Presented at the Neonatal Society 2008 Spring Meeting.
Morrison J1, Uthaya S1, De Vega I1, Hockley C2, Quigley M2, Modi N1
1 Division of Medicine, Imperial College London and Chelsea and Westminster Foundation Trust, London, UK
2 National Perinatal Epidemiology Unit, Oxford, UK
Background: The benefits of human milk are well described. We have previously shown that lower maternal age and lower gestational age are associated with lower lactation success at discharge in preterm infants. Multiple births comprise a significant proportion of admissions to neonatal units. There is little published on the lactation outcomes at discharge from neonatal units in multiple births.
Aims: The aim of this study was to survey the extent of lactation at discharge in multiple births compared to singletons admitted to neonatal units and to investigate the factors influencing breast feeding in multiple births.
Methods: Approval from all seven network Neonatal Units was obtained through standard network procedures to receive de-identified data of all babies born between 1st Jan 2006 and 31st Dec 2006 in the NWLPN, who received all of 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 932 infants representing 100% of those eligible for inclusion. The median (range) gestational age was 34 weeks (24, 42); maternal age 31 years (11, 51); and time of first milk feed 2 days (1, 14). 57% of babies did not spent any time in level 1 intensive care (IC). Of the remaining infants, the proportion of time spent in level 1 IC was 11% (2, 100). Boys represented 56% and girls 44%. 19% of infants were twins or higher order multiple births. 15% of infants (22% of multiple births and 13% of singletons) received donor breast milk at some stage. 25% of infants received their mother’s milk as their first feed. At discharge home, 40% of infants (42% of multiples and 40% of singletons) were receiving breast milk exclusively. 69% of infants (75% of multiple births and 68% of singletons) received some breast milk at discharge. Units within the network varied in the rates of breast feeding at discharge (17 – 63% for fully breast fed and 47 – 83% any breast milk). Twins were more likely to be receiving some breast milk at discharge compared to singletons but this was not significant (crude odds ratio 1.45, 95% CI 0.99 – 2.12, p=0.057). After adjusting for confounding factors, this effect was weaker and remained not statistically significant (adjusted odds ratio 1.33, 95% CI 0.88 – 2.01, p=0.168). Breast feeding at discharge was significantly associated with the mother’s age at birth, type of first feed being breast milk and the Neonatal Unit but not independently associated with baby’s sex, gestation, age at first feed and level 1 IC.
Conclusions: Mothers of twins are no less likely than those of singletons to successfully breast feed at discharge. Factors reducing the chances of successful breast feeding are the feeding of donor and formula milk as first feed and younger mothers. Unit characteristics are also important. Time of initiation of first breast feed is a powerful determinant of successful lactation success and neonatal outcome. Large population studies have shown a 2.5 fold reduction in neonatal mortality in infants who initiated breast feeding on day 1 with an increasingly powerful effect the shorter the interval between birth and feeding initiation (1). Our study demonstrates the importance of focusing on obtaining maternal milk as early as possible in neonatal unit populations.
References
1. Edmond K et al. Delayed Breastfeeding Initiation Increases Risk of Neonatal Mortality. Pediatrics 2006 117:380-386