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Infant Feeding at 3 Months of Age in a Prospective Cohort Born in a WHO Baby Friendly Hospital: the Relationship with Mode of Delivery

Presented at the Neonatal Society 2015 Summer Meeting (programme).

Scerif S, Jeffries S, Heppolette C, Hyde MJ, Modi N

Section of Neonatal Medicine, Imperial College London, Chelsea and Westminster Hospital campus, 369 Fulham Road, London, SW10 9NH, UK

Background: We have previously presented evidence that pre-labour Caesarean section (PLCS) is strongly associated with lower breastfeeding initiation (1); however, independent UK data on infant feeding at 3 months of age are sparse. Here we report method of feeding at 3 months post-partum in infants born in a WHO baby friendly hospital; we use these data to test the hypothesis that feeding 3 months post-partum is associated with mode of delivery.

Methods: In February 2014 we commenced recruitment of a prospective cohort of babies born by vaginal delivery (VD), pre-labour Caesarean section (PLCS) and in-labour CS (ILCS) to examine the association between mode of birth and atopy at 1 year of age (Research Ethics Approval 13/LO/1793). Babies were recruited on the post-natal ward at Chelsea and Westminster Hospital following informed maternal consent. We recorded data on feeding prior to discharge and at 3 months post-partum we telephoned mothers to obtain follow-up information. We categorised infant feeding as 1) exclusively breast-fed (EBF); 2) mixed feeding (MF); 3) exclusively formula-fed (EFF). Method of feeding at hospital discharge and at three months was compared between mode of delivery groups using Chi-square tests.

Results: We have to-date recruited 321 infants (VD=107; PLCS=107; ILCS=107) and have obtained follow-up data on feeding at age 3 months on 256 (VD=84; PLCS=85; ILCS=87). At hospital discharge 12.5% of the cohort had received some formula milk, but use of formula prior to discharge was similar across the three delivery groups (VD 8.3% of babies received formula; PLCS 17.2%; ILCS 11.8%; p=0.21). By three months 23.4% overall were EFF; 44.1% EBF and 32.4% MF. Mode of delivery had a significant impact on breastfeeding at 3 months, with babies born by PLCS being more likely to be EFF (VD 17.9%; PLCS 31.0%; ILCS 21.2%; p=0.03). Of the 60 EFF babies fed at 3 months, 19 received some formula milk before discharge but only one was never breastfed; breastfeeding ceased during the first week in 11%, and around the 2nd post-partum month for the majority.

Conclusion: PLCS is associated with an increased rate of EFF at 3 months in babies born in a WHO baby friendly hospital. Mothers delivering by PLCS may require additional breast feeding support. We found an EBF rate at 3 months postpartum more than double that in the 2010 NHS Infant Feeding Survey (national average of 17%). Additionally, given that our cohort was selectively recruited so that 67% of births were by CS (normal CS rate in the hospital is 33%), which is associated with increased EFF at 3 months, 44.1% is likely to be an underestimate of the rate of EBF at 3 months. It is unclear whether this high rate of EBF at 3 months reflects population characteristics or the impact of adherence to the WHO baby friendly hospital initiative. These conclusions have the caveats of maternally reported feeding data, but the strengths of an independent prospective cohort.

Corresponding author:

1. Prior E, et al. (2012) Am J Clin Nutr 95:1113-1135.

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