The Impact of Neonatal Service ReOrganisation on Feeding of Preterm Infants (<34 Weeks): A Prospective Cohort Study in a Regional Neonatal Unit from 1992 to 2010

Objectives: To describe Neonatal Intensive Care Unit (NICU) feeding practices during the neonatal period and explore predictors of any breast milk feeding at discharge among very preterm infants admitted before and after re-organisation of neonatal services in a region of the UK. Methods: Data on feeding of preterm infants (<34+0 weeks) at four time-points in the neonatal period and at discharge were collected prospectively on 1018 infants admitted to a regional NICU over a 19-year period. These data were subjected to unadjusted and adjusted analyses and time trends calculated before and after the transition. Results: Initiation of breast milk feeding in preterm infants increased throughout the study. However, the proportion of infants receiving breast milk declined steadily through the neonatal period and beyond. Before re-organisation, breast milk feeding (any) at discharge increased year-by-year (slope coefficient for trend 0.127, p<0.001). After re-organisation, the trend slowed down/decelerated (slope coefficient for trend 0.071, p 0.32). Any breast milk feeding at day 7 of life, singleton pregnancy, and length of hospital stay were associated with any breast milk feeding at discharge. Conclusions: Breast milk feeding of preterm infants increased in line with secular trends. However, this trend fell away following neonatal service reorganisation. This finding suggests that service providers and commissioners should monitor infant feeding trends in NICUs against national trends, as a benchmark of maternal and infant wellbeing and service delivery. The early predictors of any breast milk feeding at discharge found in this study need further research to validate their usefulness.

Author(s): Akuma Oti Akuma, Sue Jordan and Alan Watkins

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