487 - Preterm infant attachment is independent of breast milk intake during neonatal care.

Poster Number: 487
Publication Number: 487.2045

Background: Breast milk intake following preterm birth may promote secure attachment relationships in preterm infants via improvements in brain development, emotion regulation and/or cognition. Elucidating the relationship between breast milk intake and attachment is crucial to support parents of preterm infants to make informed feeding choices, and to provide accurate counselling when breast milk is not available.

Objective: To investigate whether breast milk exposure during neonatal care is associated with attachment outcomes at 9 months of age.

Design/Methods: We studied 77 preterm ( < 33 weeks’ gestation) and 71 term infants. Preterm infant feeding data were collected from birth until hospital discharge. Attachment outcomes were derived from the videocoding of infants’ responses to the Still-Face paradigm at 9 months corrected age. Attachment behaviours (infants’ distress, fretfulness, attentiveness to the caregiver) and classification (secure versus insecure attachment) were compared between preterm infants who received exclusive human (maternal or donor) milk for < 75% of inpatient days, preterm infants who received exclusive human milk for ≥ 75% of inpatient days and term infants. One way analysis of variance and binary logistic regression were used for analyses of attachment behaviours and classification, respectively. Thresholds of milk intake were chosen based on our previous work demonstrating positive associations between human milk intake and MRI markers of brain maturation. P-values were adjusted for false-discovery rate using the Benjamini-Hochberg procedure separately for analyses of attachment behaviours and analyses of secure versus insecure attachment classification. The study protocol was preregistered (https://doi.org/10.17605/OSF.IO/AYT5F).

Results: Attachment outcomes were derived from 131 mother-infant dyads, 16 father-infant dyads and one grandmother-infant dyad. Clinical and demographic characteristics of participants are detailed in Table 1. There were no significant differences in infant distress, fretfulness, attentiveness to the caregiver (p-values > 0.19, Figure 1), or in the odds of secure versus insecure attachment classification (relative risk ratio = 0.57–0.89, p-values = 1.00, Table 2) between the three groups.

Conclusion(s): Breastmilk intake was not associated with infant attachment in this preterm-enriched cohort. Although breast milk intake may have other benefits (e.g. brain development) this result may reassure parents when early birth and associated NICU stays disrupt access to breastmilk in the first weeks of life.