Factors associated with successful establishment of breastfeeding in very preterm infants

Aim: To describe feeding practices at hospital discharge in relation to characteristics of the very preterm infants (VPI) and their mothers. Methods: Design. Prospective hospital‐based registration of very preterm infants born with a gestational age ≤32 weeks in Denmark during 2004–2008. Subjects. Healthy mothers and VPI without diseases causing eating disabilities at discharge. Results: A total of 478 VPI were registered. At discharge, 60% were exclusively breastfed, 35% were exclusively bottlefed, and 5% were both breast‐ and bottle‐fed. Mothers of high social class (p = 0.000) and ‘not smoking’ (p = 0.003) were significantly more often breastfeeding their preterm infant(s) at discharge. Single births infants tended more often to be breastfed (p = 0.09). Infant age at discharge and duration of hospitalization did not influence breastfeeding at discharge. Increase in weight z‐score from birth to discharge was largest in the bottlefeeding‐group compared with the breastfeeding‐group (p = 0.000) probably as a result of feeding practice the last week(s) of hospitalization. Conclusion: Breastfeeding can successfully be established in very preterm infants. Mothers of low social classes, smokers, multiple birth and very preterm infants with low weight for age may need extra attention in breastfeeding establishing policies.     

The effect of a combined intervention on exclusive breastfeeding in primiparas: A randomised controlled trial

An antenatal/postnatal intervention involving proactive telephone support and written materials was conducted among primiparas. Four hundred women, from the Split‐Dalmatia County, Croatia, were randomized between November 2013 and December 2016 into three groups: intervention (IG), active control (ACG) and standard care (SCG). Primary outcome was exclusive breastfeeding (EBF) at 3 months. Secondary outcomes included breastfeeding difficulties, attitudes towards infant feeding, breastfeeding self‐efficacy and social support. Practice staff were blinded to group allocation. Of 400 women, 45 (11%) were lost to follow‐up, and final analyses were conducted on 129 (IG), 103 (ACG) and 123 (SCG) participants. EBF rates at 3 months were significantly higher for the IG (odds ratio [OR] 4.6, 95% confidence interval [CI], 2.7 to 8.1; EBF 81%) as well as at 6 months (OR 15.7, 95% CI, 9.1 to 27.1; EBF 64%) compared with SCG (EBF 47% at 3 months and 3% at 6 months). Higher rates were also observed for the ACG at 3 months (OR 2.2, 95% CI, 1.3 to 3.8, EBF 68%) and 6 months (OR 2.3, 95% CI, 1.4 to 3.9, EBF 16%). Participants in the IG had the highest increase in positive attitudes towards infant feeding, in comparison to baseline, and significantly higher breastfeeding self‐efficacy. Participants in SCG experienced significantly more breastfeeding difficulties, both at 3 and 6 months, in comparison to AC and IGs. Written breastfeeding materials and proactive telephone support among primiparas are an effective means of increasing breastfeeding rates, decreasing breastfeeding difficulties and improving self‐efficacy and attitudes towards infant feeding.     

