Chen Y, Cai SL. Effect of early micro-breastfeeding on growth rate and postpartum depression in preterm infants with low-birth-weight. World J Psychiatry 2025; 15(8): 108919 [DOI: 10.5498/wjp.v15.i8.108919]
Corresponding Author of This Article
Sheng-Lan Cai, Department of Neonatology, Suzhou Ninth Hospital Affiliated to Soochow University, No. 2666 Ludang Road, Taihu New Town, Wujiang District, Suzhou 215200, Jiangsu Province, China. 13584419577@163.com
Research Domain of This Article
Pediatrics
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Author contributions: Chen Y and Cai SL were responsible for research and write a manuscript, conceiving the research and analyzing data; Cai SL conducted the analysis and provided guidance for the research; all authors reviewed and approved the final manuscript.
Institutional review board statement: This study was approved by the Ethic Committee of Suzhou Ninth Hospital Affiliated to Soochow University.
Informed consent statement: All research subjects provided informed written consent regarding personal and medical data collection prior to enrollment in the study.
Conflict-of-interest statement: All authors declare that there is no conflict of interest.
Data sharing statement:
No additional data are available.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Sheng-Lan Cai, Department of Neonatology, Suzhou Ninth Hospital Affiliated to Soochow University, No. 2666 Ludang Road, Taihu New Town, Wujiang District, Suzhou 215200, Jiangsu Province, China. 13584419577@163.com
Received: April 25, 2025 Revised: May 26, 2025 Accepted: June 19, 2025 Published online: August 19, 2025 Processing time: 105 Days and 2.9 Hours
Abstract
BACKGROUND
Premature infant formula is based on milk and contains energy, vitamins, etc. Breast milk is rich in minerals, such as phosphorus and calcium, and proteins. Both can be used for nutritional support in preterm infants with low-birth-weight. However, their effects on the difference in infant growth rate and postpartum depression are still unclear.
AIM
To explore the effect of early micro-breastfeeding on the growth rate of preterm infants with low-birth-weight and maternal postpartum depression.
METHODS
Data of 68 preterm infants with low-birth-weight and their mothers admitted to the Department of Neonatology, Suzhou Ninth Hospital Affiliated to Soochow University, between January 2022 and December 2024, were retrospectively collected. The infants were divided into two groups according to the different enteral feeding methods in the early stage: Control group (n = 32 cases, premature infant formula feeding) and observation group (n = 36 cases, micro-breastfeeding, i.e., exclusive breastfeeding, no mixed feeding). The baseline data; feeding status; gastrointestinal adverse reactions such as vomiting, gastric retention, and abdominal distension; growth rate (body weight, body length, and head circumference); and adverse events (infection, cholestasis, hyperbilirubinemia, and necrotizing enterocolitis) were compared between the two groups. Moreover, the maternal postpartum depression status of the two groups based of infants based on the Edinburgh postpartum depression scale (EPDS) was compared.
RESULTS
No significant difference in baseline data was found between the two groups (P > 0.05). The onset time of weight gain (6.49 ± 0.53 days vs 7.09 ± 0.61 days, P < 0.001), time for complete meconium excretion (6.28 ± 0.92 days vs 8.31 ± 1.17 days, P < 0.001), time for recovery to birth weight (8.81 ± 1.40 days vs 10.95 ± 1.64 days, P < 0.001), and time to reach full enteral feeding (12.29 ± 2.08 days vs 15.48 ± 2.27 days, P < 0.001) were compared between the observation and control groups. The incidence of vomiting, abdominal distension, and gastric retention was significantly lower in the observation group than in the control group, and the difference was significant (P < 0.05). The rates of the weight growth (15.88 ± 1.57 g/day vs 14.84 ± 1.51 g/day, P = 0.007), head circumference (0.63 ± 0.08 cm/week vs 0.59 ± 0.05 cm/week, P = 0.018), and length (0.80 ± 0.12 cm/week vs 0.73 ± 0.14 cm/week, P = 0.029) were compared between the observation and control groups. On hospital admission of preterm infants with low-birth-weight, the mothers of the two groups did not show a significant difference in the EPDS scores for postpartum depression (P > 0.05). Preterm infants with low-birth-weight were hospitalized for 2 weeks, and the EPDS score for maternal postpartum depression was significantly lower in the observation group than in the control group (8.38 ± 1.47 vs 9.49 ± 2.35, P = 0.021).
