Initiation of Breast Milk Expression and Associated Factor Among Mothers of Preterm Neonates Admitted to Neonatal Intensive Care Unit, Amhara Region Comprehensive Specialized Hospitals, Ethiopia 2023: Cross-sectional study

Tigist Nigatu Demissew; Yalemwork Getahun Azanaw; Marta Adugna Birhan; Masresha Asmare Techane

doi:10.12688/f1000research.168551.1

Home Browse Initiation of Breast Milk Expression and Associated Factor Among Mothers...

ALL Metrics

-

Views

-

Downloads

Get PDF

Get XML

Export

▬

✚

Research Article

Initiation of Breast Milk Expression and Associated Factor Among Mothers of Preterm Neonates Admitted to Neonatal Intensive Care Unit, Amhara Region Comprehensive Specialized Hospitals, Ethiopia 2023: Cross-sectional study

[version 1; peer review: awaiting peer review]

Tigist Nigatu Demissew ¹, Yalemwork Getahun Azanaw², Marta Adugna Birhan³, Masresha Asmare Techane⁴

PUBLISHED 04 Sep 2025

Author details Author details

¹ Department of Pediatric and Child Health Nursing,, Woldia university, Woldia, Amhara, 400, Ethiopia
² Department of Surgical Nursing, School of Nursing, university of Gondar, Gondar, Amhara, Ethiopia
³ Department of Neonatal Nursing, School of Nursing, University of Gondar, Gondar, Amhara, Ethiopia
⁴ Department of Pediatrics and Child Health Nursing, School of Nursing, University of Gondar, Gondar, Amhara, Ethiopia

Tigist Nigatu Demissew
Roles: Conceptualization, Data Curation, Formal Analysis, Methodology, Software, Validation, Writing – Original Draft Preparation, Writing – Review & Editing

Yalemwork Getahun Azanaw
Roles: Formal Analysis, Investigation, Methodology, Project Administration, Supervision, Validation, Visualization

Marta Adugna Birhan
Roles: Conceptualization, Data Curation, Methodology, Software, Supervision, Validation, Visualization, Writing – Original Draft Preparation

Masresha Asmare Techane
Roles: Conceptualization, Formal Analysis, Project Administration, Supervision, Validation, Visualization

OPEN PEER REVIEW

REVIEWER STATUS AWAITING PEER REVIEW

This article is included in the Global Public Health gateway.

Abstract

Background

The initiation of breast milk expression was when mothers began expressing their breast milk. In preterm neonates, due to poor coordination of the sucking and swallowing reflex with breathing, breast milk expression is the best solution to start feeding. This study assesses the initiation of breast milk expression and associated factors among mothers of preterm neonates admitted to NICUs in the Amhara region and comprehensive specialized hospitals.

Methods

An institutional-based cross-sectional study was conducted in the Amhara region’s comprehensive specialized hospitals from April 15–May 15, 2023. Maternal interviews and the neonate’s chart review were used to gather data from 401 respondents using systematic random sampling. The collected data was entered, coded, and cleaned into Epi-Data version 4.6.0.2 and analyzed by Stata 14.0 software. In the bivariable logistic regression model, variables that had a p-value < 0.25 were further analyzed in the multivariable logistic regression model, where a p-value < 0.05 with a 95% confidence interval was used to determine the association between the dependent and independent variables.

Result

late initiation of breast milk expression was 340 (84.79%). Respondents GA < 32 weeks (AOR = 3.59; 95% CI: 1.21, 10.61), getting instruction (AOR = 2.48; 95% CI: 1.06, 5.79), family support (AOR = 2.19; 95% CI: 1.10, 4.36), and importance of mother’s milk (AOR = 2.36; 95% CI: 1.24, 4.47) were the results express factors that negatively impact breast milk expression initiation.

Conclusion and recommendation

Based on the findings, the initiation of breast milk expression was poor, 15.21% of mothers expressed within the first 6 hours of delivery. In the delivery room, it is better to encourage mothers to express breast milk with in the first 6 hours after delivery who gave preterm birth, especially those < 32 weeks.

Keywords

associated factor, breast milk, expression, initiation, and neonate.

Corresponding author: Tigist Nigatu Demissew

Competing interests: No competing interests were disclosed.

Grant information: The University of Gondar has funded this work, but there is no funding for the publication process.
The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Copyright: © 2025 Demissew TN et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

How to cite: Demissew TN, Azanaw YG, Birhan MA and Techane MA. Initiation of Breast Milk Expression and Associated Factor Among Mothers of Preterm Neonates Admitted to Neonatal Intensive Care Unit, Amhara Region Comprehensive Specialized Hospitals, Ethiopia 2023: Cross-sectional study [version 1; peer review: awaiting peer review]. F1000Research 2025, 14:871 (https://doi.org/10.12688/f1000research.168551.1) First published: 04 Sep 2025, 14:871 (https://doi.org/10.12688/f1000research.168551.1) Latest published: 04 Sep 2025, 14:871 (https://doi.org/10.12688/f1000research.168551.1)

Introduction

The initiation of breast milk expression was when mothers began expressing milk from their breasts.¹ The World Health Organization (WHO) advises mothers to breastfeed their newborns during their first life hour.² In preterm neonates, sucking and swallowing reflex coordination with breathing is poor, and breast milk expression is the solution to start feeding.^1,3 Early initiation of breast milk expression plays a similar role as early initiation of breastfeeding.^1,4–10 Breast milk is the best form of milk for premature neonates; it reduces complications, improves long-term health, and improves neurodevelopmental outcomes.^11–15 Studies in Finland, Australia, and Florida suggest that early initiation of breast milk expression within the first six hours following delivery is key to the long-term success of providing breast milk and is recommended as a strategy to increase milk production.^7,16–18 Initiating milk expression after the first 6 hours following delivery was found to be related to an increased likelihood of being formula-fed, according to a study in Milan, Italy.¹⁹ According to WHO estimates, failure to follow the best practices for newborn breastfeeding results in more than 800,000 neonatal deaths worldwide each year.²⁰ Breastfeeding could reduce 20% to 22% of infant fatalities, according to recent studies from Ethiopia, Ghana, Bolivia, and Madagascar.²¹ In Ethiopia, preterm birth complications were the first cause of neonatal mortality, it accounts for 37% of the total neonatal deaths, and premature neonates die 1.3 times more than term neonates.^1,22 Breast milk reduces morbidity and mortality and supports optimal growth, development, and the overall outcome of the preterm neonate.^4,17,23–28 Preterm neonates have increased impacts on short- and long-term negative outcomes due to delaying breast milk feedings, such as sepsis and necrotizing enterocolitis (NEC), hypoglycemia, weight loss, jaundice, neurodevelopmental delays, morbidity, and mortality.^29,30 Initiation of breast milk expression is affected by different factors, including mode of delivery (CS), gestational hypertension, gestational age, a high risk of necrotizing enterocolitis, respiratory distress syndrome, and patent ductus arteriosus.^1,31,32 WHO recommends a universal target coverage of 90% for exclusive breastfeeding to prevent 13-15% of the 9 million under-five deaths per year in middle- and low-income countries.³³ However, the survival, health growth, and neurodevelopment of preterm newborns remain a problem in many countries despite significant advancements over the previous ten years.² According to a study on the breastfeeding experiences of mothers of preterm neonates, expressing milk and breastfeeding are seen as ways to strengthen the development of motherhood and build a stronger bond with their child.¹⁹ A previous study in Ethiopia shows that all respondents were late to initiate breast milk expression.^6,34 In the Amhara region, there is limited study, and early breast milk expression is crucial to the management of preterm neonates. Identifying factors promoting ideal breastfeeding practices facilitates efforts to decrease preterm deaths. However little concern was given to the early initiation of breast milk expression. This study aimed to assess the initiation of breast milk expression and associated factors among mothers of preterm neonates admitted to NICUs in the Amhara region.

