Predictors of breastfeeding non-initiation in the NICU

Brooke Gertz, Emily DeFranco

Research output: Contribution to journalArticlepeer-review

22 Scopus citations


This study compared predictors of breastfeeding non-initiation between infants who were and were not admitted to the NICU so that interventions can target high-risk mothers whose infants desperately need breastmilk. This was a population-based retrospective cohort study of singleton Ohio live births using birth certificates, 2006–2015. In babies who were and were not admitted to the NICU, a multivariable logistic regression model assessed the association between breastfeeding non-initiation and predictors relating to the mother, neonate, and labour and delivery events while adjusting for covariables. Of 1,463,506 births, 76,855 infants were admitted to the NICU (5.8% of study population), and breastfeeding was not initiated in 39.4% of them, compared with 31.5% of infants in the newborn nursery, p < 0.001. Apart from abnormal newborn conditions, smoking during pregnancy was the most significant risk factor for not breastfeeding in the NICU (RR 1.91 [95% CI 1.82–2.02]) and newborn nursery (RR 2.10 [95% CI 2.08–2.13]), followed by socioeconomic factors and multiparity. Limited prenatal visits (≤5) were a significantly higher risk factor in the NICU (RR 1.41 [95% CI 1.34–1.49]) than in the newborn nursery (RR 1.24 [95% CI 1.22–1.26]). Intentional home birth and use of infertility treatment were associated with breastfeeding initiation. The rate of breastfeeding initiation is lower in infants admitted to the NICU than those who are not, especially among mothers with limited prenatal care. Interventions should target mothers who smoke because they are least likely to breastfeed, and their babies, who are prone to serious health conditions, could especially benefit from breastmilk.

Original languageEnglish
Article numbere12797
JournalMaternal and Child Nutrition
Issue number3
StatePublished - Jul 2019

Bibliographical note

Publisher Copyright:
© 2019 John Wiley & Sons Ltd


  • breast milk
  • breastfeeding
  • breastfeeding initiation
  • NICU
  • prenatal care
  • smoking

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Obstetrics and Gynecology
  • Nutrition and Dietetics
  • Public Health, Environmental and Occupational Health


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