CONCLUSION
Compared with preterm infant formula feeding, early micro-breastfeeding can more effectively promote the growth rate of preterm infants with low-birth-weight and reduce the gastrointestinal feeding intolerance and related complications, thereby alleviating mothers’ concerns about their children and reducing the risk of postpartum depression.
Core Tip: Preterm infants with low-birth-weight are prone to feeding intolerance reactions, such as vomiting and bloating, when using gastric tubes, which is attributed to the incomplete development of the gastrointestinal system. This results in feeding difficulty and affects growth and development, thereby increasing maternal anxiety and depression. The results reveal that early micro-breastfeeding can effectively improve the growth rate of preterm infants with low-birth-weight and alleviate mothers’ negative emotions.
Citation: Chen Y, Cai SL. Effect of early micro-breastfeeding on growth rate and postpartum depression in preterm infants with low-birth-weight. World J Psychiatry 2025; 15(8): 108919
Premature low-birth-weight (LBW) infants refer to infants born at a gestational age of < 37 weeks and having a birth weight of < 2500 g[1]. These newborns are small for gestational age, have underdeveloped organs, including the respiratory, nervous, and gastrointestinal systems, unable to adapt well to the external environment after birth. The presence of conditions increases their risk of cyanosis, muscle weakness, respiratory arrest, and even death[2]. Many studies have shown that mothers of premature LBW (PLBW) often experience feelings of sadness, guilt, anxiety, along with worries and fears regarding the uncertain health of their child[3-6], which increases their susceptibility to postpartum depression. Depression, as a common mental illness characterized by emotional distress, low mood, and sluggish thinking, can progress from feelings of depression to grief, rigidity, and even pessimism and suicide attempts. Therefore, to promote the growth and development of PLBW infants in clinical practice the psychological changes of their mothers must be also monitored.
Effective feeding to improve nutritional intake is the primary method to promote the extrauterine catch-up growth and development of PLBW infants. However, due to the poor sucking and swallowing function, underdeveloped gastrointestinal system, and limited digestion and absorption function, PLBW infants are susceptible to feeding intolerance reactions such as vomiting, abdominal distension, and increased gastric residues during gastric tube feeding. In addition, difficulties in feeding milk, gastroesophageal reflux, etc., may arise, which can affect intestinal heat intake, results in insufficient nutrition, negatively affects the growth and development of PLBW[7], and increases the risk of maternal postpartum depression[8]. To ensure the nutritional needs of PLBW infants and avoid feeding intolerance, clinicians usually adopt a micro-feeding mode in the early stage and adjust the feeding dose according to the feeding tolerance of premature infants. Studies have shown that nutritional intake of premature infants is an important cause of extrauterine growth retardation[9]. Feeding materials directly affect the energy and protein obtained by premature infants[10], which may have different effects on their growth rate. Breast milk is the preferred source of enteral nutrition for newborns. Breastfeeding can provide premature infants with the energy, nutrients, and fluids they need to grow[11]. However, some mothers cannot provide breast milk due to disease factors, insufficient milk secretion, and others. In this case, premature infants are mainly fed with formula milk. Premature infant formula is based on milk, containing energy, vitamins, etc., and can be used as a breast milk substitute to provide safe and adequate nutritional support for infants[12]. However, if the optimal growth rate of premature infants is not reached after early minimal feeding, it may aggravate the mother’s worries for the child, which increases the risk of maternal postpartum depression. This study enrolled PLBW infants fed with formula milk as a control to analyze the effects of early micro-breastfeeding on the growth rate of these infants and postpartum depression in mothers and provide a reference for clinical selection of reasonable feeding methods.
