Enhancing Breastfeeding Quality among Preterm Infants: A Dual-Approach Intervention Combining a Dedicated Breastfeeding Position and Family Engagement

Enhancing Breastfeeding Quality among Preterm Infants: A Dual-Approach Intervention Combining a Dedicated Breastfeeding Position and Family Engagement | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Enhancing Breastfeeding Quality among Preterm Infants: A Dual-Approach Intervention Combining a Dedicated Breastfeeding Position and Family Engagement FU Zhenyan, Chen yan, Jin yao, zhao yan, quan mingtao, yang kaidi, and 6 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6987659/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 30 Apr, 2026 Read the published version in Journal of Perinatology → Version 1 posted 9 You are reading this latest preprint version Abstract Objective : This study aimed to investigate the combined effects of establishing a dedicated breastfeeding position in the neonatal intensive care unit (NICU) and family support on improving the breastfeeding rate of very low birth weight infants (VLBWIs). Methods : A non-concurrent controlled study was conducted. VLBWIs hospitalized at the Affiliated Hospital of Zunyi Medical University from November 2023 to November 2024 were selected as the intervention group. A dedicated team of breastfeeding nurses was established to implement the following interventions: early assessment and guidance for mothers within 12 hours after neonatal NICU admission; regular communication with mothers and families to monitor maternal conditions; enhanced breast milk management via digital platforms; a nighttime breast milk reception green channel; material support; and the promotion of colostrum utilization. VLBWIs admitted between November 2022 and October 2023 were included as the conventional group for comparison. Results : The breastfeeding rate in the intervention group (62.5%) was significantly higher than that in the conventional group (42.6%). The colostrum feeding rate in the intervention group (36.5%) was higher than that in the conventional group (19%), and the breastfeeding rate at discharge was significantly greater in the intervention group (37%) than in the conventional group (26.4%) ( P <0.05). The initiation time of breastfeeding in the intervention group was significantly earlier than that in the control group ( P <0.05). Both earlier initiation of breastfeeding and increased breastfeeding rates at discharge were significantly different between the groups. Conclusion : The dual-track empowerment model, which integrates dedicated breastfeeding positions and family support, effectively improved breastfeeding rates and practices for VLBWIs. This model provides a valuable reference for clinical healthcare providers to promote breastfeeding. Health sciences/Health care/Health services Scientific community and society/Developing world Preterm infants human milk Dedicated Breastfeeding Position Family Engagement Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 1. Introduction Very low birth weight infants (VLBWIs, < 1500 g) constitute a high-risk population in neonatal intensive care units (NICUs). These infants exhibit extreme immaturity in terms of organ system development, coupled with the incomplete establishment of both immune regulation and metabolic pathways [ 1 ] . Therefore, these infants face significantly increased risks of morbidity and mortality. Breast milk is the optimal nutrition for infants – particularly preterm infants – and plays a crucial role in improving both the short- and long-term outcomes of VLBWIs [ 2 – 4 ] . On the one hand, human milk contains numerous bioactive compounds that promote gut microbiota colonization, enhance intestinal barrier function, and reduce the risk of necrotizing enterocolitis (NEC) [ 5 , 6 ] . Breastfeeding has also yielded benefits among VLBWIs such as lower incidence rates of late-onset sepsis (LOS) and severe retinopathy of prematurity (ROP) [ 7 ] . Moreover, exclusive breastfeeding or higher proportions of human milk among total feeding volumes are associated with reduced rates of feeding intolerance, NEC, LOS, ROP, bronchopulmonary dysplasia (BPD), and mortality [ 4 , 8 – 10 ] . On the other hand, the bioactive components in breast milk provide specific protection and promote neurodevelopment in infants [ 1 ] . Breastfeeding is critical for VLBWIs. Despite various institutional interventions to promote breastfeeding, the implementation of breastfeeding is challenging due to maternal–infant separation, insufficient maternal lactation, NICU environmental stressors, and inadequate family support [ 11 – 13 ] . Significant disparities in breastfeeding rates exist across countries and healthcare facilities: 44% in Portugal, 49% in Sweden, 54.5% in Italy, 47–60% in Germany, 48–61.1% in the United States, 53.6–78% in Greece, and 50–93.4% in Brazil [ 2 , 14 – 16 ] . Overall, breastfeeding outcomes for VLBWIs remain suboptimal. This study adopts a dual-track model that combines dedicated lactation specialist roles and family-centred support to enhance breastfeeding in extremely preterm infants. The intervention aims to bridge the gap between existing clinical support systems and family needs in order to provide an evidence-based framework for improving nutritional outcomes in this vulnerable population. The findings will optimize NICU breastfeeding protocols and advance clinical practices towards achieving the World Health Organization (WHO)-recommended feeding targets for preterm infants. 2. Materials and Methods 2 .1 . Study Participants The study was conducted at a Grade III Class A hospital in Zunyi city, Guizhou Province, China. Serving as a provincial and municipal-level neonatal care centre, this facility admits approximately 200 VLBWIs annually. Owing to the absence of a human milk bank and to preserve the nutritional integrity of breast milk as much as possible, breastfeeding is provided using milk expressed by mothers within 24 hours of expression. VLBWIs and their mothers were enrolled via consecutive sampling between November 2022 and November 2024. The inclusion Criteria were as follows: ① VLBWIs with a birth weight <1500 g; and ② no contraindications to breastfeeding for either VLBWIs or their mothers. The exclusion Criteria were as follows: ① VLBWIs with congenital gastrointestinal disorders (e.g., oesophageal atresia, gastrointestinal malformations); ② maternal use of medications explicitly contraindicated for breastfeeding; ③severe comorbidities among mothers that precluded participation in breastfeeding education; or ④ parental refusal to participate. The withdrawal Criteria were as follows: ① death of the VLBWI; ②DISCHARGE or transfer of the VLBWI; or (3) voluntary withdrawal from the study. This non-concurrent controlled study compared two groups: the conventional group, which comprised VLBWIs and mothers receiving standard unit-based breastfeeding support (recruited from November 2022 to November 2023); and the intervention group, comprising VLBWIs and mothers receiving the dual-track education support model (recruited from November 2023 to November 2024).Sample size calculation: Using G*Power 3.1.9.7, with α=0.05, power=0.8, and a 1:1 allocation ratio, the calculated sample size required for each group was 64 cases. Accounting for a 10% dropout rate, at least 70 cases per group were included in the VBWI. This study protocol was reviewed and approved by Biomedical Research Ethics Committee of the Affiliated Hospital of Zunyi Medical University, approval number,KLL-2023-505.Informed consent was obtained from parent to participate in the study. 2 .2 Research Methods 2 .2.1 Conventional Group (1) After the admission of VLBWIs, the medical team evaluates whether the VLBWI can initiate enteral feeding. If enteral feeding is feasible, the attending physician notifies the infant's family to provide breast milk and conducts breastfeeding education simultaneously. (2) The nurse checks whether the family’s breast milk delivery method and labeling (including bed number, name, pumping date, and time) comply with the department’s breast milk acceptance requirements and provides guidance if needed. (3) When the breast milk delivery and labeling meet the standards, breastfeeding is initiated. (Shown in Figure.1) 2 .2.2 Intervention Group A dedicated breastfeeding nurse, trained in breastfeeding-related knowledge, was assigned to this group. Following the admission of VLBWI, this nurse was responsible for the “execution, implementation, coordination, and organization” of all intervention measures.(Shown in Figure.2) (1) Early Assessment and Guidance Within 12 hours of VLBWI admission, the dedicated breastfeeding nurse conducted the following protocol: ① Clinical Evaluation: The nurse assessed the infant’s clinical condition, reviewed maternal medical records, and communicated with the mother to determine whether breastfeeding contraindications (e.g., maternal HIV infection, infant galactosemia) existed in either the infant or the mother. ②Eligibility Screening: The nurse verified that the infants and mothers met the eligibility criteria if no contraindications were identified. ③ Family-Centred Intervention: The nurse either visited the obstetric department or invited the mother and primary caregivers (prioritizing the spouse and/or mother-in-law) to the neonatal unit for breastfeeding education. Educational Components: The nurse explained preterm infant risks, such as feeding intolerance, infection, and complications; The nurse emphasized the benefits of breastfeeding, including the prevention or reduction of complications, the promotion of oral feeding, and the decreased incidence of feeding intolerance. Furthermore, the nurse provided early lactation support, which included emphasizing the importance of early milk expression and demonstrating proper breast pump techniques (frequency, duration, hygiene);The logistical training involved the nurses educating the families about protocols for breast milk storage (ambient temperature (16~29°C) ≤4 hours; refrigeration at 4°C ≤4 days; freezing at -20°C: recommended for use within 6 months and should not be stored beyond 12 months) and safe transportation (validated cooler boxes with temperature monitoring);Finally, the nurse provided the families with resources, including an illustrated breastfeeding education manual. (2)Tracking Maternal Lactation Progress Prior to family delivery of breast milk, the dedicated breastfeeding nurse established daily contact (1~2 times/day) with the VLBWI’s family to monitor maternal lactation status. If lactation difficulties were identified, the nurse conducted a bedside lactation assessment and guidance session until expressed breast milk was successfully delivered to the neonatal unit. (3) Enhanced Breast Milk Management via Digital Platforms A “QQ group” (a Chinese