423 Breast Milk Feeding at Discharge Varies by Hospital and Latitude in Very Preterm Infants in Italy

Abstract

Aim: To study the mode of feeding at discharge in a cohort of very preterm infants in Italy, and investigate differences among hospitals.

Methods: We studied 6197 infants < 1500 g or < 30 weeks gestation, born in 2004-2008, and discharged home from 57 tertiary-care hospitals (about 2/3 of all Italian units) participating in the Italian Neonatal Network.

Feeding at discharge was coded as any breast milk (BM) versus formula.

Results: Overall, 59.8% were discharged home on BM.

Neonates discharged on BM had higher gestation (30.1 vs 29.2 weeks), higher birthweight, and higher weight for GA (Z-score). After adjusting for GA and birthweight, neonates on BM were discharged 5 days earlier and at a lower weight (218 g less).

Differences between hospitals were striking, with the proportion of BM at discharge ranging from 5.4 to 87.8% (interquartile range 47-70%).

In addition, there was a clear North-South gradient across Italy: the adjusted odds ratio of BM was 0.60 for Central Italy and 0.52 for Southern Italy, as compared to Northern Italy. Even after taking infant characteristics and latitude into consideration, differences between hospitals were highly significant (P< 0.001), and this explained 14% of variance.

Conclusion: This large cohort shows that most very preterm infants are discharged home on BM. This compares favourably to the Vermont-Oxford Network proportion (46.3%).

In addition to infant characteristics, hospital and region of birth are responsible for striking differences in feeding method at discharge.

An analysis of different “styles of care” of NICUs is needed.

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