{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,25]],"date-time":"2025-11-25T05:52:37Z","timestamp":1764049957616,"version":"3.45.0"},"reference-count":79,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,11,25]],"date-time":"2025-11-25T00:00:00Z","timestamp":1764028800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Nutr."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Early lactation failure among mothers of moderate preterm infants poses a persistent public health concern. This study identified key predictors and developed a risk stratification tool.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a prospective cohort study of 3,210 mother-infant dyads (32.0\u201334.9 weeks gestation) at a tertiary hospital in China (February 2022\u2013April 2025). Early lactation failure was defined as absence of direct breastfeeding with documented latch or provision of &amp;lt; 5 ml cumulative expressed breast milk within 72 h postpartum. Data included psychosocial assessments [breastfeeding self-efficacy scale-short form (BSES-SF), Edinburgh postnatal depression scale (EPDS), family support], obstetric factors, neonatal characteristics, and early care variables. Missing data was imputed using multiple chained equations (50 datasets). Multilevel logistic regression with ward-level random intercepts identified predictors, with bootstrap validation (1,000 resamples) assessing performance.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 3,210 mother-infant dyads enrolled, 716 (22.3%) experienced early lactation failure within 72 h postpartum. Key predictors included higher BSES-SF scores [adjusted odds ratio (aOR) = 0.96 per point, 95% confidence interval (CI): 0.94\u20130.98], higher EPDS scores (aOR = 1.08, 95% CI: 1.04\u20131.12), cesarean delivery (aOR = 1.42, 95% CI: 1.15\u20131.75), neonatal respiratory support (aOR = 1.28, 95% CI: 1.05\u20131.56), and shorter kangaroo care duration (aOR = 0.92 per 10 min, 95% CI: 0.87\u20130.97). A five-factor risk tool stratified mothers into low-risk (13.0% failure rate), moderate-risk (20.5%), and high-risk (31.0%) groups, with strong discrimination (\n                      <jats:italic>C<\/jats:italic>\n                      -statistic = 0.704; calibration slope = 0.952; Hosmer-Lemeshow\n                      <jats:italic>p<\/jats:italic>\n                      = 0.267). Population-attributable risks were highest for cesarean delivery (20.4%), low self-efficacy (18.9%), and depression (18.2%), with numbers needed to treat (NNT) ranging from 11 to 18.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This study confirms the multifactorial basis of early lactation failure, highlighting maternal psychosocial factors as key predictors. The validated risk tool enables identification of high-risk dyads for targeted nutritional support interventions.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fnut.2025.1668778","type":"journal-article","created":{"date-parts":[[2025,11,25]],"date-time":"2025-11-25T05:11:21Z","timestamp":1764047481000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Determinants of early lactation failure in mothers of moderately preterm neonates: a multilevel analysis of survey 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