Risk factors and predictive modeling of exclusive breastfeeding failure in mothers separated from their infants

Weiwei Wu, Xiangxue Wang

Abstract

This study explored factors contributing to exclusive breastfeeding failure in mothers separated from their infants and developed a predictive nomogram model. Clinical data from 258 such mothers admitted to the First Affiliated Hospital of Soochow University between June 2023 and June 2024 were analyzed. Among them, 119 experienced breastfeeding failure. Prolonged separation, lack of breastfeeding knowledge, inverted nipples, maternal anxiety, and depression were identified as independent risk factors. The nomogram model showed good predictive performance, with an AUC of 0.739 and positive net benefit across a wide range of threshold probabilities. This model could support targeted interventions in clinical practice.

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References

Nagel EM, Howland MA, Pando C, Stang J, Mason SM,

Fields

DA and Demerath EW. Maternal

psychological

distress

and

lactation

and

breastfeeding outcomes: A narrative review. Clin

Ther 2022; 44:215–227.

Agrawal J, Chakole S and Sachdev C. The Role of Fathers

in Promoting Exclusive Breastfeeding. Cureus no

date; 14:e30363.

Rodríguez-Gallego I, Vila-Candel R, Corrales-Gutierrez I,

Gomez-Baya D and Leon-Larios F. Evaluation of the

Impact of a Midwife-Led Breastfeeding Group

Intervention

on Prevention of Postpartum

Depression: A Multicentre Randomised Clinical

Trial. Nutrients 2024; 16:227.

Rohini AM, Elavally S and Saradakutty G. Effectiveness of

breastfeeding education compared to standard

hospital information on exclusive breastfeeding

among mothers: A systematic review. J Educ Health

Promot 2022; 11:125.

Zhao S, Jiang H, Sun H, Shao Q, Zu X, Li Y, Zhang Y, Wang

A and Cui X. Effects of responsive breastfeeding

intervention on breastfeeding and infant growth in

China: A randomised controlled trial. Matern Child

Nutr 2024; 20:e13654.

Li X, Li Y, Qian L, Han P, Feng H and Jiang H. Mothers’

experiences of breast milk expression during

separation from their hospitalized infants: a

systematic review of qualitative evidence. BMC

Pregnancy Childbirth 2024; 24:124.

Kain VJ, Phumdoung S, Vetcho S and Chaisri P. The Impact

of Pandemic-Induced Separation and Visitation

Restrictions on the Maternal-Infant Dyad in Neonatal

Units: A Systematic Review. Adv Neonatal Care

; 25:84–91.

Chertok IA, Artzi-Medvedik R, Arendt M, Sacks E, Otelea

MR, Rodrigues C, Costa R, Linden K, Zaigham M,

Elden H, Drandic D, Grylka-Baeschlin S, Miani C,

Valente EP, Covi B, Lazzerini M and Mariani I.

Factors associated with exclusive breastfeeding at

discharge during the COVID-19 pandemic in 17

WHO European Region countries. Int Breastfeed J

; 17:83.

Anjur KI and Darmstadt GL. Separation of Maternal and

Newborn Care in US Hospitals: A Systemic Threat

to Survival, Health and Well-Being. Health Syst

Reform 2023; 9:2267255.

Bergman NJ. New policies on skin-to-skin contact warrant

an oxytocin-based perspective on perinatal health

care. Front Psychol 2024; 15:1385320.

Yigletu S, Tendulkar SA, Holmes AC, Abdelmenan S,

Tadesse A, Berhane HY and Kosinski KC. Key

correlates of exclusive breastfeeding at three

timepoints: Evidence from Ethiopia. Reprod Female

Child Health 2022; 1:99–110.

Nyqvist KH, Rosenblad A, Volgsten H, Funkquist E-L and

Mattsson E. Early skin-to-skin contact between

healthy late preterm infants and their parents: an

observational cohort study. PeerJ 2017; 5:e3949.

Ung B, Suils H, Cohen C, Autret F and Walter-Nicolet E.

Implementation of neonatal phototherapy with the

BiliCocoon Bag® device in the maternity ward and

impact on mother-infant separation. Arch Pediatr

; 30:283–290.

Wu N, Wang Y, Ding L, Xu Y, Jia X, Huo K, Yao X, Zhang

W, Wan Y, Xie P, Ye L and Huang R. Breastfeeding

trajectory of mothers of preterm infants within 6

months postpartum: A longitudinal study. Int J Nurs

Stud Adv 2025; 8:100311.

Ouyang Y, Xu Y and Zhang Q. Survey on breastfeeding

among Chinese female physicians and nurses. Nurs

Health Sci 2012; 14:298–303.

Tang X, Lu Z, Hu D and Zhong X. Influencing factors for

prenatal Stress, anxiety and depression in early

pregnancy among women in Chongqing, China.

Journal of Affective Disorders 2019; 253:292–302.

Wang S, Deng C-M, Zeng Y, Chen X-Z, Li A-Y, Feng S

W, Xu L-L, Chen L, Yuan H-M, Hu H, Yang T, Han

T, Zhang H-Y, Jiang M, Sun X-Y, Guo H-N, Sessler

DI and Wang D-X. Efficacy of a single low dose of

esketamine after childbirth for mothers with

symptoms of prenatal depression: randomised

clinical trial. BMJ 2024; 385:e078218.