instant messaging platform) and official WeChat account were established for breastfeeding management. The dedicated breastfeeding nurse oversaw both platforms and regularly uploaded educational videos and articles on breast milk collection, storage, and transportation for mothers and families. Additionally, families could post questions in the QQ group, and five healthcare professionals (including neonatal nurses and lactation consultants) provided real-time responses to the questions. (4) Establishment of a Nighttime Breast Milk Reception Green Channel Since the department's breast milk collection service was only available during daytime hours and postpartum mothers lacked refrigerator access for breast milk storage during their hospital stay in the obstetrics department, nighttime expressed milk could only be stored at room temperature. Milk stored for more than 4 hours at room temperature had to be discarded, resulting in significant waste. To address this challenge, the department installed a dedicated breast milk refrigerator. Mothers were thus able to deliver milk that was expressed at nighttime to the ward for temporary refrigeration, thereby ensuring standardized storage protocols. This initiative improved breast milk utilization rates and enhance the perceived benefits for both mothers and their families. (5) Provision of Essential Supplies The department provided ballpoint pens and pumping log stickers to document critical information such as bed number, patient name, expression time, and expression method (manual or pump). This standardized breast milk labelling system ensured consistent identification and prevented unnecessary waste caused by mislabelling, illegible markings, or incomplete records. (6) Promoting Colostrum Utilization The department implemented an oral colostrum administration protocol for VLBWIs, with the following specifications: frequency: every 3 hours (or every 6 hours as clinically indicated); dosage: 0.2 mL per administration (0.1 mL applied to each buccal mucosa); duration: at least 2.5 minutes per application; and treatment course: 10 consecutive days. This protocol enhanced immunological benefits by ensuring mucosal absorption of colostrum components while optimizing nutritional uptake for VLBWIs. 2.2.3 Advantage of intervention group Comparision with conventional group, intervention group has several advantages:Family menbers can acquire breastfeeding education early;VLBWI can breastfeeding timely once they initiate enteral feeding;Less breast milk wastage and more family support. 2.3 Outcomes This study includes one primary outcome and seven secondary outcomes. Any breastfeeding rate during hospitalization as this study’s primary outcome; This study’s secondary outcomes include exclusive breastfeeding rate、breastfeeding rate at discharge、colostrum feeding rate、breastfeeding initiation time and duration、 Breastfeeding Discontinuation Rates(Interruption of continuous breastfeeding in VLBWI caused by inadequate maternal milk volume to fulfill their daily nutritional demands)、NEC incidence. 2 . 4 Statistical analysis Data management was performed using Excel 2003, and statistical analyses were conducted using SPSS software (version 29.0). Maternal age(years), Gestational age (wk), Weight at birth (g), Apgar score, Initiation time of breastfeeding (days), and Duration of breastfeeding (days) conforming to a normal distribution are presented as mean ± standard deviation (SD) and were analyzed using the Student's t-test, not conforming to a normal distribution are presented as median (interquartile range, IQR; P25, P75) and were analyzed using the Mann-Whitney U test (for two groups) or the Kruskal-Wallis test (for more than two groups). Mode of conception, Mode of delivery, Experience of delivery, Infant sex, Any breastfeeding rate, Colostrum feeding rate, Exclusive breastfeeding rate, Breastfeeding rate at discharge, breastfeeding discontinuation, and NEC incidence are presented as frequencies (percentages, %) and were analyzed using the Chi-square test (χ² test). A p-value of less than 0.05 ( P < 0.05) was considered statistically significant. 3. Results 3 .1 Study Population and Baseline Characteristics Ultimately, 363 mother‒infant dyads were included for analysis, encompassing 189 dyads in the intervention group and 174 dyads in the control group. No statistically significant differences were found between the two groups (all P > 0.05) in terms of maternal age, mode of conception, mode of delivery or experience of delivery. The VLBWIs in both groups showed comparable baseline measurements (all P > 0.05) in terms of sex distribution, gestational age (weeks), birth weight (grams) and Apgar scores at 1 minute and 5 minutes. (Shown in Fig.3 and Table 1). Table 1 Baseline Characteristics of the Study Population Variable Intervention group （ n=189 ） Conventional group （ n=174 ） Statistic value P Maternal age(years), median (IQR) 30（27,33.50） 29（26,33） Z= ﹣ 1.541 0.123 Mode of conception, n (%) χ 2 = ﹣ 2.848 0.091 Spontaneous conception 144（76.2%） 145（83.3%） ART pregnancies 45（23.8%） 29（16.7%） Mode of delivery, n (%) χ 2 = ﹣ 2.033 0.154 Vaginal delivery 45（23.8%） 53（30.5%） Caesarean section 144（76.2%） 121（69.5%） Experience of delivery , n (%) χ 2 = ﹣ 0.489 0.484 Nullipara 80（42.3%） 80（46.0%） Multiparous 109（57.7%） 94（54.0%） Infant sex, n (%) χ 2 = ﹣ 0.028 0.866 Male 95（50.3%） 89（51.1%） Female 94（49.7%） 85（48.9%） Gestational age (wk), mean±SD 30.49±2.17 30.34±2.20 t = 0.666 0.506 Weight at birth (g), median (IQR) 1300 （1075,1480） 1255（1100,1392.50） Z= ﹣ 1.475 0.140 Apgar score 1 minute 10（8,10） 10（8,10） Z= ﹣ 0.138 0.890 5 minutes 10（10,10） 10（10,10） Z= ﹣ 0.510 0.610 3 .2 Comparison of Breastfeeding Rates between Groups The breastfeeding rates in the intervention group were significantly higher than those in the control group ( P < 0.05). More specifically, the differences between the groups were as follows: any breastfeeding rate: 62.4% (intervention) vs. 42.5% (control); colostrum feeding rate: 36.5% (intervention) vs. 19% (control); and breastfeeding rate at discharge: 37% (intervention) vs. 26.2% (control). However, no statistically significant difference was observed in the exclusive breastfeeding rate for VLBWIs between the two groups ( P > 0.05). Detailed data are provided in Table 2. Table 2 Breastfeeding status Content Intervention group （ n=189 ） Conventional group （ n=174 ） Statistic value P Any breastfeeding rate, n (%) χ 2 = ﹣ 14.406 ＜0.001 Yes 118（62.4%） 74（42.5%） No 71（37.6%） 100（57.5%） Colostrum feeding rate, n (%) χ 2 = ﹣ 13.799 ＜0.001 Yes 69（36.5%） 33（19%） No 120（63.5%） 141（81%） Exclusive breastfeeding rate, n (%) χ 2 = ﹣ 3.338 0.068 Yes 10（5.3%） 3（1.7%） No 179（94.7%） 171（98.3%） Breastfeeding rate at discharge, n (%) χ 2 = ﹣ 4.682 0.03 Yes 70（37%） 46（26.4%） No 119（63%） 128（73.6%） 3 .3 Comparison of Breastfeeding Initiation Time and Duration between Groups The time to breastfeeding initiation among VLBWIs was significantly earlier in the intervention group than in the control group ( P 0.05). Detailed data are provided in Table 3. Table 3 Breastfeeding initiation time and duration Content Intervention group （ n=118 ） Conventional group （ n=74 ） Statistic value P Initiation time of breastfeeding (days), median (IQR) 6（4,10） 7.5（5,15） Z= 2.155 0.031 Duration of breastfeeding (days), median (IQR) 29（16,41） 27.5（12.5,41.5） Z= ﹣ 0.555 0.579 2.4 Comparison of Breastfeeding Discontinuation Rates and NEC Incidence between the Two Groups The results of this study indicated that the intervention group had lower rates of breastfeeding discontinuation and NEC than the conventional group, but the differences were not statistically significant (Figure. 4, 5). 4. Discussion VLBWIs often require immediate admission to the NICU for specialized care and treatment [ 17 ] , typically involving prolonged hospitalization. In China, most NICUs operate under closed management policies, which ensure infection control but present unique challenges for breastfeeding maintenance. Mothers must rely on breast pumping to sustain lactation while enduring prolonged mother–infant separation and heightened anxiety factors that collectively exacerbate breastfeeding difficulties [ 18 , 19 ] . Previous studies [ 20 – 22 ] have implemented structured programs and quality improvement initiatives to promote breastfeeding among VLBWIs with measurable success. Building on these evidence-based approaches, our study introduced a "dual-track empowerment" intervention tailored to institutional realities. This strategy combined the establishment of a dedicated breastfeeding support role and enhanced family support systems. The intervention significantly increased in-hospital breastfeeding rates from 42.6–62.5%, with parallel improvements in colostrum feeding rates and breastfeeding-at-discharge metrics. The Study’s Mechanisms of Impact: (1) Dedicated Lactation Role: The specialized nurse ensured comprehensive, timely, and individualized breastfeeding education and support. By maintaining close contact with mothers, nurses could dynamically assess lactation status and psychological well-being, enabling prompt personalized interventions. (2) Family-Centred Support: The provision of pumping supplies and a streamlined milk delivery system alleviated financial burdens, reinforced family engagement, and standardized milk handling protocols while reducing waste and logistical barriers. Limitations and Real-World Challenges: Despite these gains, contextual constraints persist. As a tertiary hospital serving a wide geographic area (~ 50% of families resided > 60 km away), many households faced untenable choices: renting nearby accommodations for milk delivery (cost-prohibitive for most) or abandoning breastfeeding owing to the impracticality of daily hospital visits. These socioeconomic barriers underscore the need for systemic solutions beyond unit-level interventions. Early initiation of breastfeeding has been shown to prolong breastfeeding duration in VLBWIs [ 23 ] while also reducing mortality, sepsis risk, and hospital stay in preterm infants [ 24 ] . In this study, through early assessment and guidance, the intervention group initiated breastfeeding 1.5 days earlier than the conventional group and exhibited a longer duration of breastfeeding. Challenges in Early Breastfeeding Initiation: In this study, the NICU did not implement donor human milk (DHM) feeding, meaning that all VLBWIs received their mother’s own milk (MOM) that had been pumped within 24 hours. However, several factors hindered early breastfeeding initiation, such as high Caesarean section rates among participating mothers; traditional postpartum confinement practices, which emphasize maternal rest but may conflict with frequent pumping (increasing physical activity and potentially disrupting recovery); and delayed lactogenesis (few mothers initiate pumping within 24 hours postpartum, with most beginning 3 ~ 5 days after delivery, thereby significantly delaying early milk availability for VLBWI). These cultural and physiological barriers highlight the need for future research to explore innovative strategies that balance maternal recovery with early lactation support, potentially challenging traditional postpartum care norms. Despite these challenges, the study demonstrated that the intervention group had a lower breastfeeding discontinuation rate than the conventional group, suggesting that comprehensive support (e.g., dedicated lactation roles་family empowerment) improved breastfeeding sustainability even in high-barrier settings. Human milk oligosaccharides (HMOs) and immunologically active components in breast milk play critical roles in modulating the gut microbiota balance and reducing pathogenic bacterial colonization [ 25 , 26 ] . Compared with formula feeding, exclusive breastfeeding has been shown to significantly decrease the incidence of NEC in VLBWIs [ 27 ] . Notably, preterm infants fed formula face a 2.99-fold greater risk of developing NEC than do those fed human milk [ 28 ] . Although this difference did not reach statistical significance, our intervention—which promoted MOM feeding—demonstrated a trend towards reduced NEC incidence in VLBWIs. 