Room for improvement in breast milk feeding after very preterm birth in Europe: Results from the EPICE cohort

Emilija Wilson, Anna Karin Edstedt Bonamy, Mercedes Bonet, Liis Toome, Carina Rodrigues, Elizabeth A. Howell, Marina Cuttini, Jennifer Zeitlin, the EPICE Research Group

Research output: Contribution to journalArticlepeer-review


Breast milk feeding (BMF) is associated with lower neonatal morbidity in the very preterm infant (<32 weeks gestation) and breastfeeding is beneficial for maternal health. Previous studies show large variations in BMF after very preterm birth and recognize the need for targeted breastfeeding support in the neonatal intensive care units (NICU). In a European collaboration project about evidence-based practices after very preterm birth, we examined the association between maternal, obstetric, and infant clinical factors; neonatal and maternal care unit policies; and BMF at discharge from the NICU. In multivariable analyses, covariates associated with feeding at discharge were first investigated as predictors of any BMF and in further analysis as predictors of exclusive or partial BMF. Overall, 58% (3,826/6,592) of the infants received any BMF at discharge, but there were large variations between regions (range 36–80%). Primiparity, administration of antenatal corticosteroids, first enteral feed <24 hr after birth, and mother's own milk at first enteral feed were predictors positively associated with any BMF at discharge. Vaginal delivery, singleton birth, and receiving mother's own milk at first enteral feed were associated with exclusive BMF at discharge. Units with a Baby Friendly Hospital accreditation improved any BMF at discharge; units with protocols for BMF and units using donor milk had higher rates of exclusive BMF at discharge. This study suggests that there is a high potential for improving BMF through policies and support in the NICU.

Original languageEnglish
Article numbere12485
JournalMaternal and Child Nutrition
Issue number1
Publication statusE-pub ahead of print - Jul 17 2017


  • baby friendly hospital
  • breast milk
  • breastfeeding
  • neonatal intensive care unit (NICU)
  • policies
  • very preterm birth

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Obstetrics and Gynaecology
  • Nutrition and Dietetics
  • Public Health, Environmental and Occupational Health


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