Influence of anthropometric parameters on breastmilk provision in preterm infants.

OBJECTIVE: To explore how growth trends may relate to maternal provision of breastmilk to preterm infants in the Neonatal Intensive Care Unit (NICU).

DESIGN: Non-experimental, retrospective, descriptive.

SETTING: Level III, 40-bed suburban neonatal intensive care unit (NICU).

PARTICIPANTS: 94 preterm infants (<37 post-menstrual age) admitted to the NICU between September 2011 and May 2013.

METHODS: This retrospective chart review explored the relationship between infant growth during hospitalization and maternal provision of breastmilk at discharge. Growth data were collected including standard weekly growth measurements from birth through hospital discharge. In addition, average growth over time or growth velocity was assessed for weight (g/kg/d), head circumference (cm/d) and length (cm/d). Growth parameters at birth and discharge were plotted using the Olsen 2010 Growth Calculator for Preterm Infants to obtain standardized assessments of growth percentiles. Key growth factors were examined against the primary investigational outcomes of continued breastmilk provision at discharge and length of hospital stay. Variables included infant characteristics, number of daily direct-to-breast feedings (identified as traditional oral breastfeeding), and maternal characteristics. Statistical tests included student t-test and chi square. Logistic regression models were used to evaluate data and multiple regression was used to examine growth variables.

RESULT: In this cohort, 44% of mothers continued to provide breastmilk at the time of infant discharge. Growth velocity was a significant predictor of continued provision of breastmilk at discharge (p=0 0.002, OR 1.39). Ponderal index, combined with other variables were highly predictive of length of stay (p<0.001, R2 =0.858). Those infants whose first oral feed was direct-to-breast (versus bottle) were more likely to still be receiving breastmilk at discharge (adj OR 5.3).

CONCLUSION: First oral feed being direct-to-breast and higher growth velocity are supportive of continued breastmilk provision throughout hospitalization. These results highlight a need for additional breastfeeding support for mother-infants dyads who provided a bottle as the first oral feed or with poorer growth progression.