5. Conclusion The establishment of dedicated breastfeeding positions combined with family support effectively improves breastfeeding rates and promotes breastfeeding practices for VLBWIs. However, owing to prolonged hospitalization periods and maternal‒neonatal separation, breastfeeding is prone to interruption, and VLBWIs still face challenges in sustaining long-term breastfeeding. Future studies should further explore strategies to enhance continuous breastfeeding in preterm mothers and reduce breastfeeding discontinuation, such as implementing internet-based family visitation programs. Limitation: Despite active interventions, the breastfeeding rate in our intervention group of Very Low Birth Weight Infants (VLBWIs) only reached 62.4%, with a low rate of exclusive breastfeeding. This was primarily due to the fact that some families came from remote regions and faced economic hardship; we lacked the resources to provide them with additional financial support to sustain breastfeeding for their VLBWIs. Furthermore, without a milk bank, we were unable to implement donor milk feeding. In the future, it may be necessary to explore peer-to-peer milk-sharing strategies to ensure that families without breast milk, particularly those in remote areas, can access an adequate supply. Declarations Conflict of Interest Statement The authors have no conflicts of interest to declare. Ethics approval and consent to participate This study protocol was reviewed and approved by Biomedical Research Ethics Committee of the Affiliated Hospital of Zunyi Medical University, approval number,KLL-2023-505.Informed consent was obtained from parent to participate in the study. Availability of Data and Materials The datasets generated and analyzed during the current study are available from the corresponding author on reasonable request. Funding ： This research was supported by Guizhou Provincial Key TechnologyR&D Program (Qiankehe Support [2023] General 264) and Zunyi Municipal Science and Technology Cooperation Project (Zun Shi Ke He HZ Zi (2023) No. 294. However, therewas no conflict of interest, which did not affect the results of theresearch report. Funding ： This work was supported was supported by Guizhou Provincial Key TechnologyR&D Program (Qiankehe Support [2023] General 264) and Zunyi Municipal Science and Technology Cooperation Project (Zun Shi Ke He HZ Zi (2023) No. 294. However, therewas no conflict of interest, which did not affect the results of theresearch report. Author contributions: Yan Chen and Yao Jin made equal contributions to this manuscript. Zhen y an F u: Conceptualization, Data curation, Formal analysis, Funding acquisition, Investigation, Methodology, Project administration, Resources, Software, Writing-original draft. Yan Chen : Conceptualization, Data curation, Methodology, Project administration, Software, Writing-original draft. Yao Jin: Conceptualization, Data curation, Formal analysis, Project administration, Software, Writing-original draft. Yan Zhao: Conceptualization, Formal analysis, Project administration, Software. Juan Chen: Conceptualization, Data curation, Methodology, Project administration, Supervision, Writing - review & editing. Kaidi Yang: Conceptualization, Project administration, Validation. Chi Huang: Methodology, Project administration, Resources. Mingtao Quan: Conceptualization, Data curation, Methodology, Supervision, Writing - review & editing. Na Yu, Yunfang Wang, Yuxin Xiao, and Qijuan Huang: Investigation, Project administration. 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Cite Share Download PDF Status: Published Journal Publication published 30 Apr, 2026 Read the published version in Journal of Perinatology → Version 1 posted Editorial decision: revise 04 Aug, 2025 Review # 2 received at journal 01 Aug, 2025 Review # 1 received at journal 09 Jul, 2025 Reviewer # 2 agreed at journal 08 Jul, 2025 Reviewer # 1 agreed at journal 02 Jul, 2025 Reviewers invited by journal 02 Jul, 2025 Submission checks completed at journal 27 Jun, 2025 Editor assigned by journal 26 Jun, 2025 First submitted to journal 26 Jun, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6987659","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":479621278,"identity":"57639ee6-35ab-4b52-bf84-975fa9404256","order_by":0,"name":"FU Zhenyan","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA1ElEQVRIiWNgGAWjYBACfvnDBx9I8NjYsckfPkCcFskZbMkGFjJpyfwSbAnEaTG4waMmUWFzmHHmDB4DIl12u4fZ4EZOGrPB7Z6PN94w2MnpNhDQwTjn7MGHM87Y8BncObvZcg5DsrHZAQJamBnyko0le4C2HMjdJs3DcCBxGyEtbAw5ZtJ//x1m3HAg5xlxWngkcswkJHhA3s9hI06LBM+xZAMJHmAg8xwztpxjQIRf7I83Q6OSvfnhjTcVdnIEtaBZSWzUIGkhVccoGAWjYBSMCAAA/itDpM4/RM0AAAAASUVORK5CYII=","orcid":"","institution":"affiliated hospital of zunyi medical university","correspondingAuthor":true,"prefix":"","firstName":"FU","middleName":"","lastName":"Zhenyan","suffix":""},{"id":479621279,"identity":"59160127-1d71-4262-b443-1928e24742f8","order_by":1,"name":"Chen yan","email":"","orcid":"","institution":"zunyi medical university","correspondingAuthor":false,"prefix":"","firstName":"Chen","middleName":"","lastName":"yan","suffix":""},{"id":479621280,"identity":"eb178571-90be-40a0-aa89-77bf05720dfe","order_by":2,"name":"Jin yao","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Jin","middleName":"","lastName":"yao","suffix":""},{"id":479621281,"identity":"7fb2b1c8-b6cb-4ab7-89bf-8ce9f9bbed3a","order_by":3,"name":"zhao yan","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"zhao","middleName":"","lastName":"yan","suffix":""},{"id":479621282,"identity":"83fc4c43-bcbd-4fa8-972c-37e0cf066674","order_by":4,"name":"quan mingtao","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"quan","middleName":"","lastName":"mingtao","suffix":""},{"id":479621283,"identity":"b14ac052-ebf2-44b3-9c61-e234f909f196","order_by":5,"name":"yang kaidi","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"yang","middleName":"","lastName":"kaidi","suffix":""},{"id":479621284,"identity":"bf3f2366-9ba3-4e92-8dce-3f24ac3dbe79","order_by":6,"name":"huang chi","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"huang","middleName":"","lastName":"chi","suffix":""},{"id":479621285,"identity":"2069e470-0e71-4a21-bddd-b6e51be77cd0","order_by":7,"name":"Yu Na","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Yu","middleName":"","lastName":"Na","suffix":""},{"id":479621286,"identity":"6d6baa58-ad91-4c4d-82d4-fb667b3cfbf0","order_by":8,"name":"Wang Yunfang","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Wang","middleName":"","lastName":"Yunfang","suffix":""},{"id":479621287,"identity":"0bc89cdb-f69a-4615-852f-3fea9c521768","order_by":9,"name":"Xiao Yuxin","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Xiao","middleName":"","lastName":"Yuxin","suffix":""},{"id":479621288,"identity":"5ccc93a6-a702-4b87-9f34-0b5a5b91a138","order_by":10,"name":"Huang Qijuan","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Huang","middleName":"","lastName":"Qijuan","suffix":""},{"id":479621289,"identity":"15d770ad-8aae-4d0a-a409-c425adf2b740","order_by":11,"name":"chen juan","email":"","orcid":"","institution":"zunyi medical university","correspondingAuthor":false,"prefix":"","firstName":"chen","middleName":"","lastName":"juan","suffix":""}],"badges":[],"createdAt":"2025-06-27 04:00:27","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6987659/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6987659/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1038/s41372-025-02482-z","type":"published","date":"2026-04-30T04:00:00+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":86131097,"identity":"794172bd-8a95-44fd-9d90-7fa352b5263a","added_by":"auto","created_at":"2025-07-07 06:45:59","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":35385,"visible":true,"origin":"","legend":"\u003cp\u003eSee image above for figure legend.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-6987659/v1/e25fb2b798e5b166a0009fdf.png"},{"id":86132126,"identity":"d51c65f3-1cc5-45a1-aca2-d19b04106bdd","added_by":"auto","created_at":"2025-07-07 06:54:00","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":75648,"visible":true,"origin":"","legend":"\u003cp\u003eSee image above for figure legend.