Infant feeding practices among macrosomic infants: A prospective cohort study

The health benefits of breastfeeding are well recognised, but breastfeeding rates worldwide remain suboptimal. Breastfeeding outcomes have yet to be explored among women who give birth to macrosomic (birthweight ≥4000 g) infants, a cohort for whom the benefits of breastfeeding may be particularly valuable, offering protection against later‐life morbidity associated with macrosomia. This longitudinal prospective cohort study aimed to identify whether women who give birth to macrosomic infants are at greater risk of breastfeeding non‐initiation or exclusive breastfeeding (EBF) cessation. A total of 328 women in their third trimester were recruited from hospital and community settings and followed to 4 months post‐partum. Women gave birth to 104 macrosomic and 224 non‐macrosomic (<4000 g) infants between 2018 and 2020. Longitudinal logistic regression models calculated odds ratios (ORs) and 95% confidence intervals (CIs) to assess likelihood of EBF at four timepoints post‐partum (birth, 2 weeks, 8 weeks, and 4 months) between women who gave birth to macrosomic and non‐macrosomic infants, adjusted for maternal risk (obesity and/or diabetes), ethnicity and mode of birth. Macrosomic infants were more likely to be exclusively breastfed at birth and 2 weeks post‐partum than non‐macrosomic infants with adjusted OR = 1.94 (95% CI: 0.90, 4.18; p = 0.089) and 2.13 (95% CI: 1.11, 4.06; p = 0.022), respectively. There were no statistically significant associations between macrosomia and EBF at 8 weeks or 4 months post‐partum. Macrosomia may act as a protective factor against early formula‐milk supplementation, increasing the likelihood of EBF in the early post‐partum period, but rates of exclusive breastfeeding continued to decline over the first 4 months post‐partum.     

Predictive factors of exclusive breastfeeding attrition at Week 6 post-partum among mothers of preterm infants based on the theory of planned behaviour

Breastfeeding plays an important role in the growth and development of preterm infants, and exclusive breastfeeding (EBF) in the first 6 weeks post-partum is the key to continuous breastfeeding. This study was designed to explore the influencing factors that contribute to breastfeeding attrition among mothers of preterm infants at Week 6 post-partum based on the theory of planned behaviour (TPB). We herein adopted a prospective observational study design in which 97 mothers who exclusively breastfed at Week 6 post-partum at a tertiary specialised hospital in Shanghai from June 2021 to February 2022 were taken as the EBF group, and 179 mothers without EBF were assigned to the EBF attrition group. Through an extensive literature review and expert consultation, we determined the possible factors influencing EBF attrition, analysed those factors that showed statistical significance in our univariate analysis by applying binary logistic regression, and constructed a nomogram model for predicting EBF attrition. The results revealed that negative breastfeeding sentiment (odds ratio [OR] = 1.006; 95% confidence interval [CI], 1.000–1.011) generated a greater risk of breastfeeding attrition. However, positive breastfeeding sentiment (OR = 0.991; 95% CI, 0.983–0.999), social and professional support (OR = 0.993; 95% CI, 0.987–0.999), breastfeeding control (OR = 0.945; 95% CI, 0.896–0.996), knowledge (OR = 0.893; 95% CI, 0.799–0.998), and intention to EBF at Week 6 post-partum (OR = 0.522; 95% CI, 0.276–0.988) were the protective factors and facilitated the development of our nomogram model. The Hosmer–Lemeshow goodness-of-fit test generated a χ² value of 11.344 (p = 0.183) and an area under the curve of 0.822 (95% CI, 0.771–0.873). The C-index was 0.800 in the internal bootstrap validation, indicating that the nomogram model possessed favourable predictive accuracy and discrimination.     

Kangaroo Mother Care in Kangaroo ward for improving the growth and breastfeeding outcomes when reaching term gestational age in very low birth weight infants

Aim: To study the effect of Kangaroo mother care in the Kangaroo ward in comparison with conventional care at neonatal unit on growth and breastfeeding in very low birth weight infants at 40 weeks’ corrected gestational age. Methods: One hundred and forty neonates with birth weight <1500 g were randomized. The primary outcome was the average weight gain (g/kg/day) from the time of randomization to term gestational age. Results: Mean birth weight, age in days and weight at randomization were similar in both the groups. At term gestational age, average weight gain (g/kg/day) post randomization (23.3 ± 8.7 g vs. 22.64 ± 9.1 g, p = 0.67) and breastfeeding rate (85.9% vs. 87.0%) were comparable. There was no difference in weight gain (g/kg/day) from randomization to hospital discharge between the Kangaroo care group and conventional care group (18.01 g vs. 15.64 g, p = 0.12). Mortality, morbidities like sepsis, hypothermia, apnoea, hypoglycaemia and duration of hospitalization were equally distributed. On average, 11.5 days of intermediate care were saved in the kangaroo group. Conclusion: Kangaroo mother care in the Kangaroo ward is as effective as conventional care in the neonatal unit without any increase in morbidity or mortality in stable VLBW infants.     

