Prenatal education increases breastfeeding rate of preterm infants in neonatal intensive care unit

Objective To evaluate the effectiveness of maternal prenatal education on promoting breastfeeding rate for preterm infants in neonatal intensive care unit (NICU). Methods Gravidas who were admitted to Peking University First Hospital for any risk of preterm delivery from November 2013 to December 2014 and preterm infants admitted to the NICU (length of stay≥5 d) of the same hospital during the same period were involved. All the gravidas received prenatal education and completed questionnaires. Two hundred and ninety-five preterm infants who met the inclusion criteria were divided into two groups including education group (n=125) and non-education group (n=170) according to whether their mothers received prenatal education or not. Conditions of the preterm infants during hospitalization and after discharge and breastfeeding rates were comparatively analyzed between the two groups. T test, Chi-test and Wilcoxon rank-sum test were used for statistical analysis. Results (1) There were 380 gravidas received questionnaires. Among them, 346 (91.1%) completed the questionnaires and were recruited in this study. Only 31.8% (110/346) of these gravidas were active in learning more about breastfeeding and 46.2% (160/346) of them lacked confidence in breastfeeding after the appearance of preterm delivery signs. There were significant improvements in their attitudes towards "considering breastfeeding seriously and discussing with their family", "confidence in breastfeeding", "the importance of colostrum" and "how to breastfeed a preterm infant in hospital" after maternal prenatal education (all P 0.05). Proportions of breast milk intake (breast milk intake over total dairy intake) in preterm infants were higher in education group than those in non-education group within 5 d after birth [0.0 (0.0-16.5)% vs 0.0 (0.0-2.5)%, Z=-3.422], >5-≤7 d [33.7 (0.0-82.8)% vs 0.0 (0.0-50.3)%, Z=-3.070], >7-≤14 d [75.2(23.5-96.4)% vs 47.6(0.0-92.2)%, Z=-2.345] and during hospitalization [58.4 (21.0-78.8)% vs 31.9 (0.0-71.7)%, Z=-3.902] (all P<0.05). Breastfeeding rates were higher in education group than those in non-education group at the age of 5 d [47.2% (59/125) vs 27.1% (46/170), χ2=12.747], 7 d [70.4% (88/125) vs 51.2% (87/170), χ2=11.031], three months [83.3% (65/78) vs 56.1% (60/107), χ2=15.297] and six months [64.5% (49/76) vs 49.1% (53/108), χ2=4.282] (all P<0.05). Exclusive breastfeeding rates in the first, third and sixth months after birth were higher in education group [45.7% (53/116), 42.3% (33/78) and 36.9% (28/76)] than those in non-education group [21.3% (32/150), 28.0% (30/107) and 22.2% (24/108)] (χ2=17.847, 4.091 and 4.703, all P<0.05), respectively. Conclusions Most gravidas with risk factors of preterm delivery have no confidence on breastfeeding. Prenatal maternal education is an effective and feasible intervention to improve breastfeeding rate for preterm infants in NICU from early hospitalization till six months after birth. Key words: Breast feeding; Infant, premature; Pregnant women; Patient Education; Intensive care units, neonatal