{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T11:51:36Z","timestamp":1787313096959,"version":"build-2736575974"},"reference-count":55,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2017,11,1]],"date-time":"2017-11-01T00:00:00Z","timestamp":1509494400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Background: In spite of high rates of initiating breast milk feeding (BMF) among preterm infants, a significant rate of discontinuation occurs shortly after discharge. Aim: To investigate the effect of mode (direct feeding at the breast vs. expressing) and exclusivity (breast milk combined with formula vs. breast milk only) as well as maternal perceptions on the duration of BMF among preterm infants. Methods: The study included mothers whose infants were born before 32 weeks gestation, between January 2012 and August 2015 at Sheba Medical Center (SMC). Perinatal data were collected retrospectively from infants\u2019 computerized charts. Mothers were approached &gt;12 months postpartum and were asked to complete a questionnaire. Those who agreed to participate were asked (during their visit to the follow-up clinic or by phone or mail) to complete a questionnaire regarding mode and duration of BMF as well as reasons for its discontinuation. Mothers were also asked about their pre-partum intentions to feed directly at the breast. Results: Out of 162 eligible mothers, 131 (80.8%) initiated BMF during their intensive care unit (ICU) hospitalization. Of these, 66 (50.3%) discontinued BMF earlier than six months postpartum. BMF \u2265 6 months was significantly associated with direct feeding at the breast, duration of exclusive BMF, and singleton birth. Regression analysis revealed that direct feeding at the breast (any or only) and duration of BMF exclusivity were the only significant variables associated with BMF duration (Odds ratio (OR) 5.5 and 95% confidence interval (CI) 2.00\u201315.37; OR 1.5 and 95% CI 1.25\u20131.88, respectively). Milk supply (inadequate or nonexistent) was the most commonly reported cause for BMF discontinuation &lt;6 months. Direct feeding at the breast was significantly associated with BMF duration and was more common among singletons. Conclusions: Direct feeding at the breast and duration of exclusive BMF are associated with duration of BMF among infants born &lt;32 weeks of gestational age (GA). These findings suggest that targeting these two factors may play a key role in prolonging BMF duration among preterm infants.<\/jats:p>","DOI":"10.3390\/nu9111202","type":"journal-article","created":{"date-parts":[[2017,11,1]],"date-time":"2017-11-01T16:01:19Z","timestamp":1509552079000},"page":"1202","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":47,"title":["Direct Feeding at the Breast Is Associated with Breast Milk Feeding Duration among Preterm Infants"],"prefix":"10.3390","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6280-291X","authenticated-orcid":false,"given":"Shiran","family":"Pinchevski-Kadir","sequence":"first","affiliation":[{"name":"The Edmong and Lily Safra Children Hospital, Chaim Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Ramat Gan 5262000, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6497-6887","authenticated-orcid":false,"given":"Shir","family":"Shust-Barequet","sequence":"additional","affiliation":[{"name":"Rappoport Faculty of Medicine, Technion\u2014Israel Institute of Technology, Haifa 3525422, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7430-2237","authenticated-orcid":false,"given":"Michal","family":"Zajicek","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Tel Hashomer, Sackler Faculty of Medicine, Tel Aviv University, Ramat Gan 5262000, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7978-9478","authenticated-orcid":false,"given":"Mira","family":"Leibovich","sequence":"additional","affiliation":[{"name":"Newborn Neonatal Unit, Mayanei Hayeshua Medical Center, Bnei-Brak 5154475, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1607-2650","authenticated-orcid":false,"given":"Tzipi","family":"Strauss","sequence":"additional","affiliation":[{"name":"The Edmong and Lily Safra Children Hospital, Chaim Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Ramat Gan 5262000, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5576-5092","authenticated-orcid":false,"given":"Leah","family":"Leibovitch","sequence":"additional","affiliation":[{"name":"The Edmong and Lily Safra Children Hospital, Chaim Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Ramat Gan 5262000, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1763-1066","authenticated-orcid":false,"given":"Iris","family":"Morag","sequence":"additional","affiliation":[{"name":"The Edmong and Lily Safra Children Hospital, Chaim Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Ramat Gan 5262000, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2017,11,1]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1592","DOI":"10.1016\/j.jpeds.2013.07.011","article-title":"Randomized trial of exclusive human milk versus preterm formula diets in extremely premature infants","volume":"163","author":"Cristofalo","year":"2013","journal-title":"J. Pediatr."