title: Biophysiologic and social stress relationships with breast milk feeding pre- and post-discharge from the neonatal intensive care unit.
abstract: OBJECTIVE
  To determine influences on incidence of breast milk feeding (BMF) at time of discharge and 6 months later among infants cared for in the neonatal intensive care unit (NICU).
  
  
  METHODS
  A 2-year prospective descriptive NICU hospital-based cohort design.
  
  
  METHODS
  Academic Center Level III-IV NICU.
  
  
  METHODS
  Five hundred and thirty-five infants cared for in NICU and a subgroup of one hundred twenty-nine participant mothers who answered questionnaires.
  
  
  METHODS
  Predischarge data were collected using maternal and infant medical records. Post-discharge data were collected from maternal questionnaires.
  
  
  RESULTS
  At NICU discharge, biophysiologic stressors predictive of not receiving BMF included birth weight <1500 grams (p < .035), heart surgery (p = .014), and inhaled nitric oxide treatment (p = .002). Teenage mothers were less likely to BMF (p = .022). After discharge, BMF duration correlated with BMF duration of a prior infant (p < .009). Most mothers reported BMF >4 months, 91% continued pumping, and 89% indicated an interest in a hospital support group. Logistic regression analysis (R(2) 0.45) identified factors that significantly increased the likelihood of BMF > 4 months: BMF plan (p < .001), convenience (p = .018), and family as resource (p = .025). Negative associations were: awareness of immune benefits (p = .025), return to work (p = .002), and infants requiring surgical ligation of the patent ductus arterious (p = .019).
  
  
  CONCLUSIONS
  Social and medical stressors contribute to BMF duration pre- and post-NICU discharge. We speculate that active NICU BMF support targeting vulnerable infants and their families and assisting with plans for BMF pre- and post-discharge will help overcome barriers.
authors: David Geffen School of Medicine, University of California, Los Angeles, CA 90096-1752, USA. ipurdy@mednet.ucla.edu
authors: Isabell B
authors: IB
authors: Purdy
authors: Namrata
authors: N
authors: Singh
authors: Cindy
authors: C
authors: Le
authors: Cynthia
authors: C
authors: Bell
authors: Christy
authors: C
authors: Whiteside
authors: Mara
authors: M
authors: Collins
mesh_terms: D000293:Adolescent; D000328:Adult; D001294:Attitude to Health; D001942:Breast Feeding / Q000523:psychology; D002140:California; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D008895:Milk, Human / Q000276:immunology; D010351:Patient Discharge; D011446:Prospective Studies; D012944:Social Support; D013312:Stress, Physiological; D013315:Stress, Psychological