How to assess slow growth in the breastfed infant. Birth to 3 months

Pediatricians must monitor early breastfeeding to detect and manage breastfeeding difficulties that lead to slow weight gain and subsequent low milk production. Infant growth during the first 3 months of life provides a clear indication of breastfeeding progress. Healthy, breastfed infants lose less than 10% of birth weight and return to birth weight by age 2 weeks. They then gain weight steadily, at a minimum of 20 g per day, from age 2 weeks to 3 months. Any deviation from this pattern is cause for concern and for a thorough evaluation of the breastfeeding process. Evaluation includes history taking and physical examination for the mother and infant. Observation of a breastfeeding session by a skilled clinician is crucial. A differential diagnosis is generated, followed by a problem-oriented management plan. Special techniques may be used to assist in complicated situations. Ongoing monitoring is required until weight gain has normalized. In most cases, early intervention can restore promptly infant growth and maternal milk supply. Underlying illness of the infant or mother must be considered if weight gain and milk supply do not respond to the earlier-mentioned interventions as expected. Physicians are responsible for knowledge about additional resources and for coordination of breastfeeding care. Pediatricians have a pivotal role in achieving the goals of optimal breastfeeding and appropriate infant growth.     

How multiple episodes of exclusive breastfeeding impact estimates of exclusive breastfeeding duration: report from the eight‐site MAL‐ED birth cohort study

The duration of exclusive breastfeeding (EBF) is often defined as the time from birth to the first non‐breast milk food/liquid fed (EBFLONG), or it is estimated by calculating the proportion of women at a given infant age who EBF in the previous 24 h (EBFDHS). Others have measured the total days or personal prevalence of EBF (EBFPREV), recognizing that although non‐EBF days may occur, EBF can be re‐initiated for extended periods. We compared breastfeeding metrics in the MAL‐ED study; infants' breastfeeding trajectories were characterized from enrollment (median 7 days, IQR: 4, 12) to 180 days at eight sites. During twice‐weekly surveillance, caretakers were queried about infant feeding the prior day. Overall, 101 833 visits and 356 764 child days of data were collected from 1957 infants. Median duration of EBFLONG was 33 days (95% CI: 32–36), compared to 49 days based on the EBFDHS. Median EBFPREV was 66 days (95% CI: 62–70). Differences were because of the return to EBF after a non‐EBF period. The median number of returns to EBF was 2 (IQR: 1, 3). When mothers re‐initiated EBF (second episode), infants gained an additional 18.8 days (SD: 25.1) of EBF, and gained 13.7 days (SD: 18.1) (third episode). In settings where women report short gaps in EBF, programmes should work with women to return to EBF. Interventions could positively influence the duration of these additional periods of EBF and their quantification should be considered in impact evaluation studies. © 2016 John Wiley & Sons Ltd     

Maternal and neonatal factors associated with poor early weight gain and later retinopathy of prematurity

Aim: To identify factors associated with poor early weight gain as reflected in an alarm system, WINROP, and risk of later proliferative retinopathy of prematurity (ROP) in infants with gestational age (GA) < 28 weeks. Methods: Infants with a WINROP alarm and proliferative ROP, the ‘alarm group’ (n = 23), were matched to GA and gender to a ‘no alarm group’ (n = 23) with no WINROP alarm and no or mild ROP. Retrospectively maternal variables, birth characteristics and neonatal factors, during the first three postnatal weeks, were compared. Results: The ‘alarm group’ had lower birth weight (BW) and BW standard deviation score, longer stay in ventilator, more insulin and corticosteroid treatments, and lower white blood cell count. In a logistic regression model, BW standard deviation score, insulin, low white blood cell count, absence of both elevated C‐reactive protein and premature rupture of membranes were associated with proliferative ROP and WINROP alarm (p = 0.000, r² = 0.704). Conclusions: This study shows that prenatal factors resulting in low BW have persisting effects on early postnatal growth, metabolism and inflammatory response. Future prospective studies will focus on the link between these factors and pathological retinal vessel development in the early postnatal period to find possible preventive strategies.     