MATERIALS AND METHODS
Research object
Using a retrospective study, data of 68 PLBW infants and their mothers admitted to the Department of Neonatology, Suzhou Ninth Hospital Affiliated to Soochow University, between January 2022 and December 2024 were selected for the study. According to the different early enteral feeding methods, the infants were divided into the observation group (n = 36) and control group (n = 32); the observation group implemented micro-breastfeeding (i.e., exclusive breastfeeding and no mixed feeding), whereas the control group received formula milk for feeding premature infants.
Inclusion and exclusion criteria
Inclusion criteria: (1) Single live birth, premature birth (gestational age < 37 weeks) and birth weight < 2.5 kg; (2) Birth to neonatology consultation time < 12 hours; (3) Hospitalization time for PLBW infants is ≥ 2 weeks; and (4) Mothers of PLBW infants are aged ≥ 18 years old and possess reading, writing, and communication skills.
Exclusion criteria: (1) Children with congenital malformations of the gastrointestinal tract, such as esophageal atresia, duodenal obstruction, hypertrophic pyloric stenosis, and congenital defects including perforation of the gastric wall muscle layer; (2) Children experiencing severe asphyxia or presenting with shock, multiple-organ failure, infection, intracranial lesions; (3) Presence of clear contraindications to enteral feeding; (4) PLBW infants with muscle spasms; and (5) Maternal history of severe mental illness and personality disorder.
Research methods
All PLBW infants received enteral feeding. For children who possess sucking ability, oral feeding is implemented directly, whereas for children lacking sucking ability or having weak swallowing ability, gastric tube feeding is adopted. Before each feeding through stomach tube, the residual amount in the stomach must be aspirated. If the residual amount exceeds 1/3 of the previous feeding amount, adjustments must be made according to the situation until the transition to full milk feeding.
The control group was fed with premature infant milk (standard premature infant formula), whereas the observation group received micro-breastfeeding. Both groups started feeding within 24 hours of birth, the initial dose was 0.5-2.0 mL/kg, fed once every 2-3 hours, and then increased by 1.0-2.0 mL/(kg· d) every day until it increased to 15-25 mL/(kg· d) for approximately 1 week. During feeding, the child’s head was slightly raised approximately 20° above the foot. After feeding, the baby was lifted for 10 minutes and belched properly to promote gastric emptying.
Observation indicators
Baseline data: Gestational age, sex, Apgar score at birth, body weight, body length, and head circumference were compared between the two groups. Moreover, the mother’s age, reproductive history, and pregnancy complications (such as gestational diabetes, gestational hypertension, gestational hypothyroidism, and gestational chorioamnionitis) were collected.
Feeding situation: During the feeding period, the time when the child’s weight begins to increase, meconium is completely eliminated, birth weight is regained, and full enteral feeding is achieved were recorded.
Feeding intolerance: The incidence of feeding intolerance such as stomach retention, vomiting, and abdominal distention during feeding was recorded. According to the relevant criteria in the “Diagnosis and Treatment Guidelines for Feeding intolerance in premature infants (2020 Edition)”[13], if one of the following criteria is met, PLBW infants can be diagnosed with feeding intolerance in the following: (1) Vomiting: With vomiting frequency ≥ 3 times a day; (2) Stomach retention: Gastric residual > 50% of the previous feeding amount, accompanied by vomiting and/or abdominal distention; and (3) Abdominal distension: Measured at fixed times in the same area, with an increase of ≥ 1.5 cm in abdominal circumference per day.
Growth rate: The weight, length, and head circumference of the child were measured every week, and the growth rate was calculated based on the measurement results: (1) Weight growth rate [g/(kg· d)] = 1000 × (n-1), where w1 represents discharge weight (kg), w2 represents birth weight (kg), n is the time from recovery to birth weight to discharge (day); (2) Growth rate of the body length (cm/week) = (difference between the discharge length and the birth length)/Length of hospital stay; and (3) Head circumference growth rate (cm/week) = (difference between discharge head circumference and birth head circumference)/length of hospital stay.
