The Impact of NICU Admission On Breastfeeding in the First Hour of Life

Monday, October 28, 2013: 11:41 AM
Plaza International Ballroom I-K (Hyatt Regency Orlando, formerly the Peabody)
Rashi Kochhar, MD1, Neel S. Bhatt, MD MPH1, Nidhi Kotwal, MD1, Linda Chandranath, MD1, Ivan L. Hand, MD, FAAP2, Anita Noble, DNSc3 and Lawrence Noble, MD1, (1)Elmhurst Hospital Center/ Icahn School of Medicine, Elmhurst, NY, (2)Division of Neonatology, SUNY Downstate Medical School/Kings County Hospital, Brooklyn, NY, (3)Hebrew University/Hadassah School of Nursing, Jerusalem, Israel

Background: Breastfeeding (BF) in the first hour of life has been demonstrated to increase the duration of optimal BF through infancy. Although BF is especially important for vulnerable infants, such as those admitted to the Neonatal Intensive Care Unit (NICU), it is often difficult to achieve in the first hour of birth especially for most NICU admissions as this is a critical time period for evaluation. BF in the first hour of the asymptomatic term infant admitted to the NICU, however, should be achievable.

Purpose: To explore factors associated with successful BF in the first hour of life of the term asymptomatic infant admitted to the NICU

Methods: We prospectively evaluated breastfeeding initiation for 50 asymptomatic term infants admitted to the NICU to rule out sepsis and 50 healthy control infants admitted to regular nursery, matched for Gestational age (GA), birth weight (BW) and mode of delivery. Additionally, in-hospital breastfeeding practices were explored via a structured interview of labor and delivery staff. Data was analyzed by chi-square, t-test and regression analysis. P value <0.05 was considered statistically significant.

Results: Mean gestational age for all patients was 39.0±1.9 weeks, while mean BW was 3331±375 grams and rate of cesarean section was 18%. The number of infants who were breast fed in the first hour of life was significantly lower in infants admitted to the NICU than in regular nursery (29% vs. 62%, p=0.001, OR=0.245, CI 0.096-0.616). The rate of BF in the first hour differed by type of admission and mode of delivery: 1) NICU admission & C/S: 10%, 2) NICU & vaginal delivery: 34%, 3) regular nursery & C/S: 29%, 4) regular nursery & vaginal delivery: 67%. This rate did not differ by GA, BW or length of time mother spent in the Labor/ Delivery/Recovery suites (mean time 4.1±2.1 hours). Regression analysis revealed that both NICU admission (p <0.0001) and C/S (p=0.012) significantly increased time to first BF. The clinical course of the infants who were breast fed in the first hour did not reveal complications resulting from the delay in NICU admission. Staff identified maternal request and maternal fatigue as the most important factors in delaying BF past the first hour. Other factors included poor suck reflex, infant behavior, maternal fever and separation of babies for lab workup and stabilization.

Conclusion: BF in the first hour of life is achievable and safe in asymptomatic term infants admitted to the NICU. The rate of BF in the first hour in this population, however, remains low. We speculate that simple initiatives to ameliorate maternal concerns in the delivery room and promotion of early BF by NICU staff could correct this problem and increase the rate of BF in this at-risk population.