Lactation counseling for mothers of very low birth weight infants: Effect on maternal anxiety, infant intake of human milk, and infant health in the neonatal intensive care unit

Premature infants, especially very low birth weight infants (VLBW, ≤1500 grams birth weight) have increased incidence of late-onset infection, necrotizing enterocolitis, feeding intolerance, growth faltering, and retinopathy of prematurity compared to term infants. When human milk (HM) is given, the incidence of these problems is diminished. Despite the health benefits of HM for VLBW infants, lactation initiation among mothers who deliver prematurely is lower than among mothers who deliver at term, and out of concern for increasing maternal anxiety, health care providers are often reluctant to encourage mothers to initiate lactation if that was not the original plan. Therefore, the purpose of this prospective cohort study was to investigate the effect of lactation counseling on feeding decision and anxiety in mothers of VLBW infants, comparing mothers who planned to formula feed with mothers who planned to breast feed, and to determine the amount of HM needed to decrease adverse health outcomes in their infants.; Maternal anxiety was measured using The State Trait Anxiety Inventory (STAI), administered to mothers of VLBW infants before and after counseling. Maternal stress was measured after counseling by The Parental Stressor Scale: NICU (PSS: NICU). Initial plan to breast (IBG n = 115) or formula feed (IFG n = 81) was determined prior to counseling. Counseling included infant health benefits, collection and storage of HM, and breast pump procurement. Infant intake and health outcomes were measured throughout the hospital stay. Infants were assigned to groups based on the first 28 day intake: low HM (LHM) intake (<50 ml/kg/day [n = 105]) and high HM (HHM) intake (≥50 ml/kg/day [n = 113]).; After counseling, 85% of IFG and 100% of IBG women expressed HM. IFG and IBG anxiety and PSS: NICU scores were not significantly different. The proportion of enteral intake that was HM was greater for the IBG compared to IFG (P < 0.001) during the hospitalization. However, IFG infants received at least 50% of their enteral intake as HM for the first 3 weeks and 33% the entire hospitalization. The number of days central venous access was required (LHM 17.3 +/- 1.8 vs. HHM 7.5 +/- 0.7) and the number of days to reach 100 (LHM 19.3 +/- 1.1 vs. HHM 12.2 +/- 0.5) and 150 ml/kg/day (LHM 26.5 +/- 1.6 vs. HHM 16.5 +/- 0.6) were significantly lower in the HHM group compared to the LHM group. The incidence of late-onset infection or necrotizing enterocolitis (NEC) was significantly lower in the HHM (5%) vs. LHM (19%). High HM intake decreased risk of infection or NEC by 68% (odds ratio = 0.32; 95% confidence interval; 0.12--0.86).; Lactation counseling for mothers of VLBW infants increases the incidence of lactation initiation and HM feeding without increasing maternal anxiety. At least 50 ml/kg/day of HM in the first 28 days are needed to improve health outcomes.