We recruited 400 infants after getting informed consent and 364 cases were eligible for complete data analysis after exclusion (Figure 2). The baseline demography details of neonates and parents are represented in table 1.
Feeding practices at discharge, at 4 weeks and at 8 weeks.
The chart 1 shows the rate of exclusive breast feeding, exclusive formula feeding and partial breast feeding (breast feeding + formula feeding) at the time of NICU discharge, at 4 weeks and at 8 weeks. Rate of exclusive breast feeding was 20% (95% confidence interval 16.2% to 24.4%), 54% (95% confidence interval 48.9% to 59.1%) and 42% (95% confidence interval 37% to 47.1%) respectively at discharge, at 4 weeks and 8 weeks respectively. Rate of partial breast feeding was 64% (95% confidence interval 58.9% to 68.7%), 40% (95% confidence interval 35.2% to 45.2%) and 43% (95% confidence interval 38.1% to 48.2%) at discharge, at 4 weeks and at 8 weeks respectively. Rate of exclusive formula feeding was 16 % (95% confidence interval 12.5% to 20%), 6% (95% confidence interval 3.8% to 8.6%) and 15% (95% confidence interval 11.5% to 18.8%) at discharge, at 4 weeks and at 8 weeks respectively.
Feeding practices compared with neonatal and maternal parameters.
The breast-feeding rates at discharge, 4 weeks and 8 weeks were compared with the gestational age, duration of NICU stay, mode of delivery, parity, nationality, mother tongue, maternal educational status, occupational status and family income. These data are shown in table 2.
Term gestation predominated the study population, and the median was 38 weeks. When compared between the different gestational age groups and the breast-feeding type and rates, neonates who had lower gestation had better breast-feeding rates at the time of discharge and this relation was statistically significant (p < 0.001). During the follow up it was found that the breast-feeding rates varied between the different gestational age groups; the exclusive formula feeding, and partial breast-feeding rates were increased by 8 weeks, but this observation was not statistically significant between the groups.
The duration of NICU stay had a wide range from 1 to 55 days and the median was 3 days.
When compared between breast feeding type and rates with the duration of NICU stay, neonates who had longer than 1-week NICU stay had higher rate of exclusive breast feeding or partial breast feeding, whereas neonates who had less than 7 days of NICU stay had higher exclusive formula feeding. This observation was statistically significant (p < 0.001) at the time of discharge.
The correlation between breast feeding type and rates and the duration of NICU stay was still significant at 4 weeks (p 0.01) and not significant by 8 weeks (p 0.10).
There was no statistically significant relation between the age of parents, parity or educational status of mothers and the feeding type and rates at discharge or during the 4 weeks and 8 weeks follow up. But there was a statistically significant relation between the mode of delivery and the feeding types at discharge (p < 0.001); neonates delivered by LSCS had higher formula feeding rates, but this relation was not significant for 4 weeks and 8 weeks follow up.
When compared between the occupational status and breast-feeding practices, there was no statistically significant relation at the time of NICU discharge and 4 weeks follow up, but there was a statistically significant relation (p< 0.013) at 8 weeks follow up where the mothers who were working had higher rate of formula or mixed feeding than those mothers who were not working.
When compared with income groups, there was no statistically significant relation between type of feeding at the time of NICU discharge, but the breast-feeding rates were significantly better (p < 0.03 and 0.005) in the middle-income groups during the follow up at 4 weeks and 8 weeks respectively. When compared between Arabic speaking and non-Arabic speaking mothers, there was no statistically significant difference in the feeding practices at NICU discharge and 4 weeks follow up, but there was a statistically significant relation (p < 0.02) at 8 weeks where the Arabic speaking mothers had higher exclusive formula feeding practices.
Feeding practices in relation to breast feeding education and supports
(Feeding education and relation with practices are summarized in table 3).
95% of mothers said that they were advised and recommended for breast feeding, but only 48% said that this education was given pre partum and 86.4% said that this was by verbal method only. 91% mothers said that they received family support for breast feeding, when 61% said they received support from hospital staff and 20% said they received support from friends.
When compared with the breast-feeding practices and the education and supports received, there was no statistically significant relation between them at discharge, at 4 weeks or at 8 weeks except the feeding practices at 4 weeks and the family support (p value was < 0.03).
Breast feeding attitudes (Table 4)
During the 4 weeks mothers were asked about their attitudes and believes on breast feeding and their preferences for formula milk. Though 82% said that formula milk can over feed, 16% mothers believe that formula milk is the healthier milk. When 33% prefer formula milk for nighttime feeding and for travel, 13% believe that babies could be crying due to low breast milk and opt for formula milk feeding. 16.5% mothers felt that formula milk is the better milk for working mothers.