Breastfeeding Trends Among Very Low Birth Weight, Low Birth Weight, and Normal Birth Weight Infants Angela G. Campbell, MA, MPH, and Patricia Y. Miranda, MPH, PhD Objective To examine the change in breastfeeding behaviors over time, among low birth weight (LBW), very low birth weight (VLBW), and normal birth weight (NBW) infants using nationally representative US data. Study design Univariate statistics and bivariate logistic models were examined using the Early Child Longitu- dinal Study—Birth Cohort (2001) and National Study of Children’s Health (2007 and 2011/2012). Results Breastfeeding behaviors improved for infants of all birth weights from 2007 to 2011/2012. In 2011/2012, a higher percentage of VLBW infants were ever breastfed compared with LBW and NBW infants. In 2011/2012, LBW infants had a 28% lower odds (95% CI, 0.57-0.92) of ever breastfeeding and a 52% lower odds (95% CI, 0.38-0.61) of breastfeeding for ≥6 months compared with NBW infants. Among black infants, a larger percentage of VLBW infants were breastfed for ≥6 months (26.2%) compared with LBW infants (14.9%). Conclusions Breastfeeding rates for VLBW and NBW infants have improved over time. Both VLBW and NBW infants are close to meeting the Healthy People 2020 ever breastfeeding goal of 81.9%. LBW infants are farther from this goal than VLBW infants. The results suggest a need for policies that encourage breastfeeding specifi- cally among LBW infants. (J Pediatr 2018;■■:■■-■■). B oth the World Health Organization and the American Academy of Pediatrics 1,2 have established breastfeeding as the preferred method of feeding low birth weight (LBW) and high-risk infants because it is health protective and health promoting for all infants. 3-12 Healthy People 2020, a health initiative with specific health goals for citizens of the US, aims for 81.9% of all infants to be ever breastfed and 60.6% of infants to be breastfed for ≥6 months by 2020. 13 Previous studies investigated breastfeeding among small samples of LBW and very low birth weight (VLBW) infants, 14-16 but breastfeeding patterns by birth weight have not been established using nationally representative data. The purpose of this study was to evaluate breastfeeding initiation and duration trends among a nationally representative sample of mothers of NBW, LBW, and VLBW infants in the US. Further, we investigated how breastfeeding behavior trends may vary by racial and ethnic groups over time. We hypothesized that normal birth weight (NBW) infants would have the highest breastfeeding rates, followed by LBW and then VLBW infants, because physical ailments increase as birth weight decreases. 17,18 VLBW infants are strongly en- couraged to breastfeed while in the neonatal intensive care unit (NICU), 19-21 but may still lag behind LBW infants because breastfeeding is often more difficult for this population owing to problems with milk production 22 and latching or sucking. 23,24 Methods For the purpose of this study, breastfeeding was defined as receiving breast milk (from the mother or a donor) for nutritional purposes. It does not assume direct feeding at the breast and may include bottle-feeding or enteral tube feeding with breast milk. Breastfeeding rates by birth weight status were assessed at three time points: 2001, 2007, and 2011/2012. For 2007 and 2011/ 2012, information from the National Survey of Children’s Health (NSCH) was used 25 and, for 2001, the Early Childhood Lon- gitudinal Program—Birth Cohort (ECLS-B) was used. 26 The NSCH analytic sample is restricted to children 0-5 years of age whose mother is the survey respondent and for whom there exists full breastfeeding information. ECLS-B responses come from the birth certificate and a survey administered at 9 months of age. 27 The ECLS-B sample is restricted to singleton births with full breastfeeding information whose biological mother was the survey respondent. Infants weighing <2500 g at birth were oversampled in the ECLS-B. This is a common practice when nationally ECLSB Early Childhood Longitudinal Program—Birth Cohort LBW Low birth weight NBW Normal birth weight NICU Neonatal intensive care unit NSCH National Survey of Children’s Health VLBW Very low birth weight From the The Pennsylvania State University, University Park, PA Supported by the National Center for Advancing Translational Sciences (NCATS) (UL1 TR000127 and KL2 TR000126 [to P.M.]); the Susan G. Komen Foundation Post-Baccalaureate Training Program in Disparities Research (KG101424 [to A.C.]); and the Penn State Hershey Cancer Institute, Social Science Research Institute, and Clinical and Translational Science Institute. The authors declare no conflicts of interest. 0022-3476/$ - see front matter. © 2018 Elsevier Inc. All rights reserved. https://doi.org10.1016/j.jpeds.2018.04.039 ARTICLE IN PRESS THE JOURNAL OF PEDIATRICS • www.jpeds.com ORIGINAL ARTICLES 1 FLA 5.5.0 DTD ■ YMPD9960_proof ■ May 18, 2018