Barriers to Mother’s Own Milk Feeding for Preterm Newborns: Experience from a Tertiary Neonatal Intensive Care Unit

Abstract

Introduction: Mother’s own milk gives complete nutrition and reduces mortality and morbidity in preterm newborns. Despite its numerous benefits, the provision of mother’s own milk for preterm babies is still not optimal in Neonatal Intensive Care Units (NICU). Objectives: To determine the challenges to mother's milk feeding for preterm newborns in the NICU. Methods: This cross-sectional study was conducted from March 2021 to July 2021 prior to a quality improvement study in the Department of Neonatology at Bangabandhu Sheikh Mujib Medical University in Dhaka. Mother and preterm baby dyads (≤34 weeks and/or ≤1800 gm) who were anticipated to remain in the NICU for at least seven days were included in this study. Mother and newborn demographics, maternal illness, breastfeeding counseling, and demonstration were evaluated in relation to the early expression and feeding of mother's own milk as well as the quantity of expressed breast milk. Results: The study included 50 preterm newborn and mother dyads. Only 4% of mothers got counseling and demonstration of breast milk expression and expressed their breast milk within 6 hours of birth, and 18% on day one. The failure to express breast milk within 6 hours had a negative impact on the volume of breast milk on days 1 and 3. Similarly, lack of breast milk expression on day 1 and day 3 had a negative effect on the volume of breast milk on day 1 and day 3, respectively. Only 18% of newborns were fed on mother’s  own milk on day 1. Lack of expression on the first day had a deleterious effect on the early feeding of preterm babies. There were no effects of maternal & neonatal demographic factors and maternal illness on the mother’s own milk feeding for preterm newborns. Conclusion: Our study revealed several hurdles to mother's own milk feeding for preterm babies, including a lack of antenatal counseling, demonstration of breast milk expression and delayed breast milk expression. Therefore the implementation of a quality improvement study with a comprehensive counseling package will be a time demanding approach to improving mother’s own milk feeding in the NICU.