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-6987659/v1/2acc03d3e81f7540e9d7339f.png"},{"id":86131098,"identity":"a50ec2a7-8db0-41c9-8b10-be5145c03943","added_by":"auto","created_at":"2025-07-07 06:45:59","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":29151,"visible":true,"origin":"","legend":"\u003cp\u003eStudy Population\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-6987659/v1/04dfcfa589c80657809aacf4.png"},{"id":86132123,"identity":"49bb0471-4a98-42db-aecd-94e3c658bb24","added_by":"auto","created_at":"2025-07-07 06:53:59","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":39576,"visible":true,"origin":"","legend":"\u003cp\u003eInterval rate of breastfeeding\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-6987659/v1/84c6340bd86a25728bcc1026.png"},{"id":86132122,"identity":"19cdc2cb-654a-4956-8786-43fe7233a57a","added_by":"auto","created_at":"2025-07-07 06:53:59","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":31414,"visible":true,"origin":"","legend":"\u003cp\u003eThe incidence of necrotizing enterocolitis\u003c/p\u003e","description":"","filename":"5.png","url":"https://assets-eu.researchsquare.com/files/rs-6987659/v1/ec50af48f03308d040d7ab57.png"},{"id":108495077,"identity":"d1d7fc0a-373b-447f-baf3-48591ee905b2","added_by":"auto","created_at":"2026-05-05 10:08:34","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":534137,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6987659/v1/a274de29-54de-45c9-8601-f74af921b0f8.pdf"}],"financialInterests":"There is \u003cb\u003eNO\u003c/b\u003e conflict of interest to disclose.","formattedTitle":"Enhancing Breastfeeding Quality among Preterm Infants: A Dual-Approach Intervention Combining a Dedicated Breastfeeding Position and Family Engagement","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eVery low birth weight infants (VLBWIs, \u0026lt;\u0026thinsp;1500 g) constitute a high-risk population in neonatal intensive care units (NICUs). These infants exhibit extreme immaturity in terms of organ system development, coupled with the incomplete establishment of both immune regulation and metabolic pathways\u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]\u003c/sup\u003e. Therefore, these infants face significantly increased risks of morbidity and mortality. Breast milk is the optimal nutrition for infants \u0026ndash; particularly preterm infants \u0026ndash; and plays a crucial role in improving both the short- and long-term outcomes of VLBWIs\u003csup\u003e[\u003cspan additionalcitationids=\"CR3\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/sup\u003e. On the one hand, human milk contains numerous bioactive compounds that promote gut microbiota colonization, enhance intestinal barrier function, and reduce the risk of necrotizing enterocolitis (NEC) \u003csup\u003e[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/sup\u003e. Breastfeeding has also yielded benefits among VLBWIs such as lower incidence rates of late-onset sepsis (LOS) and severe retinopathy of prematurity (ROP)\u003csup\u003e[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/sup\u003e. Moreover, exclusive breastfeeding or higher proportions of human milk among total feeding volumes are associated with reduced rates of feeding intolerance, NEC, LOS, ROP, bronchopulmonary dysplasia (BPD), and mortality\u003csup\u003e[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan additionalcitationids=\"CR9\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/sup\u003e. On the other hand, the bioactive components in breast milk provide specific protection and promote neurodevelopment in infants\u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eBreastfeeding is critical for VLBWIs. Despite various institutional interventions to promote breastfeeding, the implementation of breastfeeding is challenging due to maternal\u0026ndash;infant separation, insufficient maternal lactation, NICU environmental stressors, and inadequate family support\u003csup\u003e[\u003cspan additionalcitationids=\"CR12\" citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]\u003c/sup\u003e. Significant disparities in breastfeeding rates exist across countries and healthcare facilities: 44% in Portugal, 49% in Sweden, 54.5% in Italy, 47\u0026ndash;60% in Germany, 48\u0026ndash;61.1% in the United States, 53.6\u0026ndash;78% in Greece, and 50\u0026ndash;93.4% in Brazil\u003csup\u003e[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan additionalcitationids=\"CR15\" citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u003c/sup\u003e. Overall, breastfeeding outcomes for VLBWIs remain suboptimal.\u003c/p\u003e \u003cp\u003eThis study adopts a dual-track model that combines dedicated lactation specialist roles and family-centred support to enhance breastfeeding in extremely preterm infants. The intervention aims to bridge the gap between existing clinical support systems and family needs in order to provide an evidence-based framework for improving nutritional outcomes in this vulnerable population. The findings will optimize NICU breastfeeding protocols and advance clinical practices towards achieving the World Health Organization (WHO)-recommended feeding targets for preterm infants.\u003c/p\u003e"},{"header":"2. Materials and Methods","content":"\u003cp\u003e\u003cstrong\u003e\u003cem\u003e2\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cem\u003e.1\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cem\u003e.\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;Study Participants\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was conducted at a Grade III Class A hospital in Zunyi city, Guizhou Province, China. Serving as a provincial and municipal-level neonatal care centre, this facility admits approximately 200 VLBWIs annually. Owing to the absence of a human milk bank and to preserve the nutritional integrity of breast milk as much as possible, breastfeeding is provided using milk expressed by mothers within 24 hours of expression.\u003c/p\u003e\n\u003cp\u003eVLBWIs and their mothers were enrolled via consecutive sampling between November 2022 and November 2024. The \u003cstrong\u003einclusion Criteria were as follows:\u0026nbsp;\u003c/strong\u003e① VLBWIs with a birth weight \u0026lt;1500 g; and ② no contraindications to breastfeeding for either VLBWIs or their mothers. The \u003cstrong\u003eexclusion Criteria were as follows: ①\u003c/strong\u003eVLBWIs with congenital gastrointestinal disorders (e.g., oesophageal atresia, gastrointestinal malformations); ② maternal use of medications explicitly contraindicated for breastfeeding; ③severe comorbidities among mothers that precluded participation in breastfeeding education; or ④ parental refusal to participate. The \u003cstrong\u003ewithdrawal Criteria were as follows:\u0026nbsp;\u003c/strong\u003e① death of the VLBWI; ②DISCHARGE or transfer of the VLBWI; or (3) voluntary withdrawal from the study.\u003c/p\u003e\n\u003cp\u003eThis non-concurrent controlled study compared two groups: the conventional group, which comprised VLBWIs and mothers receiving standard unit-based breastfeeding support (recruited from November 2022 to November 2023); and the intervention group, comprising VLBWIs and mothers receiving the dual-track education support model (recruited from November 2023 to November 2024).Sample size calculation: Using G*Power 3.1.9.7, with \u0026alpha;=0.05, power=0.8, and a 1:1 allocation ratio, the calculated sample size required for each group was 64 cases. Accounting for a 10% dropout rate, at least 70 cases per group were included in the VBWI. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThis study protocol was reviewed and approved by Biomedical Research Ethics Committee of the Affiliated Hospital of Zunyi Medical University, approval number,KLL-2023-505.Informed consent was obtained from parent to participate in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003e2\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cem\u003e.2 Research Methods\u003c/em\u003e\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e2\u003c/em\u003e\u003cem\u003e.2.1 Conventional Group\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e(1) After the admission of VLBWIs, the medical team evaluates whether the VLBWI can initiate enteral feeding. If enteral feeding is feasible, the attending physician notifies the infant\u0026apos;s family to provide breast milk and conducts breastfeeding education simultaneously. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e(2) The nurse checks whether the family\u0026rsquo;s breast milk delivery method and labeling (including bed number, name, pumping date, and time) comply with the department\u0026rsquo;s breast milk acceptance requirements and provides guidance if needed. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e(3) When the breast milk delivery and labeling meet the standards, breastfeeding is initiated.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e(Shown in Figure.1)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003e2\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cem\u003e.2.2 Intervention Group\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA dedicated breastfeeding nurse, trained in breastfeeding-related knowledge, was assigned to this group. Following the admission of VLBWI, this nurse was responsible for the \u0026ldquo;execution, implementation, coordination, and organization\u0026rdquo; of all intervention measures.(Shown in Figure.2)\u003c/p\u003e\n\u003cp\u003e(1) Early Assessment and Guidance\u003c/p\u003e\n\u003cp\u003eWithin 12 hours of VLBWI admission, the dedicated breastfeeding nurse conducted the following protocol:\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e①\u0026nbsp;\u003c/strong\u003eClinical Evaluation: The nurse assessed the infant\u0026rsquo;s clinical condition, reviewed maternal medical records, and communicated with the mother to determine whether breastfeeding contraindications (e.g., maternal HIV infection, infant galactosemia) existed in either the infant or the mother.\u003c/p\u003e\n\u003cp\u003e②Eligibility Screening: The nurse verified that the infants and mothers met the eligibility criteria if no contraindications were identified.\u003c/p\u003e\n\u003cp\u003e③ Family-Centred Intervention: The nurse either visited the obstetric department or invited the mother and primary caregivers (prioritizing the spouse and/or mother-in-law) to the neonatal unit for breastfeeding education. Educational Components: The nurse explained preterm infant risks, such as feeding intolerance, infection, and complications; The nurse emphasized the benefits of breastfeeding, including the prevention or reduction of complications, the promotion of oral feeding, and the decreased incidence of feeding intolerance. Furthermore, the nurse provided early lactation support, which included emphasizing the importance of early milk expression and demonstrating proper breast pump techniques (frequency, duration, hygiene);The logistical training involved the nurses educating the families about protocols for breast milk storage (ambient temperature (16~29\u0026deg;C) \u0026le;4 hours; refrigeration at 4\u0026deg;C \u0026le;4 days; freezing at -20\u0026deg;C: recommended for use within 6 months and should not be stored beyond 12 months) and safe transportation (validated cooler boxes with temperature monitoring);Finally, the nurse provided the families with resources, including an illustrated breastfeeding education manual.\u003c/p\u003e\n\u003cp\u003e(2)Tracking Maternal Lactation Progress\u003c/p\u003e\n\u003cp\u003ePrior to family delivery of breast milk, the dedicated breastfeeding nurse established daily contact (1~2 times/day) with the VLBWI\u0026rsquo;s family to monitor maternal lactation status. If lactation difficulties were identified, the nurse conducted a bedside lactation assessment and guidance session until expressed breast milk was successfully delivered to the neonatal unit.