Presented at the Neonatal Society 2007 Autumn Meeting.
O’Leary R, De Vega I, Uthaya S, Modi N
The NWLPN Division of Medicine, Imperial College London and Chelsea and Westminster NHS Foundation Trust, London, UK
Background: Breastfeeding is an important aspect of neonatal care but poses particular difficulties for mothers who deliver preterm. Evidence based stratagems to improve lactation outcomes for this vulnerable group of infants are urgently needed.
Aims: As an initial step to improving lactation outcomes and to target appropriate interventions, we aimed to survey the extent of breastfeeding at discharge in our large London perinatal network and to explore variables associated with successful breast feeding.
Methods: Approval from all network Neonatal Units was obtained through standard network procedures to receive de-identified data of babies born before 33 weeks gestation between 1st Jan. and 31st Dec. 2006 in NWLPN, who received all their care in the hospital of their birth. These data form part of the routine clinical data captured through SEND (Standardised Electronic Neonatal Data-system). Data were analysed using SPSS. Values are presented as median (range) unless otherwise stated.
Results: Data were received on 338 infants representing 100% of those eligible for inclusion. The median (range) for gestational age was 30.7 weeks (23.9, 32.9); maternal age 31 years (13, 51) ; proportion of time in level I intensive care 4.8% (0, 60.8) and time of first milk feed 2 days (1, 11). Boys represented 54% and girls 46%. Overall 23% of infants were twins or higher order multiple births. Use of donor milk by units ranged from 5-71% of infants. Inconsistencies in coding precluded analysis of outcomes by maternal race.
At discharge home 44% of infants were fully breast fed, 26% partially and 30% fully formula fed.
Units within the network varied in the rates of breast feeding at discharge (14-62% for fully breast fed and 36-83% any breast milk). Multinomial logistic regression analysis showed unit (p<0.001), maternal age (p=0.045) and infant gestational age at birth (p=0.007) to be significant predictors of the success of breast feeding at discharge. The younger the mother and the more preterm the infant, the less likely was breast feeding at discharge.
Variables not predictive of successful breastfeeding were proportion of time in level 1 intensive care, time of first milk feed, use of donor breast milk, infant sex and multiple birth.
Conclusions: Younger maternal age and lower infant gestation are less likely to be associated with successful breast feeding at discharge in babies born <33 weeks gestation, suggesting that that this group requires focused support. Unit based practices also appear to influence lactation success. Benchmarking of lactation outcomes requires adjustment for maternal and infant characteristics.