P0324 - Breastfeeding Practice Before Bottle Feeding Increases Breastfeeding Rates for Preterm Infants at Time of NICU Discharge

Background
In our NICU, efforts over several years have resulted in improved rates of breast milk feeds for preterm infants at time of NICU discharge, but rates of actual breastfeeding have remained low.

Aim
We aimed to increase the rate of preterm infants who were breastfeeding at the time of NICU discharge.

Methods
We created a Preterm Breastfeeding Pathway (PBP) algorithm for infants who were cleared for oral feeding and whose mothers desired to breastfeed. If mothers could be present for at least 3 feedings a day, we deferred introduction of bottle feeding for 72 hours and gave full gavage feedings during cue-based breastfeeding practice. After 72 hours of breastfeeding practice, babies continued to practice breastfeeding with full gavage support when mother was present and practice bottle feeding with gavage support when mother was absent. After 35 weeks corrected gestational age (CGA), breastfeeding intake was estimated by pre/post weights or time/quality of feeding and gavage volume was adjusted until baby was weaned off gavage feeds. In addition to breastfeeding and breast milk feeding at time of NICU discharge, we documented birth gestational age and weight, gender, CGA at first oral feed and full oral feeds, days from first to full oral feeds, as well as days of life and CGA at NICU discharge.

Results
Seventy-five preterm infants (birth GA <33 weeks) who had met criteria for the PBP were discharged from our 84-bed Level 4 NICU between April and December 2019. By chart review, we compared babies who received 72 hours of breastfeeding practice before introducing a bottle (Group 1, n=27) with babies who were introduced to bottle feeding with or before breastfeeding (Group 2, n=15) and babies who were primarily bottle fed (Group 3, n=33). We found that babies in Group 1 had significantly higher rates than those in Groups 2 or 3 for breastfeeding (88.9%, 66.7%, 3% respectively, p<0.001) and breast milk feeding (100%, 86.7%, 39.4% respectively, p<0.001) at time of NICU discharge. A slight difference in gestational age at birth among groups was found, but there were no statistical differences in CGA at first oral feed or full oral feeds, days from first to full oral feeds, CGA or days of life at NICU discharge.

Discussion/Conclusion
Introducing breastfeeding practice before bottle feeding may contribute to increased rates of breastfeeding by supporting mothers who are already highly motivated to breastfeed. Preterm infants may learn to breastfeed easier if allowed to practice breastfeeding before bottles are introduced. Preterm babies and their mothers can be supported in direct breastfeeding without increasing time to full oral feeds or length of NICU stay.