold standard for preterm infant feeding. However, data on breastfeeding continuation beyond the first year of life in very preterm infants are scarce. This study aimed to assess the rates and duration of exclusive and any breastfeeding up to and beyond 24 months of corrected age and to identify maternal, paternal, perinatal, and postdischarge feeding-related factors associated with long-term breastfeeding outcomes.

This retrospective cohort study included very preterm infants (≤32 weeks' gestation) born between 2017 and 2019 in a tertiary neonatal intensive care unit. Data were obtained from hospital records, follow-up files, and structured telephone interviews with parents. Feeding methods were evaluated at discharge and at corrected ages of 1, 4, 6, 12, 18, and 24 months, and beyond when needed. Exclusive breastfeeding (EB) duration, total breastfeeding duration, timing of complementary feeding, and reasons for breastfeeding cessation were recorded. Sociodemographic, perinatal, and postdischarge variables were analyzed to determine their association with breastfeeding outcomes.

The rate of EB at discharge was 67.1%, decreasing to 52.1%, 28.8%, and 19.2% at 1, 4, and 6 months, respectively. Breastfeeding rates at 12, 18, and 24 months were 39.7%, 30.1%, and 23.3%. The mean EB duration was 3.5 ± 2.8 months, and total breastfeeding duration was 12.2 ± 10.5 months. Lower parental education levels, younger paternal age, multiple births, partial breastfeeding at discharge, and earlier initiation of formula were significantly associated with shorter EB duration and lower long-term breastfeeding rates. Early initiation of complementary feeding was observed in 50.1% of infants. The most frequent reason for breastfeeding cessation (53.4%) was reported lack or insufficient milk.

This study, which provides the first longitudinal report from Türkiye describing breastfeeding outcomes among very preterm infants up to 24 months and beyond, demonstrated that both breastfeeding rates and durations were lower than recommended. Strengthening breastfeeding support at NICU discharge and maintaining lactation follow-up throughout infancy-particularly for families with lower education levels, younger parents, multiple births, and earlier formula exposure-may improve long-term breastfeeding outcomes in this vulnerable population.