Objectives

General objective

• To assess the Initiation of breast milk expression and associated factors among mothers of preterm neonates admitted to the Neonatal intensive care unit, at Amhara region comprehensive specialized Hospitals, Ethiopia 2023.

Specific objective

• To determine the Initiation of breast milk expression among mothers of preterm neonates admitted to the Neonatal intensive care unit, at Amhara region comprehensive specialized Hospitals, Ethiopia 2023.
• To assess factors associated with the Initiation of breast milk expression among mothers of preterm neonates admitted to the Neonatal intensive care unit at Amhara region, comprehensive specialized Hospitals, Ethiopia 2023.

Methods

Study design, period, and area

A multicenter institutional-based cross-sectional study was conducted from April 15 to May 15, 2023, in the Amhara region. The study was conducted in eight comprehensive specialized hospitals (University of Gondar, Felege-Hiwot, Tibebe-Ghion, Debre-Markos, Dessie, Deberetabor, Debreibrhan, and Woldya). Those hospitals have special units, like the NICU, and the major services in the NICU include general neonatal care services, routine prescription of a complete blood count, blood exchange transfusion, phototherapy, and ventilation support.

Population

Source population

The source population was all mothers with their preterm neonates who were admitted to the NICU of the Amhara Region Comprehensive Specialized Hospitals.

Study population

The study population was all mothers with their preterm neonates who were admitted to the NICU at Amhara Region Comprehensive Specialized Hospitals during the study period.

Inclusion criteria

All mothers with their preterm neonates who were admitted to the NICU of the Amhara Region Comprehensive Specialized Hospitals during the study period.

Exclusion criteria

The presence of medical contraindications for breastfeeding, neonates keeping NPO, and neonates with incomplete charts during the data collection period was excluded from the study.

Sample size determination and sampling procedure

The sample size was determined using the single population proportion formula by considering the following assumptions: p = 50% (proportion of mothers with initiation of breast milk expression), 95% confidence interval (Z = 1.96), 5% level of significance, and 5% margin of error (d = 0.05).

n = {(Z)}^{2} * (p * 1 - p) / d^{2}

n = {(Z)}^{2} * (p * 1 - p) / d^{2}, n = {(1.96)}^{2} * 0.5 (1 - 0.5) / {(0.05)}^{2} = 384

By adding 10% non-respondents (by considering refusal and incomplete charts) the final sample size was estimated to be 422. To ensure the adequacy of sample size, Epi-info version 7.2.3 is used to calculate sample size for factors associated with the initiation of breast milk expression by using 2 factors Gestational age and getting instruction from NICU staff. By using frequency of non-exposed groups and depends on their AOR.

Table 1. Sample size determination by considering factors of Initiation of breast milk expression among mothers of preterm.

Variables	P1	Power	CI	AOR	Sample size
GA < 32 weeks	63.7	80%	95%	2.39	238
Get instruction from NICU staff	68.5	80%	95%	0.55	404

As compared with the sample size above the sample size for this study is the largest one in the first objective single population proportion formula which is 422. The allocation of the sample to each hospital was made based on the average number of neonate admissions per month. The overall sample was taken proportionally from each hospital, and a systematic random sampling technique (sampling interval ≈ 2) was used to select the sample participants.

Study variables and their measurements

Outcome variable: Initiation of breast milk expression was the outcome variable; it is the time when mothers began expressing milk from their breasts, which was measured by asking the mother when she started milk expression.

Independent variables

Socio-demographic characteristics of the mother: 5 factors (maternal age, educational status, occupational status, marital status and residence).

Obstetric and maternal characteristics: 11 factors (Knowing the importance of breast milk for preterm neonate, getting instruction to express breast milk from NICU staff within 6 hours after delivery, Pregnancy-related complications, knowing the benefits of colostrum, Know the importance of mother’s milk over other (powder, cow) milk, mode of delivery, parity, ANC follow-up, place of delivery, Previous NICU experience with preterm admission and Previous milk expression experience for the preterm neonate).

Neonatal characteristics: 8 factors (GA, gender, birth weight, postnatal first milk-feeding time, method of feeding, can able to suck a neonate, health status of a neonate and post-natal age).

Psychological factors: 4 factors (Support from family members, separation from their premature infants and worried about the amount of milk and kangaroo mother care) were the independent variables.

Operational definitions

Family support is any support given: food, support in daily living activities, starting from the time she gives birth (husband, mother, sister).^1,6

LBW: (low birth weight) <2500 mg, VLBW: (very low birth weight) 1000 – 1500 gm,^1,35

Gestational age: this is the time counted in weeks from the first day of the woman’s last menstrual period to the date of delivery.^1,36

Preterm birth: It is the birth of a baby <37 weeks and >28 weeks GA.^1,35

Initiation of breast milk expression: It is time for the mother to begin expressing breast milk, and the mother can begin expressing breast milk usually immediately following childbirth.^3,35

Early initiation of breast milk expression: Expression of breast Early within 6 hours of birth^6–8

Late initiation of breast milk expression: expression of breast milk > 6 hrs of delivery.^6,7

Stable conditions where a neonate has stable vital signs.³⁷

Fair Vital signs are stable and within normal limits. the neonate is conscious but may be uncomfortable and the neonate needs regular follow-up.³⁷

Critical Vital signs are unstable and not within normal limits. the neonate may be unconscious. Indicators are unfavorable and the neonate needs strict follow-up.³⁷

Early neonatal period: this is a period from birth to 7 completed days of life.¹

Late neonatal period: A period from 8 to 28 completed days of life.¹

Early preterm: gestational age < 32 weeks and > 28 weeks, Moderate preterm: gestational age 32 – 34 weeks, Late preterm: >36 weeks.^1,38

Incomplete chart: Charts with one of the following factors are missed (gestational age, birth weight, feeding time and neonatal age).

Data collection tool

The data were collected using interviewer-administered and neonate chart review through structured and validated questionnaires that were adapted from a questionnaire developed from previous studies.^{6,19,24–26,30,31,34,39} To ensure consistency and accuracy, the data collection instrument was written in English, translated into the local language (Amharic) by a language expert, and then back into English. A 5%²¹ pretest was conducted. During pretesting the tool was checked for its consistency. The internal consistency was checked by computing Cronbach’s α with the value of 0.82% from the pretest data. Onsite training was given to data collectors and supervisors before the beginning of data collection. The data was collected by nurses who have previous experience in the NICU and data collection. The completeness of the collected data was checked onsite daily during data collection and received prompt feedback from the supervisor and the principal investigator. All completed data collection forms were examined for completeness and consistency during data management, storage, cleaning, and analysis. Before data collection assent was obtained from the mother then, written consent was obtained after explaining all the purpose, benefits and confidentiality of the information.