Adverse events: Count the occurrence of adverse events during early feeding intervention in two groups of children, including infection, cholestasis, hyperbilirubinemia, and necrotizing enterocolitis.
Postpartum depression in mothers: On admission of PLBW infants and after 2 weeks of hospitalization, the Edinburgh postpartum depression scale (EPDS) was used to evaluate maternal postpartum depression. The scale involves mood, fun, crying, self-blame, self-sadness, sadness, depression, coping ability, fear, and insomnia, a total of 10 items, each item has 4 options: Never (0 points), occasionally (1 points), often (2 points), and always (3 points). The total score ranges from 0 to 30 points, with EPDS ≥ 9 indicating the presence of postpartum depression[14], and higher scores indicate more severe postpartum depression.
Statistical analysis
Using IBM SPSS Statistics version 27.0 for data analysis, the measurement data were first verified by the S-W method to conform to a normal distribution, expressed as (mean ± SD). Two groups were compared using an independent sample t-test. The utilization rate and composition ratio of count data [n (%)] are expressed, the two groups were compared using χ2 test, and P < 0.05 indicates significance.
RESULTS
Comparison of baseline data between two groups
The observation and control groups did not show significant differences in terms of gestational age, mode of delivery, baby sex, Apgar score at birth, birth weight, birth length, birth head circumference, maternal age, maternal reproductive history, and maternal pregnancy complications (P > 0.05; Table 1).
Table 1 Comparison of baseline data between two groups.
Baseline information
Observer group (n = 36)
Control group (n = 32)
t value/χ2
P value
Gestational age (weeks)
32.25 ± 3.14
32.42 ± 2.95
0.229
0.819
Mode of delivery, n (%)
0.030
0.862
Abdominal delivery
21 (58.33)
18 (56.25)
Eutocia
15 (41.67)
14 (43.75)
Baby sex, n (%)
0.337
0.561
Baby boy
20 (55.56)
20 (62.50)
Baby girl
16 (44.44)
12 (37.50)
Infant Apgar score (points)
7.98 ± 1.04
8.16 ± 1.13
0.684
0.496
Infant birth weight (kg)
1.95 ± 0.26
1.97 ± 0.29
0.299
0.765
Birth length of baby (cm)
42.06 ± 3.25
42.19 ± 3.32
0.176
0.861
Birth head circumference of infants (cm)
31.38 ± 3.63
31.48 ± 3.66
0.113
0.910
Mother's age (years)
26.97 ± 4.48
26.56 ± 4.61
0.372
0.711
Mother's reproductive history, n (%)
0.260
0.610
Primipara
25 (69.44)
24 (75.00)
Multipara
11 (30.56)
8 (25.00)
Maternal pregnancy complications, n (%)
0.315
0.575
Have
28 (77.78)
23 (71.88)
Not have
8 (22.22)
9 (28.12)
Comparison of feeding between the two groups
The observation group started to gain weight earlier than the control group (6.49 ± 0.53 days vs 7.09 ± 0.61 days, P < 0.001). The observation group had an earlier complete elimination of meconium than the control group (6.28 ± 0.92 days vs 8.31 ± 1.17 days, P < 0.001). The observation group recovered the birth weight earlier than the control group (8.81 ± 1.40 days vs 10.95 ± 1.64 days, P < 0.001). The observation group achieved full enteral feeding earlier than the control group (12.29 ± 2.08 days vs 15.48 ± 2.27 days, P < 0.001; Table 2).
Table 2 Comparison of feeding between the two groups.
