343 - Association of First Oral Feed and Discharge from the NICU on Human Milk in Preterm Infants

Publication Number: 3330.343

Mackenzie Petersen, Johns Hopkins University, Grafton, WI, United States; Sarah Song, Johns Hopkins Children's Center, Baltimore, MD, United States; Amanda Finney, Johns Hopkins University School of Medicine, Columbia, MD, United States; Sean Tackett, Johns Hopkins University School of Medicine, Baltimore, MD, United States; Khyzer B. Aziz, Johns Hopkins University School of Medicine, Baltimore, MD, United States; Jennifer Fundora, Johns Hopkins University School of Medicine, Baltimore, MD, United States

Background: Breastfeeding provides nutritional, immunological, and developmental benefits for infants and improves outcomes by reducing morbidity and mortality. This is especially true for preterm infants. Despite the well-documented advantages of breastfeeding, few studies examine how direct breastfeeding in the neonatal intensive care unit (NICU) impacts feeding outcomes.

Objective: Determine whether first oral (PO) feed at the breast compared to bottle is associated with discharge on mother’s own milk (MOM) in preterm and very low birth weight infants in the NICU.

Design/Methods: This was a retrospective cohort study that included infants born at < 34 weeks gestational age or < 1500 grams admitted to Johns Hopkins Hospital NICU between October 2023 and January 2025. We included infants if they were receiving breastmilk at 33 weeks post-menstrual age (PMA). Infants that never received MOM or received MOM only prior to 33 weeks PMA were excluded. We collected demographic and clinical data from the electronic health record, including feeding data, PO feed mode (breast vs. bottle) and discharge feed type. We compared those discharged on MOM vs. those not on MOM using t-tests, Fisher’s exact tests, and logistic regressions.

Results: 164 infants met inclusion criteria. 120 of the 164 (73%) infants receiving MOM at 33 weeks PMA were discharged on MOM. The mean gestational age of those discharged on MOM was 31.4 (2.4) weeks vs 30.4 (2.8) weeks (p=0.03). Race differed: those discharged on MOM were 51% White, 36% Black, and 4% Asian compared to 18% White, 68% Black, 7% Asian in those not discharged on MOM (p < 0.0001).

Among the cohort, 56 infants (34%) received their first PO feed at the breast compared to 108 (66%) receiving their first PO via bottle. Of the infants who received their first PO at the breast, 51 (91%) were discharged on MOM compared to 69 (64%) of those that received a bottle for their first PO feed (p < 0.001).

An infant's first PO feed at the breast compared to bottle was significantly associated with being discharged on MOM, with an unadjusted odds ratio (OR) of 5.76 (95% CI: 2.12-15.65). When adjusted for gestational age and race, the OR was 5.03 (95% CI: 1.82-13.9).

Conclusion(s): In preterm or VLBW infants receiving enteral breastmilk, initial feeding directly at the breast compared to bottle was associated with a significantly higher odds of discharge on maternal milk. This study demonstrates the importance of supporting early direct breastfeeding in preterm and very low birth weight infants in the NICU.