A Review of the Literature Examining the Benefits and Challenges, Incidence and Duration, and Barriers to Breastfeeding in Preterm Infants

Jennifer Callen, RNC, MSC; Janet Pinelli, RNC, MSCN, DNS

Disclosures

Adv Neonatal Care. 2005;5(2):72-88. 

In This Article

Abstract and Introduction

Breastfeeding benefits preterm infants from a nutritional, gastrointestinal, immunological, developmental, and psychological perspective. Despite the benefits, the incidence and duration of breastfeeding preterm infants continues to be less than that of full-term infants. The lower incidence is probably related to breastfeeding challenges that preterm infants and parents face, including establishing and maintaining a milk supply and transitioning from gavage feeding to breastfeeding. In order to increase the incidence and duration of breastfeeding preterm infants, researchers must examine breastfeeding experiences longitudinally. This way, researchers and clinicians can begin to understand the barriers to breastfeeding at various time periods in the breastfeeding experience and begin implementing strategies to remove these barriers.

Despite the documented benefits of human milk, the incidence and duration of breastfeeding preterm infants continues to be less than that of full-term infants. In the United States, while 69% of term infants and mothers initiate either partial or exclusive breastfeeding,[1] the average rate of breastfeeding for preterm infants is approximately 50% at hospital discharge.[2,3] The incidence and duration of breastfeeding in preterm infants has been reported in a number of studies published from 1990 to 2001.[2—13] Unfortunately, the results of this body of research are difficult to interpret because of methodological problems, differences in breastfeeding definitions, and wide ranges in the gestational ages of the infants studied.

Breastfeeding preterm infants presents unique challenges that include establishing and maintaining a milk supply and transitioning from gavage feeding to breastfeeding. Mothers of preterm infants must pump for weeks or months until their infant is able to feed directly from the breast.[14] Studies examining the optimal stage for infants to begin breastfeeding agree that the infant must be physiologically stable.[15,16] Non-nutritive sucking[17] and kangaroo care may also help infants transition from gavage feeding to breastfeeding by providing infants with experience at the breast and enhancing the maternal milk supply.[18]

In order to increase the incidence and duration of breastfeeding, interventions to support and educate breastfeeding mothers have been implemented in various hospital and community settings.[4,10,11,13] Unfortunately, the implementation of programs that involve training registered nurses and lactation consultants to provide directed breastfeeding support are based on nonexperimental study designs that provide no data regarding the incidence and duration of breastfeeding in comparison to nonintervention control groups.[4,10,13] To effectively intervene, caregivers must be aware of the specific problems inherent in this high-risk population.

Since 1990, only 6 studies have investigated barriers to the successful establishment and maintenance of breastfeeding in the low-birthweight (LBW; BW < 2500 g) and preterm population (< 37 weeks gestational age).[2,3,6,7,18,19] None of these studies used a longitudinal design to identify barriers to breastfeeding in LBW infants up to 12 months corrected age or until weaning from breastfeeding. This gap in knowledge may lead to clinical practice, research, and education that does not customize interventions to the specific problems encountered by very-low-birthweight (VLBW) infants and their mothers at various time periods throughout the breastfeeding experience.

This article examines current research that documents the benefits of human milk for preterm infants, the challenges to breastfeeding VLBW infants, and the incidence and duration of breastfeeding for preterm infants. It also reviews the literature identifying barriers to the successful establishment and maintenance of breastfeeding in preterm infants and discusses the strengths and limitations of this body of research.

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