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PEDIATRICS Vol. 111 No. 6 June 2003, pp. 1337-1342

Initiation of Breastfeeding Among Mothers of Very Low Birth Weight Infants

Melanie M. Smith, MNS*,§, Maureen Durkin, PhD, DrPH*,§,¶, Veronica J. Hinton, PhD*,{ddagger}, David Bellinger, PhD, MSc|| and Louise Kuhn, PhD*,§

* Gertrude H. Sergievsky Center
{ddagger} Department of Neurology, College of Physicians and Surgeons
§ Division of Epidemiology, Joseph L. Mailman School of Public Health, Columbia University, New York, New York
|| Harvard Medical School, Boston, Massachusetts
University of Wisconsin Medical School, Madison, Wisconsin

Objective. To examine factors that predict the initiation of expressed milk feedings and the transition to direct breastfeedings among mothers of very low birth weight (VLBW) infants.

Methods. The sample consists of 361 mother-infant pairs enrolled in a follow-up study of children aged 6 to 8 years who were born weighing <1501 g in 1 of 5 hospitals between 1991–1993. Chart review at birth provided data on neonatal characteristics and demographic factors at delivery were obtained by postpartum maternal interview. Information regarding infant feeding practices was obtained at follow-up.

Results. In this study, 60% of mothers initiated expressed milk feedings for their VLBW infants. However, the duration of these feedings was brief with 52% of infants receiving 1 to 3 months or less of human milk feedings. Greater educational attainment, private insurance, and breastfeeding experience were each independently associated with the decision to provide expressed milk feedings. Only 27% of mothers reported directly breastfeeding their VLBW infants. The transition from expressed milk feedings to direct breastfeedings was positively associated with sociodemographic factors including maternal age, insurance status, and breastfeeding experience as well as the length of hospitalization, an indicator of infant health.

Conclusions. Sociodemographic factors were associated with both the decision to initiate expressed milk feedings and the transition to direct breastfeedings. However, factors relating to infant health only influenced the transition to direct breastfeedings. Intervention programs need to consider the sociodemographic factors that influence infant feeding decisions as well as specific challenges encountered by mothers of VLBW infants.

Key Words: very low birth weight infant • breastfeeding • infant nutrition

Abbreviations: VLBW, very low birth weight • NICU, neonatal intensive care unit

Received for publication May 9, 2002; Accepted Sep 16, 2002.




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