Preterm infants lose out on breastfeeding

Katelyn Chiang, MPH

The majority of infants are fed breast milk, but some of youngest, most fragile infants may be missing out on its benefits, according to a new report from the Centers for Disease Control and Prevention (CDC).

“Breast milk is the optimal source of infant nutrition. For infants born prematurely, breast milk is especially beneficial. However, our research shows that many medically fragile, high-risk infants might not be receiving breast milk during their first few days of life,” says Katelyn Chiang, MPH, a researcher for the CDC and lead author of the report.

In the new report, CDC researchers analyzed how many infants were receiving breast milk by gestational age. Overall, 83.9% of infants received breast milk, but extremely preterm infants received breast milk least, with 71.3% receiving breast milk compared with 76% of early preterm infants, 77.3% of later preterm infants, and 84.6% of term infants.¹

“These data highlight differences in receipt of breast milk across gestational ages. Although infants delivered at the earliest gestational ages may not be able to consume breast milk right away, hospitals and healthcare providers can support future breast milk feeding among these infants by helping mothers begin expressing milk soon after delivery and helping mothers maintain their milk supplies,” Chiang says. “We hope that in the future, more infants born prematurely will receive breast milk, which can help prevent infections such as necrotizing enterocolitis (NEC) and promote neurologic development. Ultimately, decreasing disparities in breast milk feeding may help improve infant morbidity and mortality.”

First-time national estimates

The surveillance reviewed data on more than 3 million infants, and the findings were published June 7 in the Morbidity and Mortality Weekly Report.

“These are the first near-national estimates of breast milk feeding by gestational age. Available data do not allow us to examine trends in these rates over time as breast milk-feeding information has only recently been collected on the birth certificate,” Chiang says. “Our research shows that fewer premature infants receive breast milk during their first few days of life compared with term infants. In the future, programs promoting breastfeeding might consider efforts to improve breast milk feeding among premature infants.”

The report acknowledges that breast milk is the optimal source of nutrition, and it focused on collecting data on intake by gestational age. Moving forward, the report suggests that hospitals implement policies and practices to ensure mothers and babies receive adequate support for breastfeeding, and that preterm infants are given breast milk “as soon as is medically feasible.”

Breast milk is particularly important for preterm infants, who account for 1 in 10 infants born in the United States, according to the report. It can help prevent sepsis, promote neurologic development, and more. Estimates for the receipt of breast milk have not been available by gestational age before, according to the report. With the availability of this data, however, researchers have issued a new call to action, with a focus on promoting breast milk for the youngest infants.

“These estimates suggest that many infants, particularly infants at high risk for medical complications, might not be receiving breast milk,” the report notes. “Efforts are needed to increase the implementation of existing evidence-based policies and practices that support breast milk feeding, particularly for medically fragile infants.”

Effect of socioeconomic factors

In addition to disparities by gestational age, researchers also noted differences in breast milk intake based on sociodemographic factors such as maternal race and ethnicity. Examining feeding practices among extremely preterm infants a little closer, the research team found that 67.1% of those delivered to black mothers and 60.7% of those delivered to American Indian/Alaska Native mothers received breast milk compared with 75% of extremely preterm infants delivered to mothers from other racial/ethnic groups. Additionally, infants born to mothers who were younger, unmarried, and less educated were also more likely to miss out on breast milk, the report notes.

Some mothers of preterm infants are unable to produce sufficient breast milk, the report notes, but the American Academy of Pediatrics promotes donor milk as the ideal alternative in these cases. However, access to donor milk can be difficult. According to the report, 66% of hospitals with level-3 neonatal intensive care units (NICUs) and 73% of level-4 NICUs reported using donor milk in 2015.

Chiang says she hopes the study will highlight the benefits of feeding breast milk at every gestational age and help clinicians close disparities.

“Our goal was to present newly available data on breast milk feeding by gestational age and to determine if disparities by gestational age exist. Ideally, these data will alert hospitals and healthcare providers about the opportunity to continue to improve infant nutrition so that more infants can receive the benefits of breast milk,” Chiang says. “Pediatricians can help make sure that all infants receive support for breast milk feeding by encouraging the hospitals in which they work to implement maternity care policies and practices supportive of breastfeeding. Pediatricians can also support and assist new mothers with breast milk feeding during checkups or refer mothers who need additional help to qualified lactation consultants.”

References:

1. Chiang KV, Sharma AJ, Nelson JM, Olson CK, Perrine CG. Receipt of breast milk by gestational age-United States, 2017. MMWR Morb Mortal Wkly Rep. 2019;88(22):489-493. Available at: https://www.cdc.gov/mmwr/volumes/68/wr/mm6822a1.htm. Accessed July 11, 2019.