Predictive factors of the interruption of exclusive breastfeeding in premature infants: a prospective cohort

Luz, Lucyana Silva; Minamisava, Ruth; Scochi, Carmen Gracinda Silvan; Salge, Ana Karina Marques; Ribeiro, Laiane Medeiros; Castral, Thaíla Corrêa

doi:10.1590/0034-7167-2017-0762

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Brasil

Revista Brasileira de Enfermagem

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Sumário

RESEARCH • Rev. Bras. Enferm. 71 (6) • Nov-Dec 2018 • https://doi.org/10.1590/0034-7167-2017-0762 copy

Predictive factors of the interruption of exclusive breastfeeding in premature infants: a prospective cohort

Factores predictivos de la interrupción de la lactancia materna exclusiva en prematuros: cohorte prospectiva

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

to evaluate the incidence of exclusive breastfeeding and the risk factors associated to its interruption in premature infants after hospital discharge.

Method:

this is a prospective cohort with 113 premature infants in a neonatal unit, whom were followed-up from 7 to 15 days after hospital discharge. The outcome was the interruption of exclusive breastfeeding. Maternal and neonatal exposure variables were evaluated by a regression model and described by the confidence interval (95%) and risk ratio.

Results:

exclusive breastfeeding rate was 81.4% at discharge and 66.4% at 7 to 15 days after discharge. Double gestation, time of mechanical ventilation and birth weight were associated with higher risks of interruption of exclusive breastfeeding after discharge.

Conclusion:

there is a need for the implementation of actions that promote the early onset and maintenance of exclusive breastfeeding of premature infants.

Descriptors:
Premature; Breast Feeding; Neonatal Intensive Care Unit; Patient Discharge; Cohort Studies

Type of breastfeeding	fǂ	%#
Hospital discharge
Exclusive Breastfeeding	92	81.4
Breastfeeding	15	13.3
Bottle feeding	5	4.4
Prevailing Breastfeeding	1	0.9
Second week after hospital discharge
Exclusive Breastfeeding	75	66.4
Breastfeeding	19	16.8
Prevailing Breastfeeding	11	9.7
Bottle feeding	8	7.1

Exposure variables	Exclusive Breastfeeding				p value*
	No		Yes
	fǂ	%#	fǂ	%#
MATERNAL
Mother with extreme age (≤18 or ≥35 years)
Yes	12	32.4	25	67.6	0.974
No	26	34.2	50	65.8
Maternal education
Up to High School	26	31.3	57	68.7	0.367
Higher Education	12	40.0	18	60.0
Parents live together
No	4	33.3	8	66.7	0.267
Yes	34	33.7	67	66.3
Primípara
Yes	19	31.1	42	68.9	0.181
No	19	36.5	33	63.5
Underwent six or more prenatal consultations
No	14	34.1	27	65.9	0.296
Yes	24	33.3	48	66.7
Prior experience with breastfeeding
No	29	37.2	49	62.8	0.525
Yes	9	25.7	26	74.3
There were problems with the breasts
Yes	2	8.3	22	91.7	0.070^* * p < 0.10,
No	36	40.4	53	59.6
Double gestation
Yes	12	60.0	8	40.0	0.002^* * p < 0.10,
No	26	28.0	67	72.0
Delivery type
Cesarean section	29	35.8	52	64.2	0.219
Vaginal	9	28.1	23	71.9
NEONATAL
Gender
Female	16	29.6	38	70.4	0.330
Male	22	37.3	37	62.7
Gestational age at birth
< 28 – extreme	3	37.5	5	62.5	0.000^* * p < 0.10,
28-31 – moderate	13	39.4	20	60.6	0.000^* * p < 0.10,
32-37 – borderline	22	30.6	50	69.4
Hospitalization time
> 30 days	24	46.2	28	53.8	0.014^* * p < 0.10,
≤ 30 days	14	23.0	47	77.0
Ventilation time
> 7 days	8	42.1	11	57.9	0.001^* * p < 0.10,
7 days	30	31.9	64	68.1	<=
Age of first milk feeding
> 24 hours	18	46.2	21	53.8	0.306
≤ 24 hours	20	27.0	54	73.0
Sucked on the breast on the first week of life
No	26	40.0	39	60.0	0.000^* * p < 0.10,
Yes	12	25.0	36	75.0
Exclusive breastfeeding at discharge
No	20	95.2	1	4.8	0.112
Yes	18	19.6	74	80.4
	Mean	SD#	Mean	SD\|	p *value^ * p < 0.10,**
Household income (BRL)	1.762.8	9	1.983.0		0.881
Birth weight (in grams)	1.452	454.0	1.686	565.0	0.000^* * p < 0.10,

Variables	Beta	p value	Adjusted hazard risk	Confidence interval (95%)
Problems with the breasts	-1.362	0.071	0.256	0.058 a 11.213
Double gestation	1.503	0.001^* * p < 0.05.	4.495	1.802 a 11.213
Gestational age at birth
< 28 weeks	-1.391	0.106	0.249	0.046 a 1.344
28-31 weeks	-0.163	0.788	0.849	0.258 a 2.707
32-37 weeks
Birth weight (in grams)	0.001	0.038^* * p < 0.05.	1.001	1.000 a 1.002
Hospitalization time	-12.128	0.882	0.000	0.000 a 2.367
Ventilation time	-1.941	0.016^* * p < 0.05.	0.144	0.030 a 0.694
Gender	-0.385	0.297	0.680	0.330 a 1.403
Sucked on the breast on the first week of life	-0.606	0.284	0.545	0.180 a 1.654

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[1] CORRESPONDING AUTHOR: Thaíla Corrêa Castral. E-mail: thaccastral@gmail.com