},{"key":"ref_2","first-page":"CD002971","article-title":"Formula versus donor breast milk for feeding preterm or low birth weight infants","volume":"4","author":"Quigley","year":"2014","journal-title":"Cochrane Libr."},{"key":"ref_3","first-page":"CD002972","article-title":"Formula milk versus maternal breast milk for feeding preterm or low birth weight infants","volume":"17","author":"Henderson","year":"2007","journal-title":"Cochrane Database Syst Rev."},{"key":"ref_4","unstructured":"World Health Organization, and The United Nations Children\u2019s Fund (2003). Global Strategy for Infant and Young Child Feeding, World Health Organization."},{"key":"ref_5","unstructured":"World Health Organization (2010). Indicators for Assessing Infant and Young Child Feeding Practices Part 3: Country Profiles, World Health Organization."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"e827","DOI":"10.1542\/peds.2011-3552","article-title":"Breastfeeding and the use of human milk","volume":"129","author":"Eidelman","year":"2012","journal-title":"Pediatrics"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"72","DOI":"10.1016\/j.adnc.2004.12.003","article-title":"A review of the literature examining the benefits and challenges, incidence and duration, and barriers to breastfeeding in preterm infants","volume":"5","author":"Callen","year":"2005","journal-title":"Adv. Neonatal Care"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"657","DOI":"10.1016\/j.jpeds.2009.04.064","article-title":"Factors influencing breast milk versus formula feeding at discharge for very low birth weight infants in California","volume":"155","author":"Lee","year":"2009","journal-title":"J. Pediatr."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1626","DOI":"10.1111\/j.1651-2227.2007.00495.x","article-title":"Breastfeeding promotion in neonatal intensive care unit: impact of a new program toward a BFHI for high-risk infants","volume":"96","author":"Salvatori","year":"2007","journal-title":"Acta Paediatr."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1126","DOI":"10.1111\/j.1651-2227.2007.00386.x","article-title":"Perinatal and socioeconomic determinants of breastfeeding duration in very preterm infants","volume":"96","author":"Flacking","year":"2007","journal-title":"Acta Paediatr."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Pang, W.W., Bernard, J.Y., Thavamani, G., Chan, Y.H., Fok, D., Soh, S.-E., Chua, M.C., Lim, S.B., Shek, L.P., and Yap, F. (2017). Direct vs. Expressed Breast Milk Feeding: Relation to Duration of Breastfeeding. Nutrients, 9.","DOI":"10.3390\/nu9060547"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"e007512","DOI":"10.1136\/bmjopen-2014-007512","article-title":"Feeding infants directly at the breast during the postpartum hospital stay is associated with increased breastfeeding at 6 months postpartum: a prospective cohort study","volume":"5","author":"Forster","year":"2015","journal-title":"BMJ Open"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1186\/1746-4358-1-28","article-title":"Breastfeeding duration in mothers who express breast milk: A cohort study","volume":"1","author":"Win","year":"2006","journal-title":"Int. Breastfeed. J."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"202","DOI":"10.1111\/j.1523-536X.2007.00172.x","article-title":"Hospital practices that increase breastfeeding duration: Results from a population-based study","volume":"34","author":"Murray","year":"2007","journal-title":"Birth"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"273","DOI":"10.1097\/00005237-200507000-00014","article-title":"Milk volume on day 4 and income predictive of lactation adequacy at 6 weeks of mothers of nonnursing preterm infants","volume":"19","author":"Hill","year":"2005","journal-title":"J. Perinat. Neonatal Nurs."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1177\/089033449401000313","article-title":"Mothers of low birthweight infants: breastfeeding patterns and problems","volume":"10","author":"Hill","year":"1994","journal-title":"J. Hum. Lact."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"e702","DOI":"10.1542\/peds.2005-0537","article-title":"Do baby-friendly hospitals influence breastfeeding duration on a national level?","volume":"116","author":"Merten","year":"2005","journal-title":"Pediatrics"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"106","DOI":"10.1111\/j.1365-2214.2008.00899.x","article-title":"Effects of hospital policies and practices on initiation and duration of breastfeeding","volume":"35","author":"Manganaro","year":"2009","journal-title":"Child. Care. Health Dev."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"505","DOI":"10.1038\/jp.2008.32","article-title":"Positive effect of NICU admission on breastfeeding of preterm US infants in 2000 to 2003","volume":"28","author":"Colaizy","year":"2008","journal-title":"J. Perinatol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1177\/0890334404272389","article-title":"Breastfeeding the premature infant: experience of a baby-friendly hospital in Brazil","volume":"21","author":"Issler","year":"2005","journal-title":"J. Hum. Lact."