Positive effect of NICU admission on breastfeeding of preterm US infants in 2000 to 2003

Objective: We hypothesized that neonatal intensive care unit (NICU) admission reduces breastfeeding in a recent population of US infants, adjusting for confounding factors. Study Design: Using pregnancy risk assessment monitoring system data from 27 states for the years 2000 to 2003, we determined the relationship between breastfeeding and gestational age (GA) stratified by NICU status. We fitted a proportional odds model for breastfeeding duration as a function of NICU status adjusted for other covariates. SAS 9.1.3 and SUDAAN 9.0 were used for the weighted analyses. Result: In total 138 359 surveys, including 29 940 NICU-admitted infants, were analyzed. A total of 73% of mothers of nonadmitted infants initiated breastfeeding vs 70% of mothers of NICU-admitted infants. Mothers of GA < 38 weeks NICU-admitted infants were 34% more likely to initiate breastfeeding and 21% more likely to breastfeed for 4 weeks than were mothers of nonadmitted preterm infants (P < 0.001). However, mothers of term NICU-admitted infants were less likely to initiate and continue breastfeeding to 4 weeks than were mothers of term nonadmitted infants (P < 0.001). Adjusting for GA, race, maternal age, maternal education, mode of delivery and Medicaid status, NICU admission was associated with increasing duration of breastfeeding (OR 1.10, CI 1.03, 1.17). Compared with mothers of term infants, mothers of < 32-week infants were 40% more likely to continue breastfeeding for 4 weeks, mothers of 32 to 34 week infants were 13% less likely to continue and mothers of 35-37 week infants were 22% less likely to continue for at least 4 weeks (P < 0.001). Conclusion: NICU admission is now a positive influence on breastfeeding continuation, improving the overall likelihood by 10%. Mothers of preterm NICU-admitted infants were more likely than mothers of nonadmitted infants to continue breastfeeding for 4 weeks, while mothers of term NICU-admitted infants were less likely to continue. Breastfeeding support should be enhanced for term and late preterm infants.