Health-related quality of life of premature infants at 2 years in relation to breastfeeding and maternal emotional state: a retrospective cohort study

Figures & data

Table 1. Characteristics of pregnancy, childbirth and development.

	LBW (n = 23)	VLBW (n = 35)	ELBW (n = 39)	Total (n = 97)
Characteristics of pregnancy and childbirth:
Gestational weeks (M; SD)	33.478; 2.483	31.4; 2.403	27.025; 2.804	30.13; 3.7
Birth weight: g (M; SD)	1945.217; 325.211	1382.028; 134.715	713.589; 177.904	1246.81; 531.25
Gender distribution: boys (%, n)/girls (%, n)	56.52% (13/23)/43.47% (10/23)	45.7% (16/35)/54.2% (19/35)	35.8% (14/39)/64.1% (25/39)	44.3% (43/97)/55.6% (54/97)
Ratio of high-risk pregnancy (%, n)	52.1% (12/23)	91.4% (32/35)	69% (27/39)	73.1% (71/97)
Childbirth: sectio caesarea (%, n)/per vias naturales (%, n)	78.2% (18/23)/21.8% (5/23)	80% (28/35)/20% (7/35)	74.3% (29/39)/25.7% (10/39)	77.3% (75/97)/22.6% (22/97)
Ratio of smoking during pregnancy (%, n)	13% (3/23)	11.4% (4/35)	23% (9/39)	16.4% (16/97)
Breastfeeding (%, n)	91.3% (21/23)	68.5% (24/35)	23% (9/39)	55.6% (54/97)
Developmental characteristics:
Age of sitting without support: month (M; SD)	7.8; 1.723	8; 2.086	9.5; 3.322	8.55; 2.683
Age of standing without support: month (M; SD)	10.43; 2.292	10.14; 2.045	12.25; 3.965	11.061; 3.145
Walking without support: month (M; SD)	13.45; 2.56	14; 2.249	16.61; 4.398	14.92; 3.597
Age of first words: month (M; SD)	14.04; 4.685 (have not said a word: 0 children)	15.37; 4.433 (have not said a word: 0 children)	14.98; 5.477 (have not said a word: 3 children)	14.89; 4.892 (have not said a word: 3 children)
Toilet training:
Wearing diapers (%, n)	73.9% (17/23)	60% (21/35)	71.7% (28/39)	68% (66/97)
Developing (%, n)	26% (6/23)	31.4% (11/35)	25.6% (10/39)	27.8% (27/97)
Dry during the day (%, n)	(0/23)	8.5% (3/35)	2.5% (1/39)	4.1% (4/97)

Table 2. Distribution of chronic neonatal morbidities.

	< 999 g n (%)	1000–1499 g n (%)	1500–2499 g n (%)	Total
Neonatal morbidities
Respiratory pathologies
Bronchopulmonary dysplasia (BPD)	17/38 (44.7)	0/35 (0)	0/23 (0)	17/97 (17.5)
Intrauterine hypoxia	4/38 (10.5)	2/35 (5.7)	1/23 (4.3)	7/97 (7.2)
Intrauterine asphyxia	1/38 (2.6)	0/35 (0)	0/23 (0)	1/97 (1)
Abdominal pathologies
Necrotizing enterocolitis (NEC)	3/38 (7.8)	0/35 (0)	0/23 (0)	3/97 (3)
Cerebral pathologies
Intraventricular haemorrhage (IVH I/II)	10/38 (26.3)	0/35 (0)	1/23 (4.3)	13/97 (13.4)
Intraventricular haemorrhage (IVH III/IV)	2/38 (5.2)	0/35 (0)	0/23 (0)
Periventricular leukomalacia (PVL)	0/38 (0)	1/35 (2.8)	0/23 (0)	1/97 (1)
Other premature pathologies
Retinopathy of prematurity (ROP I/II)	12/38 (31.5)	0/35 (0)	0/23 (0)	17/97 (17.5)
Retinopathy of prematurity (ROP III/IV)	5/38 (13.1)	0/35 (0)	0/23 (0)

Table 3. Quality of life at 2 years in association with behavioural characteristics of infants.