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"853","DOI":"10.1001\/jama.1994.03520110033025","article-title":"Individualized developmental care for the very low-birth-weight preterm infant: medical and neurofunctional effects","volume":"272","author":"Als","year":"1994","journal-title":"JAMA"},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Maastrup, R., Hansen, B.M., Kronborg, H., Bojesen, S.N., Hallum, K., Frandsen, A., Kyhnaeb, A., Svarer, I., and Hallstr\u00f6m, I. (2014). Factors associated with exclusive breastfeeding of preterm infants. Results from a prospective national cohort study. PLoS ONE, 9.","DOI":"10.1371\/journal.pone.0089077"},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Maastrup, R., Hansen, B.M., Kronborg, H., Bojesen, S.N., Hallum, K., Frandsen, A., Kyhnaeb, A., Svarer, I., and Hallstr\u00f6m, I. (2014). Breastfeeding progression in preterm infants is influenced by factors in infants, mothers and clinical practice: the results of a national cohort study with high breastfeeding initiation rates. PLoS ONE, 9.","DOI":"10.1371\/journal.pone.0108208"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"138","DOI":"10.1089\/bfm.2015.0161","article-title":"Factors Associated with Breast Milk Feeding of Very Preterm Infants from Birth to 6 Months Corrected Age","volume":"11","author":"Morag","year":"2016","journal-title":"Breastfeed. Med."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"981","DOI":"10.1111\/j.1651-2227.2009.01248.x","article-title":"Long hospitalization is the most important risk factor for early weaning from breast milk in premature babies","volume":"98","author":"Kirchner","year":"2009","journal-title":"Acta Paediatr."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"607","DOI":"10.1542\/peds.112.3.607","article-title":"Risk factors for suboptimal infant breastfeeding behavior, delayed onset of lactation, and excess neonatal weight loss","volume":"112","author":"Dewey","year":"2003","journal-title":"Pediatrics"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"311","DOI":"10.1891\/0730-0832.28.5.311","article-title":"Breastfeeding changes for VLBW infants in the NICU following staff education","volume":"28","author":"Pineda","year":"2009","journal-title":"Neonatal Netw."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"S35","DOI":"10.1016\/j.earlhumdev.2013.08.002","article-title":"Challenges in the practice of human milk nutrition in the neonatal intensive care unit","volume":"89","author":"Kim","year":"2013","journal-title":"Early Hum. Dev."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"241","DOI":"10.2223\/1190","article-title":"Exclusive breastfeeding at the point of discharge of high-risk newborns at a neonatal intensive care unit and the factors associated with this practice","volume":"80","year":"2004","journal-title":"J. Pediatr."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"166","DOI":"10.1177\/0890334403252475","article-title":"The baby-friendly hospital initiative increases breastfeeding rates in a US neonatal intensive care unit","volume":"19","author":"Merewood","year":"2003","journal-title":"J. Hum. Lact."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"354","DOI":"10.1177\/0890334413489374","article-title":"10 years after baby-friendly designation: breastfeeding rates continue to increase in a US neonatal intensive care unit","volume":"29","author":"Parker","year":"2013","journal-title":"J. Hum. Lact."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1301","DOI":"10.1111\/j.1651-2227.2002.tb02824.x","article-title":"Effect of early skin-to-skin contact after delivery on duration of breastfeeding: a prospective cohort study","volume":"91","author":"Mazur","year":"2002","journal-title":"Acta Paediatr."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1072","DOI":"10.1542\/peds.108.5.1072","article-title":"A randomized, controlled trial of kangaroo mother care: Results of follow-up at 1 year of corrected age","volume":"108","author":"Charpak","year":"2001","journal-title":"Pediatrics"},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Lok, K.Y.W., Chau, P.H., Fan, H.S.L., Chan, K.M., Chan, B.H., Fung, G.P.C., and Tarrant, M. (2017). Increase in Weight in Low Birth Weight and Very Low Birth Weight Infants Fed Fortified Breast Milk versus Formula Milk: A Retrospective Cohort Study. Nutrients, 9.","DOI":"10.3390\/nu9050520"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"799","DOI":"10.1001\/jama.281.9.799","article-title":"Maternal psychological distress and parenting stress after the birth of a very low-birth-weight infant","volume":"281","author":"Singer","year":"1999","journal-title":"JAMA"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"960","DOI":"10.1016\/S0022-3476(05)83056-2","article-title":"Breathing patterns of preterm infants during bottle feeding: role of milk flow","volume":"119","author":"Mathew","year":"1991","journal-title":"J. Pediatr."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1016\/S0095-5108(18)30784-X","article-title":"Sucking disorders in neurologically impaired infants: assessment and facilitation of breastfeeding","volume":"14","author":"McBride","year":"1987","journal-title":"Clin. Perinatol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"413","DOI":"10.1177\/0890334405280798","article-title":"Human milk pumping rates of mothers of singletons and mothers of multiples","volume":"21","author":"Geraghty","year":"2005","journal-title":"J. Hum. Lact."