Impact of maternal obesity and breastfeeding intention on lactation intensity and duration

Exclusive breastfeeding (EBF) has numerous maternal health benefits. However, EBF rates are lower in mothers with obesity. We sought to better understand whether maternal body composition measurements in early pregnancy are also predictive of lower rates of EBF. Healthy pregnant women with prepregnancy body mass index (BMI) of 17.5–51 kg/m² underwent determination of percent body fat (% body fat) in early (12–16 weeks) and late (37 weeks) gestation. Intent and duration of EBF were determined by surveys completed at 6 weeks and 6 months postpartum (PP). Unadjusted and adjusted analyses were performed to compare EBF rates and weaning by maternal BMI and % body fat. Increasing BMI and % body fat in early pregnancy were significantly associated with lower rates of EBF among women intending EBF. Women with BMI ≥ 25 were less likely to be EBF at 6 weeks and 6 months PP compared with women of normal BMI (67 and 37% vs. 91 and 79%, P value 0.005 and 0.001, respectively). Among primiparous women intending EBF, 100% of women in the lowest two body fat quartiles in early pregnancy were EBF at 6 weeks PP compared with 66.7 and 63.6% of women in the higher quartiles (P = 0.03). Lactation cessation by 6 months PP was higher with increasing maternal BMI (P = 0.001). Maternal obesity in early gestation is associated with lower EBF rates among women intending EBF and earlier weaning. Excess adiposity in early pregnancy may impede EBF.     

Predictors of post‐partum weight retention in a prospective longitudinal study

Post‐partum weight retention (WR) occurs in 60–80% of women with some retaining ≥10 kg with contributing factors reported as pre‐pregnancy body mass index (BMI), gestational weight gain (GWG) and breastfeeding. A longitudinal study of pregnancy, with 12‐month post‐partum follow‐up was conducted to determine factors associated with WR. Pregnant women (n = 152) were recruited from the John Hunter Hospital antenatal clinic in New South Wales, Australia. Pre‐pregnancy weight was self‐reported; weight was measured four times during pregnancy (for GWG) and in the first 12 months post‐partum. Infant feeding data were obtained via questionnaires. Breastfeeding was categorised as exclusive, predominant, complementary or not breastfeeding. Linear mixed models tested the predictors of WR, with and without adjustment for potential confounders. Compared with pre‐pregnancy weight, 68% of women retained weight at 12 months, median (interquartile range) [4.5 kg (2.1–8.9)]. After adjustment, GWG was positively associated with WR (P < 0.01), but pre‐pregnancy weight did not predict WR. For each additional week of any breastfeeding, 0.04 kg less weight was retained. Compared with women who retained weight, those women who did retain had higher rates of exclusive breastfeeding at three months (P < 0.05), but the number of weeks of exclusive breastfeeding failed to predict WR for all women. WR following childbirth is common and associated with GWG, while the number of weeks of ‘any’ breastfeeding contributed to post‐partum weight loss. Whether these factors are modifiable strategies to optimise the weight status of women at this life stage requires further research.     

Mothers' understanding of the term ‘exclusive breastfeeding’: a systematic review