\u003c/p\u003e\n\u003cp\u003e(3) Enhanced Breast Milk Management via Digital Platforms\u003c/p\u003e\n\u003cp\u003eA \u0026ldquo;QQ group\u0026rdquo; (a Chinese instant messaging platform) and official WeChat account were established for breastfeeding management. The dedicated breastfeeding nurse oversaw both platforms and regularly uploaded educational videos and articles on breast milk collection, storage, and transportation for mothers and families. Additionally, families could post questions in the QQ group, and five healthcare professionals (including neonatal nurses and lactation consultants) provided real-time responses to the questions.\u003c/p\u003e\n\u003cp\u003e(4) Establishment of a Nighttime Breast Milk Reception Green Channel\u003c/p\u003e\n\u003cp\u003eSince the department\u0026apos;s breast milk collection service was only available during daytime hours and postpartum mothers lacked refrigerator access for breast milk storage during their hospital stay in the obstetrics department, nighttime expressed milk could only be stored at room temperature. Milk stored for more than 4 hours at room temperature had to be discarded, resulting in significant waste. To address this challenge, the department installed a dedicated breast milk refrigerator. Mothers were thus able to deliver milk that was expressed at nighttime to the ward for temporary refrigeration, thereby ensuring standardized storage protocols. This initiative improved breast milk utilization rates and enhance the perceived benefits for both mothers and their families.\u003c/p\u003e\n\u003cp\u003e(5) Provision of Essential Supplies\u003c/p\u003e\n\u003cp\u003eThe department provided ballpoint pens and pumping log stickers to document critical information such as bed number, patient name, expression time, and expression method (manual or pump). This standardized breast milk labelling system ensured consistent identification and prevented unnecessary waste caused by mislabelling, illegible markings, or incomplete records.\u003c/p\u003e\n\u003cp\u003e(6) Promoting Colostrum Utilization\u003c/p\u003e\n\u003cp\u003eThe department implemented an oral colostrum administration protocol for VLBWIs, with the following specifications: frequency: every 3 hours (or every 6 hours as clinically indicated); dosage: 0.2 mL per administration (0.1 mL applied to each buccal mucosa); duration: at least 2.5 minutes per application; and treatment course: 10 consecutive days. This protocol enhanced immunological benefits by ensuring mucosal absorption of colostrum components while optimizing nutritional uptake for VLBWIs.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.2.3 Advantage of intervention group\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eComparision with conventional group, intervention group has several advantages:Family menbers can acquire breastfeeding education early;VLBWI can breastfeeding timely once they initiate enteral feeding;Less breast milk wastage and more family support.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.3 Outcomes\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study includes one primary outcome and seven secondary outcomes. Any breastfeeding rate during hospitalization as this study\u0026rsquo;s primary outcome; This study\u0026rsquo;s secondary outcomes include exclusive breastfeeding rate、breastfeeding rate at discharge、colostrum feeding rate、breastfeeding initiation time and duration、\u0026nbsp;Breastfeeding Discontinuation Rates(Interruption of continuous breastfeeding in VLBWI caused by inadequate maternal milk volume to fulfill their daily nutritional demands)、NEC incidence.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003e2\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cem\u003e.\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cem\u003e4\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cem\u003eStatistical analysis\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData management was performed using Excel 2003, and statistical analyses were conducted using SPSS software (version 29.0).\u0026nbsp;Maternal age(years), Gestational age (wk), Weight at birth (g), Apgar score, Initiation time of breastfeeding (days), and Duration of breastfeeding (days)\u0026nbsp;conforming to a normal distribution are presented as mean \u0026plusmn; standard deviation (SD) and were analyzed using the Student\u0026apos;s t-test,\u0026nbsp;not conforming to a normal distribution are presented as median (interquartile range, IQR; P25, P75) and were analyzed using the Mann-Whitney U test (for two groups) or the Kruskal-Wallis test (for more than two groups).\u0026nbsp;Mode of conception,\u0026nbsp;Mode of delivery,\u0026nbsp;Experience of delivery,\u0026nbsp;Infant sex,\u0026nbsp;Any breastfeeding rate,\u0026nbsp;Colostrum feeding rate,\u0026nbsp;Exclusive breastfeeding rate,\u0026nbsp;Breastfeeding rate at discharge,\u0026nbsp;breastfeeding discontinuation, and\u0026nbsp;NEC\u0026nbsp;incidence\u0026nbsp;are presented as frequencies (percentages, %) and were analyzed using the Chi-square test (\u0026chi;\u0026sup2; test). A p-value of less than 0.05 (\u003cem\u003eP\u003c/em\u003e\u0026lt; 0.05) was considered statistically significant.\u003c/p\u003e"},{"header":"3. Results","content":"\u003cp\u003e\u003cstrong\u003e\u003cem\u003e3\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cem\u003e.1 Study Population and Baseline Characteristics\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eUltimately, 363 mother‒infant dyads were included for analysis, encompassing 189 dyads in the intervention group and 174 dyads in the control group. No statistically significant differences were found between the two groups (all \u003cem\u003eP\u003c/em\u003e \u0026gt; 0.05) in terms of maternal age, mode of conception, mode of delivery or experience of delivery. The VLBWIs in both groups showed comparable baseline measurements (all\u003cem\u003e\u0026nbsp;P\u003c/em\u003e \u0026gt; 0.05) in terms of sex distribution, gestational age (weeks), birth weight (grams) and Apgar scores at 1 minute and 5 minutes. (Shown in Fig.3 and Table 1).\u003c/p\u003e\n\u003cdiv align=\"Left\"\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"560\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" style=\"width: 560px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable 1 \u0026nbsp;Baseline Characteristics of the Study Population\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 182px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIntervention group\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e（\u003c/strong\u003e\u003cstrong\u003en=189\u003c/strong\u003e\u003cstrong\u003e）\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eConventional group\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e（\u003c/strong\u003e\u003cstrong\u003en=174\u003c/strong\u003e\u003cstrong\u003e）\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eStatistic value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 182px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMaternal age(years), median (IQR)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e30（27,33.50）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e29（26,33）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003e\u003cem\u003eZ=\u003c/em\u003e\u003cem\u003e﹣\u003c/em\u003e1.541\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e0.123\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 182px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMode of conception, n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026chi;\u003c/em\u003e\u003cem\u003e\u003csup\u003e2\u003c/sup\u003e\u003c/em\u003e\u003cem\u003e=\u003c/em\u003e\u003cem\u003e﹣\u003c/em\u003e2.848\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e0.091\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 182px;\"\u003e\n \u003cp\u003eSpontaneous conception\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e144（76.2%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e145（83.3%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 182px;\"\u003e\n \u003cp\u003eART pregnancies\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e45（23.8%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e29（16.7%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 182px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMode of delivery, n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026chi;\u003c/em\u003e\u003cem\u003e\u003csup\u003e2\u003c/sup\u003e\u003c/em\u003e\u003cem\u003e=\u003c/em\u003e\u003cem\u003e﹣\u003c/em\u003e2.033\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e0.154\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 182px;\"\u003e\n \u003cp\u003eVaginal delivery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e45（23.8%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e53（30.5%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 182px;\"\u003e\n \u003cp\u003eCaesarean section\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e144（76.2%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e121（69.5%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 182px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eExperience of delivery , n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026chi;\u003c/em\u003e\u003cem\u003e\u003csup\u003e2\u003c/sup\u003e\u003c/em\u003e\u003cem\u003e=\u003c/em\u003e\u003cem\u003e﹣\u003c/em\u003e0.489\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e0.484\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 182px;\"\u003e\n \u003cp\u003eNullipara\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e80（42.3%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e80（46.0%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 182px;\"\u003e\n \u003cp\u003eMultiparous\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e109（57.7%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e94（54.0%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 182px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eInfant sex, n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026chi;\u003c/em\u003e\u003cem\u003e\u003csup\u003e2\u003c/sup\u003e\u003c/em\u003e\u003cem\u003e=\u003c/em\u003e\u003cem\u003e﹣\u003c/em\u003e0.028\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e0.866\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 182px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e95（50.3%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e89（51.1%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 182px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e94（49.7%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e85（48.9%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 182px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGestational age (wk), mean\u0026plusmn;SD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e30.49\u0026plusmn;2.