Breast milk feeding rates at discharge increased between 1997 and 2011 (Epipage-1 and -2 cohort studiesy) among very preterm infants (<32 weeks’ gestation) from 19 to 47%, and among moderate preterm infants (32-34 weeks) from 30 to 59%.
However, rates of breast milk feeding varied widely among neonatal units, partly explained by practices and policies facilitating breast milk feeding.
Breast milk feeding a preterm infant is an individual choice, the success of which is linked to the specialized support received throughout the neonatal hospital stay.
Background : Despite acknowledged benefits of maternal milk, breast milk feeding rates for preterm infants vary between countries and neonatal units. Maternal and infant characteristics have been extensively studied and do not totally explain this variability.
Objectives : To describe and analyze factors associated with breast milk feeding at discharge for preterm infants, with a special focus on unit policies aiming to support breast milk feeding.
Method : Epipage-2 cohort is a national prospective population-based study, which included infants born between 22 and 34 completed weeks of gestation in all neonatal units in 25 French regions in 2011. Determinants of breast milk feeding were analyzed with multilevel logistic regressions in two separate populations: 3,108 very preterm infants (<32 weeks’ gestation) and 883 moderate preterm infants (32-34 weeks).
Results : In total, 47% of very preterm infants and 59% of moderate preterm infants received breast milk feeding at discharge. There was a great variability of breast milk feeding rates between units, ranging from 21% to 84% for very preterm and from 27% to 87% for moderate preterm infants. Unit policies associated with breast milk feeding at discharge, particularly early skin-to-skin, early involvement of parents in feeding support for the infant, partly explained this variability. High breast milk feeding initiation rates in the general population were associated with breast milk feeding at discharge only in moderate preterm infants.
Conclusion : Adopting support policies of best performing units may reduce the variability in breast milk feeding rates at discharge for this high-risk population of preterm infants.