Determinants of delayed initiation of breast milk expression among mothers of premature infants in Kelantan, Malaysia

Background The initiation of breastfeeding in premature infants is often more challenging than in full-term infants due to their physiological immaturity. These infants often exhibit reduced alertness, limited stamina, and underdeveloped coordination of sucking, swallowing, and breathing, making effective latching difficult. As a result, lactation initiation and maintenance often begin with breast milk expression. This study aimed to determine the prevalence of delayed breast milk expression initiation (beyond six hours after delivery) and to identify factors associated with this delay among mothers of premature infants admitted to the Neonatal Intensive Care Unit (NICU) at two tertiary hospitals in Kelantan, Malaysia. Methods A total of 234 mothers who delivered premature infants participated in this cross-sectional study. From the third to the seventh day of the infants’ admission to the NICU, respondents completed a self-administered questionnaire to obtain data on maternal demographics, infant characteristics, obstetric and breastfeeding history, and the timing of breast milk expression initiation. In addition, mothers’ knowledge of breast milk feeding to premature infants and barriers to breast milk expression during NICU admission were assessed using a validated questionnaire. Descriptive statistics and logistic regression analyses were conducted. Results Most mothers (87.6%) initiated breast milk expression more than six hours after delivery. Common reasons given included caesarean delivery (36.6%), maternal health problems post-delivery (24.9%), perceived insufficient milk supply (22%), and unpreparedness for premature birth (18.5%). Two factors were found to be significantly associated with delayed breast milk expression initiation: not performing skin-to-skin contact (SCC) after delivery (adjusted odds ratio (AOR) 2.60; 95% confidence interval (CI) [1.12–5.95]; P  = 0.027), and unclear knowledge regarding the recommended frequency of milk expression when separated from the infant (AOR 15.15; 95% CI [1.97–116.76]; P  = 0.009). Conclusion A high proportion of mothers did not initiate breast milk expression within six hours after premature delivery. Strengthening healthcare provider support is essential in promoting early initiation of breast milk expression, emphasizing the benefits of SCC, and providing timely emotional and technical support to improve breastfeeding outcomes among premature infants.