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Changes in the prevalence of breast feeding in preterm infants discharged from neonatal units: a register study over 10 years
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics. Ctr Clin Res Dalarna, Falun, Sweden.;Falun Cent Hosp, Dept Pediat, Falun, Sweden..
Dalarna Univ, Sch Educ Hlth & Social Studies, Falun, Sweden..
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
Univ Orebro, Sch Hlth Sci, Fac Med & Hlth, Orebro, Sweden..
2016 (English)In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 6, no 12, article id e012900Article in journal (Refereed) Published
Abstract [en]

Objective: There are indications that the prevalence of exclusively breastfed preterm infants is decreasing in Sweden. The objective was to investigate trends in exclusive breast feeding at discharge from Swedish neonatal units and associated factors in preterm infants. Design, setting and participants: This is a register study with data from the Swedish Neonatal Quality Register. Data from 29 445 preterm infants (gestational age (GA) < 37 weeks) who were born during the period 2004-2013 were retrieved. Data included maternal, perinatal and neonatal characteristics. Data were analysed for the whole population as well as for 3 GA groups. Results: From 2004 to 2013, the prevalence of exclusive breast feeding decreased, in extremely preterm (GA 22-27 weeks) from 55% to 16%, in very preterm (GA 28-31 weeks) from 41% to 34% and in moderately preterm infants (GA 32-36 weeks) from 64% to 49%. The decline was statistically significant (p<0.001) in all 3 GA groups. This decline remained significant when adjustments were made for factors negatively associated with exclusive breast feeding and which became more prevalent during the study period, that is, small for GA (all groups) and maternal mental illness (very preterm and moderately preterm infants). Conclusions: In the past 10 years, Sweden has experienced a lower rate of exclusive breast feeding in preterm infants, especially in extremely preterm infants. The factors analysed in this study explain only a small proportion of this decline. The decline in exclusive breast feeding at discharge from neonatal units raises concern and present challenges to the units to support and promote breast feeding.

Place, publisher, year, edition, pages
2016. Vol. 6, no 12, article id e012900
National Category
Pediatrics
Identifiers
URN: urn:nbn:se:uu:diva-315938DOI: 10.1136/bmjopen-2016-012900ISI: 000391303600043PubMedID: 27965252OAI: oai:DiVA.org:uu-315938DiVA, id: diva2:1076453
Available from: 2017-02-22 Created: 2017-02-22 Last updated: 2017-11-29Bibliographically approved
In thesis
1. Breastfeeding in mothers of preterm infants: Prevalence and effects of support
Open this publication in new window or tab >>Breastfeeding in mothers of preterm infants: Prevalence and effects of support
2018 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The overall aim of this thesis was to describe the prevalence of breastfeeding in preterm infants and to evaluate the effectiveness and mother’s experiences of proactive person-centred telephone support after discharge. Furthermore, to describe the duration of breastfeeding and risks of ceasing breastfeeding up to 12 months. The first study, a register study with data from the Swedish Neonatal Quality register (SNQ), included breastfeeding data at discharge from 29 445 preterm infants born from 2004-2013. The results demonstrated that the prevalence of exclusive breastfeeding among preterm infants in Sweden decreased during the study period, especially among extremely preterm infants (<28 weeks). We also performed a multicentre randomised controlled trial (RCT) of 493 breastfeeding mothers of preterm infants discharged from six neonatal units in Sweden. The intervention consisted of a proactive breastfeeding telephone support system in which a breastfeeding support team called the mothers once everyday up to 14 days after discharge. The control group received reactive support; the mothers were invited to call the breastfeeding support team if they wanted to talk or ask any questions (i.e., usual care).

The RCT demonstrated that the intervention did not affect exclusive breastfeeding at eight weeks after discharge (primary outcome) or up to 12 months. The proactive support did not affect maternal breastfeeding satisfaction, attachment, quality of life or method of feeding (secondary outcomes). However, parental stress was significantly reduced in mothers in the intervention group. Mothers in the intervention group were significantly more satisfied and involved in the support and felt empowered compared with mothers in the control group, who experienced reactive support as dual. Further findings showed that a lower maternal educational level, partial breastfeeding at discharge and longer stay in the neonatal unit increased the risk of ceasing breastfeeding during the first 12 months of postnatal age. In conclusion, the trend for exclusive breastfeeding at discharge in preterm infants is declining, which necessitates concern. The evaluated intervention of telephone support did not affect breastfeeding, in the short-or long-term. However, maternal stress was reduced and mothers were significantly more satisfied with the proactive support and felt empowered by the support.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2018. p. 69
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1398
Keyword
Breastfeeding, preterm infant, mother, support, prevalence
National Category
Pediatrics
Research subject
Pediatrics
Identifiers
urn:nbn:se:uu:diva-333575 (URN)978-91-513-0161-7 (ISBN)
Public defence
2018-01-18, Föreläsningssalen, Falu lasarett, Falun, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2017-12-22 Created: 2017-11-23 Last updated: 2018-03-08

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