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"540","DOI":"10.1038\/jp.2010.205","article-title":"Direct breast-feeding in the neonatal intensive care unit: is it important?","volume":"31","author":"Pineda","year":"2011","journal-title":"J. Perinatol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1016\/j.apnr.2016.04.004","article-title":"Direct-breastfeeding in the neonatal intensive care unit and breastfeeding duration for premature infants","volume":"32","author":"Briere","year":"2016","journal-title":"Appl. Nurs. Res."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1016\/j.rpped.2015.10.005","article-title":"Dura\u00e7\u00e3o do aleitamento materno em prematuros acompanhados em servi\u00e7o de refer\u00eancia secund\u00e1rio","volume":"34","author":"Lima","year":"2016","journal-title":"Rev. Paul. Pediatr."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"579","DOI":"10.1177\/0890334413492908","article-title":"Association between length of exclusive breastfeeding and subsequent breastfeeding continuation","volume":"29","author":"Howel","year":"2013","journal-title":"J. Hum. Lact."},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Jiang, B., Hua, J., Wang, Y., Fu, Y., Zhuang, Z., and Zhu, L. (2015). Evaluation of the impact of breast milk expression in early postpartum period on breastfeeding duration: A prospective cohort study. BMC Pregnancy Childbirth, 15.","DOI":"10.1186\/s12884-015-0698-6"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"e646","DOI":"10.1542\/peds.2005-1991","article-title":"Predictors of breastfeeding duration: evidence from a cohort study","volume":"117","author":"Scott","year":"2006","journal-title":"Pediatrics"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"1320","DOI":"10.1111\/j.1651-2227.1999.tb01044.x","article-title":"Factors associated with the duration of breastfeeding","volume":"88","author":"Vogel","year":"1999","journal-title":"Acta Paediatr."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"945","DOI":"10.2105\/AJPH.87.6.945","article-title":"Maternal employment and breast-feeding: findings from the 1988 National Maternal and Infant Health Survey","volume":"87","author":"Visness","year":"1997","journal-title":"Am. J. Public Health"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1111\/j.1523-536X.1996.tb00454.x","article-title":"Predicting the duration of lactation: evidence from a national survey","volume":"23","author":"Piper","year":"1996","journal-title":"Birth"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"370","DOI":"10.1177\/0890334412440846","article-title":"Breastfeeding support in neonatal intensive care: A national survey","volume":"28","author":"Maastrup","year":"2012","journal-title":"J. Hum. Lact."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1097\/00005237-199509000-00004","article-title":"Delayed initiation of breast-feeding the preterm infant","volume":"9","author":"Hill","year":"1995","journal-title":"J. Perinat. Neonatal Nurs."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"729","DOI":"10.1046\/j.1365-2648.1997.1997025729.x","article-title":"The impact of prematurity and neonatal illness on the decision to breast-feed","volume":"25","author":"Jaeger","year":"1997","journal-title":"J. Adv. Nurs."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"e107","DOI":"10.1542\/peds.2005-1145","article-title":"Early dyadic patterns of mother\u2013infant interactions and outcomes of prematurity at 18 months","volume":"118","author":"Pierrehumbert","year":"2006","journal-title":"Pediatrics"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1089\/bfm.2011.0029","article-title":"Predictors of breastmilk expression by 1 month postpartum and influence on breastmilk feeding duration","volume":"7","author":"Geraghty","year":"2012","journal-title":"Breastfeed. Med."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1089\/bfm.2016.0105","article-title":"Barriers to human milk feeding at discharge of very-low-birth-weight infants: Maternal goal setting as a key social factor","volume":"12","author":"Fleurant","year":"2017","journal-title":"Breastfeed. Med."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"900","DOI":"10.1016\/j.socscimed.2009.07.001","article-title":"Expressing yourself: A feminist analysis of talk around expressing breast milk","volume":"69","author":"Johnson","year":"2009","journal-title":"Soc. Sci. Med."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"257","DOI":"10.1089\/bfm.2011.0081","article-title":"Breastfeeding is a dynamic biological process\u2014Not simply a meal at the breast","volume":"6","author":"Raju","year":"2011","journal-title":"Breastfeed. Med."}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/9\/11\/1202\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T18:49:08Z","timestamp":1760208548000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/9\/11\/1202"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,11,1]]},"references-count":55,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2017,11]]}},"alternative-id":["nu9111202"],"URL":"https:\/\/doi.org\/10.3390\/nu9111202","relation":{},"ISSN":["2072-6643"],"issn-type":[{"value":"2072-6643","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,11,1]]}}}