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e30.34\u0026plusmn;2.20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003e\u003cem\u003et\u003c/em\u003e = 0.666\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e0.506\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 182px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWeight at birth (g), median (IQR)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e1300\u0026nbsp;（1075,1480）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e1255（1100,1392.50）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003e\u003cem\u003eZ=\u003c/em\u003e\u003cem\u003e﹣\u003c/em\u003e1.475\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e0.140\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 182px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eApgar score\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 182px;\"\u003e\n \u003cp\u003e1 minute\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e10（8,10）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e10（8,10）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003e\u003cem\u003eZ=\u003c/em\u003e\u003cem\u003e﹣\u003c/em\u003e0.138\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e0.890\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 182px;\"\u003e\n \u003cp\u003e5 minutes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e10（10,10）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e10（10,10）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003e\u003cem\u003eZ=\u003c/em\u003e\u003cem\u003e﹣\u003c/em\u003e0.510\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e0.610\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003e3\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cem\u003e.2 Comparison of Breastfeeding Rates between Groups\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe breastfeeding rates in the intervention group were significantly higher than those in the control group (\u003cem\u003eP\u003c/em\u003e\u0026lt; 0.05). More specifically, the differences between the groups were as follows: any breastfeeding rate: 62.4% (intervention) vs. 42.5% (control); colostrum feeding rate: 36.5% (intervention) vs. 19% (control); and breastfeeding rate at discharge: 37% (intervention) vs. 26.2% (control). However, no statistically significant difference was observed in the exclusive breastfeeding rate for VLBWIs between the two groups (\u003cem\u003eP\u003c/em\u003e \u0026gt; 0.05). Detailed data are provided in Table 2.\u003c/p\u003e\n\u003cdiv align=\"Left\"\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"536\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" style=\"width: 536px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable 2 Breastfeeding status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 182px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eContent\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIntervention group\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e（\u003c/strong\u003e\u003cstrong\u003en=189\u003c/strong\u003e\u003cstrong\u003e）\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eConventional group\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e（\u003c/strong\u003e\u003cstrong\u003en=174\u003c/strong\u003e\u003cstrong\u003e）\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eStatistic\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003evalue\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 182px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAny breastfeeding rate, n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026chi;\u003c/em\u003e\u003cem\u003e\u003csup\u003e2\u003c/sup\u003e\u003c/em\u003e\u003cem\u003e=\u003c/em\u003e\u003cem\u003e﹣\u003c/em\u003e14.406\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 182px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e118（62.4%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e74（42.5%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 182px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e71（37.6%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e100（57.5%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 182px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eColostrum feeding rate, n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026chi;\u003c/em\u003e\u003cem\u003e\u003csup\u003e2\u003c/sup\u003e\u003c/em\u003e\u003cem\u003e=\u003c/em\u003e\u003cem\u003e﹣\u003c/em\u003e13.799\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 182px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e69（36.5%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e33（19%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 182px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e120（63.5%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e141（81%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 182px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eExclusive breastfeeding rate, n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e\u003cem\u003eχ\u003c/em\u003e\u003cem\u003e\u003csup\u003e2\u003c/sup\u003e\u003c/em\u003e\u003cem\u003e=\u003c/em\u003e\u003cem\u003e﹣\u003c/em\u003e3.338\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e0.068\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 182px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e10（5.3%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e3（1.7%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 182px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e179（94.7%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e171（98.3%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 182px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBreastfeeding rate at discharge, n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e\u003cem\u003eχ\u003c/em\u003e\u003cem\u003e\u003csup\u003e2\u003c/sup\u003e\u003c/em\u003e\u003cem\u003e=\u003c/em\u003e\u003cem\u003e﹣\u003c/em\u003e4.682\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e0.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 182px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e70（37%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e46（26.4%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 182px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e119（63%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e128（73.6%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003e3\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cem\u003e.3 Comparison of Breastfeeding Initiation Time and Duration between Groups\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe time to breastfeeding initiation among VLBWIs was significantly earlier in the intervention group than in the control group (\u003cem\u003eP\u003c/em\u003e\u0026lt; 0.05). However, there was no statistically significant difference in the duration of breastfeeding between the two groups (\u003cem\u003eP\u0026nbsp;\u003c/em\u003e\u0026gt; 0.05). Detailed data are provided in Table 3.\u003c/p\u003e\n\u003cdiv align=\"Left\"\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"533\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" style=\"width: 533px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable 3 \u0026nbsp;Breastfeeding initiation time and duration\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 211px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eContent\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIntervention group\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e（\u003c/strong\u003e\u003cstrong\u003en=118\u003c/strong\u003e\u003cstrong\u003e）\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eConventional group\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e（\u003c/strong\u003e\u003cstrong\u003en=74\u003c/strong\u003e\u003cstrong\u003e）\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eStatistic value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 211px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eInitiation time of breastfeeding (days), median (IQR)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e6（4,10）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e7.5（5,15）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e\u003cem\u003eZ=\u003c/em\u003e2.155\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e0.031\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 211px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDuration of breastfeeding (days), median (IQR)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e29（16,41）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e27.5（12.5,41.5）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e\u003cem\u003eZ=\u003c/em\u003e\u003cem\u003e﹣\u003c/em\u003e0.555\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e0.579\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e2.4 Comparison of Breastfeeding Discontinuation Rates and NEC Incidence between the Two Groups\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;The results of this study indicated that the intervention group had lower rates of breastfeeding discontinuation and NEC than the conventional group, but the differences were not statistically significant (Figure. 4, 5).\u003c/p\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eVLBWIs often require immediate admission to the NICU for specialized care and treatment\u003csup\u003e[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]\u003c/sup\u003e, typically involving prolonged hospitalization. In China, most NICUs operate under closed management policies, which ensure infection control but present unique challenges for breastfeeding maintenance. Mothers must rely on breast pumping to sustain lactation while enduring prolonged mother\u0026ndash;infant separation and heightened anxiety factors that collectively exacerbate breastfeeding difficulties\u003csup\u003e[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]\u003c/sup\u003e. Previous studies\u003csup\u003e[\u003cspan additionalcitationids=\"CR21\" citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]\u003c/sup\u003e have implemented structured programs and quality improvement initiatives to promote breastfeeding among VLBWIs with measurable success. Building on these evidence-based approaches, our study introduced a \"dual-track empowerment\" intervention tailored to institutional realities. This strategy combined the establishment of a dedicated breastfeeding support role and enhanced family support systems. The intervention significantly increased in-hospital breastfeeding rates from 42.6\u0026ndash;62.5%, with parallel improvements in colostrum feeding rates and breastfeeding-at-discharge metrics. The Study\u0026rsquo;s Mechanisms of Impact: (1) Dedicated Lactation Role: The specialized nurse ensured comprehensive, timely, and individualized breastfeeding education and support. By maintaining close contact with mothers, nurses could dynamically assess lactation status and psychological well-being, enabling prompt personalized interventions. (2) Family-Centred Support: The provision of pumping supplies and a streamlined milk delivery system alleviated financial burdens, reinforced family engagement, and standardized milk handling protocols while reducing waste and logistical barriers. Limitations and Real-World Challenges: Despite these gains, contextual constraints persist. As a tertiary hospital serving a wide geographic area (~\u0026thinsp;50% of families resided\u0026thinsp;\u0026gt;\u0026thinsp;60 km away), many households faced untenable choices: renting nearby accommodations for milk delivery (cost-prohibitive for most) or abandoning breastfeeding owing to the impracticality of daily hospital visits. These socioeconomic barriers underscore the need for systemic solutions beyond unit-level interventions.