Modifiable Determinants of Exclusive Breastfeeding at NICU Discharge among Infants Born before 32 Weeks’ Gestation: A Cross-Sectional Study in Malaysia

Background: Mothers of preterm infants often face unique challenges in the Neonatal Intensive Care Unit (NICU), which may adversely affect breastfeeding outcomes. Aim: To determine the rate of exclusive breastfeeding (EBF) at NICU discharge among infants born <32 weeks’ gestation and to identify associated maternal and clinical factors. Method: A cross-sectional study was conducted between 2021 and 2023 in two tertiary NICUs in Malaysia. A total of 180 mothers of preterm infants were enrolled. Prior to discharge, participants completed self-administered questionnaires assessing their breastfeeding experiences, including the NICU Mother’s Breastfeeding Survey and the Breastfeeding Self-Efficacy Scale–Short Form (BSES-SF). Data on skin-to-skin contact, antenatal breastfeeding education, and prior breastfeeding experience were also collected. Results: EBF at discharge was achieved by 52% of the cohort. Factors significantly associated with EBF included prior breastfeeding experience (adjusted odds ratio [aOR]: 1.95; 95% confidence interval [CI]: 1.08–3.53; p = 0.03), antenatal breastfeeding education (aOR: 3.43; 95% CI: 1.36–8.64; p < 0.05), skin-to-skin contact in the NICU (aOR: 2.56; 95% CI: 1.20–5.47; p = 0.02), and higher BSES-SF scores (aOR: 2.19; 95% CI: 1.11–4.32; p = 0.02). Perceived breastfeeding barriers were significantly associated with lower odds of EBF (aOR: 0.11; 95% CI: 0.05–0.24; p = 0.001). Conclusion: EBF at NICU discharge among preterm infants <32 weeks is influenced by modifiable maternal factors. Enhancing breastfeeding education, fostering self-efficacy, and encouraging early skin-to-skin contact may improve breastfeeding outcomes in this population.