Feeding situation
Observer group (n = 36)
Control group (n = 32)
t value
P value
Time when weight begins to increase (day)
6.49 ± 0.53
7.09 ± 0.61
4.340
< 0.001
Complete emptying time of meconium (day)
6.28 ± 0.92
8.31 ± 1.17
7.996
< 0.001
Recovery time to birth weight (day)
8.81 ± 1.40
10.95 ± 1.64
5.805
< 0.001
Full enteral feeding reaching time (day)
12.29 ± 2.08
15.48 ± 2.27
6.047
< 0.001
Comparison of feeding intolerance between the two groups
During feeding, the difference in the incidence of vomiting, abdominal distention, and gastric retention was significantly lower in the observation group than in the control group (P < 0.05; Table 3).
Table 3 Comparison of feeding intolerance between two groups, n (%).
Feeding intolerance
Observer group (n = 36)
Control group (n = 32)
χ2
P value
Vomiting
2 (5.56)
9 (28.13)
4.808
0.028
Abdominal distension
1 (3.13)
7 (21.89)
4.254
0.039
Gastric retention
3 (8.33)
10 (31.25)
4.367
0.037
Comparison of growth rate between two groups of infants
The weight gain rate of the observation group was faster than that of the control group (15.88 ± 1.57 g/day vs 14.84 ± 1.51 g/day, P = 0.007). The growth rate of the head circumference in the observation group was faster than that in the control group (0.63 ± 0.08 cm/week vs 0.59 ± 0.05 cm/week, P = 0.018). The growth rate of the body length in the observation group was faster than that in the control group (0.80 ± 0.12 cm/week vs 0.73 ± 0.14 cm/week, P = 0.029; Table 4).
Table 4 Comparison of growth rate between two groups of infants.
Growth rate
Observer group (n = 36)
Control group (n = 32)
t value
P value
Weight growth rate (g/day)
15.88 ± 1.57
14.84 ± 1.51
2.776
0.007
Head circumference growth rate (cm/week)
0.63 ± 0.08
0.59 ± 0.05
2.436
0.018
Body length growth rate (cm/week)
0.80 ± 0.12
0.73 ± 0.14
2.220
0.029
Comparison of adverse events between the two groups
During feeding, the incidence of infections, cholestasis, hyperbilirubinemia, and necrotizing enterocolitis in the observation group infants was significantly lower than that in the control group, and the difference was significant (P < 0.05; Table 5).
Table 5 Comparison of adverse events between the two groups, n (%).
Adverse events
Observer group (n = 36)
Control group (n = 32)
χ2
P value
Infection
1 (2.78)
7 (21.88)
4.254
0.039
Intrahepatic cholestasis
0 (0.00)
5 (15.63)
3.994
0.046
Hyperbilirubinemia
1 (2.78)
8 (25.00)
5.479
0.019
Necrotizing enterocolitis
1 (2.78)
7 (21.88)
4.254
0.039
Comparison of postpartum depression scores between the two groups of mothers
When PLBW infants are admitted to the hospital, the comparison of postpartum depression EPDS scores between the two groups of mothers did not reveal a significant difference (P > 0.05). PLBW infants were hospitalized for 2 weeks. The EPDS score of maternal postpartum depression in the observation group was significantly lower than that in the control group (8.38 ± 1.47 vs 9.49 ± 2.35, P = 0.021; Table 6).
Table 6 Comparison of postpartum depression scores between the two groups of mothers.
Group
n
Mother's EPDS score
When the child was admitted to hospital
Child was hospitalized for 2 weeks
Observer group
36
11.45 ± 2.88
8.38 ± 1.47
Control group
32
11.23 ± 2.79
9.49 ± 2.35
t value
0.319
2.362
P value
0.751
0.021
DISCUSSION
PLBW infants face significant health challenges due to their early exit from the mother’s body early, have immature physiological development in the uterus, incomplete development of various tissues and organs in the body, and a higher risk of potential complications and death. Jackson et al[15] found that, premature infants have immature physiological organs and potential risks of various serious complications, which can increase parental psychological pressure. Alkozei et al[16] showed that higher levels of psychological stress positively correlated with higher EPDS scores of postpartum depression. Thus, mothers of PLBW infants are inferred to be highly susceptible to postpartum depression. Infants born premature are susceptible to extrauterine growth retardation because of early birth and have less nutrient storage at birth[17]. To achieve extrauterine catch-up growth and development of such children, exploring effective and reasonable feeding methods is significant to promote the growth of premature infants and reduce mothers’ worries about their children.
