• Carrie-Ellen Briere, Jacqueline M McGrath, Xiaomei Cong, Elizabeth Brownell, and Regina Cusson.
• School of Nursing, University of Connecticut, Storrs, CT, USA Institute for Nursing Research and Evidence Based Practice, Connecticut Children's Medical Center, Hartford, CT, USA Carrie-Ellen.Briere@uconn.edu.
• J Hum Lact. 2015 Aug 1; 31 (3): 386-92.

BackgroundThe neonatal intensive care unit (NICU) presents challenges for breastfeeding, especially with feeding directly at the breast (direct-breastfeeding).ObjectivesThe objectives of this study were to describe the characteristics of direct-breastfeeding and identify factors that are associated with direct-breastfeeding in the NICU.MethodsA retrospective chart review of 88 infants born < 34 weeks gestational age whose mothers provided human milk was conducted. Analyses included chi-square and logistic regression models.ResultsOf infants who received human milk at the time of their first oral feeding, 59% received their first oral feeding at breast and 33% of mothers had a specific breastfeeding goal. Mothers who breastfed ≥ 1 direct-breastfeed per day were more likely to have a breastfeeding goal (odds ratio [OR] = 11.13; 95% confidence interval [CI], 1.43-86.88) and be older (OR = 1.33; 95% CI, 1.03-1.72). Their infants had more days between the first breastfeed and introduction of a bottle (OR = 1.56; 95% CI, 1.11-2.17) and had shorter lengths of stay (OR = 0.9; 95% CI, 0.9-0.97). Mothers were more likely to provide direct-breastfeeding at discharge if they were non-Hispanic (OR = 0.05; 95% CI, < 0.01-0.60), were primiparous (OR = 0.06; 95% CI, 0.01-0.45), had a specific breastfeeding goal (OR = 13.79; 95% CI, 1.99-95.80), and their infant had a shorter length of stay (OR = 0.94; 95% CI, 0.90-0.98).ConclusionMothers should be supported to breastfeed before using bottles in the NICU. In addition, goal setting is important for prenatal care providers to discuss with all mothers early in pregnancy, especially those at high risk for premature delivery.© The Author(s) 2015.

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