Introduction

The first months at home may be troublesome for mothers of preterm infants (< 37 gestational weeks) due to lack of support and thereby an increased risk for ceasing breastfeeding (Kair, Flaherman, Newby, & Colaizy, 2015; Niela-Vilen, Axelin, Melender, & Salantera, 2015). Breastfeeding prevalence in preterm infants is lower than in term infants and decreases during the first months at home (Akerstrom, Asplund, & Norman, 2007; Flacking, Nyqvist, Ewald, & Wallin, 2003). The aim of this trial was to evaluate the effects of a proactive breastfeeding telephone support to mothers of preterm infants on breastfeeding, method of feeding and to describe breastfeeding duration and risks for ceasing breastfeeding up to one year of infant age.

Method

This is a multicentre randomized controlled trial with six neonatal units in Sweden participated. At each unit a breastfeeding support team, BST (10 staff/unit) recruited, randomized and delivered the telephone support to eligible and participating mothers. The intervention was a proactive telephone call initiated by the BST day 1-14 after discharge from the neonatal unit. In the control group, the mothers received a telephone number to the BST if they wanted to call and ask or talk about anything. The outcomes reported were breastfeeding, method of feeding, duration of and risks for ceasing breastfeeding. All researchers were blind to group allocation throughout the study period.

Results

In total 493 mothers were randomized. There were no statistical significant differences between intervention (n=231) and control (n=262) group on breastfeeding, at discharge (OR 0.70, 95% CI 0.44-1.12, p=0.09), eight weeks after discharge (OR 1.12, 95% CI 0.75-1.69, p=0.45), six months (OR 1.21, 95% CI 0.78-1.88, p=0.29) and 12 months (OR 0.87, 95% CI 0.42-1.79, p=0.52) of infant age. Not either on method of feeding. Most infants received human milk directly at the breast; few infants received human milk by bottle, cup or tube feeding. At discharge, eight weeks after discharge and six months of infant age 82%, 58% and 23% of the infants were exclusively breastfed respectively. At 12 months of infant age, 21% were partially breastfed. Partial breastfeeding at discharge (HR 1.81, 95%CI 1.35-2.41, p=<0.001) and secondary school or lower maternal educational level (HR 1.42, 95%CI 1.13-1.79, p=0.003) increased the risk for ceasing breastfeeding during the infants first year of life. A shorter length of stay in weeks reduced the risk of ceasing breastfeeding during the infants first year of life (HR 0.96, 95% CI 0.92-0.99, p=0.021).

Conclusion

A two-week daily proactive telephone breastfeeding support did not affect exclusive breastfeeding and method of feeding during the infants first year of life. Few infants received human milk by other method than at breast-feeding. However, partial breastfeeding at discharge from the neonatal unit, secondary school or lower maternal educational level and longer hospital stay significantly increased the risk for ceasing breastfeeding during the infants first year of life. The study gives a unique long-term follow-up on breastfeeding in preterm infants.