# A quality improvement intervention to improve medium-term breastfeeding in moderate- and late-preterm infants

## TL;DR

A quality improvement program increased breastfeeding rates in moderate- and late-preterm infants by providing education and support to mothers and staff.

## Contribution

The study introduces a quality improvement intervention combining staff training and parent education to enhance medium-term breastfeeding success in MLPT infants.

## Key findings

- The intervention group had a 75% breastfeeding rate at four months compared to 48% in the comparison group.
- Higher socioeconomic status and maternal self-efficacy were significant predictors of successful breastfeeding.
- Cesarean delivery was associated with lower breastfeeding success.

## Abstract

Despite medical advancements, the rate of premature births remains at one in ten babies worldwide. Moderate and late preterm (MLPT, gestational age 32–36 weeks) infants constitute 80% of all preterm births and are at higher risk of short- and long-term complications compared to term infants. Breastfeeding helps to reduce these risks, but evidence on breastfeeding rates and success factors in MLPT infants is limited.

A prospective intervention trial included a pre-intervention phase from June to September 2022 (comparison) and a post-intervention phase from June to October 2023 (intervention) at one tertiary academic hospital. Clinical parameters from pregnancy, delivery, and postnatal care were collected from MPLT infants and their mothers, including mid-term breastfeeding at infant´s four-month health check-up. Intervention was a quality improvement (QI) initiative involving staff training and parent education using an information platform (Neo-MILK app) with breastfeeding content. Primary outcome was breastfeeding rate at the age of four months after birth. Various secondary outcomes were defined, including growth sufficient exclusive breast milk feeding at 14 days after birth. Relative risks (RR) and 95% confidence intervals approximated from odds ratios obtained through univariate logistic regression to identify predictors of breastfeeding success.

Out of 170 eligible mothers of MLPT infants, 69 participated (36 intervention, 33 comparison group) with similar baseline characteristics. At four months of age (primary endpoint), 75% of the intervention group were breastfeeding compared to 48% of the comparison group (p = 0.023). Significant independent predictors of medium-term breastfeeding success were higher socioeconomic status (RR 1.16; 95% CI 1.01, 1.31), growth sufficient exclusive breast milk feeding and maternal self-efficacy, both measured at 14 days postpartum (RR 1.84; 95% CI 1.37, 2.01 and RR 1.04; 95% CI 1.02, 1.06, respectively). In contrast, delivery by cesarean section was associated with lower medium-term breastfeeding success (RR 0.21; 95% CI 0.07, 0.52).

The implementation of a QI initiative, including breastfeeding education, early postpartum milk pumping and lactation support based on a common information platform for staff and parents was associated with increased medium-term breastfeeding success in MLPT infants. Despite early interventions, caesarean section remains a barrier to breastfeeding.

The study is registered in the German Clinical Trials Register (DRKS00034762).

The online version contains supplementary material available at 10.1186/s13006-025-00751-3.