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Pattern of Breastfeeding of Preterm Infants in Hospitals and After Discharge

2003; King Faisal Specialist Hospital and Research Centre; Volume: 23; Issue: 3-4 Linguagem: Inglês

10.5144/0256-4947.2003.220

0975-4466

Mohammed K.M. Khalil, Yasser S AI-Ghamdi, Omer A Al-Yahia, Al-Ameen Subahee, Roula Barmada Sate,

Neonatal Respiratory Health Research

Brief ReportsPattern of Breastfeeding of Preterm Infants in Hospitals and After Discharge Mohammed K.M. Khalil, MB Bch, MSc, MPH, MD Yasser S AI-Ghamdi, DCH, FRCP Omer A Al-Yahia, MBBS, ABFM Al-Ameen Subahee, and DCH, FRCP Roula Barmada SateMBBS, ABP Mohammed K.M. Khalil Correspondence to: Dr. M. Khalil P.O. Box 2290 Buaridah, Al Qassim Saudi Arabia From the Professional Education Department(MERC), King Fahad Specialist Hospital, Buraidah, Al Qassim, Saudi Arabia Search for more papers by this author , Yasser S AI-Ghamdi From the Professional Education Department(MERC), King Fahad Specialist Hospital, Buraidah, Al Qassim, Saudi Arabia Search for more papers by this author , Omer A Al-Yahia From the Professional Education Department(MERC), King Fahad Specialist Hospital, Buraidah, Al Qassim, Saudi Arabia Search for more papers by this author , Al-Ameen Subahee From the Professional Education Department(MERC), King Fahad Specialist Hospital, Buraidah, Al Qassim, Saudi Arabia Search for more papers by this author , and Roula Barmada Sate From the Professional Education Department(MERC), King Fahad Specialist Hospital, Buraidah, Al Qassim, Saudi Arabia Search for more papers by this author Published Online:1 May 2003https://doi.org/10.5144/0256-4947.2003.220SectionsPDF ToolsAdd to favoritesDownload citationTrack citations ShareShare onFacebookTwitterLinked InRedditEmail AboutIntroductionInfants born before 37 weeks of gestational age are defined as premature. These infants, who usually weigh less than 2500 g, constitute about 10% of all births.1 A substantial proportion of them require hospitalization before they are fit for discharge.During hospitalization, many factors may negatively affect the initiation and sustainability of breastfeeding. The American Academy of Pediatrics recommends that breastfeeding begin within one hour of delivery,2 but this is impossible in hospitalized premature infants. Conflicting advice may also contribute to this problem.3The factor that probably has the greatest negative effect on breastfeeding is the feeding pattern for preterm infants in the neonatology unit, where expressed breast milk for feeding of preterm or low birth weight infants is not consistently available. Although published data show that human milk provides adequate nutrition to facilitate growth in term infants, this may not be the case in preterm infants.4 Term (mature) human breast milk, compared with artificial formula, may provide insufficient nutrition for growth and development in preterm or low birth weight infants. The nutritional requirements of these infants, who are born with relatively impoverished nutrient reserves and are subjected to additional metabolic stress compared with term infants, may not be fully met by enteral feeding with human milk.5,6 In addition, the use of formula feeding, compared with unfortified term human milk, leads to a greater rate of growth in the short term. However, human milk may be better tolerated. The Multicenter Trial of Early Diet, which included 1000 infants from five neonatal centers, demonstrated better feeding tolerance among breastfed infants than among formula-fed infants, as evidenced by shorter time to full enteral feedings and a lower incidence of necrotizing enterocolitis.7 However, the two options are not mutually exclusive; even when formula is needed, breastfeeding can be maintained as a complementary measure.8Because of concerns about the nutritional adequacy of expressed breast milk and its lack of availability during hospitalization, exclusive breastfeeding is less likely to occur in the preterm infant compared with normal children, even after discharge.The aim of this study was to compare the pattern of breastfeeding in preterm infants before and after discharge with that of normal infants in the Al-Qassim region of Saudi Arabia.METHODSOur follow-up study was conducted at the two hospitals in Buraidah city, Qassim, in the central region of Saudi Arabia, with neonatology units. All infants born in these units with <37-week gestation period or a weight <2500 grams (low birth weight) during a six-month period in 2001 were included in the study. Infants with congenital anomalies were excluded. For each newborn, we recorded gestational age, anthropometric measures at birth, feeding pattern in the hospital and at discharge, discharge weight and feeding pattern one month after discharge. The feeding pattern one month after discharge was compared with that of a control group of infants during their first vaccination visit at a primary health care center (PHC) for routine immunizations at 6 to 8 