\u003c/p\u003e \u003cp\u003eEarly initiation of breastfeeding has been shown to prolong breastfeeding duration in VLBWIs\u003csup\u003e[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]\u003c/sup\u003e while also reducing mortality, sepsis risk, and hospital stay in preterm infants\u003csup\u003e[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]\u003c/sup\u003e. In this study, through early assessment and guidance, the intervention group initiated breastfeeding 1.5 days earlier than the conventional group and exhibited a longer duration of breastfeeding. Challenges in Early Breastfeeding Initiation: In this study, the NICU did not implement donor human milk (DHM) feeding, meaning that all VLBWIs received their mother\u0026rsquo;s own milk (MOM) that had been pumped within 24 hours. However, several factors hindered early breastfeeding initiation, such as high Caesarean section rates among participating mothers; traditional postpartum confinement practices, which emphasize maternal rest but may conflict with frequent pumping (increasing physical activity and potentially disrupting recovery); and delayed lactogenesis (few mothers initiate pumping within 24 hours postpartum, with most beginning 3\u0026thinsp;~\u0026thinsp;5 days after delivery, thereby significantly delaying early milk availability for VLBWI). These cultural and physiological barriers highlight the need for future research to explore innovative strategies that balance maternal recovery with early lactation support, potentially challenging traditional postpartum care norms. Despite these challenges, the study demonstrated that the intervention group had a lower breastfeeding discontinuation rate than the conventional group, suggesting that comprehensive support (e.g., dedicated lactation roles་family empowerment) improved breastfeeding sustainability even in high-barrier settings.\u003c/p\u003e \u003cp\u003eHuman milk oligosaccharides (HMOs) and immunologically active components in breast milk play critical roles in modulating the gut microbiota balance and reducing pathogenic bacterial colonization\u003csup\u003e[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]\u003c/sup\u003e. Compared with formula feeding, exclusive breastfeeding has been shown to significantly decrease the incidence of NEC in VLBWIs\u003csup\u003e[\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]\u003c/sup\u003e. Notably, preterm infants fed formula face a 2.99-fold greater risk of developing NEC than do those fed human milk\u003csup\u003e[\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]\u003c/sup\u003e. Although this difference did not reach statistical significance, our intervention\u0026mdash;which promoted MOM feeding\u0026mdash;demonstrated a trend towards reduced NEC incidence in VLBWIs.\u003c/p\u003e"},{"header":"5. Conclusion","content":"\u003cp\u003eThe establishment of dedicated breastfeeding positions combined with family support effectively improves breastfeeding rates and promotes breastfeeding practices for VLBWIs. However, owing to prolonged hospitalization periods and maternal‒neonatal separation, breastfeeding is prone to interruption, and VLBWIs still face challenges in sustaining long-term breastfeeding. Future studies should further explore strategies to enhance continuous breastfeeding in preterm mothers and reduce breastfeeding discontinuation, such as implementing internet-based family visitation programs.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLimitation:\u0026nbsp;\u003c/strong\u003eDespite active interventions, the breastfeeding rate in our intervention group of Very Low Birth Weight Infants (VLBWIs) only reached 62.4%, with a low rate of exclusive breastfeeding. This was primarily due to the fact that some families came from remote regions and faced economic hardship; we lacked the resources to provide them with additional financial support to sustain breastfeeding for their VLBWIs. Furthermore, without a milk bank, we were unable to implement donor milk feeding. In the future, it may be necessary to explore peer-to-peer milk-sharing strategies to ensure that families without breast milk, particularly those in remote areas, can access an adequate supply.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eConflict of Interest Statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors have no conflicts of interest to declare.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study protocol was reviewed and approved by Biomedical Research Ethics Committee of the Affiliated Hospital of Zunyi Medical University, approval number,KLL-2023-505.Informed consent was obtained from parent to participate in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of Data and Materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated and analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003cstrong\u003e：\u003c/strong\u003eThis research was supported by Guizhou Provincial Key TechnologyR\u0026amp;D Program (Qiankehe Support [2023] General 264) and Zunyi Municipal Science and Technology Cooperation Project (Zun Shi Ke He HZ Zi (2023) No. 294. However, therewas no conflict of interest, which did not affect the results of theresearch report.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003cstrong\u003e：\u003c/strong\u003e\u003cstrong\u003eThis work was supported\u003c/strong\u003e was supported by Guizhou Provincial Key TechnologyR\u0026amp;D Program (Qiankehe Support [2023] General 264) and Zunyi Municipal Science and Technology Cooperation Project (Zun Shi Ke He HZ Zi (2023) No. 294. However, therewas no conflict of interest, which did not affect the results of theresearch report.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eYan Chen and Yao Jin\u003c/strong\u003e made equal contributions to this manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eZhen\u003c/strong\u003e\u003cstrong\u003ey\u003c/strong\u003e\u003cstrong\u003ean F\u003c/strong\u003e\u003cstrong\u003eu:\u003c/strong\u003eConceptualization,\u0026nbsp;Data\u0026nbsp;curation, Formal analysis, Funding acquisition, Investigation,\u0026nbsp;Methodology, Project\u0026nbsp;administration, Resources,\u0026nbsp;Software, Writing-original draft.\u0026nbsp;\u003cstrong\u003eYan Chen\u003c/strong\u003e:\u0026nbsp;Conceptualization,\u0026nbsp;Data\u0026nbsp;curation, \u0026nbsp;Methodology,\u0026nbsp;Project\u0026nbsp;administration,\u0026nbsp;Software,\u0026nbsp;Writing-original\u0026nbsp;draft.\u0026nbsp;\u003cstrong\u003eYao Jin:\u0026nbsp;\u003c/strong\u003eConceptualization,\u0026nbsp;Data\u0026nbsp;curation, Formal analysis,\u0026nbsp;Project\u0026nbsp;administration,\u0026nbsp;Software,\u0026nbsp;Writing-original\u0026nbsp;draft.\u0026nbsp;\u003cstrong\u003e\u0026nbsp;Yan Zhao:\u0026nbsp;\u003c/strong\u003eConceptualization, Formal analysis,\u0026nbsp;Project\u0026nbsp;administration,\u0026nbsp;Software.\u003cstrong\u003eJuan Chen:\u003c/strong\u003eConceptualization,\u0026nbsp;Data\u0026nbsp;curation,\u0026nbsp;Methodology,\u0026nbsp;Project\u0026nbsp;administration,\u0026nbsp;Supervision,\u0026nbsp;Writing - review \u0026amp; editing.\u003cstrong\u003eKaidi Yang:\u0026nbsp;\u003c/strong\u003eConceptualization,\u0026nbsp;Project\u0026nbsp;administration, Validation.\u003cstrong\u003eChi Huang:\u003c/strong\u003eMethodology,\u0026nbsp;Project\u0026nbsp;administration, Resources.\u003cstrong\u003eMingtao Quan:\u003c/strong\u003eConceptualization,\u0026nbsp;Data\u0026nbsp;curation,\u0026nbsp;Methodology,\u0026nbsp;Supervision, Writing - review \u0026amp; editing.\u003cstrong\u003eNa Yu, Yunfang Wang,\u003c/strong\u003e\u003cstrong\u003eYuxin Xiao, and Qijuan Huang:\u003c/strong\u003eInvestigation,\u0026nbsp;Project\u0026nbsp;administration.\u0026nbsp;\u003c/p\u003e\n\u003ch1\u003eAcknowledgements\u003c/h1\u003e\n\u003cp\u003eWe acknowledge the department of neonatology of affiliated Hospital of Zunyi Medical University for their support.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003ePATEL A L, JOHNSON T J, MEIER P P. Racial and socioeconomic disparities in breast milk feedings in US neonatal intensive care units.[J]. Pediatric research, 2021,89(2): 344-352.\u003c/li\u003e\n \u003cli\u003eQUITADAMO P A, ZAMBIANCO F, PALUMBO G, et al. Trend and Predictors of Breastmilk Feeding among Very-Low-Birth-Weight Infants in NICU and at Discharge.[J]. Nutrients, 2023,15(15).\u003c/li\u003e\n \u003cli\u003eQUITADAMO P A, ZAMBIANCO F, PALUMBO G, et al. Monitoring the Use of Human Milk, the Ideal Food for Very Low-Birth-Weight Infants-A Narrative Review.[J]. Foods (Basel, Switzerland), 2024,13(5).\u003c/li\u003e\n \u003cli\u003ePARKER M G, STELLWAGEN L M, NOBLE L, et al. Promoting Human Milk and Breastfeeding for the Very Low Birth Weight Infant.[J]. Pediatrics, 2021,148(5).\u003c/li\u003e\n \u003cli\u003eJIRILLO E, TOPI S, CHARITOS I, et al. Gut Microbiota and Immune System in Necrotizing Enterocolitis and Related Sepsis[J]. Gastrointestinal Disorders, 2024,6(2).\u003c/li\u003e\n \u003cli\u003eKUMBHARE S V, JONES W, FAST S, et al. Source of human milk (mother or donor) is more important than fortifier type (human or bovine) in shaping the preterm infant microbiome.[J]. Cell reports. Medicine, 2022,3(9): 100712.\u003c/li\u003e\n \u003cli\u003eHANFORD J, MANNEBACH K, OHLER A, et al. Rates of Comorbidities in Very Low Birth Weight Infants Fed an Exclusive Human Milk Diet Versus a Bovine Supplemented Diet.[J]. Breastfeeding medicine : the official journal of the Academy of Breastfeeding Medicine, 2021,16(10): 814-820.\u003c/li\u003e\n \u003cli\u003eHAIR A B, PELUSO A M, HAWTHORNE K M, et al. Beyond Necrotizing Enterocolitis Prevention: Improving Outcomes with an Exclusive Human Milk-Based Diet.[J]. Breastfeeding medicine : the official journal of the Academy of Breastfeeding Medicine, 2016,11(2): 70-74.\u003c/li\u003e\n \u003cli\u003eASSAD M, ELLIOTT M J, ABRAHAM J H. Decreased cost and improved feeding tolerance in VLBW infants fed an exclusive human milk diet.[J]. Journal of perinatology : official journal of the California Perinatal Association, 2016,36(3): 216-220.