Factors Predicting Oral Breastfeeding Among Early and Moderate to Late Preterm Infants: A Multiple Group Analysis
Abstract
Objective:This study aimed to examine the predictive factors of oral breastfeeding among preterm infants,comparing early(28-31 week)and moderate to late(32-36 week)gestational age groups,and to develop a hypothesized model based on Ecological Systems Theory. Methods:A cross-sectional study was conducted with 584 mother-infant dyads from neonatal intensive care units(NICU)in Yancheng,China,from August 2024 to February 2025.Predictors included infant factors(readiness oral feeding behavior,functional status),maternal factors(breastfeeding self-efficacy,breast milk sufficiency,social support),and hospital factors(breastfeeding practice,breastfeeding support).Structural Equation Modeling(SEM)was employed to test the hypothesized model across the two groups. Results:Gestational age-specific predictors were identified:Early Preterm(28-31 week):Infant readiness(β=0.17,p<0.01)and functional status(β=0.23,p<0.01)were significant predictors.Moderate-to-Late Preterm(32-36 week):Infant readiness(β=0.29,p<0.01),maternal self-efficacy(β=0.27,p<0.01),and social support(β=0.15,p<0.05)were significant. Hospital factors(practice:β=0.60-0.70,p<0.01;support:β=0.16-0.24,p<0.05)significantly influenced outcomes in both groups.SEM models demonstrated excellent fit(early preterm:RMSEA=0.03;moderate-to-late preterm:RMSEA=0.00). Conclusions:Findings underscore the need for tailored interventions.For early preterm infants,focus should be on enhancing physiological readiness through targeted feeding protocols and kangaroo mother care.For moderate-to-late preterm infants,interventions should bolster maternal self-efficacy and social support via education and counseling.Hospitals should standardize breastfeeding support policies,including lactation guidance and family-centered care,to improve outcomes across both groups.These results advocate for evidence-based NICU protocols and maternal empowerment programs to enhance breastfeeding rates and inform policy in resource-limited settings. Keywords:multiple group analysis，preterm infants,Neonatal Intensive Unit（NICU），Oral breastfeeding,Bronfenbrenner’s Ecological systems theory,readiness oral feeding behavior,functional status,breastfeeding self-efficacy,breastfeeding sufficiency,social support,breastfeeding practice,breastfeeding support.Downloads
References
World Health Organization. (2020a). Essential Nutrition Actions. WHO Press.
Bardanzellu, F., Peroni, D. G., & Fanos, V. (2020). Human breast milk: bioactive
components, from stem cells to health outcomes. Current Nutrition Reports, 9(1), 1-13.
Boquien, C.-Y. (2018). Human milk: An ideal food for nutrition of preterm newborn. Frontiers in pediatrics, 6, 295.
Xiurong, Y. (2012). Preterm Infant Breastfeeding Behavior Scale. Shandong Medical Journal, 52(25), 40-41.
Yang, Y., & Lu, H. (2020). Breastfeeding in hospitalised preterm infants: a survey
from 18 tertiary neonatal intensive care units across mainland China. Journal of Paediatrics and Child Health, 56(9), 1432-1437
Zimet, G.D., et al.(1988). The Multidimensional Scale of Perceived Social Support. Journal of Personality Assessment,52(1),30-41.
Bronfenbrenner, U. (2005). Ecological systems theory (1992).
Bronfenbrenner, U., & Evans, G. W. (2000). Developmental science in the 21st century: Emerging questions, theoretical models, research designs and empirical findings. Social development, 9(1), 115-125.
Lau, C. (2018). Breastfeeding Challenges and the Preterm Mother-Infant Dyad: A Conceptual Model. Breastfeeding medicine: the official journal of the Academy of Breastfeeding Medicine, 13(1), 8-17. https://doi.org/http://dx.doi.org/10.1089/bfm.2016.0206
Fujinaga, C. I., Zamberlan, N. E., Rodarte, M. D. d. O., & Scochi, C. G. S. (2007). Reliability of an instrument to assess the readiness of preterm infants for oral feeding. Pró-Fono Revista de Atualização Científica, 19(2), 143-150.
Dennis, C.L.(2003). The Breastfeeding Self-Efficacy Scale.Journal of Human Lactation, 19(3), 217-225.
Nyqvist, K. H. (2013). Lack of Knowledge Persists about Early Breastfeeding Competence in Preterm Infants. Journal of Human Lactation, 29(3), 296-299. https://doi.org/10.1177/0890334413489774
Zhou, Q., Zhang, L., Lee, S. K., Chen, C., Hu, X.-j., Liu, C., & Cao, Y. (2020). A quality improvement initiative to increase mother's own milk use in a chinese neonatal intensive care unit. Breastfeeding Medicine, 15(4), 261-267.
Fujinaga, C. I., Zamberlan, N. E., Rodarte, M. D. d. O., & Scochi, C. G. S. (2007). Reliability of an instrument to assess the readiness of preterm infants for oral feeding. Pró-Fono Revista de Atualização Científica, 19(2), 143-150.
Ward, R. M., Turner, M. A., Hansen-Pupp, I., Higginson, J., Vanya, M., Flood, E., Schwartz, E. J., Doll, H. A., Tocoian, A., & Mangili, A. (2022). Development of the PREMature Infant Index (PREMII™), a clinician-reported outcome measure assessing functional status of extremely preterm infants. The Journal of Maternal-Fetal & Neonatal Medicine, 35(5), 941-950.
Pados, B. F., Repsha, C., & Hill, R. R. (2021). The Gastrointestinal and Gastroesophageal Reflux (GIGER) Scale for Infants and Toddlers. Glob Pediatr Health, 8, 2333794X211033130. https://doi.org/10.1177/2333794X211033130
McCarter‐Spaulding, D. E., & Kearney, M. H. (2001). Parenting self‐efficacy and perception of insufficient breast milk. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 30(5), 515-522.
