Date of Completion

Spring 5-1-2015

Project Advisor(s)

Jacqueline McGrath, Georgine Burke, Anastasios Tzingounis

University Scholar Major



Critical Care Nursing | Maternal, Child Health and Neonatal Nursing



Background: Increasingly, evidence supports oral feeding of very-low-birth-weight (VLBW) preterm infants exclusively at breast or with breastmilk. Despite known breastmilk benefits, outcomes related to exclusive breastmilk provision are poor. Identifying factors that promote breastmilk provision is critical.

Purpose: Breastfeeding practices of mothers of VLBW infants admitted to neonatal intensive care unit (NICU) were explored to identify factors associated with mode of feeding at discharge.


This retrospective study replicates previous work. Subjects were VLBW preterm infants consecutively admitted during a 24-month period. Primary outcomes included receiving any breastmilk at discharge. Infant variables included gestational age (GA), post-menstrual age (PMA) of first direct breastfeeding, and co-morbid conditions. Maternal variables included age and ethnicity. Nursing practices variables included first direct-to-breast feeding, number of times to breast daily and total direct-to-breast feeding encounters 24 hours prior to discharge.

Results: 96 VLBW infants (28.7 ± 2.8 weeks GA) met inclusion criteria. Of these, 48% received breastmilk at discharge. Controlling for significant effect of length of stay, infants receiving first oral feed at breast were more likely discharged home receiving breastmilk (adj OR 8.7, 95% CI 2.9-32.3, p<0.0001). There was both an independent effect of first oral feed at breast, and an interaction where infants of non-married women also benefited from the first oral feed at breast.

Implications: Significant associations were found between first oral feeding at breast and infant receiving any breastmilk at discharge. Targeting VLBW infants to receive first oral feeding at breast may yield the best outcome even among sickest and smallest infants.

New Figure 1_GB.docx (82 kB)
Figure 1. Diagram of Study Participants and Outcome Variables

R3_TABLE_1_Exclusion Criteriajmm.docx (17 kB)
Table 1. Exclusion Criteria

R3_Table 2_GB2jmm.docx (16 kB)
Table 2. Infant Characteristics

R3 Table 3_after discussion with jmm.docx (17 kB)
Table 3. Comparison of Infants Who Were or Were Not Receiving Breastmilk After Discharge

R3 Table 4_GBjmm.docx (18 kB)
Table 4. Predictors of Any Breastfeeding At Discharge

R3_Table 5_Summary.docx (17 kB)
Table 5. Future Research and Clinical Issues to Consider