An integrative review of factors that influence breastfeeding duration for premature infants after NICU hospitalization

Objective: To determine what factors affect breastfeeding duration after discharge home from the neonatal intensive care unit (NICU) for high-risk mothers and their premature infants. Data Sources: The electronic databases of CINAHL and PubMed were used to identify studies published in English. Date of publication did not limit inclusion in the review. Study Selection: Using exclusion and inclusion criteria, 292 articles were initially assessed for relevance to the research question through abstract review. Further screening resulted in full review of 52 articles. Reference list searching added an additional six articles. Finally, in-depth review of these 58 articles resulted in 24 studies that fully met inclusion and exclusion criteria. Data Extraction: Studies were reviewed for information related to factors associated with breastfeeding duration for high-risk mothers and preterm infants after NICU discharge home. Data Synthesis: Studies were categorized into five themes, including NICU factors, feeding and soothing methods, maternal characteristics, maternal experiences, and support programs. Most significant factors affecting duration included exposure to kangaroo mother care, prenatal education, and quantity of maternal breast milk supply during the first week after discharge. Breastfeeding also was affected by maternal breastfeeding knowledge and perception of providing appropriate volumes. Conclusions: Mothers face many challenges breastfeeding their premature infants after NICU discharge. Ideally, all mothers need to receive support after NICU discharge, and the transition to home can be challenging even if breastfeeding is well established. However, NICU professionals are in a perfect position to provide guidance to families so they are able to anticipate and effectively solve lactation challenges at home.