title: Factors Influencing Parent Reports of Facilitators and Barriers to Human Milk Supply in Neonatal Intensive Care Units.
abstract: BACKGROUND
  Successful human milk supply in neonatal intensive care units (NICUs) requires the development of family-centered services.
  
  
  OBJECTIVE
  This study aimed to assess parent perceptions of factors that help or hinder providing human milk to very preterm infants (VPI) in the NICU according to sociodemographic, reproductive, and obstetric characteristics.
  
  
  METHODS
  This cross-sectional quantitative study included 120 mothers and 91 fathers of VPI hospitalized in a level 3 NICU located in the Northern Health Region of Portugal (July 2013-June 2014). Interviewers administered structured questionnaires regarding parent characteristics and the provision and perception of factors that help or hinder human milk supply in the NICU, 15 to 22 days after birth.
  
  
  RESULTS
  The main facilitators of human milk supply were its contribution to infant growth and well-being (51.4%) and parents' knowledge of breastfeeding benefits (27.6%). The main barriers were worries related to inadequate milk supply (35.7%), difficulties with expressing breast milk (24.8%), and physical separation from infants (24.3%). Fathers referred less frequently to the contribution of human milk to infant growth and well-being (odds ratio [OR] = 0.57; 95% confidence interval [CI], 0.32-1.00) but more frequently to knowledge of breastfeeding benefits as facilitators (OR = 2.31; 95% CI, 1.23-4.32). Participants with > 12 years of education (OR = 1.91; 95% CI, 1.05-3.47) and those with an extremely low birth weight infant (OR = 1.90; 95% CI, 1.02-3.54) highlighted worries related to inadequate milk supply. Fathers (OR = 2.16; 95% CI, 1.11-4.19) and participants with ≤ 12 years of education (OR = 0.25; 95% CI, 0.11-0.57) more frequently reported difficulties with expressing as the main barrier.
  
  
  CONCLUSIONS
  The parent's gender and education and the infant's birth weight are crucial considerations for establishing optimal practices for supporting breastfeeding.
authors: 1 ISPUP-EPIUnit, Universidade do Porto, Rua das Taipas, no. 135, 4050-600 Porto, Portugal.
authors: Elisabete
authors: E
authors: Alves
authors: 2 Faculdade de Medicina, Universidade do Porto, Rua Doutor Plácido da Costa, 4200-450 Porto, Portugal.
authors: Raquel
authors: R
authors: Magano
authors: 1 ISPUP-EPIUnit, Universidade do Porto, Rua das Taipas, no. 135, 4050-600 Porto, Portugal.|3 Global Public Health Doctoral Programme, Institute of Public Health of University of Porto, Porto, Portugal.
authors: Mariana
authors: M
authors: Amorim
authors: 4 Center for Psychology at University of Porto, Faculty of Psychology and Educational Sciences of the University of Porto, Porto, Portugal.
authors: Conceição
authors: C
authors: Nogueira
authors: 1 ISPUP-EPIUnit, Universidade do Porto, Rua das Taipas, no. 135, 4050-600 Porto, Portugal.
authors: Susana
authors: S
authors: Silva
mesh_terms: D000328:Adult; D001942:Breast Feeding / Q000379:methods / Q000523:psychology*; D003430:Cross-Sectional Studies; D005260:Female; D005523:Food Supply / Q000592:standards*; D006801:Humans; D007223:Infant; D062071:Infant, Extremely Premature / Q000254:growth & development; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal / Q000592:standards*; D008895:Milk, Human; D011174:Portugal
keywords: breastfeeding; child; hospitalized; human; intensive care units; milk; neonatal; parents; patient-centered care