Data processing and analysis

The collected data were entered and coded into Epi-Data version 4.6.0.2 and exported into Stata 16.0 software for analysis. Descriptive statistics were carried out using the mean, frequency, percentage, tables, and figures to present the findings. A box plot was used to check the normality of the continuous data. The outcome variable was dichotomized and coded as 0 and 1, representing those late in initiation of breast milk expression and early in initiation of breast milk expression, respectively. The data was checked for consistency. Descriptive statistics were used to identify the distributions of socio-demographic characteristics among study respondents. Frequencies and cross-tabulations were computed before regression analysis. Multicollinearity was checked by using variance inflation factors (VIF 1.02–1.57, mean VIF = 1.20), and the model goodness of fit test was checked by Hosmer and Lem show goodness of fit tests (p = 0.63). A bivariable logistic regression was conducted to see the relation between the dependent and independent variables of initiation of breast milk expression using a p-value < 0.25. Multivariable logistic regressions at p-value < 0.05 with a 95% confidence interval of the odds ratio were used to determine a statistically significant association.

Results

Out of 422 participants, 401 (95.02%) were involved in the study.

Socio-demographic characteristics

Among the study respondents, the age range of respondents was 16–42, and the mean age was 28.86 ± 6.77 SD. More than half of the 245 (61.10%) respondents lived in urban areas. Regarding marital status, 338 (84.29%) respondents were married.

Table 2. Socio-demographic characteristics on the Initiation of breast milk expression among mothers of preterm neonate.

Variable	Frequency (N = 401)	Percent (%)
Age
<24	121	30.17
25-29	87	21.70
30-34	96	23.94
>35	97	24.19
Residence
Rural	156	38.90
Urban	245	61.10
Marital status
Married	338	84.29
Single	27	6.73
Widowed, divorced, separated	36	8.98
Educational status
Unable to read and write	105	26.18
Primary school	98	24.44
Secondary school	92	22.94
Diploma and above	106	26.43
Occupational status
Housewife	187	46.63
Governmental employer	65	16.21
Student	21	5.24
Private employer	53	13.22
Daily laborer	29	7.23
Merchant	46	11.47

Maternal and obstetric characteristics

Out of 401 respondents, 236 (58.85%) were Multi para. And 347 (85.79%) have ANC follow-ups; 119 (29.68%) of them have had 4 or more visits. Regarding pregnancy complications, 150 (37.41%) have pregnancy complications. 289 (72.07%) mothers knew the importance of mother’s milk over other (powder, cow) milk.

Table 3. Obstetric and maternal factors on the Initiation of breast milk expression among mothers of preterm neonate.

Variable	Frequency	Percent (%)
Parity
Prime para	126	31.42
Multi para	236	58.85
Grand multi para	39	9.73
ANC follow-up (private or governmental health institution)
No	57	14.21
1 time	35	8.73
2 times	74	18.45
3 times	116	28.93
4 and above	119	29.68
Pregnancy-related complications
No pregnancy complication	251	62.59
Pregnancy-induced hypertension	87	21.70
Gestational Debits Miletus	10	2.49
Other (APH, malaria, chorioamnionitis, PROM)	53	13.21
Place of delivery
Hospital\|	245	61.10
Health Center	123	30.67
Home	33	8.23
Mode of delivery
SVD	270	67.33
CS delivery	120	29.93
Instrument assisted delivery	11	2.74
Previous NICU experience with preterm admission
Yes	51	12.72
No	350	87.28
Previous milk expression experience for the preterm neonate
Yes	44	10.97
No	357	89.03
Know the importance of colostrum (first milk)
Yes	134	33.42
No	267	66.58
Know the importance of mother’s milk over other (powder, cow) milk
Yes	289	72.07
No	112	27.93
Know the importance of mother’s milk for the preterm neonate
Yes	182	45.39
No	219	54.61
Get instruction to express breast milk within 6 hours of delivery, from NICU staff
Yes	296	73.8
No	105	26.1
When do you express breast milk (outcome variable)
Birth - 6 hours	61	15.21
>6 hours	340	84.79

Neonatal factors

Among 401 neonates 217 (54.11%) were female and 184 (45.89%) were male neonates. Regarding birth weight, there were 249 (62.09%) LBWT and 152 (37.91%) VLBWT, and the mean birth weight of neonates was 1557.73 with ± 303.23 SD, and the minimum and maximum birth weights were 1000 g and 2200 g, respectively.

Table 4. Neonatal characteristics on the Initiation of breast milk expression among mothers of preterm neonate.

Variable	Frequency	Percent (%)
Gender
Male	184	45.89
Female	217	54.11
Gestational age (GA)
<32 weeks (Early preterm)	132	32.92
32-34 weeks (Moderate preterm)	111	27.68
34-36 +6 weeks (Late preterm)	158	39.40
Birth weight
1000 – 1499 (VLBWT)	152	37.91
1500 – 2499 (LBWT)	249	62.09
Post-natal feeding time
Birth - 6 hours	59	14.71
>6 hours	342	85.29
Can ably Suck neonate
Yes	140	34.91
No	261	65.09
Method of feeding
Directly breastfeed	87	21.70
NG tube	204	50.87
Bottle	77	19.20
Other (Cup, Syringe) feeding	33	8. 23
Post-natal age of the neonate
Early neonatal period	185	46.13
Late neonatal period	216	53.87
Health status of the neonate
Stable	161	40.65
Fair	154	153
Critical	86	21.20

Psychological factors

Psychological factors Out of 401 participants, 236 (58.85%) got family support during breast milk expression and 109 (27.18%) are worried about the amount of milk to express milk the first time.

Table 5. Psychological factors on the Initiation of breast milk expression among mothers of preterm neonate admitted.

Variable	Frequency	Percent (%)
Family support during the expression of breast milk
Yes	236	58.85
No	165	41.15
Worry about the amount of milk to express milk the first time
Yes	109	27.18
No	292	72.82
KMC (kangaroo mother care)
Yes	195	48.63
No	206	51.37
Feeling about separation from neonate
Yes	42	10.47
No	359	89.53

Initiation of breast milk expression

Out of 401 participants, 340 (84.79%) with [95% CI (80.91, 87.99)] were late initiation of breast milk expression (expressed after 6 hours of delivery) and 15.21% (61) with [95% CI (12.00,19.08)] were early initiation of breast milk expression (expressed within 6 hours of delivery).

Figure 1. Initiation of breast milk expression among mothers of preterm neonates admitted at NICU, Amhara region.

