Long-term breastfeeding outcomes in very preterm infants: predictors and challenges
Ebru Senol1,2, Seyma Karatekin1,3, Alev Bakir Kayı4
1Social Pediatrics Doctorate Program, Istanbul University Institute of Health Sciences, Istanbul, Türkiye.
Insights
Breastfeeding rates for very preterm infants decline significantly after discharge, with insufficient milk being a primary reason for cessation. Targeted support for vulnerable families can improve long-term breastfeeding outcomes.
Area of Science:
- Neonatal care
- Pediatric nutrition
- Lactation research
Background:
- Breastfeeding is optimal for preterm infants, but long-term continuation data is limited.
- Very preterm infants (<=32 weeks gestation) require specialized feeding support.
- Understanding factors influencing sustained breastfeeding is crucial for infant health.
Purpose of the Study:
- To assess exclusive and any breastfeeding rates up to and beyond 24 months corrected age in very preterm infants.
- To identify maternal, paternal, perinatal, and postdischarge factors associated with long-term breastfeeding.
- To provide longitudinal data on breastfeeding outcomes in Türkiye for this population.
Main Methods:
- Retrospective cohort study of very preterm infants (<=32 weeks gestation) born 2017-2019.
- Data collected via hospital records, follow-up files, and parental telephone interviews.
- Feeding methods assessed at discharge and corrected ages of 1, 4, 6, 12, 18, and 24 months.
Main Results:
- Exclusive breastfeeding at discharge was 67.1%, dropping to 19.2% by 6 months and 23.3% by 24 months.
- Mean exclusive breastfeeding duration was 3.5 months; mean total breastfeeding duration was 12.2 months.
- Lower parental education, younger paternal age, multiple births, and early formula initiation correlated with shorter breastfeeding duration.
Conclusions:
- Breastfeeding rates and durations in very preterm infants were below recommended levels.
- Insufficient milk was the main reason for cessation (53.4%).
- Enhanced NICU discharge support and lactation follow-up are vital for vulnerable families to improve outcomes.
Background:
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.
Methods:
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.
Results:
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.
Conclusions:
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.
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