weeks of age. Two hundred infants recruited for the control group were selected randomly from ten PHCs in the city of Buraidah. Exclusive breast-feeding was defined as receiving only breast milk (no other liquid or solids); mixed or partially breast-fed was defined as receiving other milk in addition to breast milk, and formula-fed was defined as receiving only formula.Data were analyzed using SPSSPC v10. To compare the study and control groups, we used the chi-square test.RESULTSThe 91 preterm infants in the study included 43 from King Fahad Specialist Hospital (KFSH) and 48 from the Maternity and Childrens Hospital (MCH). There were 44 males and 47 females.The mean gestational age was 33.75 (±2.2) weeks with a mean birth weight of 1883.66 (±400) g. Fourteen newborns weighed less than 1500 grams. The mean length of stay was 12.2 (±14.4) days and the mean discharge weight was 2065 (±233) g. On discharge 13.2% (12/91) were on mixed breast and preterm formula feeding, while 86.8% (79/91) wereexclusively on preterm formula. This pattern did not differ between the 14 infants of very low birth weight (VLBW) (<1500 grams) and the low birth weight (LBW) infants (the rest of the group).When asked why they did not breast feed their infant, most mothers 75.9% (60/79) stated they were not available most of the time. The remainder said they did not have enough milk.One month after discharge, 59 of the 91 preterm infants attended the follow up clinic. Of the 59,20.3% were on mixed feeding, 59.3% were taking only formula and 20.3% were breast-feeding (Table 1). Those discharged on formula only were more likely to continue that feeding pattern compared with those discharged on mixed breast/formula (70% vs. 44% on the same feeding pattern, respectively; P=0.0001). In other words, breastfeeding at one month after discharge was more common in those discharged on a mixed breast/formula feeding than in those discharged on formula. Twenty-five percent of those discharged on formula had changed to another brand one month later.Table 1. Comparison of the feeding pattern of preterm infants one month after hospital discharge and normal infants at 6-8 weeks of age.Table 1. Comparison of the feeding pattern of preterm infants one month after hospital discharge and normal infants at 6-8 weeks of age.Although VLBW infants had a feeding pattern similar to the LBW infants at discharge, 80% (10/14) of the VLBW were on formula exclusively compared with 55% (27/49) of the LBW infants one month after discharge. The difference was not statistically significant, possibly because of the small sample size.Compared with the preterm infants, normal infants were more likely to be breastfeeding exclusively at the age of 6 to 8 weeks (P=0.008) or receiving a mixed feeding (P =0.03), while preterm infants were more likely to be receiving formula exclusively (P =0.0001) (Table 1).DISCUSSIONAlthough breast-feeding of preterm and low birth weight infants is gaining wider acceptance and numerous studies support its safety and effectiveness, our data suggest that preterm and low birth weight (LBW) infants are less likely to be breastfed at all or are breast fed for shorter periods. Our study showed no difference in the feeding pattern between LBW and very low birth weight (VLBW) infantson discharge. More than 80% of both groups were on formula feeding exclusively. This suggests that the neonatology unit setting itself is more likely than the feeding pattern to affect successful breastfeeding. Successful breastfeeding after discharge depends on the preparation for and initiation of breastfeeding of preterm infants during hospitalization. In another study of the breastfeeding patterns of LBW infants, (1500-2500 g body weight) on the day of hospital discharge and 4 weeks later, 38% of infants were exclusively breast fed on the day of hospital discharge and 40% of infants were exclusively breast fed at 4 weeks.9The 40% rate of exclusive breast-feeding in normal children at 6 to 8 weeks in our study is comparable to published data from other Saudi studies. In Riyadh city, one study showed that 32.4% and 22.1% of the Saudi infants were exclusively breast-fed at 3 and 6 months respectively.10 The same study showed that 18.2%, 48,4% and 65% were exclusively bottle fed at 3, 6 and 12 months, respectively. Other data showed that over half of the children had been bottle-fed with infant formula at some stage.11Breastfeeding is a key public health measure, offering benefits to both mother and infant. Exclusive breastfeeding for six months is recommended as general policy in both developed and developing countries.12,13 Data from our study and others show that exclusive breastfeeding in Saudi Arabia is not concordant with current global recommendations. Consideration needs to be given to the revision of local and national policy to reflect the evidence-based approach to the promotion of breastfeeding. There is some evidence to suggest that small, informal discussion classes led by health professionals that