Factors associated with initiation of breast milk expression

On bivariable analysis, eleven (maternal age, get instruction to express breast milk within 6 hours of delivery, from NICU staff, Birth weight, Gestational Age, method of feeding, can able to suck a neonate, postnatal age, know the benefit of colostrum, know the benefit of mother’s milk for preterm neonate, family support and health condition of neonates) variables that have a p-value less than 0.25 was taken as a candidate for multivariable logistic regression analysis. In multivariable logistic regression analysis, mothers who did not get instruction within the first 6 hours after delivery, mothers who did not know the importance of mother’s milk for preterm neonates, mothers who did not get family support, and GA < 32 weeks had p-value < 0.05 with a 95% confidence interval of the odds ratio were the results express factors that negatively impact breast milk expression initiation. Respondents (neonates) with GA < 32 weeks were 3.59 times late to initiate breast milk expression compared to GA > 34 weeks (AOR = 3.59; 95% CI: 1.21, 10.61). The other factor identified was that respondents who did not get instruction within the first 6 hours of delivery to express milk from NICU staff were 2.48 times late to initiate breast milk expression as compared with those who got instruction within the first 6 hours of delivery (AOR = 2.48; 95% CI: 1.06, 5.79). Similarly, respondents who did not get family support were 2.19 times late to initiate breast milk expression as compared with those who got family support (AOR = 2.19; 95% CI: 1.10, 4.36). Finally, respondents who do not know the importance of mother’s milk for preterm neonates were 2.36 times late to initiate breast milk expression as compared with those who know the importance of mother’s milk for preterm neonates (AOR = 2.36; 95% CI: 1.24, 4.47).

Table 6. Multivariable analysis of factors associated with the Initiation of breast milk expression among mothers of preterm neonate.

Variables	Late initiation	Early initiation	COR (95% CI)	AOR (95% CI)	P value
Age <24	103 (30.29)	18 (29.51)	1.70(0. 84, 3.46)	2.05(0.92,4.58)	0.07
25-29	67 (19.71)	20 (32.79)	1	1
30-34	85 (25.00)	11 (18.03)	2.30 (1.03,5.14)	1.63(0.66,4.02)	0.28
>35	85 (25.00)	12 (19.67)	2.11 (0. 96,4.63)	1.68(0.70,4.06)	0.24
Get instruction to express breast milk within 6 hours of delivery, from NICU staff
Yes	243 (73.82)	53 (86.89)	1	1
No	97 (28.53)	8 (13.11)	2.64(1.21,5.76)	2.48(1.06,5.79)	0.03**
Know the importance of colostrum
Yes	108 (31.76)	26 (42.62)	1	1
No	232 (68.24)	35 (57.38)	1.59(0.91,2.78)	1.59(0.84,3.01)	0.14
Know the importance of Breast milk for the preterm neonate
Yes	141 (41.47)	41 (67.21)	1	1
No	199 (58.53)	20 (32.79)	2.89 (1.62,5.14)	2.36(1.24,4.47)	0.00**
Gestational age in weeks
>34 weeks	119 (35.00)	39 (63.93)	1	1
32-34 weeks	95 (27.94)	16 (26.23)	1.94 (1.02,3.69)	1.99(0.97,4.07)	0.058
< 32 weeks	126 (37.06)	6 (9.84)	6.88(2.81,16.84)	3,59(1.21,10.61)	0.02**
Birth weight
LBWT	196 (57.65)	53 (86.89)	1	1
VLBWT	144 (42.35)	8 (13.11)	4.86(2.24,10.55)	1.98(0.76,5.13)	0.15
Can a neonate able to suck
Yes	109 (32.06)	31 (50.82)	1	1
No	231 (67.94)	30 (49.18)	2.18 (1.26,3.80)	0.64(0.25,1.63)	0.35
Method of feeding
Breastfeed	63 (18.53)	24 (39.34)	1	1
NG tube	182 (53.53)	22 (36.07)	3.15(1.65, 6.01)	2.26(0.78,6.51)	0.13
Bottle	65 (19.12)	12 (19.67)	2.06 (0.95,4.47)	1.80(0.65,4.95)	0.25
Other (cup, syringe)	30(8.82)	3(4.92)	3.80(1.06,13.65)	1.55(0.33,7.25)	1.55
Postnatal age
Birth-7days	145 (42.65)	40 (65.57)	1	1
8 – 28 days	195 (57.35)	21 (34.43)	2.56(1.44,4.53)	0.59(0.30,1.14)	0.11
Health status of the neonate
Stable	126 (37.06)	35 (57.38)	1	1
Fair	134 (39.41)	20 (32.79)	1.86(1.02,3.39)	1.15(0.55,2.41)	0.70
Critical	80 (23.53)	6 (9.84)	3.70 (1.49,9.20)	2.15(0.74,6.19)	0.15
Family support
Yes	191 (56.18)	45 (73.77)	1	1
No	149 (43.82)	16 (26.23)	2.19 (1.19,4.03)	2.19(1.10,4.36)	0.02**

Discussions

In this study, the late initiation of breast milk expression, 340 (84.79%) were expressed breast milk after 6 hours of delivery. Which was higher than studies conducted in Finland, Germany, England, and Australia (64%, 58.6%, 32%, and 15%, respectively).^7,30,40,41 This discrepancy could be the result of differences in the nation’s level of development, the concern of health professionals regarding milk expression and strategies for the care of premature newborns, and differences in study design. In Germany, the study was conducted using the survey method, and in Australia, the study was conducted using a systematic review study design. However, the current study findings were slightly lower than reported in Addis Ababa.⁷ These disparities are likely due to differences in the study population, sample size, and study area. This might lead to a variation. This finding revealed that the odds of neonates who had GA < 32 weeks were 3.59 times more likely late to initiate breast milk expression as compared with those with GA >34 weeks (AOR = 3.59; 95% CI: (1.21, 10.61). This finding was supported by previous studies.^{6,24,30,31,39} The possible explanations are that newborns < 32 weeks GA need orogastric or NG tube feeding, which should start within 24 hours of birth, depending on the clinical condition.^1,2,42 Due to this reason instructing mothers to express milk might be based on the neonates’ clinical condition. The odds of mothers who do not get instruction within the first 6 hours of delivery to express milk from NICU staff were 2.48 times late to initiate breast milk expression as compared with those who got instruction within the first 6 hours of delivery (AOR = 2.48; 95% CI: 1.06, 5.79). This finding was supported by studies conducted in Ethiopia.⁶ Prematurity is associated with acute or chronic maternal illness and obstetric factors.¹ Mothers are observed in the maternity department for the first six hours following delivery. Due to this reason, it might be too late to advise the woman to express breast milk.⁶ Implementation of breast milk information and staff education led to improvements in the milk expression practices of mothers who had preterm neonates.⁷ The odds of mothers who do not get family support during breast milk expression were 2.19 times late to initiate breast milk expression as compared with those who got family support during breast milk expression (AOR = 2.19; 95% CI: 1.10, 4.36). This report was supported by previous studies.^20,32 As soon as the infants’ and mothers’ conditions permit, parents of newborns in the NICU are given the proper support with milk expression.^43,44 A supporter who motivates mothers, emotionally and psychologically to increase milk production.¹ The odds of mothers who do not know the importance of mother’s milk for preterm neonates were 2.36 times more likely late to initiate breast milk expression as compared with those who know the importance of mother’s milk for preterm neonates (AOR = 2.36; 95% CI: 1.24, 4.47). This finding was supported by a previous study.³⁹ Breast milk is the main dietary source for preterm neonates. The value and significance of human milk for neonates’ health should be explained to mothers.^1,2

Limitations of the study

Due to the cross-sectional nature of the study, it is difficult to determine the association between outcome and independent variable.

