Prem babies can be as successfully breastfed

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Researchers have determined that healthy premature babies can have as much success breastfeeding as full-term babies. The study, conducted by researchers at University of British Columbia Okanagan‘s School of Nursing and the University of Hong Kong, involved 2,700 pairs of mothers and infants and included two different survey groups – one in 2006/07 and another in 2011/12. The mother-infant pairs were monitored from birth to 12 months or until breastfeeding ceased.

“An early-term birth is associated with adverse neonatal outcomes that may impede breastfeeding, especially when compared with a full-term birth,” says Marie Tarrant, director of the School of Nursing. “However, the effect of early-term birth on exclusive breastfeeding duration among healthy normal weight infants is unclear.”

Breastfeeding provides numerous benefits to infants and can potentially offset the effects of early-term birth, explains study author Heidi Fan. Traditionally, full-term births are those from 37 to 42 gestational weeks. However, previous research has shown that infants born early-term from 37 to 39 gestational weeks have a greater incidence of adverse respiratory outcomes, extended hospital stays, newborn sepsis or admission to a neonatal unit. And until now, it was also believed they might be less successful at breastfeeding.

The researchers wanted to examine the correlation between early-term births and how long these infants breastfed. Of the babies in the study who were all healthy at birth, 32% were born early-term. By two weeks postpartum, half of the infants in the study were not exclusively breastfed and by three months, more than half of the participants had stopped breastfeeding completely.

“Some studies show that early-term birth is associated with a shorter breastfeeding duration while others show no association at all,” says Fan. “And there are only two studies that we are aware of that have examined the effect of gestational age in term infants when it comes to exclusive breastfeeding duration, again with conflicting findings.”

Research assistants contacted the study participants, who were from four different hospitals in Hong Kong, when the infants were one, two, three, six, nine and 12 months old or until breastfeeding stopped.

Participants with early-term and full-term babies reported the average time they stopped breastfeeding was at nine weeks. Notably, the average times for mothers of both early- and full-term babies to stop exclusively breastfeeding was two weeks of age.

“Our findings contrast with the conclusions of some existing studies, where early-term birth was significantly associated with breastfeeding cessation,” says Fan. “A possible explanation for this difference is that our study included only normal-weight infants who did not have serious obstetrical or neonatal complications and admission to the neonatal intensive care unit.”

Fan says their study determined there is no significant increase in the risk of breastfeeding cessation between early-term and full-term infants.

“Consequently, in this sample early-term infants may have been more similar to full-term infants when compared with participants in other studies and this may explain why we were unable to find any differences in breastfeeding duration between the two groups. Our study findings therefore suggest that the shorter breastfeeding duration in early-term infants found in other studies may be due to the postpartum and neonatal complications associated with early-term birth rather than the actual effect of gestational age.”

While Fan says they found no association between early and full-term birth when it came to the duration of breastfeeding, she does suggest more research is needed in particular to determine the duration and success of breastfeeding for infants of early-term birth who may have other neonatal complications.

“It is also important for clinicians to recognise that mothers who give birth to early-term infants with neonatal complications may need individualised support to achieve their breastfeeding goals,” she adds.

Abstract
Background: When compared with full-term birth (39 to <42 weeks), early-term birth (37 to <39 weeks) is associated with adverse neonatal outcomes that may impede breastfeeding. Breastfeeding provides numerous benefits to infants and could potentially offset the effects of early-term birth. However, the effect of early-term birth on any and exclusive breastfeeding duration among healthy normal weight infants is unclear.
Objectives: The objective of this study was to examine the association between early-term birth and breastfeeding duration and exclusivity among healthy term infants.
Methods: Two prospective cohorts of 2704 healthy mother-infant pairs were recruited in Hong Kong in 2006–07 and 2011–12. Participants were followed prospectively for 12 months or until they stopped breastfeeding.
Results: Approximately one-third (32.8%) of the infants were born early-term. More than one-half of all participants had stopped breastfeeding by three months postpartum and approximately one-half of the infants were not being exclusively breastfed by two weeks postpartum. There was no significant difference in the odds of any (adjusted odds ratio [aOR] = 1.05; 95% 0.85, 1.31) or exclusive (aOR = 0.89; 95% 0.73, 1.08) breastfeeding at one-month postpartum between infants born early-term and at full-term. There was also no significant difference in the duration of any (adjusted hazard ratio [aHR] = 1.0; 95% 0.91, 1.10) or exclusive (aHR = 1.0; 95% 0.91, 1.09) breastfeeding between early-term and full-term infants.
Conclusion: In this cohort, early-term birth was not associated with breastfeeding duration and exclusivity. This suggests that, in the absence of neonatal complications, early-term birth itself may not lead to a shorter duration of any or exclusive breastfeeding.

Authors
Heidi Sze Lok Fan, Janet Yuen Ha Wong, Daniel Yee Tak Fong, Kris Yuet Wan Lok, Marie Tarrant

University of British Columbia Okanagan material
Midwifery abstract


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