title: Factors associated with exclusive breastfeeding of preterm infants. Results from a prospective national cohort study.
abstract: OBJECTIVE
  Evidence-based knowledge of how to guide the mothers of preterm infants in breastfeeding establishment is contradictive or sparse. The aim was to investigate the associations between pre-specified clinical practices for facilitating breastfeeding, and exclusive breastfeeding at discharge as well as adequate duration thereof.
  
  
  METHODS
  A prospective survey based on questionnaires was conducted with a Danish national cohort, comprised of 1,221 mothers and their 1,488 preterm infants with a gestational age of 24-36 weeks. Adjusted for covariates, the pre-specified clinical practices were analysed by multiple logistic regression analyses.
  
  
  RESULTS
  At discharge 68% of the preterm infants were exclusively breastfed and 17% partially. Test-weighing the infant, and minimizing the use of a pacifier, showed a protective effect to exclusive breastfeeding at discharge (OR 0.6 (95% CI 0.4-0.8) and 0.4 (95% CI 0.3-0.6), respectively). The use of nipple shields (OR 2.3 (95% CI 1.6-3.2)) and the initiation of breast milk expression later than 48 hours postpartum (OR 4.9 (95% CI 1.9-12.6)) were associated with failure of exclusive breastfeeding at discharge. The clinical practices associated with an inadequate breastfeeding duration were the initiation of breast milk expression at 12-24 hours (OR 1.6 (95% CI 1.0-2.4)) and 24-48 hours (OR 1.8 (95% CI 1.0-3.1)) vs. before six hours postpartum, and the use of nipple shields (OR 1.4 (95% CI 1.1-1.9)).
  
  
  CONCLUSIONS
  Early initiation of breast milk pumping before 12 hours postpartum may increase breastfeeding rates, and it seems that the use of nipple shields should be restricted. The use of test-weighing and minimizing the use of a pacifier may promote the establishment of exclusive breastfeeding, but more research is needed regarding adequate support to the mother when test-weighing is ceased, as more of these mothers ceased exclusive breastfeeding at an early stage after discharge.
authors.affiliation: Knowledge Centre for Breastfeeding Infants with Special Needs at Department of Neonatology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark ; Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden ; Danish National Panel of Experts on Breastfeeding Infants with Special Needs.
authors.forename: Ragnhild
authors.initials: R
authors.lastname: Maastrup
authors.affiliation: Department of Neonatology, Copenhagen University Hospital Herlev, Herlev, Denmark.
authors.forename: Bo Moelholm
authors.initials: BM
authors.lastname: Hansen
authors.affiliation: Department of Public Health, Section of Nursing, University of Aarhus, Aarhus, Denmark.
authors.forename: Hanne
authors.initials: H
authors.lastname: Kronborg
authors.affiliation: Danish National Panel of Experts on Breastfeeding Infants with Special Needs ; Department of Neonatology, Copenhagen University Hospital Herlev, Herlev, Denmark.
authors.forename: Susanne Norby
authors.initials: SN
authors.lastname: Bojesen
authors.affiliation: Danish National Panel of Experts on Breastfeeding Infants with Special Needs ; Department of Neonatology, Viborg Regional Hospital, Viborg, Denmark.
authors.forename: Karin
authors.initials: K
authors.lastname: Hallum
authors.affiliation: Danish National Panel of Experts on Breastfeeding Infants with Special Needs ; Paediatric Department, Holbaek University Hospital, Holbaek, Denmark.
authors.forename: Annemi
authors.initials: A
authors.lastname: Frandsen
authors.affiliation: Danish National Panel of Experts on Breastfeeding Infants with Special Needs ; Department of Neonatology, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark.
authors.forename: Anne
authors.initials: A
authors.lastname: Kyhnaeb
authors.affiliation: Danish National Panel of Experts on Breastfeeding Infants with Special Needs ; Department of Neonatology, Odense University Hospital, Odense, Denmark.
authors.forename: Inge
authors.initials: I
authors.lastname: Svarer
authors.affiliation: Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden.
authors.forename: Inger
authors.initials: I
authors.lastname: Hallström
mesh_terms: D000328:Adult; D001724:Birth Weight / Q000502:physiology; D001942:Breast Feeding / Q000706:statistics & numerical data*; D061186:Breast Milk Expression; D015984:Causality; D015331:Cohort Studies; D036861:Delivery, Obstetric / Q000379:methods / Q000706:statistics & numerical data; D003718:Denmark / Q000453:epidemiology; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D010865:Pilot Projects; D011446:Prospective Studies; D011795:Surveys and Questionnaires