Conclusion and recommendations

In conclusion, the initiation of breast milk expression was poor; 15.21% of mothers expressed within the first 6 hours of delivery; respondents didn’t get instruction within the first 6 hours of delivery; respondents didn’t know the importance of mother’s milk for preterm neonates; respondents didn’t get family support; and neonates with GA < 32 weeks were significantly associated with late initiation of breast milk expression. In the delivery room, it is better to encourage mothers to express breast milk with in the first 6 hours after delivery, who give preterm birth, especially < 32 weeks.

Ethical approval and consent to participate

Ethical approval (Ref. No S/N/178/2015) was obtained from the ethical review committee of the institution review board (IBR) of the University of Gondar. A formal latter of administrative approval was obtained from Amhara Public Health Institute for each Hospital. Finally, written consent was obtained from the mothers after explaining all the purpose, benefits, confidentiality of the information, and the voluntary nature of participation in the study before data collection. All methods were carried out in accordance with the declaration of Helsinki and relevant guidelines and regulations. The names, identification number of study participants were not recorded on the data collection tool. All data were kept in strictly confidential and used only for the study purpose.

Availability of data and materials

figshare: Initiation of breast milk expression and associated factors among mothers of preterm neonates admitted to NICUs in the Amhara region and comprehensive specialized hospitals (data), https://doi.org/10.6084/m9.figshare.29958278.v1.⁴⁵

figshare: ethical clearance, https://doi.org/10.6084/m9.figshare.29958374.v1.⁴⁶

figshare: Questionary, consent and participant information, https://doi.org/10.6084/m9.figshare.29958548.v1.⁴⁷

figshare: table, https://doi.org/10.6084/m9.figshare.29958599.v1.⁴⁸

figshare: STROBE_checklist_combined, https://doi.org/10.6084/m9.figshare.29959181.v1.⁴⁹

figshare: Manuscript, https://doi.org/10.6084/m9.figshare.29959220.v1.⁵⁰

Data are available under the terms of the Creative Commons Attribution 4.0 International license (CC-BY 4.0).

Acknowledgment

The authors would like to thank the University of Gondar. We are very grateful to the Amhara Region Public Health Institute and the Amhara region comprehensive specialized hospital administrators for granting us permission to collect the data for this research. We also extend our acknowledgments to the research participants, data collectors, and supervisors.