\u003c/li\u003e\n \u003cli\u003eCHOWNING R, RADMACHER P, LEWIS S, et al. A retrospective analysis of the effect of human milk on prevention of necrotizing enterocolitis and postnatal growth.[J]. Journal of perinatology : official journal of the California Perinatal Association, 2016,36(3): 221-224.\u003c/li\u003e\n \u003cli\u003eUTAMI R, ARIEF Y S. The effectiveness of breastfeeding self-efficacy intervention on implementation of breastfeeding in low-birth-weight infants: A systematic review.[J]. JPMA. The Journal of the Pakistan Medical Association, 2023,73(Suppl 2)(2): S153-S157.\u003c/li\u003e\n \u003cli\u003eNSUBUGA R, RUJUMBA J, NYENDE S, et al. Predictors of mortality among low birth weight neonates after hospital discharge in a low-resource setting: A case study in Uganda.[J]. PloS one, 2024,19(6): e303454.\u003c/li\u003e\n \u003cli\u003eCHAUHAN A, KUMAR M, TRIPATHI S, et al. Breastfeeding rates at discharge for very low birthweight neonates and their determinants: An observational study from a tertiary care neonatal intensive care unit in India.[J]. Journal of paediatrics and child health, 2022,58(9): 1653-1660.\u003c/li\u003e\n \u003cli\u003eLEE H C, GOULD J B. Factors influencing breast milk versus formula feeding at discharge for very low birth weight infants in California.[J]. The Journal of pediatrics, 2009,155(5): 657-662.\u003c/li\u003e\n \u003cli\u003eKALLURI N S, BURNHAM L A, LOPERA A M, et al. A Quality Improvement Project to Increase Mother\u0026apos;s Milk Use in an Inner-City NICU.[J]. Pediatric quality \u0026amp; safety, 2019,4(5): e204.\u003c/li\u003e\n \u003cli\u003eDAVANZO R, RONFANI L, BROVEDANI P, et al. Breast feeding very-low-birthweight infants at discharge: a multicentre study using WHO definitions.[J]. Paediatric and perinatal epidemiology, 2009,23(6): 591-596.\u003c/li\u003e\n \u003cli\u003eELSISI G H, CHEDID F, KHAN J, et al. A budget impact analysis of exclusive human milk diet in very low birth weight infants in United Arab Emirates.[J]. Journal of medical economics, 2024,27(1): 1421-1433.\u003c/li\u003e\n \u003cli\u003eSCHWAB I, DRESBACH T, OHNH\u0026Auml;USER T, et al. Pressure to provide milk among mothers of very low birth weight infants: an explorative study.[J]. BMC pregnancy and childbirth, 2024,24(1): 134.\u003c/li\u003e\n \u003cli\u003eSONG J T, KINSHELLA M W, KAWAZA K, et al. Neonatal Intensive Care Unit Interventions to Improve Breastfeeding Rates at Discharge Among Preterm and Low Birth Weight Infants: A Systematic Review and Meta-Analysis.[J]. Breastfeeding medicine : the official journal of the Academy of Breastfeeding Medicine, 2023,18(2): 97-106.\u003c/li\u003e\n \u003cli\u003eWETZEL C M, DAVIS L, GROHLER N, et al. A Quality Improvement Project to Improve the Use of Mother\u0026apos;s Own Milk (MOM) With Precision Oropharyngeal Therapy.[J]. Advances in neonatal care : official journal of the National Association of Neonatal Nurses, 2020,20(2): E19-E30.\u003c/li\u003e\n \u003cli\u003eBIXBY C, BAKER-FOX C, DEMING C, et al. A Multidisciplinary Quality Improvement Approach Increases Breastmilk Availability at Discharge from the Neonatal Intensive Care Unit for the Very-Low-Birth-Weight Infant.[J]. Breastfeeding medicine : the official journal of the Academy of Breastfeeding Medicine, 2016,11(2): 75-79.\u003c/li\u003e\n \u003cli\u003ePERUGI S, CIARCI\u0026Agrave; M, COVIELLO C, et al. A structured programme to promote breastfeeding improved the rates in very preterm infants at discharge.[J]. Acta paediatrica (Oslo, Norway : 1992), 2024,113(6): 1322-1330.\u003c/li\u003e\n \u003cli\u003eBERNS M, BAYRAMOVA S, KUSZTRICH A, et al. Trend over 25 years of risk factors of mother\u0026apos;s own milk provision to very low birth weight infants at discharge.[J]. Early human development, 2023,177-178: 105730.\u003c/li\u003e\n \u003cli\u003eCHUBEY R, FRASER D, BRAGANZA V, et al. Quality Improvement Initiative: Identifying Barriers to Reducing Time to First Feed With Human Milk in Low Birth Weight Infants.[J]. Neonatal network : NN, 2024,43(5): 305-316.\u003c/li\u003e\n \u003cli\u003eCAMPOS-MARTINEZ A M, EXP\u0026Oacute;SITO-HERRERA J, GONZALEZ-BOL\u0026Iacute;VAR M, et al. Evaluation of Risk and Preventive Factors for Necrotizing Enterocolitis in Premature Newborns. A Systematic Review of the Literature.[J]. Frontiers in pediatrics, 2022,10: 874976.\u003c/li\u003e\n \u003cli\u003eYANG J, QU H, LIU Q, et al. Global Insights and Key Trends in Gut Microbiota Research for Premature Infants: A Bibliometric and Visualization Study.[J]. Journal of multidisciplinary healthcare, 2024,17: 4611-4626.\u003c/li\u003e\n \u003cli\u003eLANGE M, FIGURA Y, B\u0026Ouml;HNE C, et al. Management of Enteral Feeding and Application of Probiotics in Very Low Birth Weight Infants - A National Survey in German NICUs.[J]. Zeitschrift fur Geburtshilfe und Neonatologie, 2023,227(1): 51-57.\u003c/li\u003e\n \u003cli\u003eSTROBEL N A, ADAMS C, MCAULLAY D R, et al. Mother\u0026apos;s Own Milk Compared With Formula Milk for Feeding Preterm or Low Birth Weight Infants: Systematic Review and Meta-analysis.[J]. Pediatrics, 2022,150(Suppl 1).\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"journal-of-perinatology","isNatureJournal":false,"hasQc":false,"allowDirectSubmit":false,"externalIdentity":"jp","sideBox":"Learn more about [Journal of Perinatology](http://www.nature.com/jp/)","snPcode":"41372","submissionUrl":"https://mts-jper.nature.com/cgi-bin/main.plex","title":"Journal of Perinatology","twitterHandle":"@jperinatology","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"ejp","reportingPortfolio":"Nature AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Preterm infants, human milk, Dedicated Breastfeeding Position, Family Engagement","lastPublishedDoi":"10.21203/rs.3.rs-6987659/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6987659/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjective\u003c/strong\u003e: This study aimed to investigate the combined effects of establishing a dedicated breastfeeding position in the neonatal intensive care unit (NICU) and family support on improving the breastfeeding rate of very low birth weight infants (VLBWIs).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e: A non-concurrent controlled study was conducted. VLBWIs hospitalized at the Affiliated Hospital of Zunyi Medical University from November 2023 to November 2024 were selected as the intervention group. A dedicated team of breastfeeding nurses was established to implement the following interventions: early assessment and guidance for mothers within 12 hours after neonatal NICU admission; regular communication with mothers and families to monitor maternal conditions; enhanced breast milk management via digital platforms; a nighttime breast milk reception green channel; material support; and the promotion of colostrum utilization. VLBWIs admitted between November 2022 and October 2023 were included as the conventional group for comparison.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e: The breastfeeding rate in the intervention group (62.5%) was significantly higher than that in the conventional group (42.6%). The colostrum feeding rate in the intervention group (36.5%) was higher than that in the conventional group (19%), and the breastfeeding rate at discharge was significantly greater in the intervention group (37%) than in the conventional group (26.4%) (\u003cem\u003eP\u003c/em\u003e\u0026lt;0.05). The initiation time of breastfeeding in the intervention group was significantly earlier than that in the control group (\u003cem\u003eP\u003c/em\u003e\u0026lt;0.05). Both earlier initiation of breastfeeding and increased breastfeeding rates at discharge were significantly different between the groups.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e: The dual-track empowerment model, which integrates dedicated breastfeeding positions and family support, effectively improved breastfeeding rates and practices for VLBWIs. This model provides a valuable reference for clinical healthcare providers to promote breastfeeding.\u003c/p\u003e","manuscriptTitle":"Enhancing Breastfeeding Quality among Preterm Infants: A Dual-Approach Intervention Combining a Dedicated Breastfeeding Position and Family Engagement","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-07-07 06:45:55","doi":"10.21203/rs.3.rs-6987659/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"revise","date":"2025-08-04T14:21:29+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"This content is not available.","date":"2025-08-02T00:08:19+00:00","index":2,"fulltext":"This content is not available."},{"type":"editorInvitedReview","content":"This content is not available.","date":"2025-07-09T20:56:36+00:00","index":1,"fulltext":"This content is not available."},{"type":"reviewerAgreed","content":"This content is not available.","date":"2025-07-09T00:24:43+00:00","index":2,"fulltext":"This content is not available."},{"type":"reviewerAgreed","content":"This content is not available.","date":"2025-07-03T02:25:54+00:00","index":1,"fulltext":"This content is not available."},{"type":"reviewersInvited","content":"","date":"2025-07-02T12:34:31+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-06-27T10:01:16+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-06-27T03:57:47+00:00","index":"","fulltext":""},{"type":"submitted","content":"Journal of Perinatology","date":"2025-06-27T03:57:46+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"journal-of-perinatology","isNatureJournal":false,"hasQc":false,"allowDirectSubmit":false,"externalIdentity":"jp","sideBox":"Learn more about [Journal of Perinatology](http://www.nature.com/jp/)","snPcode":"41372","submissionUrl":"https://mts-jper.nature.com/cgi-bin/main.plex","title":"Journal of Perinatology","twitterHandle":"@jperinatology","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"ejp","reportingPortfolio":"Nature AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"b62d719f-f114-47e9-971b-4369c3530874","owner":[],"postedDate":"July 7th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[{"id":50930307,"name":"Health sciences/Health care/Health services"},{"id":50930308,"name":"Scientific community and society/Developing world"}],"tags":[],"updatedAt":"2026-05-05T09:56:00+00:00","versionOfRecord":{"articleIdentity":"rs-6987659","link":"https://doi.org/10.1038/s41372-025-02482-z","journal":{"identity":"journal-of-perinatology","isVorOnly":false,"title":"Journal of Perinatology"},"publishedOn":"2026-04-30 04:00:00","publishedOnDateReadable":"April 30th, 2026"},"versionCreatedAt":"2025-07-07 06:45:55","video":"","vorDoi":"10.1038/s41372-025-02482-z","vorDoiUrl":"https://doi.org/10.1038/s41372-025-02482-z","workflowStages":[]},"version":"v1","identity":"rs-6987659","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6987659","identity":"rs-6987659","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}