Exclusive breastfeeding of premature infants and reasons for discontinuation in the first month after hospital discharge

Lima, Ana Paula Esmeraldo; Castral, Thaíla Corrêa; Leal, Luciana Pedrosa; Javorski, Marly; Sette, Gabriela Cunha Schechtman; Scochi, Carmen Gracinda Silvan; de Vasconcelos, Maria Gorete Lucena

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Original Article • Rev. Gaúcha Enferm. 40 • 2019 • https://doi.org/10.1590/1983-1447.2019.20180406 copy

Exclusive breastfeeding of premature infants and reasons for discontinuation in the first month after hospital discharge

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective:

To estimate the prevalence of exclusive breastfeeding premature infants at hospital discharge, and after 15 and 30 days, and to identify the mothers’ claims for discontinuation.

Methods:

Cross-sectional study with 108 premature infants born in two Baby-Friendly Hospitals between April and July 2014. A survey was conducted on medical records and through telephone interviews. A descriptive analysis, Pearson’s chi-square test, and Fisher’s exact test were used, with a 95% confidence interval.

Results:

The prevalence of exclusive breastfeeding at discharge was 85.2%, 75% after 15 days, and 46.3% after 30 days. The main claim for the introduction of other foods and/or liquids was insufficient milk.

Conclusions:

There was a significant reduction in the rates of exclusive breastfeeding after discharge, pointing out the importance of continuity of patient care to reduce early weaning, especially with educational actions that help prevent real and perceived deficits in milk supply.

Keywords:
Breastfeeding; Infant, premature; Patient discharge; Continuity of patient care; Weaning

Variables	N	%
Gender
Female	63	58.3
Male	45	41.7
Twins
Yes	14	13.0
No	94	87.0
Gestational age (weeks)
Under 28 weeks	4	3.7
From 28 to 31 weeks	13	12.0
From 32 to 36 weeks	91	84.3
Minimum - Maximum	27.0 - 36.9
Mean (±Standard deviation)	33.7 (±2.2)
Birth weight (grams)(¹1. Sartorio BT, Coca KP, Marcacine KO, Abuchaim EDSV, Abrão ACFDV. Breastfeeding assessment instruments and their use in clinical practice. Rev Gaúcha Enferm. 2017;38(1):e64675. doi: https://doi.org/10.1590/1983-1447.2017.01.64675. https://doi.org/10.1590/1983-1447.2017.0... )
Less than 1500 g	21	19.8
1500 g to 2499 g	69	65.1
2500 g or more	16	15.1
Minimum - Maximum	620 - 3515
Mean (±Standard deviation)	1964 (±533)
Length of stay (days)
Minimum - Maximum	3 - 94
Mean (±Standard deviation)	21 (±19)

Variables	Evaluation period			p-value
Variables	High	15 days	30 days
EBF
Yes	92 (85.2%)	81 (75.0%)	50 (46.3%)	<0.001(⁵5. Freitas BAC, Lima LM, Carlos CFLV, Priore SE, Franceschini SCC. Duração do aleitamento materno em prematuros acompanhados em serviço de referência secundário. Rev Paul Pediatr. 2016;34(2):189-96. doi: https://doi.org/10.1016/j.rpped.2015.10.005. https://doi.org/10.1016/j.rpped.2015.10.... )
No	16 (14.8%)	27 (25.0%)	58 (53.7%)
Type of BF
EBF(¹1. Sartorio BT, Coca KP, Marcacine KO, Abuchaim EDSV, Abrão ACFDV. Breastfeeding assessment instruments and their use in clinical practice. Rev Gaúcha Enferm. 2017;38(1):e64675. doi: https://doi.org/10.1590/1983-1447.2017.01.64675. https://doi.org/10.1590/1983-1447.2017.0... )	92 (85.2%)	81 (75.0%)	50 (46.3%)	<0.001(⁶6. Ministério da Saúde (BR). Secretaria de Atenção à Saúde. Departamento de Ações Programadas e Estratégicas. II Pesquisa de Prevalência de Aleitamento Materno nas Capitais Brasileiras e Distrito Federal. Brasília (DF): Ministério da Saúde; 2009 [citado 2018 out 18]. Disponível em: http://bvsms.saude.gov.br/bvs/publicacoes/pesquisa_prevalencia_aleitamento_materno.pdf.)
PBF(²2. Ministério da Saúde (BR). Secretaria de Atenção à Saúde. Departamento de Atenção Básica. Saúde da criança: aleitamento materno e alimentação complementar. 2. ed. Brasília (DF): Ministério da Saúde; 2015 [citado 2018 out 18]. Disponível em: http://bvsms.saude.gov.br/bvs/publicacoes/saude_crianca_aleitamento_materno_cab23.pdf.)	0 (0.0%)	8 (7.4%)	10 (9.3%)
BF(³3. Quigley M, Embleton ND, McGuire W. Formula versus donor breast milk for feeding preterm or low birth weight infants. Cochrane Database Syst Rev. 2018;(6):CD002971. doi: https://doi.org/10.1002/14651858.CD002971.pub4. https://doi.org/10.1002/14651858.CD00297... )	14 (13.0%)	17 (15.7%)	39 (36.1%)
MS(⁴4. Dereddy N, Talati A, Smith A, Kudumula R, Dhanireddy R. A multipronged approach is associated with improved breast milk feeding rates in very low birth weight infants of an inner-city hospital. J Hum Lact. 2015;31(1):43-6. doi: https://doi.org/10.1177/0890334414554619. https://doi.org/10.1177/0890334414554619... )	2 (1.8%)	2 (1.9%)	9 (8.3%)

Evaluated reasons	15 days		30 days		p-value
Evaluated reasons	N	%	N	%	p-value
Cultural/educational causes
Belief in the benefit of tea	4	25.0	1	3.2	0.312(¹1. Sartorio BT, Coca KP, Marcacine KO, Abuchaim EDSV, Abrão ACFDV. Breastfeeding assessment instruments and their use in clinical practice. Rev Gaúcha Enferm. 2017;38(1):e64675. doi: https://doi.org/10.1590/1983-1447.2017.01.64675. https://doi.org/10.1590/1983-1447.2017.0... )
Need for water	3	18.8	3	9.7
Insufficient/dried-up milk	5	31.3	24	77.5
Social causes
Professional health guidance	1	6.2	1	3.2
Convenience of the mother	0	0.0	1	3.2
Influence of third parties	0	0.0	1	3.2
Biological causes
Baby does not suck/sleepy baby	2	12.5	0	0.0
Baby does not sleep/cries a lot	1	6.2	0	0.0
Total	16	100	31	100

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[TFN7] Source: Research data, 2014

[TFN8] ¹1. Sartorio BT, Coca KP, Marcacine KO, Abuchaim EDSV, Abrão ACFDV. Breastfeeding assessment instruments and their use in clinical practice. Rev Gaúcha Enferm. 2017;38(1):e64675. doi: https://doi.org/10.1590/1983-1447.2017.01.64675.
https://doi.org/10.1590/1983-1447.2017.0... The total does not add up to the value of N, due to inconsistency in the medical record.