FACTORS PREDICTING ORAL BREASTFEEDING AMONG EARLY AND MODERATE TO LATE PRETERM INFANTS: MULTIPLE GROUP ANALYSIS

Abstract

Background：This study examined predictors of oral breastfeeding success among early preterm (28-31 weeks) and moderate-to-late preterm (32-36 weeks) infants in Chinese NICU, framed within Bronfenbrenner's bioecological model. Research Design： A cross-sectional design was implemented with 584 mother-infant dyads recruited from two tertiary hospitals in Yancheng, Jiangsu Province between August 2024 and February 2025. Methods：The study assessed infant factors (feeding readiness, functional status), maternal factors (self-efficacy, milk sufficiency perception, social support), and hospital factors (clinical practices, support policies) using validated measurement tools that were linguistically adapted for Chinese populations. Structural Equation Modeling with multi-group analysis was employed to test gestational age-specific predictive models.

Results：Analyses revealed distinct predictive patterns by gestational age. Among early preterm infants, physiological factors dominated, with feeding readiness (β = 0.17, p < 0.01) and functional status (β = 0.23, p < 0.01) emerging as significant predictors. For moderate-to-late preterm infants, maternal psychosocial factors showed stronger associations, including self-efficacy (β = 0.27, p < 0.01) and social support (β = 0.15, p < 0.05), as well as feeding readiness (β = 0.29, p < 0.01). Hospital-level factors demonstrated substantial effects across both groups, particularly clinical practices (β = 0.60-0.70, p < 0.01) and support policies (β = 0.16-0.24, p < 0.05). Both models exhibited excellent fit indices (RMSEA ≤ 0.03).

Conclusion and Implications: These findings highlight the need for gestational age-specific breastfeeding interventions in NICUs. For early preterm infants, enhancing neonatal stability and readiness through targeted clinical support is critical. For moderate-to-late preterm infants, maternal self-efficacy and support systems should be prioritized. The consistent influence of hospital-level factors suggests that standardizing evidence-based breastfeeding practices and policies could substantially improve oral feeding outcomes across all preterm populations. NICU administrators should integrate multi-level strategies to foster a supportive breastfeeding environment tailored to the developmental needs of preterm infants and their families.

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