Early adequate nutritional support can help mature PLBW infants achieve the best level of growth and development and reduce the occurrence of growth retardation, dysplasia, and other problems. Breast milk has significant advantages in many aspects, such as host defense, gastrointestinal development and maturation, and nervous system development in PLBW infants[18]. Gebauer et al[19] found that breastfeeding can stimulate gastrointestinal hormones to facilitate the maturation of gastrointestinal motility, thereby regulating the secretion of hormones such as digestive enzymes and gastrin, encouraging the development of gastrointestinal mucosal epithelial cells, enhancing gastrointestinal motility, promoting the development of gastrointestinal structure and function, improving the nutrient absorption, alleviating the growth feeding difficulties, and accelerating the transformation of total enteral feeding. In this study, the observation group received micro-breastfeeding, and the control group was fed with premature infant milk (standard premature infant formula). The results found that the time of weight gain, time of complete excretion of meconium, time of recovery to birth weight, reaching full enteral feeding in the observation group, were earlier than those in the control group. This implies that early micro-breastfeeding is more conducive to promoting gastrointestinal motility and increasing nutrient absorption than premature milk, which can accelerate meconium excretion and promote growth and development. However, O'Connor et al[20] showed that the development of breastfed LBW infants is comparable to that of formula-fed infants. Inchingolo et al[21] showed that compared with formula feeding, breastfeeding can promote a healthier and more diverse microbial ecosystem, bringing protective health benefits. Assad et al[22] found that exclusive breastfeeding is less costly in LBW infants and can improve feeding tolerance. This is consistent with the results of our study that the incidence of feeding intolerance of vomiting, abdominal distension, and gastric retention in the observation group was significantly lower than that in the control group. Colacci et al[23] showed that compared with milk-based product feeding, exclusive breastfeeding is more beneficial to the growth and neurodevelopment of LBW infants. Consistent with the results of our study, this finding demonstrates that the weight, head circumference, and body length growth rate of the observation group were faster than those of the control group. This shows that early micro-breastfeeding is more conducive to improving the feeding tolerance of premature infants than formula feeding, and when promoting gastrointestinal peristalsis, increasing nutrient absorption can accelerate growth and development.
Reason analysis: Breast milk is rich in minerals and proteins such as phosphorus and calcium[24]. It provides newborns with better nutritional energy, which is conducive to the development and maturation of gastrointestinal structure and function, thus promoting the establishment of normal gastrointestinal flora, accelerating the secretion and release of gastrointestinal hormones, enhancing gastrointestinal motility, facilitating nutrient absorption, and promoting growth and development. Moreover, the enhancement of gastrointestinal peristalsis is beneficial to the rapid discharge of meconium. Increased gastrointestinal motility can also accelerate gastrointestinal tract emptying and reduce the incidence of feeding intolerance (vomiting, abdominal distension, gastric retention, etc.), which positively influence newborn’s growth and development. Second, early micro-breastfeeding can stimulate the oral mucosal sensory nerve endings of premature infants, enhance the excitability of the vagus nerve, expand the stomach, improve the contraction function of the stomach, accelerate gastric emptying, and reduce the incidence of gastric retention. Breast milk can also enhance the local antioxidant stress response ability of gastrointestinal mucosa, reduce the damage to gastrointestinal cells due to oxygen free radicals, protect gastrointestinal mucosa, and improve the feeding tolerance rate. In addition, breastfeeding can shorten the transport time in the gastrointestinal tract and reduce gastrointestinal reactions such as abdominal distension and vomiting by promoting the release of endogenous intestinal substances such as motilin and gastrin to achieve complete enteral feeding faster[25], effectively promote the growth rate of premature infants.