References

1. Ababa A: Neonatal Intensive Care Unit (NICU) Training Participants’ Manual.2021. January.
2. Organization WH: WHO recommendations for care of the preterm or low-birth-weight infant. Geneva: 2022 (Cite Date january 28/2023).
3. Organization WH: Guideline: protecting, promoting and supporting breastfeeding in facilities providing maternity and newborn services.2017 (cite date Feburary 30/2023).
4. Parker MG, Stellwagen LM, Noble L, et al.: Promoting human milk and breastfeeding for the very low birth weight infant. Pediatrics. 2021; 148(5): e2021054272. PubMed Abstract | Publisher Full Text
5. Vasanth Kumar DL, Parasuramappa HSC, Shivasharana B, et al.: Quality improvement (QI) initiative to increase the usage of mother’s milk (EBM) for neonates admitted in special new-born care unit in South India. Eur. J. Mol. Clin. Med. 2022; 9(1): 1007–1020.
6. Hirpha M, Mekonnen H, Fenta FA: Initiation of Breast Milk Expression and Associated Factors Among Mothers of Preterm and Low Birth Weight Neonates Admitted to Neonatal Intensive Care Units of Government Hospitals in Addis Ababa, Ethiopia, 2020. Pediatr. Health Med. Ther. 12: 213–221. Publisher Full Text
7. Goodchild L, Hussey L, McPhee AJ, et al.: Promoting early expression of breast milk in mothers of preterm infants in a neonatal unit: a best practice implementation project. JBI Evid. Synth. 2018; 16(10): 2027–2037.
8. Medcine BP: Optimising Early Maternal Breast Milk for Preterm Infants.November 2020 (Cite Date March 4/2023).
9. Goodchild L, Hussey L, McPhee A, et al.: Promoting early expression of breast milk in mothers of preterm infants in a Neonatal Unit: A best practice implementation project. Women Birth. 2017; 30: 7. Publisher Full Text
10. Huang X, Zhang J, Zhou F, et al.: Promotion of early breast milk expression among mothers of preterm infants in the neonatal ICU in an obstetrics and gynaecology hospital: a best practice implementation project. JBI Evid. Implement. 2020; 18(3): 278–287. PubMed Abstract | Publisher Full Text
11. Degaga GT, Sendo EG, Tesfaye T: Prevalence of exclusive breast milk feeding at discharge and associated factors among preterm neonates admitted to a neonatal intensive care unit in public hospitals, Addis Ababa, Ethiopia: a cross-sectional study. Pediatric Health Med. Ther. 2020; 11: 21–28. PubMed Abstract | Publisher Full Text | Free Full Text
12. Gelano TF, Bacha YD, Assefa N, et al.: Acceptability of donor breast milk banking, its use for feeding infants, and associated factors among mothers in eastern Ethiopia. Int. Breastfeed. J. 2018; 13: 1–10.
13. Brown JVE, Lin L, Embleton ND, et al.: Multi-nutrient fortification of human milk for preterm infants. Cochrane Database Syst. Rev. 2020; 2020. Publisher Full Text
14. Zhang Y, Deng Q, Wang J, et al.: The impact of breast milk feeding on early brain development in preterm infants in China: An observational study. PLoS One. 2022; 17(11): e0272125. PubMed Abstract | Publisher Full Text | Free Full Text
15. Chiurazzi M, Cozzolino M, Reinelt T, et al.: Human milk and brain development in infants. Reprod. Med. 2021; 2(2): 107–117. Publisher Full Text
16. Parker LA, Sullivan S, Krueger C, et al.: Association of timing of initiation of breastmilk expression on milk volume and timing of lactogenesis stage II among mothers of very low-birth-weight infants. Breastfeed. Med. 2015; 10(2): 84–91. PubMed Abstract | Publisher Full Text | Free Full Text
17. Gitlin C: Mother’s Own Milk Expression: A Quality Improvement Initiative to Increase the Provision of Maternal Milk in Very Low Birth Weight Infants.2023.
18. Parker LA, Hoffman J, Darcy-Mahoney A: Facilitating early breast milk expression in mothers of very low birth weight infants. MCN Am. J. Matern. Child Nurs. 2018; 43(2): 105–110. PubMed Abstract | Publisher Full Text
19. Gianni ML, Bezze EN, Sannino P, et al.: Maternal views on facilitators of and barriers to breastfeeding preterm infants. BMC Pediatr. 2018; 18: 1–7. Publisher Full Text
20. Magalhães M, Ojeda A, Mechlowitz K, et al.: Socioecological predictors of breastfeeding practices in rural eastern Ethiopia. Int. Breastfeed. J. 2022; 17(1): 1–12.
21. Beyene MG, Geda NR, Habtewold TD, et al.: Early initiation of breastfeeding among mothers of children under the age of 24 months in Southern Ethiopia. Int. Breastfeed. J. 2016; 12: 1–9. PubMed Abstract | Publisher Full Text | Free Full Text
22. Aynalem YA, Shiferaw WS, Akalu TY, et al.: The magnitude of neonatal mortality and its predictors in Ethiopia: a systematic review and meta-analysis. Int. J. Pediatr. 2021; 2021: 1–10. PubMed Abstract | Publisher Full Text | Free Full Text
23. Kulkarni D, Murki S, Pawale D, et al.: Enablers and barriers for enteral feeding with mother’s own milk in preterm very low birth weight infants in a tertiary care neonatal intensive care unit. Turk. J. Pediatr. 2021; 63(4): 564–574. PubMed Abstract | Publisher Full Text
24. Piwoszkin LM, Corley M, Meganathan K, et al.: Predictors of the Provision of Mother’s Milk Feedings in Newborns Admitted to the Neonatal Intensive Care Unit. BBreastfeed Med. 2021; 16(8): 640–647. PubMed Abstract | Publisher Full Text
25. Parker LA, Sullivan S, Kruger C, et al.: Timing of milk expression following delivery in mothers delivering preterm very low birth weight infants: a randomized trial. J. Perinatol. 2020; 40(8): 1236–1245. PubMed Abstract | Publisher Full Text
26. Bakar SAA, Muda SM, Arifin SRM, et al.: Breast milk expression for premature infant in the neonatal intensive care unit: a review of mothers’ perceptions. Enferm. Clin. 2019; 29: 725–732. Publisher Full Text
27. Oot L, Sethuraman K, Ross J, et al.: The Effect of Late Breastfeeding Initiation on Neonatal Mortality: A Model in PROFILES for Country-Level Advocacy. Food and Nutrition Technical Assistance III Project. 2018.
28. Organization WH, Unicef: Protecting, promoting and supporting breastfeeding: the Baby-friendly Hospital Initiative for small, sick and preterm newborns. World Health Organization; 2020 (Cite date Feburary25/2023).
29. Jónsdóttir RB, Jónsdóttir H, Skúladóttir A, et al.: Breastfeeding progression in late preterm infants from birth to one month. Matern. Child Nutr. 2020; 16(1): e12893. PubMed Abstract | Publisher Full Text | Free Full Text
30. Ikonen R, Paavilainen E, Helminen M, et al.: Preterm infants’ mothers’ initiation and frequency of breast milk expression and exclusive use of mother’s breast milk in neonatal intensive care units. J. Clin. Nurs. 2018; 27(3-4): e551–e558. PubMed Abstract | Publisher Full Text
31. Lin Y, Kang Y, Fan Y, et al.: Factors affecting breast feeding for premature infants in the neonatal intensive care unit. Int. J. Clin. Exp. Med. 2020; 13(6): 4588–4597.
32. Daljeet K, Geetanjli K, Praveen K: Current practices related to feeding preterm neonates with expressed breast milk: a pilot project. COJ Nurse Health Care. 2018; 3(3). Publisher Full Text
33. Tahiru R, Agbozo F, Garti H, et al.: Exclusive breastfeeding and associated factors among mothers with twins in the tamale metropolis. Int. J. Pediatr. 2020; 2020: 1–9. PubMed Abstract | Publisher Full Text | Free Full Text
34. Kedida MH, Asfaw HM, Abebe F: Factors Associated with an Inadequate Volume of Expressed Milk Among Mothers of Preterm and Low Birth Weight Neonates Admitted to Neonatal Intensive Care Units of Government Hospitals in Addis Ababa, Ethiopia. Pediatric Health Med. Ther. 2023; 14: 1–10. PubMed Abstract | Publisher Full Text | Free Full Text
35. Protocol M: Neonatal Intensive Care Unit (NICU) Training (2014).March; 2014.
36. Taha Z, Hassan AA, Wikkeling-Scott L, et al.: Risk factors associated with initiation of breastfeeding among mothers with low birth weight babies: A cross-sectional multicenter study in Abu Dhabi, United Arab Emirates. Open Access Macedonian. J. Med. Sci. 2020; 8(B): 38–44. Publisher Full Text
37. UpToDate: 2018.
38. FANAROFF AND MARTIN’S NEONATAL-PERINATAL MEDICINE: ISBN: 978-0-323-06545-0 Copyright © 2011, 2006, 2002, 1997, 1992, 1987, 1983, 1977, 1973, by Mosby, Inc., an affiliate of Elsevier, Inc.
39. Kaur D, Rana AK, Kalyan G, et al.: Expressed Breast Milk feeding in Preterm Neonates: Barriers and suggested facilitators. Nurs. Midwifery Res. J. 2017; 13(4): 160–171. Publisher Full Text
40. Scholten N, Mause L, Horenkamp-Sonntag D, et al.: Initiation of lactation and the provision of human milk to preterm infants in German neonatal intensive care units from the mothers’ perspective. BMC Pregnancy Childbirth. 2022; 22(1): 158. PubMed Abstract | Publisher Full Text | Free Full Text
41. Parker MG, Melvin P, Graham DA, et al.: Timing of first milk expression to maximize breastfeeding continuation among mothers of very low-birth-weight infants. Obstet. Gynecol. 2019; 133(6): 1208–1215. PubMed Abstract | Publisher Full Text
42. UNICEF: NEONATAL CARE CLINICAL GUIDELINES.(cite date June 17/2023) 2018.
43. WHO: who.int/docs/default-source/mca-documents/policy-documents/guideline/blz-mn-32-02-guidelie.2018-2021 cite Date June 17/2023.
44. USA: B-F. NEONATAL INTENSIVE CARE (NICU) RESOURCES.2021 cite date June 17/2023.
45. Nigatu T: initiation of breast milk expression data. figshare. 2025.
46. Nigatu T: Ethical clearance.pdf.2025.
47. Nigatu T: Quationare, consent and participant information.docx.2025.
48. Nigatu T: table for F 100 Jornal.docx. figshare. 2025.
49. Nigatu T: STROBE_checklist_combined.doc.2025.
50. Nigatu T: munscript for F 100 Jornal.docx. figshare. 2025.

Comments on this article Comments (0)

Version 1

VERSION 1 PUBLISHED 04 Sep 2025

Author details Author details

¹ Department of Pediatric and Child Health Nursing,, Woldia university, Woldia, Amhara, 400, Ethiopia
² Department of Surgical Nursing, School of Nursing, university of Gondar, Gondar, Amhara, Ethiopia
³ Department of Neonatal Nursing, School of Nursing, University of Gondar, Gondar, Amhara, Ethiopia
⁴ Department of Pediatrics and Child Health Nursing, School of Nursing, University of Gondar, Gondar, Amhara, Ethiopia

Tigist Nigatu Demissew
Roles: Conceptualization, Data Curation, Formal Analysis, Methodology, Software, Validation, Writing – Original Draft Preparation, Writing – Review & Editing

Yalemwork Getahun Azanaw
Roles: Formal Analysis, Investigation, Methodology, Project Administration, Supervision, Validation, Visualization

Marta Adugna Birhan
Roles: Conceptualization, Data Curation, Methodology, Software, Supervision, Validation, Visualization, Writing – Original Draft Preparation

Masresha Asmare Techane
Roles: Conceptualization, Formal Analysis, Project Administration, Supervision, Validation, Visualization

Competing interests

No competing interests were disclosed.

