Insights into feeding preterm infants in Aotearoa, New Zealand: A mixed-method study

Abstract

Background: Preterm infants face many challenges to achieve exclusive breastfeeding (EBF) recommendations and successful introduction of complementary foods (CF). There is limited evidence of feeding practices of preterm infants in Aotearoa, New Zealand (NZ). This thesis aimed to investigate feeding practices of preterm infants and explore mothers/caregivers’ experiences in NZ. Methods: This was a cross-sectional observational study consisting of a nationwide selfcompleted electronic questionnaire circulated to mothers/caregivers of preterm infants, including data on hospital feeding, breastfeeding, and CF practices. Relationships between feeding practices and maternal and infant characteristics were explored using SPSS. Qualitative information regarding mothers’/caregivers’ experiences with breastfeeding and CF was analysed using NVivo. Results: A total of 268 mothers/caregivers completed the survey. Most respondents selfidentified as NZ European (68%) or Māori (14%) and were between 25-34 (64%) and 35-44 (24%) years old. Most infants were identified as NZ European (73%) or Māori (21%), and were aged between 0-6 months (31%), 7-12 months (30%), or >12 months (39%) chronological age. The rate of EBF at hospital discharge was 60%, 33% EBF for more than or equal to five months chronological age, and 11% of infants received some breastmilk after 12 months. Among infants who had started CF (n=181), most infants (77%) were introduced to CF between five and eight months chronological age, and first foods were primarily vegetables (65%) and fruits (60%). Fussy eating behaviour was reported by 41%. Adherence to the Ministry of Health Healthy Eating Guidelines for Babies and Toddlerswas measured using the child feeding index score and was considered suboptimal for infants 7-12 months chronological age (5.4 ±1.3 out of 8) and those >12 months chronological age (6.0 ±1.4 out of 8). Infant ethnicity (Māori vs non-Māori) was significantly associated with the use of intravenous nutrition in-hospital, and maternal/caregiver ethnicity was significantly associated with the timing of CF introduction. Mothers/caregivers found support from health professionals and the use of breast pumps enabled their breastfeeding experience but faced challenges with their infants’ poor ability to feed and milk supply. Educational resources and personal experience with CF helped mothers/caregivers with CF; however, fussy eating behaviours and personal fears about CF introduction were commonly repoConclusion: This survey indicates that EBF practices are suboptimal for most preterm infants in NZ. Despite timely CF introduction, preterm infants often don’t meet all healthy eating recommendations. Improved access to education and support for parents of preterm infants could improve early feeding practices. This research can inform the development of future nutrition guidelines for preterm infants. rted as challenges.