Early discharge with tube feeding at home for preterm infants is associated with longer duration of breast feeding

Objective: Mothers of preterm infants are more likely to discontinue breast feeding early than mothers of term infants. We evaluated the effect of early discharge with tube feeding of preterm infants under close supervision by paediatric nurse specialists on the duration of breast feeding. Design: Case-control study. Setting: Medium/high-care neonatal unit of a large district general hospital. Subjects: Preterm infants (<37 weeks' gestational age). Interventions: Early discharge with tube feeding under close supervision by paediatric nurse specialists or regular follow-up of preterm infants discharged with oral feeding. Main outcome measure: Duration of breast feeding assessed by telephone interview 6 months after birth. Results: There were 50 preterm infants in the early discharge group and 78 in the control group. Mothers in the early discharge group continued to breast feed longer than mothers in the control group (log rank test, p = 0.028). Four months after discharge, 63% of preterm infants in the control group were fed formula compared to 36% in the early discharge group (95% CI for difference 9% to 43%, p = 0.04). The relative risk of breast feeding cessation 6 months after birth in the early discharge group compared to the control group was 0.63 (95% CI 0.41 to 0.96). After adjustment for smoking, gestational age and birth weight, this relative risk was 0.67 (95% CI 0.43 to 1.05). Conclusions: Close supervision and follow-up by paediatric nurse specialists of preterm infants discharged early with tube feeding appears to increase duration of breast feeding. A randomised controlled trial to confirm these findings is warranted.