Grant information

The University of Gondar has funded this work, but there is no funding for the publication process.
The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Article Versions (1)

version 1

Published: 04 Sep 2025, 14:871

https://doi.org/10.12688/f1000research.168551.1

Copyright

© 2025 Demissew TN et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Download

Export To

metrics

	Views	Downloads
F1000Research	-	-
PubMed Central Data from PMC are received and updated monthly.	-	-

Citations

0

SEE MORE DETAILS

CITE

how to cite this article

Demissew TN, Azanaw YG, Birhan MA and Techane MA. Initiation of Breast Milk Expression and Associated Factor Among Mothers of Preterm Neonates Admitted to Neonatal Intensive Care Unit, Amhara Region Comprehensive Specialized Hospitals, Ethiopia 2023: Cross-sectional study [version 1; peer review: awaiting peer review]. F1000Research 2025, 14:871 (https://doi.org/10.12688/f1000research.168551.1)

NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article.

track

receive updates on this article

Track an article to receive email alerts on any updates to this article.

Open Peer Review

Comments on this article Comments (0)

Version 1

VERSION 1 PUBLISHED 04 Sep 2025

Open Peer Review

Reviewer Status

AWAITING PEER REVIEW

Comments on this article

All Comments(0)

Add a comment

Sign up for content alerts

Browse by related subjects

[1] 1. Ababa A: Neonatal Intensive Care Unit (NICU) Training Participants’ Manual.2021. January.

[2] 2. Organization WH: WHO recommendations for care of the preterm or low-birth-weight infant. Geneva: 2022 (Cite Date january 28/2023).

[3] 3. Organization WH: Guideline: protecting, promoting and supporting breastfeeding in facilities providing maternity and newborn services.2017 (cite date Feburary 30/2023).

[4] 4. Parker MG, Stellwagen LM, Noble L, et al.: Promoting human milk and breastfeeding for the very low birth weight infant. Pediatrics. 2021; 148(5): e2021054272. PubMed Abstract | Publisher Full Text

[5] 5. Vasanth Kumar DL, Parasuramappa HSC, Shivasharana B, et al.: Quality improvement (QI) initiative to increase the usage of mother’s milk (EBM) for neonates admitted in special new-born care unit in South India. Eur. J. Mol. Clin. Med. 2022; 9(1): 1007–1020.

[6] 6. Hirpha M, Mekonnen H, Fenta FA: Initiation of Breast Milk Expression and Associated Factors Among Mothers of Preterm and Low Birth Weight Neonates Admitted to Neonatal Intensive Care Units of Government Hospitals in Addis Ababa, Ethiopia, 2020. Pediatr. Health Med. Ther. 12: 213–221. Publisher Full Text

[7] 7. Goodchild L, Hussey L, McPhee AJ, et al.: Promoting early expression of breast milk in mothers of preterm infants in a neonatal unit: a best practice implementation project. JBI Evid. Synth. 2018; 16(10): 2027–2037.

[8] 8. Medcine BP: Optimising Early Maternal Breast Milk for Preterm Infants.November 2020 (Cite Date March 4/2023).

[9] 9. Goodchild L, Hussey L, McPhee A, et al.: Promoting early expression of breast milk in mothers of preterm infants in a Neonatal Unit: A best practice implementation project. Women Birth. 2017; 30: 7. Publisher Full Text

[10] 10. Huang X, Zhang J, Zhou F, et al.: Promotion of early breast milk expression among mothers of preterm infants in the neonatal ICU in an obstetrics and gynaecology hospital: a best practice implementation project. JBI Evid. Implement. 2020; 18(3): 278–287. PubMed Abstract | Publisher Full Text

[11] 11. Degaga GT, Sendo EG, Tesfaye T: Prevalence of exclusive breast milk feeding at discharge and associated factors among preterm neonates admitted to a neonatal intensive care unit in public hospitals, Addis Ababa, Ethiopia: a cross-sectional study. Pediatric Health Med. Ther. 2020; 11: 21–28. PubMed Abstract | Publisher Full Text | Free Full Text

[12] 12. Gelano TF, Bacha YD, Assefa N, et al.: Acceptability of donor breast milk banking, its use for feeding infants, and associated factors among mothers in eastern Ethiopia. Int. Breastfeed. J. 2018; 13: 1–10.

[13] 13. Brown JVE, Lin L, Embleton ND, et al.: Multi-nutrient fortification of human milk for preterm infants. Cochrane Database Syst. Rev. 2020; 2020. Publisher Full Text

[14] 14. Zhang Y, Deng Q, Wang J, et al.: The impact of breast milk feeding on early brain development in preterm infants in China: An observational study. PLoS One. 2022; 17(11): e0272125. PubMed Abstract | Publisher Full Text | Free Full Text

[15] 15. Chiurazzi M, Cozzolino M, Reinelt T, et al.: Human milk and brain development in infants. Reprod. Med. 2021; 2(2): 107–117. Publisher Full Text

[16] 16. Parker LA, Sullivan S, Krueger C, et al.: Association of timing of initiation of breastmilk expression on milk volume and timing of lactogenesis stage II among mothers of very low-birth-weight infants. Breastfeed. Med. 2015; 10(2): 84–91. PubMed Abstract | Publisher Full Text | Free Full Text

[17] 17. Gitlin C: Mother’s Own Milk Expression: A Quality Improvement Initiative to Increase the Provision of Maternal Milk in Very Low Birth Weight Infants.2023.

[18] 18. Parker LA, Hoffman J, Darcy-Mahoney A: Facilitating early breast milk expression in mothers of very low birth weight infants. MCN Am. J. Matern. Child Nurs. 2018; 43(2): 105–110. PubMed Abstract | Publisher Full Text

[19] 19. Gianni ML, Bezze EN, Sannino P, et al.: Maternal views on facilitators of and barriers to breastfeeding preterm infants. BMC Pediatr. 2018; 18: 1–7. Publisher Full Text

[20] 20. Magalhães M, Ojeda A, Mechlowitz K, et al.: Socioecological predictors of breastfeeding practices in rural eastern Ethiopia. Int. Breastfeed. J. 2022; 17(1): 1–12.

[21] 21. Beyene MG, Geda NR, Habtewold TD, et al.: Early initiation of breastfeeding among mothers of children under the age of 24 months in Southern Ethiopia. Int. Breastfeed. J. 2016; 12: 1–9. PubMed Abstract | Publisher Full Text | Free Full Text

[22] 22. Aynalem YA, Shiferaw WS, Akalu TY, et al.: The magnitude of neonatal mortality and its predictors in Ethiopia: a systematic review and meta-analysis. Int. J. Pediatr. 2021; 2021: 1–10. PubMed Abstract | Publisher Full Text | Free Full Text

[23] 23. Kulkarni D, Murki S, Pawale D, et al.: Enablers and barriers for enteral feeding with mother’s own milk in preterm very low birth weight infants in a tertiary care neonatal intensive care unit. Turk. J. Pediatr. 2021; 63(4): 564–574. PubMed Abstract | Publisher Full Text

[24] 24. Piwoszkin LM, Corley M, Meganathan K, et al.: Predictors of the Provision of Mother’s Milk Feedings in Newborns Admitted to the Neonatal Intensive Care Unit. BBreastfeed Med. 2021; 16(8): 640–647. PubMed Abstract | Publisher Full Text

[25] 25. Parker LA, Sullivan S, Kruger C, et al.: Timing of milk expression following delivery in mothers delivering preterm very low birth weight infants: a randomized trial. J. Perinatol. 2020; 40(8): 1236–1245. PubMed Abstract | Publisher Full Text

[26] 26. Bakar SAA, Muda SM, Arifin SRM, et al.: Breast milk expression for premature infant in the neonatal intensive care unit: a review of mothers’ perceptions. Enferm. Clin. 2019; 29: 725–732. Publisher Full Text

[27] 27. Oot L, Sethuraman K, Ross J, et al.: The Effect of Late Breastfeeding Initiation on Neonatal Mortality: A Model in PROFILES for Country-Level Advocacy. Food and Nutrition Technical Assistance III Project. 2018.

