Duration of breastmilk feeding of NICU graduates who live with individuals who smoke

BACKGROUND: Breastmilk has many benefits for infants, but initiating breastfeeding/pumping can be difficult for mothers of preterm infants, especially those who smoke (or live with individuals who smoke). The primary aim of this study was to identify risks for breastfeeding/pumping cessation with neonatal ICU (NICU) infants’ mothers who smoke or live with individuals who smoke, using a novel survival-analytic approach. METHODS/DESIGN: Mothers (N=360) were recruited for a secondhand-smoke-prevention intervention during infants’ NICU hospitalizations and followed for approximately six months after infant discharge. Data were obtained from medical records and participant selfreport/interviews. RESULTS: The sample was predominantly ethnic/racial minorities; mean age was 26.8 (SD=5.9) years. One-fifth never initiated breastfeeding/pumping (n=67; 18.9%) and mean time-to-breastfeeding cessation was 48.1 days (SD=57.2; Median=30.4 [IQR: 6.0-60.9]). Education, length-of-stay, employment, race/ethnicity, number of household members who smoke, and readiness-to-protect infants from tobacco smoke were significantly associated with breastfeeding cessation. Further, infants fed breastmilk for ≥4 months had 42.7% more well-child visits (p<0.001) and 50.0% fewer respiratory-related clinic visits (p<0.05). DISCUSSION: One-quarter of infants admitted to NICUs will be discharged to households where individuals who smoke live; we demonstrated that smoking-related factors were associated with mothers’ breastfeeding practices. Infants who received breastmilk longer had fewer respiratory-related visits.