title: Breastfeeding progression in preterm infants is influenced by factors in infants, mothers and clinical practice: the results of a national cohort study with high breastfeeding initiation rates.
abstract: OBJECTIVE
  Many preterm infants are not capable of exclusive breastfeeding from birth. To guide mothers in breastfeeding, it is important to know when preterm infants can initiate breastfeeding and progress. The aim was to analyse postmenstrual age (PMA) at breastfeeding milestones in different preterm gestational age (GA) groups, to describe rates of breastfeeding duration at pre-defined times, as well as analyse factors associated with PMA at the establishment of exclusive breastfeeding.
  
  
  METHODS
  The study was part of a prospective survey of a national Danish cohort of preterm infants based on questionnaires and structured telephone interviews, including 1,221 mothers and their 1,488 preterm infants with GA of 24-36 weeks.
  
  
  RESULTS
  Of the preterm infants, 99% initiated breastfeeding and 68% were discharged exclusively breastfed. Breastfeeding milestones were generally reached at different PMAs for different GA groups, but preterm infants were able to initiate breastfeeding at early times, with some delay in infants less than GA 32 weeks. Very preterm infants had lowest mean PMA (35.5 weeks) at first complete breastfeed, and moderate preterm infants had lowest mean PMA at the establishment of exclusive breastfeeding (36.4 weeks). Admitting mothers to the NICU together with the infant and minimising the use of a pacifier during breastfeeding transition were associated with 1.6 (95% CI 0.4-2.8) and 1.2 days (95% CI 0.1-2.3) earlier establishment of exclusive breastfeeding respectively. Infants that were small for gestational age were associated with 5.6 days (95% CI 4.1-7.0) later establishment of exclusive breastfeeding.
  
  
  CONCLUSIONS
  Breastfeeding competence is not developed at a fixed PMA, but is influenced by multiple factors in infants, mothers and clinical practice. Admitting mothers together with their infants to the NICU and minimising the use of pacifiers may contribute to earlier establishment of exclusive breastfeeding.
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, Copenhagen, Denmark.
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, Copenhagen, Denmark; 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, Copenhagen, Denmark; 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, Copenhagen, Denmark; 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, Copenhagen, Denmark; 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, Copenhagen, Denmark; 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; D001942:Breast Feeding / Q000379:methods* / Q000706:statistics & numerical data*; D015331:Cohort Studies; D003718:Denmark; D005260:Female; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature / Q000502:physiology; D008297:Male; D009035:Mothers; D011446:Prospective Studies