Impact of Comprehensive Breastfeeding Support Strategies on Exclusive Breastfeeding Rates at Discharge in a Neonatal Unit

<b>Background/Objectives:</b> Exclusive breastfeeding (EBF) at discharge from neonatal units is influenced by maternal, neonatal, and healthcare-related factors. Structured breastfeeding support may improve outcomes. This study aimed to assess the impact of specialized breastfeeding support provided by a pediatric nurse on EBF rates at discharge and to explore associated factors. <b>Methods:</b> A retrospective observational cohort study was conducted in a regional referral neonatal unit within the Spanish public healthcare system. Newborns admitted to the unit whose mothers intended to breastfeed were included. Two periods were compared: a pre-intervention period, April 2017-March 2019, (breastfeeding working group, written protocol, staff training, and donor human milk bank) and a post-intervention period, April 2019-March 2021, (incorporation of a lactation consultant and establishment of a Breastfeeding Committee). EBF at discharge and at 6 and 12 months was analyzed using descriptive statistics and multivariate logistic regression. <b>Results:</b> A total of 1136 newborns were included in the analysis. EBF at discharge increased from 39.6% in the pre-intervention period to 75.8% in the post-intervention period (<i>p</i> < 0.001). The post-intervention period was independently associated with EBF (OR 4.45; 95% CI: 3.45-5.75). Factors positively associated with EBF included participation in breastfeeding workshops, adequate milk expression frequency, initiation of breastfeeding at birth, and previous breastfeeding experience. Negative associations included hypogalactia, donor human milk use, and maternal pain. EBF rates were 38.5% at 6 months and 20.9% at 12 months. <b>Conclusions:</b> Specialized breastfeeding support within neonatal units was associated with a substantial increase in EBF at discharge, supporting its systematic integration into routine neonatal care.