There is a lack of knowledge and understanding of the term exclusive breastfeeding (EBF) among health professionals. The purpose of this review was to examine the best available literature on mothers' understanding of the term EBF. A systematic search of eight electronic databases (Medline, Embase, CINAHL, CDSR, CENTRAL, Cab Abstracts, Scopus and African Index Medicus) was conducted (Protocol registration in PROSPERO: CRD42015019402). All study designs were eligible for inclusion. Studies were included if they: (1) involved mothers aged 18 years or older; (2) assessed mothers' knowledge/understanding/awareness of the term ‘EBF’; (3) used the 1991 WHO definition of EBF and (4) were published between 1988 and 2015. Two reviewers retrieved articles, assessed study quality and performed data extraction. Of the 1700 articles identified, 21 articles met the inclusion criteria. Quantitative findings were pooled to calculate a proportion rate of 70.9% of mothers who could correctly define EBF, although the range varied between 3.1 and 100%. Qualitative findings revealed three themes: (1) EBF was understood by mothers as not mixing two milks; (2) the term ‘exclusive’ in EBF was incorrectly understood as not giving breast milk and (3) mothers believing that water can be given while exclusively breastfeeding. Research investigating aspects of self‐reported EBF may consequently be unreliable. A standardised tool to assess mothers' knowledge of EBF could provide more accurate data. Public health campaigns should emphasise EBF to target mothers, while addressing the education of health professionals to ensure that they do not provide conflicting advice.     

Mothers' experiences of exclusive breastfeeding in a postdischarge home setting

Re‐establishment and maintenance of exclusive breastfeeding (EBF) is recommended by the World Health Organization for the nutritional rehabilitation of malnourished infants under 6 months; however, there is no explicit guidance on how this should be achieved. The IBAMI study—a pilot study conducted in Kilifi, Kenya—implemented these recommendations using an intervention for hospitalized infants and their mothers that included ward‐based breastfeeding peer supporters. This paper explores how the challenges of maintaining EBF are recontextualized after infant hospitalization for malnutrition. Four weeks after discharge, semistructured interviews on experiences of trying to maintain EBF in a postdischarge home setting were conducted with a total of 20 mothers. Although most stated the aspiration of maintaining EBF for 6 months, a range of challenges were reported and not all had successfully maintained EBF post discharge. Reported challenges include the stress of household chores, food insecurity, technical difficulties and social stigma of expressing breast milk, pressure from neighbours and family members to introduce mixed feeding, and needing more community‐based awareness and support. Most of these challenges were specific to the home setting and were not easily surmountable, despite the breastfeeding practices mothers had learned in the ward. Indeed, in some cases, challenges were exacerbated by the overmedicalized nature of the breastfeeding practices taught in the ward. In order to aid the transition from ward to home, there may be a need to further translate ward‐based education and promotional messaging for EBF into a community setting, targeting other caregivers as well.     

Individualized breastfeeding support for acutely ill,malnourished infants under 6 months old

Reestablishing exclusive breastfeeding is the cornerstone of the 2013 World Health Organization (WHO) treatment guidelines for acute malnutrition in infants less than 6 months. However, no studies have investigated guideline implementation and subsequent outcomes in a public hospital setting in Africa. To facilitate implementation of the WHO 2013 guidelines in Kilifi County Hospital, Kenya, we developed standard operating procedure, recruited, and trained three breastfeeding peer supporters (BFPS). Between September 2016 and January 2018, the BFPS provided individual breastfeeding support to mothers of infants aged 4 weeks to 4 months admitted to Kilifi County Hospital with an illness and acute malnutrition (mid‐upper‐arm circumference < 11.0 cm OR weight‐for‐age z score < ?2 OR weight‐for‐length z score < ‐2). Infants were followed daily while in hospital then every 2 weeks for 6 weeks after discharge with data collected on breastfeeding, infant growth, morbidity, and mortality. Of 106 infants with acute malnutrition at admission, 51 met the inclusion criteria for the study. Most enrolled mothers had multiple breastfeeding challenges, which were predominantly technique based. Exclusive breastfeeding was 55% at admission and 81% at discharge; at discharge 67% of infants had attained a weight velocity of >5 g/kg/day for three consecutive days on breastmilk alone. Gains in weight‐for‐length z score and weight‐for‐age z score were generally not sustained beyond 2 weeks after discharge. BFPS operated effectively in an inpatient setting, applying the 2013 updated WHO guidelines and increasing rates of exclusive breastfeeding at discharge. However, lack of continued increase in anthropometric Z scores after discharge suggests the need for more sustained interventions.     