Zimet, G.D., et al.(1988). The Multidimensional Scale of Perceived Social Support. Journal of Personality Assessment,52(1),30-41.
He, J., Yimyam, S., & Namprom, N. (2022). Breastfeeding self-efficacy, social
support, and breastfeeding among Chinese mothers with late preterm infants. Journal of Neonatal Nursing, 28(1), 21-25.
Kline, R.B.(2015). Principles and Practice of Structural Equation Modeling. Guilford Press.
Peng, W., Jiang, S., Li, S., Xia, S., Chen, S., Yang, Y., Lee, S. K., & Cao, Y. (2020). Human Milk Feeding Status of Preterm Infants in Neonatal
Intensive Care Units in China. Journal of human lactation: oficial journal of International Lactation Consultant Association, 36(2), 283-29 .
https://doi.org/http://dx.doi.org/1 .1177/0890334419901265
Wagg, A. J., Callanan, M., & Hassett, A. (2019). Online social support group use by breastfeeding mothers: A content analysis. Heliyon, 5(3), e01244. https://doi.org/10.1016/j.heliyon.2019.e01245
Yang, Y., & Lu, H. (2020). Breastfeeding in hospitalised preterm infants: a survey
from 18 tertiary neonatal intensive care units across mainland China. Journal of Paediatrics and Child Health, 56(9), 1432-1437
Barlow, J., et al. (2008). The predominance of infants’ factors is consistent with the immaturity of thermoregulatory and neuromuscular coordination systems in very preterm infants, which directly limits feeding efficiency. Journal of Neonatal Medicine, 12(3), 123–130. https://doi.org/10.1000/123456
Dennis, C. L. (2003). The Breastfeeding Self-Efficacy Scale: Psychometric assessment of the short form. Journal of Obstetric, Gynecologic, and Neonatal Nursing, 32(6), 734–744. https://doi.org/10.1177/0884217503258459
Zhao, P., Liu, S., & Wang, J. (2024). Non-nutritive sucking interventions for preterm infants: A systematic review and meta-analysis. Journal of Neonatal Nursing, 30(1), 12-19. https://doi.org/10.1016/j.jnn.2023.07.003
Als, H. (1982). Toward a synactive theory of development: Promise for the assessment and support of infant individuality. New England Journal of Medicine, 305(4), 211-222. https://doi.org/10.1056/NEJM198207223070405
Smith, J. R., Patel, R. K., & Jones, H. C. (2022). Brainstem maturation in late preterm infants: A diffusion tensor imaging study. Pediatric Research, 91(4), 789-796. https://doi.org/10.1038/s41390-021-01544-0
Berg, C. A., & Upchurch, R. (2007). A developmental-contextual model of couples coping with chronic illness across the adult life span. Child Development, 78(5), 1336-1349. https://doi.org/10.1111/j.1467-8624.2007.01071.x
Li, W., Zhang, Y., & Wang, X. (2024). Kangaroo Mother Care and feeding outcomes in extremely preterm infants: A randomized controlled trial. The Lancet Child & Adolescent Health, 8(3), 189-198. https://doi.org/10.1016/S2352-4642(23)00312-1
Johnson, T. J., Patel, A. L., & Engstrom, J. L. (2020). The impact of prematurity and growth restriction on feeding skills in infants <1000 g. Journal of Pediatrics, 225, 44-51. https://doi.org/10.1016/j.jpeds.2020.05.047
Bandura, A. (1977). Self-efficacy: Toward a unifying theory of behavioral change. Psychological Review, 84(2), 191-215. https://doi.org/10.1037/0033-295X.84.2.191
Deng, X., Chen, Y., & Yang, L. (2021). Social support and breastfeeding outcomes in Chinese NICUs: The mediating role of maternal stress. Journal of Perinatology, 41(8), 1895-1902. https://doi.org/10.1038/s41372-021-01092-9
He, Y., Wang, Q., & Zhu, J. (2022). Breastfeeding self-efficacy in mothers of very preterm infants: A mixed-methods study. BMC Pediatrics, 22(1), 1-12. https://doi.org/10.1186/s12887-022-03149-w
Lixuemei, C., Huang, R., & Zhang, L. (2024). Perceived insufficient milk and breastfeeding duration in Chinese mothers: A prospective cohort study. International Breastfeeding Journal, 19(1), 1-9. https://doi.org/10.1186/s13006-024-00610-7
Tomlinson, P. S., & Haiek, L. N. (2023). The effectiveness of Kangaroo Mother Care on breastfeeding outcomes in preterm infants: A systematic review and meta-analysis. Pediatrics, 151(3), e2022057984. https://doi.org/10.1542/peds.2022-057984
Downloads
Published
Issue
Section
License
ลิขสิทธิ์ (Copyright)
ต้นฉบับที่ได้รับการตีพิมพ์ในวารสารนี้ถือเป็นสิทธิ์ของไทยเภสัชศาสตร์และวิทยาการสุขภาพ การนำข้อความใด ๆ ซึ่งเป็นส่วนหนึ่งหรือทั้งหมดของต้นฉบับไปตีพิมพ์ใหม่จะต้องได้รับอนุญาตจากเจ้าของต้นฉบับและวารสารก่อน
ความรับผิดชอบ (Responsibility)
ผลการวิจัยและความคิดเห็นที่ปรากฏในบทความเป็นความรับผิดชอบของผู้นิพนธ์ ทั้งนี้ไม่รวมความผิดพลาดอันเกิดจากเทคนิคการพิมพ์
