LAUSR

Purpose of study To compare the rates of breastfeeding (BF) initiation and continuation among mothers of late preterm infants (LPIs) who were cared for in a NICU versus those who were not cared for in a NICU (non-NICU). Methods used Data from the Pregnancy Risk Assessment Monitoring System (PRAMS) was analysed, including data from 36 states from 2000–2013. Chi-square tests and 95% confidence intervals were used to assess differences in infant and maternal characteristics and BF practices between the NICU and non-NICU LPI groups. Multivariate regression models were used to estimate the independent effect of NICU admission on BF initiation and continuation, controlling for maternal and infant characteristics. All analyses were weighted and standard errors were adjusted to account for the complex survey design of PRAMS. Summary of results In this sample of weighted n=62 494 LPIs over a 14 year period, 48.6% were cared for in a NICU. For BF initiation, 76.2% of NICU mothers reported initiating BF compared to 71.1% of non-NICU mothers (p-value<0.0001). For BF continuation, 52.0% of NICU mothers reported continuing BF at 10 weeks compared to 55.6% of non-NICU mothers (p-value 0.0001). After adjusting for maternal and infant characteristics, mothers of NICU LPIs were more likely to initiate BF (APR 1.07; 95% CI: 1.05 to 1.09) while there was no difference in BF continuation between the two groups (APR 0.98; 95% CI: 0.94 to 1.0). Conclusions Mothers of NICU LPIs were more likely to initiate breastfeeding than mothers of non-NICU LPIs but equally likely to continue breastfeeding at 10 weeks. Previous studies have shown that among term infants, 64% of mothers continue BF for at least 10 weeks, a higher percentage than what we have found among both NICU and non-NICU LPIs. It has been well established that LPIs have increased morbidity and mortality as compared to term infants and further work is needed to increase the rates of breastfeeding, and particularly breastfeeding continuation, in this vulnerable population. In addition, future studies are required to better understand why BF initiation is higher in NICU mothers so that newborn nurseries can potentially adopt effective practices that promote BF initiation in this high-risk group.