Does breastfeeding method influence infant weight gain?

OBJECTIVE: To compare the effect of traditional and "baby-led" breastfeeding advice on early infant weight gain and exclusive breastfeeding rates. DESIGN: Longitudinal cohort study: part prospective, part retrospective. SETTING: One UK general practice. PARTICIPANTS: 63 exclusively breastfed infants in two cohorts: 32 babies born before and 31 babies born after a change in breastfeeding advice. INTERVENTION: A change from baby-led to traditional breastfeeding advice. MAIN OUTCOME MEASURES: Primary analysis: comparison of the effectiveness of the intervention (ie, weight gain expressed as standard deviation score gain (SDSG) between birth and 6-8 weeks) and exclusive breastfeeding rates between babies whose mothers received traditional advice and those whose mothers received baby-led advice. Secondary analysis: relevance of feed length (ie, weight gain expressed as SDSG between birth and 6-8 weeks in babies feeding for 10 min or less from the first breast and those feeding for longer than 10 min). RESULTS: The two groups were equivalent with respect to birth weight, gestational age, and parity. Primary outcome: babies whose mothers received the traditional advice were more likely to be exclusively breast fed up to 12 weeks (log rank chi2 = 9.68, p = 0.002) and gained more weight up to 6-8 weeks than those given baby-led advice (mean SDSG 0.41 (95% CI 0.13 to 0.69) vs -0.23 (95% CI -0.72 to 0.27)). Secondary outcome: irrespective of feeding advice given, babies feeding for 10 min or less from the first breast gained more weight by 6-8 weeks than babies feeding for longer than 10 min (mean SDSG 0.42 (95% CI 0.11 to 0.73) vs -0.19 (95% CI -0.64 to 0.26)). CONCLUSIONS: In this study, traditional breastfeeding advice resulted in increased weight gain and increased exclusive breastfeeding rates compared with baby-led advice. Exclusively breastfed babies who had shorter feeds (10 min or less from the first breast) gained more weight.     

Agreement of invasive versus non‐invasive blood pressure in preterm neonates is not dependent on birth weight or gestational age

Purpose: Blood pressure constitutes an important parameter in the assessment of the cardiovascular status in preterm infants. Invasive arterial blood pressure (IBP) is considered the ‘gold‐standard’, but non‐invasive blood pressure (NIBP) is used frequently in preterm infants. The aim of this prospective study was to compare mean IBP and mean NIBP arterial blood pressure measurements in three subsets of preterm infants (>1500 g; 1000–1500 g, and <1000 g, and >31 weeks, 28–31 weeks, and <28 weeks of gestation). Methods: Prospective, simultaneous assessment of both IBP and NIBP measurements in 50 preterm neonates at 6, 12, 18, 24 h after birth in a tertiary University centre. Results: Mean gestational age was 26.7 ± 2.2 (24–32) in group I (n= 18), 29.6 ± 2.0 (27–34) in group II (n= 19) and 32.2 ± 1.9(30–36) weeks in group III (n= 13), respectively; mean birth weight was 777 ± 161 (495–995), 1251 ± 154 (1010–1490) and 2010 ± 332 (1590–2550) g. Mean IBP and mean NIBP increased significantly during the first 24 h of life in all three sub‐groups (P < 0.01); IBP and NIBP measurements were significantly correlated, and showed good agreement, irrespective of birth weight and gestational age. Conclusions: Although IBP monitoring is considered the ‘gold standard’, NIBP values showed good agreement with those obtained invasively irrespective of gestational age and birth weight. We conclude that NIBP monitoring constitutes an important parameter in the assessment of the cardiovascular status even in extremely low birth weight infants.     

