Room for improvement in breast milk feeding after very preterm birth in Europe: Results from the EPICE cohort |
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| Authors: | Emilija Wilson Anna‐Karin Edstedt Bonamy Mercedes Bonet Liis Toome Carina Rodrigues Elizabeth A. Howell Marina Cuttini Jennifer Zeitlin the EPICE Research Group |
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| Affiliation: | 1. Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden;2. Department of Women's and Children's Health, and Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden;3. Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé) and Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, Paris, France;4. Department of Neonates and Infants, Tallinn Children's Hospital, Tallinn, and University of Tartu, Tartu, Estonia;5. ISPUP‐EPIUnit, Universidade do Porto, Porto, Portugal;6. Departments of Population Health Science & Policy and Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York, USA;7. Research Unit of Perinatal Epidemiology, Clinical Care and Management Innovation Research Area, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy;8. INSERM, Obstetrical, Perinatal and Paediatric Epidemiology Research Team, Centre for Epidemiology and Biostatistics (U1153), Paris‐Descartes University, Paris, France |
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| Abstract: | Breast milk feeding (BMF) is associated with lower neonatal morbidity in the very preterm infant (<32 weeks gestation) and breastfeeding is beneficial for maternal health. Previous studies show large variations in BMF after very preterm birth and recognize the need for targeted breastfeeding support in the neonatal intensive care units (NICU). In a European collaboration project about evidence‐based practices after very preterm birth, we examined the association between maternal, obstetric, and infant clinical factors; neonatal and maternal care unit policies; and BMF at discharge from the NICU. In multivariable analyses, covariates associated with feeding at discharge were first investigated as predictors of any BMF and in further analysis as predictors of exclusive or partial BMF. Overall, 58% (3,826/6,592) of the infants received any BMF at discharge, but there were large variations between regions (range 36–80%). Primiparity, administration of antenatal corticosteroids, first enteral feed <24 hr after birth, and mother's own milk at first enteral feed were predictors positively associated with any BMF at discharge. Vaginal delivery, singleton birth, and receiving mother's own milk at first enteral feed were associated with exclusive BMF at discharge. Units with a Baby Friendly Hospital accreditation improved any BMF at discharge; units with protocols for BMF and units using donor milk had higher rates of exclusive BMF at discharge. This study suggests that there is a high potential for improving BMF through policies and support in the NICU. |
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| Keywords: | baby friendly hospital breast milk breastfeeding neonatal intensive care unit (NICU) policies very preterm birth |
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