Brown A and Shenker N. Experiences of breastfeeding

during COVID-19: Lessons for future practical and

emotional support. Matern Child Nutr 2021;

:e13088.

Wasti SP, Shrestha A, Dhakal P and Gc VS. The prevalence

of exclusive breastfeeding practice in the first six

months of life and its associated factors in Nepal: A

systematic review and meta-analysis. Sex Reprod

Healthc 2023; 37:100863.

Sartika RAD, Wirawan F, Gunawan W, Putri PN and

Shukri NHM. Parental support and exclusive

breastfeeding at 3 months in West Java, Indonesia: a

mixed-methods approach. Clin Exp Pediatr 2024;

:358–367.

Jones RA, Elhindi J, Lowe G, Henry L, Maheshwari R,

Culcer MR, Pasupathy D and Melov SJ.

Investigating short-stay admission to a neonatal

intensive care unit as a risk factor for reduced breast

feeding at discharge in infants ≥36 weeks’ gestation:

a retrospective cohort study. BMJ Open 2023;

:e075658.

Jiang X, Jiang H, Shan SS and Huang R. Breastfeeding

experience of postnatal mothers separated from

preterm infants after discharge: a phenomenology

qualitative approach. BMC Pregnancy Childbirth

; 24:28.

Cimino S and Cerniglia L. Impact of Maternal-Newborn

Separation in Italian Women with Suspected

COVID-19 Infection on Psychopathological

Symptoms and Quality of Interactions during

Breastfeeding. Psychopathology 2023; 56:335–341.

Sirico A, Musto R, Migliorini S, Brigidi S, Anzelmo Sciarra

F, Carlea A, Saccone G, Guida M and Sarno L.

Impact of COVID-19 on Breastfeeding among

SARS-CoV-2 Infected Pregnant Women: A Single

Centre Survey Study. Int J Environ Res Public

Health 2022; 20:228.

Yang R, Chen D, Wang H and Xu X. Experiences of

mothers of NICU preterm infants in milk

management out of the hospital: a qualitative study.

Int Breastfeed J 2022; 17:95.

Briere C-E and Gomez J. Fresh Parent’s Own Milk for

Preterm Infants: Barriers and Future Opportunities.

Nutrients 2024; 16:362.

McLardie-Hore FE, Forster DA, Shafiei T and McLachlan

HL. First-time mothers’ experiences of receiving

proactive telephone-based peer support for

breastfeeding in Australia: a qualitative study. Int

Breastfeed J 2022; 17:31.

Gebremariam KT, Wynter K, Zheng M, Rawstorn JC,

Denney-Wilson E and Laws R. Breastfeeding - a

survey of fathers’ support needs and preferred

sources of information. Int Breastfeed J 2024; 19:50.

Mudau AG, Mabunda JT and Mushaphi LF. Challenges and

strategies to implement exclusive breastfeeding in

the selected Districts of Limpopo Province, South

Africa: professional nurses´ perspectives. Pan Afr

Med J 2023; 46:75.

Srichalerm T, Jacelon CS, Sibeko L, Granger J and Briere

C-E. Thai novice nurses’ lived experiences and

perspectives of breastfeeding and human milk in theNeonatal Intensive Care Unit (NICU). Int Breastfeed

J 2024; 19:20.

Abargil M, Irani M, Klein Selle N and Atzil S.

Breastfeeding at Any Cost? Adverse Effects of

Breastfeeding Pain on Mother-Infant Behavior.

Biology (Basel) 2023; 12:636.

Chowdhry BK, Nair A, Jha S, Banerjee A, Singh P and

Dalai R. Breastfeeding Success With Use of Electric

Breast Pump Versus Inverted Syringe Technique in

Lactating Women With Inverted Nipple: Open

Labelled Randomized Control Trial. Cureus 2024;

:e68153.

Nabulsi M, Ghanem R, Abou-Jaoude M and Khalil A.

Breastfeeding success with the use of the inverted

syringe technique for management of inverted

nipples in lactating women: a study protocol for a

randomized controlled trial. Trials 2019; 20:737.

Russell M, Lucas R and Bernier Carney K. Perceptions of

Coping With Breastfeeding Pain: A Secondary

Analysis. J Midwifery Womens Health 2024; .

Roberts D, Jackson L, Davie P, Zhao C, Harrold JA, Fallon

V and Silverio SA. Exploring the reasons why

mothers do not breastfeed, to inform and enable

better support. Front Glob Womens Health 2023;

:1148719.

Özcan H and Güngör T. Breastfeeding experience and

anxiety in mothers with covid-19 in the postnatal

period: a qualitative study. Arch Public Health 2024;

:62.

Nourizadeh R, Shamsdanesh S, Mehrabi E, Ranjbar F,

Hakimi S and Salehi Pourmehr H. The Effect of

Psychological Interventions on the Anxiety and

Breastfeeding Self-Efficacy: A Systematic Review

and Meta-Analysis. Iran J Public Health 2023;

:937–949

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