© Pexels/Helena Jankovičová Kováčová

Regular skin-to-skin contact and exclusive breastfeeding are important measures to promote newborn health and development. However, preterm infants face challenges as they may not be mature enough to be breastfed. One method proven successful in introducing breastfeeding for preterm newborns is cue-based breastfeeding. Instead of feeding at scheduled times, the newborn indicates when they are ready for breastfeeding, making it individually adapted to the specific needs of each preterm infant. A new study encompassing 105 neonatal intensive care units (NICUs) in 15 European countries revealed significant differences in ward regulations on cue-based breastfeeding and skin-to-skin care.

Breastfeeding a preterm newborn can be a complex process, as infants of younger gestational age face development-related challenges such as immature sucking skills, difficulty coordinating sucking-swallowing-breathing, as well as shorter awake-alert periods. Preterm infants, therefore, require time and support from healthcare professionals and parents to develop their feeding skills and reach the stage where they can exclusively breastfeed.

A new study aims to identify the restrictions present in neonatal intensive care units (NICUs) across Europe that hinder or support cue-based breastfeeding for preterm infants. A total of 105 NICUs from 15 countries across Europe participated in the survey.

Understanding cue-based breastfeeding

Cue-based breastfeeding is an approach in which feeding is guided by the infant’s natural hunger signals rather than a strict schedule. Feeding begins when the infant shows signs of readiness, such as waking up before usual feeding times, looking towards the mother’s breast, or sucking on their fingers. This method respects each newborn’s individual readiness and can lead to a more positive feeding experience, especially for preterm infants who may have varying levels of development and alertness.

However, because the newborn determines the timing and duration of feeding, it is difficult to measure the exact volume of milk intake needed for sufficient growth. As a result, NICU staff require training in cue-based feeding, along with appropriate guidelines for implementing this approach in the ward.

Breastfeeding practices vary significantly between NICUs

The study highlights significant differences in how NICUs implement practices to support cue-based breastfeeding. Only 46% of NICUs allowed parents to have unrestricted skin-to-skin contact with their infants, even though this plays a crucial role in initiating breastfeeding for preterm newborns.

Many NICUs continued to impose breastfeeding restrictions due to tradition or safety concerns, despite the fact that early breastfeeding is safe and recommended without restrictions. One week after birth, only 48% of NICUs encouraged breastfeeding for infants at 33 weeks gestational age when they showed feeding cues, regardless of scheduled tube feeding times. Furthermore, less than half of the NICUs reported having the necessary resources to facilitate the transition from tube feeding to breastfeeding, highlighting a lack of equipment and support.

The findings of the study emphasise the need for standardised practices and improved support for cue-based breastfeeding in NICUs across Europe. By recognising and responding to an infant’s natural feeding cues, healthcare providers and parents can work together to improve health outcomes for preterm infants.

Paper available at: https://internationalbreastfeedingjournal.biomedcentral.com/articles/10.1186/s13006-024-00697-y

Ful list of authors: Bente Silnes Tandberg, Hege Grundt, Ragnhild Maastrup, Annie Aloysius, Livia Nagy, Renée Flacking

DOI: https://doi.org/10.1186/s13006-024-00697-y

Find out more about breastfeeding a preterm infant here