Original Article| Volume 23, ISSUE 2, P351-358, March 2023

Real-Time Breastfeeding Documentation: Timing of Breastfeeding Initiation and Outpatient Duration

  • Carole H. Stipelman
    Address correspondence to Carole H. Stipelman, MD, MPH, Department of Pediatrics, University of Utah School of Medicine, 295 Chipeta Way, Salt Lake City, UT 84108.
    University Pediatric Clinic, Department of Pediatrics (CH Stipelman, PC Young, and LL Brown), University of Utah School of Medicine, Salt Lake City

    Sugar House Health Center, Department of Pediatrics (CH Stipelman), University of Utah School of Medicine, Salt Lake City

    University Information Technology (CH Stipelman and J Bennion), University of Utah, Salt Lake City
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  • Gregory J. Stoddard
    Department of Internal Medicine (GJ Stoddard), University of Utah School of Medicine, Salt Lake City
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  • Jeff Bennion
    University Information Technology (CH Stipelman and J Bennion), University of Utah, Salt Lake City
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  • Paul C. Young
    University Pediatric Clinic, Department of Pediatrics (CH Stipelman, PC Young, and LL Brown), University of Utah School of Medicine, Salt Lake City
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  • Laura L. Brown
    University Pediatric Clinic, Department of Pediatrics (CH Stipelman, PC Young, and LL Brown), University of Utah School of Medicine, Salt Lake City
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      Current breastfeeding guidelines promote initiating breastfeeding ≤1 h after birth to establish long-term breastfeeding. Previous studies dichotomized initiation to ≤1 h versus subsequent hours combined. There are limited data evaluating the effect of initiation in each subsequent hour on breastfeeding duration. Our objective was to evaluate the association between breastfeeding initiated at ≤1 h versus the subsequent 23 hours after birth and outpatient breastfeeding duration.


      In this retrospective cohort study, we analyzed real-time, discretely documented electronic health record (EHR) breastfeeding data for 3315 infants born at a university center and followed to age ≥12 mo at 27 university primary care clinics. The primary outcome was breastfeeding duration. The exposure variable was hour of breastfeeding initiation within 24 h postnatally. Data were analyzed by univariable and multivariable linear regression separately for infants born by vaginal versus cesarean delivery.


      In adjusted models, initiating breastfeeding during each hour from age >1 to ≤6 h and during ages >6 to ≤24 h was not associated with decreased breastfeeding duration versus initiating breastfeeding at ≤1 h after birth for infants born via vaginal or cesarean delivery.


      Delaying breastfeeding initiation to >1 to ≤24 h after birth is not associated with decreased breastfeeding duration compared with initiating breastfeeding at ≤1 h after birth. Integration of breastfeeding measures into inpatient and outpatient EHR discrete data fields may clarify best practices that support long-term breastfeeding as a public health imperative.



      CI (confidence interval), EHR (Electronic health record), LASSO (Least absolute shrinkage and selection operator), MICE (Multiple imputation by chained equations)
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