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Breastfeed Med. 2017 Dec 6. doi: 10.1089/bfm.2017.0135. [Epub ahead of print]

The Type of Feeding at Discharge of Very Preterm Infants: Neonatal Intensive Care Units Policies and Practices Make a Difference.

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1 EPIUnit-Instituto de Saúde Pública, Universidade do Porto , Porto, Portugal .
2 Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto , Alameda Prof. Hernâni Monteiro, Porto, Portugal .
3 INSERM UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University , Paris, France .



To assess the influence of neonatal intensive care units (NICUs) on feeding practices at discharge of Portuguese very preterm infants.


We analyzed data from 580 very preterm infants (<32 gestational weeks) discharged home from NICUs of two Portuguese regions and enrolled during 2011-2012 in Effective Perinatal Intensive Care in Europe population-based cohort. Maternal and infant characteristics were abstracted from medical records, and heads of NICUs provided the units characteristics. Feeding at discharge was classified as exclusive formula, exclusive breast milk or mixed, and differences among NICUs were obtained by comparison with pooled geometric mean odds of all NICUs, using multinomial logistic regression. Median odds ratios (MOR) were calculated to quantify variability among NICUs using multilevel logistic regression.


At discharge, 25.2% very preterm infants were exclusively on breast milk, 34.1% exclusively on formula, and 40.7% had mixed feeding, with a wide variation among NICUs. Exclusive breast milk increased in NICUs that had higher numbers of admissions, provided parents eating facilities, and by having designated members to support mothers who were breastfeeding. The individual NICU odds of mixed versus exclusive formula feeding ranged from 0.36 to 2.07 and for exclusive breast milk versus exclusive formula ranged from 0.16 and 5.11. Adjusting for individual and unit characteristics, heterogeneity across NICUs remained evident, being the MOR 1.33 for mixed feeding and 1.35 for exclusive breast milk.


NICUs influence feeding practices independently of individual characteristics, highlighting the importance of institution-based interventions to promote breast milk.


EPICE project; breast milk; breastfeeding; infant; intensive care units; neonatal; premature


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