Human Milk Feeding Rates Post-NICU Discharge
Human Milk Feeding Rates Post-NICU Discharge
The purpose of this study is to discover the incentives and barriers to human milk use and
 breast-feeding in the NICU graduate. By better understanding the incentives and barriers we
 believe we can define better methods for promoting higher rates and longer duration of human
 milk use in this medically fragile population.
The AAP continues to reaffirm its recommendation of exclusive breast feeding for about 6
 months, with continuation of breastfeeding as complementary feeding starts. Ideally,
 breastfeeding continues for the first year of life. NICUs have implemented increasing use of
 human milk with reports of more than 80 percent of infants receiving at least some human milk
 at discharge. Research has shown that breastfeeding rates in preterm infants and initiation
 of breastfeeding at discharge are far less than that of term infants (Mastrup, 2014). Yet
 studies continue to show the ongoing benefits of breast milk initiation in low birth weight
 neonates while they are in the NICU and better developmental outcomes at 30 months of age
 (Vohr, Poindexter, Dusick, McKinley, et al., 2007). A large cohort of low birth weight
 infants studied revealed that those who were given breast milk early in their hospitalization
 and continued receiving it , whether expressed or breast fed, had less frequent
 re-hospitalizations and higher Bayley Developmental scores for emotional regulation at 30
 months of age. Additionally, as their breast milk volume exposure increased, these children
 had improved mental development index and total behavioral index improvement as well.

 In a CQI survey done in three NICU follow up clinics, we discovered that only about 30
 percent were still breastfeeding at 1-3 months post discharge. There are a few studies
 investigating factors which contribute to increased human milk post discharge. Factors
 studied include kangaroo care, quick access to pumping support, and history of breast feeding
 while in the NICU.

 There are a few studies investigating factors which contribute to increased human milk use
 post discharge. Callen and Pinelli found that successful breast feeding in preterm infants
 (mean gestation 28 weeks) was more likely in mothers who pumped early and continued
 diligently. In addition to early pumping and lactation support, kangaroo care, and having the
 experience of breast feeding while still in the NICU have been associated with longer use of
 human milk and successful breast feeding after discharge. Pineda (2011) looked at the effects
 of breast-feeding while in the NICU and whether the first oral sucking feeding was at the
 breast in preterm infants. Mean gestational age when the infant was put to breast was 33.1
 weeks + 1.59 weeks. Though challenging for mothers, the ability to continue to maintain
 breast-feeding during the NICU stay and until discharge as well as having the first feed be
 at the breast increased overall duration of breast-feeding duration after discharge. Direct
 breast-feeding also increases oxytocin levels in the mother, which leads to psychological
 benefits such as improved maternal response and improved attachment behaviors. These factors
 may indirectly lead to improved use of breast milk.

 This study will investigate which babies are receiving human milk, either expressed or breast
 fed at varying times post discharge, and further explores NICU factors which may foster or
 inhibit increasing breast milk use in NICU graduates.
Inclusion Criteria:

 -  Survival to discharge

 -  Site ability to plan and implement developmental follow-up for two years corrected age

 Exclusion Criteria:

 -  Parents unwilling to participate in follow-up