[28] 28. Organization WH, Unicef: Protecting, promoting and supporting breastfeeding: the Baby-friendly Hospital Initiative for small, sick and preterm newborns. World Health Organization; 2020 (Cite date Feburary25/2023).

[29] 29. Jónsdóttir RB, Jónsdóttir H, Skúladóttir A, et al.: Breastfeeding progression in late preterm infants from birth to one month. Matern. Child Nutr. 2020; 16(1): e12893. PubMed Abstract | Publisher Full Text | Free Full Text

[30] 30. Ikonen R, Paavilainen E, Helminen M, et al.: Preterm infants’ mothers’ initiation and frequency of breast milk expression and exclusive use of mother’s breast milk in neonatal intensive care units. J. Clin. Nurs. 2018; 27(3-4): e551–e558. PubMed Abstract | Publisher Full Text

[31] 31. Lin Y, Kang Y, Fan Y, et al.: Factors affecting breast feeding for premature infants in the neonatal intensive care unit. Int. J. Clin. Exp. Med. 2020; 13(6): 4588–4597.

[32] 32. Daljeet K, Geetanjli K, Praveen K: Current practices related to feeding preterm neonates with expressed breast milk: a pilot project. COJ Nurse Health Care. 2018; 3(3). Publisher Full Text

[33] 33. Tahiru R, Agbozo F, Garti H, et al.: Exclusive breastfeeding and associated factors among mothers with twins in the tamale metropolis. Int. J. Pediatr. 2020; 2020: 1–9. PubMed Abstract | Publisher Full Text | Free Full Text

[34] 34. Kedida MH, Asfaw HM, Abebe F: Factors Associated with an Inadequate Volume of Expressed Milk Among Mothers of Preterm and Low Birth Weight Neonates Admitted to Neonatal Intensive Care Units of Government Hospitals in Addis Ababa, Ethiopia. Pediatric Health Med. Ther. 2023; 14: 1–10. PubMed Abstract | Publisher Full Text | Free Full Text

[35] 35. Protocol M: Neonatal Intensive Care Unit (NICU) Training (2014).March; 2014.

[36] 36. Taha Z, Hassan AA, Wikkeling-Scott L, et al.: Risk factors associated with initiation of breastfeeding among mothers with low birth weight babies: A cross-sectional multicenter study in Abu Dhabi, United Arab Emirates. Open Access Macedonian. J. Med. Sci. 2020; 8(B): 38–44. Publisher Full Text

[37] 37. UpToDate: 2018.

[38] 38. FANAROFF AND MARTIN’S NEONATAL-PERINATAL MEDICINE: ISBN: 978-0-323-06545-0 Copyright © 2011, 2006, 2002, 1997, 1992, 1987, 1983, 1977, 1973, by Mosby, Inc., an affiliate of Elsevier, Inc.

[39] 39. Kaur D, Rana AK, Kalyan G, et al.: Expressed Breast Milk feeding in Preterm Neonates: Barriers and suggested facilitators. Nurs. Midwifery Res. J. 2017; 13(4): 160–171. Publisher Full Text

[40] 40. Scholten N, Mause L, Horenkamp-Sonntag D, et al.: Initiation of lactation and the provision of human milk to preterm infants in German neonatal intensive care units from the mothers’ perspective. BMC Pregnancy Childbirth. 2022; 22(1): 158. PubMed Abstract | Publisher Full Text | Free Full Text

[41] 41. Parker MG, Melvin P, Graham DA, et al.: Timing of first milk expression to maximize breastfeeding continuation among mothers of very low-birth-weight infants. Obstet. Gynecol. 2019; 133(6): 1208–1215. PubMed Abstract | Publisher Full Text

[42] 42. UNICEF: NEONATAL CARE CLINICAL GUIDELINES.(cite date June 17/2023) 2018.

[43] 43. WHO: who.int/docs/default-source/mca-documents/policy-documents/guideline/blz-mn-32-02-guidelie.2018-2021 cite Date June 17/2023.

[44] 44. USA: B-F. NEONATAL INTENSIVE CARE (NICU) RESOURCES.2021 cite date June 17/2023.

[45] 45. Nigatu T: initiation of breast milk expression data. figshare. 2025.

[46] 46. Nigatu T: Ethical clearance.pdf.2025.

[47] 47. Nigatu T: Quationare, consent and participant information.docx.2025.

[48] 48. Nigatu T: table for F 100 Jornal.docx. figshare. 2025.

[49] 49. Nigatu T: STROBE_checklist_combined.doc.2025.

[50] 50. Nigatu T: munscript for F 100 Jornal.docx. figshare. 2025.

Initiation of Breast Milk Expression and Associated Factor Among Mothers of Preterm Neonates Admitted to Neonatal Intensive Care Unit, Amhara Region Comprehensive Specialized Hospitals, Ethiopia 2023: Cross-sectional study

Abstract

Background

Methods

Result

Conclusion and recommendation

Keywords

Introduction

Objectives

General objective

Specific objective

Methods

Study design, period, and area

Population

Sample size determination and sampling procedure

Table 1. Sample size determination by considering factors of Initiation of breast milk expression among mothers of preterm.

Study variables and their measurements

Independent variables

Operational definitions

Data collection tool

Data processing and analysis

Results

Socio-demographic characteristics

Table 2. Socio-demographic characteristics on the Initiation of breast milk expression among mothers of preterm neonate.

Maternal and obstetric characteristics

Table 3. Obstetric and maternal factors on the Initiation of breast milk expression among mothers of preterm neonate.

Neonatal factors

Table 4. Neonatal characteristics on the Initiation of breast milk expression among mothers of preterm neonate.

Psychological factors

Table 5. Psychological factors on the Initiation of breast milk expression among mothers of preterm neonate admitted.

Initiation of breast milk expression

Figure 1. Initiation of breast milk expression among mothers of preterm neonates admitted at NICU, Amhara region.

Factors associated with initiation of breast milk expression

Table 6. Multivariable analysis of factors associated with the Initiation of breast milk expression among mothers of preterm neonate.

Discussions

Limitations of the study

Conclusion and recommendations

Ethical approval and consent to participate

Availability of data and materials

Acknowledgment

References

Comments on this article Comments (0)

Open Peer Review

Comments on this article Comments (0)

Open Peer Review

Reviewer Status

Comments on this article

Browse by related subjects

Competing Interests Policy

Stay Updated