Doctor: Ayoub Mitha
Title: Breast milk feeding at discharge of preterm infants and unit policies : EPIPAGE-2 cohort study
Supervisors: Véronique Pierrat Pierre-Yves Ancel
Doctoral school: ED 393 Epidemiology and Biomedical Information Sciences, Université Paris Cité
Date of thesis defense: 11/2019
Jury: Delphine Mitanchez, Dominique Turck, Henrique Barros, Valérie Briand.
Despite acknowledged benefits of human milk, breast milk feeding rates for preterm infants vary between countries and neonatal units. Maternal and infant characteristics have been extensively studied and do not explain all part of this variability. With data from the french national cohort EPIPAGE 2 and the French Perinatal Survey, we showed that: 1) rates of initiation of lactation for term infants (69%) were almost equal to those of very preterm (<32 weeks’ gestation) and moderate preterm infants (32-34 weeks) (68% and 72%, respectively); 2) 47% of very preterm infants and 59% of moderate preterm infants received breast milk feeding at discharge; 3) Some measures, known to support breast milk feeding, were widely available in France (use of donor milk, protocols for breast milk feeding, and breast pumps); 4) Despite this “friendly environment”, there was a great variability of breast milk feeding rates between units, ranging from 30% to 80%; 5) Unit policies associated with breast milk feeding at discharge – early skin to skin, early involvement of parents in feeding support for the infant, policies supporting breast milk feeding initiation and maintenance – partly explained this variability; 6) High breast milk feeding initiation rates in the general population were associated with breast milk feeding at discharge only in moderate preterm infants. These results highlight the need for an in-depth approach to breast milk feeding support. Adopting policies of higher performing units offers an effective strategy and realistic potential for neonatal units to increase breast milk feeding rates at discharge in this high-risk population of preterm infants.