The calorie intake and weight gain of low birth weight infants fed on fresh breast milk or a special formula milk

The calorie intake and weight gain of 24 low birth weight (LBW) infants, <33 weeks gestation and <1500 g birth weight, was studied prospectively. Fourteen infants were fed on a commercially available LBW formula milk and ten were fed on their own mother's fresh unpasteurised expressed breast milk (EBM). The difference between the two feeding groups in the intake of milk and calories was not significant, but from the third week onwards those fed on the LBW formula gained weight faster. The mean (±SEM) weight increments for weeks 3–6 (inclusive) for LBW formula and EBM fed infants was 189.3 (±7.9) and 139.6 (±11.1) g/wk respectively (P<0.001).The LBW formula was well tolerated and is a suitable feed for LBW infants. However some babies thrived well on fresh EBM and so we are continuing to encourage mothers who wish, to breast feed their own preterm infants. When such infants fail to thrive it is appropriate to supplement with a LBW formula.     

Pressure and judgement within a dichotomous landscape of infant feeding: a grounded theory study to explore why breastfeeding women do not access peer support provision

Lack of support is reported as a key reason for early breastfeeding cessation. While breastfeeding peer support (BPS) is a recommended intervention to increase breastfeeding rates, a number of studies identify that engagement with BPS is problematic. Due to paucity of research in this area, this study explores why breastfeeding women do not access BPS in South‐West England. Utilising a constructionist grounded theory approach, 33 participants (women (n = 13), health professionals (n = 6) and peer supporters (n = 14)) participated in a semi‐structured interview (n = 22) or focus group (n = 11). Analysis involved open coding, constant comparisons and focussed coding. One core category and three main themes explicating non‐access were identified. The core category concerns women's experiences of pressure and judgement around their feeding decisions within a dichotomous landscape of infant feeding language and support. Theme one, ‘place and space of support’, describes the contrast between perceived pressure to breastfeed and a lack of adequate and appropriate support. Theme two, ‘one way or no way’, outlines the rules‐based approach to breastfeeding adopted by some health professionals and how women avoided BPS due to anticipating a similar approach. Theme three, ‘it must be me’, concerns how lack of embodied insights could lead to ‘breastfeeding failure’ identities. A background of dichotomised language, pressure and moral judgement, combined with the organisation of post‐natal care and the model of breastfeeding adopted by health professionals, may inhibit women's access to BPS. A socio‐cultural model of breastfeeding support providing clear messages regarding the value and purpose of BPS should be adopted.     

Postnatal growth curves for extremely low birth weight infants with early enteral nutrition

Early enteral nutrition improves growth of extremely low birth weight infants, but growth curves beyond 30 days of life are lacking for such infants receiving early enteral nutrition. Based on the data of all infants born in a 4-year interval with a birth weight <1000 g and surviving for >56 days, we calculated growth rates and weight gain over 120 postnatal days. Infants with major congenital anomalies or necrotising enterocolitis were excluded. Daily weight, weekly length, head circumference and nutritional data were collected until discharge or for maximal 120 days. Curves were calculated in 100 g birth weight intervals, and separately for appropriate for gestational age (AGA) and small for gestational age (SGA) infants. Data were available from 163 infants (birth weight 768 g ± 153 g; gestational age 26.8±1.8 weeks; mean ± SD) including 55 SGA infants (33.7%). Full enteral feeding was achieved at day 21.7 (±10.4). After 12.8% (±6.6%) maximal postnatal weight loss at day 7.5 (±3.0), birth weight was regained at 14.6 (±6.0) days. Mean overall weight gain was 15 g/kg per day with a significantly higher weight gain for SGA than for AGA infants ( P <0.05). Conclusion:Our early fed infants achieved better weight gain than those recently published receiving late enteral nutrition, but nevertheless fell below the 10th percentile of intrauterine curves. Which postnatal growth is ideal for extremely low birth weight infants infants is unclear. Our growth curves should not be taken as reference curves of a normal population but may help to identify infants with growth failure.These data are part of the doctoral thesis of Mareike Diekmann. The study was partly supported by Nestlé