emphasize the benefits of breast feeding and provide practical advice can increase the initiation of breast feeding.14,15 While family support is essential for all lactating mothers,16 extra attention and support are needed for mothers of preterm infants.The dispensing of commercial hospital discharge packs, especially those that contain formula, appears to reduce the number of exclusively breastfed infants, but not the early termination of mixed feeding. The high level of exclusive formula use in our study (86% at discharge, 75% on the same brand one month after discharge) suggests that mothers are influenced by the easy availability of the commercial formulas provided in the hospital.17The results of our study support evidence from other studies that there is a strong and consistent effect of LBW on infant feeding patterns.18 To initiate and sustain breastfeeding in the NICU setting, mothers need to express milk until the infant is well enough to begin breastfeeding.19 The support needed to accomplish this can be provided by a lactation specialist.ARTICLE REFERENCES:1. Berkowitz GS, Papiernik E. "Epidemiology of preterm birth" . Epidemiol Rev. 1993; 15:414–43. Google Scholar2. American Academy of Pediatrics, Work Group on Breastfeeding. "Breastfeeding and the use of human milk" . Pediatrics. 1997; 100:1035–9. Google Scholar3. Jaeger M C, Lawson M, Filteau S. "The impact of prematurity and neonatal illness on the decision to breast-feed" . Journal of Advanced Nursing.. 1997; 25:729–37. Google Scholar4. McGuire W, Anthony MY. "Formula milk versus term human milk feeding for feeding preterm or low birth weight infants (Cochrane Review)" . In: the Cochrane Library, 1, 2002. Oxford: Update Software. Google Scholar5. Hay WW. "Nutritional rquirments of extremely low birth weight infants" . Acta Paediatr Suppl. 1994; 402:94–9. Google Scholar6. Schalner RJ. "Suitability of human milk for low-birthweight infant" . Clin Perinatal. 1995; 22:207–22. Google Scholar7. Arnold LDW. "Currents in human milk banking; Human milk for premature infants. An important health issue" . Journal of Human Lactation. 1993;(9):121–3. Google Scholar8. Pinell J, Atkinson SA, Saigal S. "Randomized trial of breastfeeding support in very low-birth-weight infants" . Arch Pediatr Adolesc MedMay2001; 155(5):548–53. Google Scholar9. Hill PD, Ledbetter RJ, Kavanaugh KL. "Breastfeeding patterns of low-birth-weight infants after hospital discharge" . Journal of Obstetric, Gynecologic, and Neonatal Nursing. 1997; 26:189–97. Google Scholar10. Al-Ayed IH, Qureshi Ml. "Breast feeding practices in Urban Riyadh" . J Trop Pediatr. 1998; 44(2):113–7. Google Scholar11. Wyen AH, Spencer AJ, Szuster FS. "Infant and child feeding practices: a preliminary investigation" . Aust Dent J. 1997; 42(1):54–8. Google Scholar12. Kramer MS, Kakuma R. "Optimal duration of exclusive breastfeedinf (Cochrane Review)" . The Cochrane Library, Issue 2, 2002. Oxford: Update Sofware. Google Scholar13. Cohen R, Brown KH, Canahaut J, Rivera LL, Dewey KG. "Effect of age of introduction of complementary foods on infants breast milk intake, total energy intake, and growth: a randomized intervention study in Honduras" . Lancet. 1995; 344:288–93. Google Scholar14. NHS Center for Reviews and Dissemination. "Promoting the initiation of breast feeding (provisional record)" . Effective Health Care.. 2000; 6(2):12. Google Scholar15. Fairbank L, O’Meara S, Renfrew MJ, Woolridge M, Sowden AJ, Lister D. "A systematic review to evaluate the effectiveness of interventions to promote the initiation of breast feeding," . Health Technol Assess.. 2000; 4(25):1–171. Google Scholar16. Haider R, Kabir I, Hamadani JH, Habte D. "Reasons for failure of breast-feeding: Mothers’ perspectives in Bangladesh" . Bulletin of the World Health Organization.. 1997; 75(3):191. Google Scholar17. Donnelly A, Snowden HM, Renfrew MJ, Woolridge MW. "Commercial hospital discharge packs for breast feeding women. (Cochrane review)" . The Cochrane Library, 1, 2002. Oxford: Update Software. Google Scholar18. Adair LS, Popkin BM. "Low birth weight reduces the likehood of breast-feeding among Filipino infants" . The Journal of Nutrition. 1996; 126(1):103. Google Scholar19. Barton AJ, Danek G, Owens B. "Clinical and economic outcomes of infants receiving breast milk in the NICU" . Journal of Society of Pediatric Nurses. 2001; 6(1):5–10. Google Scholar Previous article Next article FiguresReferencesRelatedDetailsCited byAl-Jassir M, El-Bashir B and Moizuddin S (2019) Surveillance of infant feeding practices in Riyadh city, Annals of Saudi Medicine , 24:2, (136-140), Online publication date: 1-Mar-2004. Volume 23, Issue 3-4May-July 2003 Metrics History Accepted1 January 2003Published online1 May 2003 ACKNOWLEDGEMENTThis study was partially supported by Wyeth Nutritional company. The authors acknowledge with thanks the contribution and efforts of their colleagues in KFSH and MCH and Primary Health Care centers.InformationCopyright © 2003, Annals of Saudi MedicinePDF download