The mature development and prognosis of premature infants must be improved by employing special treatment and optimized nutrition in hospitals[26]. Postpartum is a vulnerable period for women’s mental health, particularly for those who have preterm birth[27]. Ueda et al[28] found that infant-related health issues that require outpatient or inpatient treatment are significantly associated with postpartum depression in mothers. In addition, studies have shown that having PLBW infants is a risk factor for postpartum depression[29]. Perhaps, premature mothers often attribute the cause of premature birth to them, which increases their psychological guilt and inferiority, making them more prone to postpartum depression. Breast milk, as the best natural food for newborns, contains various nutrients necessary for their growth and development[30]. Multiple observational studies have shown that breast milk is superior to formula milk in reducing the incidence of complications in premature infants[31,32]. This study found significantly lower rates of infection, cholestasis, hyperbilirubinemia, and necrotizing enterocolitis during feeding in the observation group than in the control group. This indicates that breastfeeding can reduce the complications related to PLBW. Studies have shown that complications of preterm birth during postdelivery hospital observation tend to exacerbate the mother’s concerns about the child, causing her to feel severe anxiety, fear, and stress[33]. This study found that when PLBW infants were hospitalized for 2 weeks, the EPDS score of postpartum depression in mothers of PLBW infants in the observation group was significantly lower than that in the control group. The potential reason was that breastfeeding can reduce the related complications in PLBW infants, to a certain extent, and can indirectly alleviate the mother’s concerns about the child, reduce the mother’s mental and psychological pressure, and thus mitigate postpartum depression. Second, exclusive breastfeeding usually requires mothers to squeeze out milk at home and store it, which is brought by family members to the hospital and handed over to medical staff. The medical staff arranges breastfeeding for PLBW infants, which also fully reflects the positive parenting style adopted by the mothers. A study showed that the positive parenting style adopted by the mother can reduce bad psychology to a certain extent[34], reducing the incidence of postpartum depression. However, some mothers have difficulty breastfeeding because they live far from the hospital or suffer from postpartum diseases (postpartum hemorrhage, postpartum infection, etc.) or insufficient milk secretion. In this case, premature infants can only receive formula feeding. Therefore, mothers of infants who received preterm formula feeding tend to have a higher risk for postpartum depression. Second, the milk formula for premature infants is not as good as breast milk for the overall development of infants, and it will also increase maternal postpartum depression.
This study has some limitations. Although this study confirms the important role of early micro-breastfeeding in the growth rate of PLBW infants and, to some extent, reduces the depressive emotions caused by mothers’ worries about their children’s growth and development. However, as this is a single-center study with a small sample size and limited representativeness, large-sample studies from multiple centers are still needed to support the conclusion.
CONCLUSION
Early micro-breastfeeding can promote the maturity and peristalsis of gastrointestinal function in PLBW infants, improve nutrient absorption, achieve the best growth rate, reduce the risk of neonatal complications, reduce maternal worries about children’s health, and alleviate postpartum depression.
Footnotes
Provenance and peer review: Unsolicited article; Externally peer reviewed.
Peer-review model: Single blind
Specialty type: Pediatrics
Country of origin: China
Peer-review report’s classification
Scientific Quality: Grade B, Grade C
Novelty: Grade B, Grade C
Creativity or Innovation: Grade B, Grade B
Scientific Significance: Grade C, Grade C
P-Reviewer: El-Marasy SA; Kappelmann N S-Editor: Lin C L-Editor: A P-Editor: Zhang YL
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Newkirk M, Shakeel F, Parimi P, Rothpletz-Puglia P, Patusco R, Marcus AF, Brody R. Comparison of Calorie and Protein Intake of Very Low Birth Weight Infants Receiving Mother's Own Milk or Donor Milk When the Nutrient Composition of Human Milk Is Measured With a Breast Milk Analyzer.Nutr Clin Pract. 2018;33:679-686.
[RCA] [PubMed] [DOI] [Full Text][Cited by in Crossref: 9][Cited by in RCA: 9][Article Influence: 1.3][Reference Citation Analysis (0)]