	The number of positive behavioural characteristics of the infants (calm, good sleeper, adaptable, easy to take care of)
	0 (n = 19)	1 (n = 22)	2 (n = 26)	3 (n = 17)	4 (n = 12)	p-value
Overall quality of life (%) M; SD	80.55; 10.18	79.32; 12.37	87.57; 9.83	86.11; 10.85	75.43; 13.74	p = 0.596; r = 0.054
Physical functioning (%) M; SD	80.09; 12.76	83.94; 17.6	86.78; 10.17	89.28; 12.72	73.43; 20.87	p = 0.847; r = 0.02
Emotional functioning (%) M; SD	72.63; 13.26	69.09; 15.7	79.81; 16.7	80; 12.5	80; 14.3	p = 0.033; r = 0.216*
Social functioning (%) M; SD	88.95; 10.18	85; 14.14	93.85; 9.3	89.12; 14.05	72.92; 18.39	p = 0.129; r = −0.155
	The number of negative behavioural characteristics of the infants (weepy, irritated, colicky, loss of appetite, bad sleeper)
	0 (n = 55)	1 (n = 22)	2 (n = 10)	3 (n = 5)	4 (n = 4)	p-value
Overall quality of life (%) M; SD	84.71; 12.19	80.14; 11.8	75.91; 8.63	78.74; 16.6	78.47; 4.21	p = 0.004; r = −0.291**
Physical functioning (%) M; SD	85.46; 15.87	86.61; 16.9	78.75; 13.4	81.25; 17.25	74.21; 7.38	p = 0.018; r = −0.240*
Emotional functioning (%) M; SD	79.55; 15.67	72.73; 13.9	65.5; 12.27	72; 13.03	63.75; 4.78	p = 0.002; r = −0.313**
Social functioning (%) M; SD	88.27; 15.28	86.14; 12.43	83.5; 17.95	83; 30.33	97.5; 5	p = 0.854; r = −0.019

*p < 0.05; **p < 0.01.

Table 4. Associations between breastfeeding and quality of life.

	Breastfed (n = 54), the sucking method:			p-value
	Good technique (n = 28)	Lazy (n = 18)	Frequent swallowing and sucking difficulties (n = 8)
Overall quality of life (%) M; SD	85.77; 10.56	82.71; 13.8	81.63; 9.85	p = 0.433; χ^2 = 1.672
Physical functioning (%) M; SD	87.16; 14.65	82.94; 18.11	82.42; 11.32	p = 0.407; χ^2 = 1.799
Emotional functioning (%) M; SD	76.96; 16.51	75.28; 18.05	72.5; 9.25	p = 0.744; χ^2 = 0.592
Social functioning (%) M; SD	91.07; 10.39	90.56; 11.36	90; 14.39	p = 0.893; χ^2 = 0.226
	Non-breastfed (n = 43)	Breastfed (n = 54)		p-value
Overall quality of life (%) M; SD	79.92; 12.24	84.14; 11.56		p = 0.05; U = 891.5*
Physical functioning (%) M; SD	80.73; 15.84	85.05; 15.38		p = 0.120; U = 948.00
Emotional functioning (%) M; SD	75.7; 14.82	75.74; 16.03		p = 0.980; U = 1157.5
Social functioning (%) M; SD	83.37; 19.17	90.74; 11.13		p = 0.127; U = 958.00

*p < 0.05; **p < 0.01.

Table 5. Associations between predominant maternal emotional state and reported quality of life at 2 years.

Predominant maternal emotional state	Overall quality of life (%) M; SD	Physical functioning (%) M; SD	Emotional functioning (%) M; SD	Social functioning (%) M; SD
During pregnancy
Calm, collected, positive, excited (n = 67)	84.69; 11.17	85.31; 15.04	76.87; 15.14	91.19; 13.08
Emotionally unstable, ambivalent (n = 6)	79.88; 11.49	88.01; 13.61	69.17; 18.55	82.5; 11.72
Nervous, anxious (n = 24)	76.10; 12.47	75.85; 16.05	74.17; 15.58	78.33; 18.92
p-value	p = 0.007; χ^2 = 10.059*	p = 0.013; χ^2 = 8.688*	p = 0.48; χ^2 = 1.468	p = 0.02; χ^2 = 12.654*
After childbirth
Calm, collected, positive, excited (n = 71)	84.89; 11.07	85.56; 14.62	78.52; 14.81	89.79; 14.35
Emotionally unstable, ambivalent (n = 11)	77.01; 14.31	82.01; 17.11	68.18; 19.27	81.82; 20.76
Nervous, anxious (n = 15)	73.71; 9.61	72.5; 15.81	68; 10.98	80.67; 14.98
p-value	p < 0.01; χ^2 = 15.209**	p = 0.012; χ^2 = 8.905*	p = 0.006; χ^2 = 10.333**	p = 0.024; χ^2 = 7.462*

*p < 0.05; **p < 0.01.

Figure 1. The positive, self-reinforcing cycle of breastfeeding.