Effectiveness of a multimodal intervention for mothers of newborns hospitalized in the intensive care unit to increase exclusive breastfeeding

BACKGROUND: Globally, only 40% of newborns admitted to neonatal intensive care units (NICUs) are exclusively breastfed, a figure that decreases to approximately 20% in low- and middle-income countries. This study aimed to evaluate the effect of a multimodal intervention on exclusive breastfeeding at NICU discharge and to assess changes in parental stress, breastfeeding self-efficacy, breastfeeding knowledge, and risk of postpartum depression among mothers during their newborns' hospitalization. METHODS: We conducted a quasi-experimental before-and-after intervention study among mothers of newborns admitted to the NICU of a tertiary care hospital in Bogotá, Colombia. The primary outcome was exclusive breastfeeding at discharge. Secondary outcomes included parental stress, breastfeeding self-efficacy, breastfeeding knowledge, and risk of postpartum depression. The intervention combined parental education, structured support from healthcare providers, and a mobile application delivering breastfeeding-related educational content. Propensity score matching was used to control for potential confounders, and conditional logistic regression was applied to estimate adjusted odds ratios (ORs) for the primary outcome. Paired odds ratios (admission-discharge) and Becker's d coefficient were calculated for secondary outcomes. RESULTS: Newborns whose mothers received the intervention had substantially higher odds of being discharged with exclusive breastfeeding compared with those whose mothers did not receive the intervention (adjusted OR [aOR] = 10.35; 95% confidence interval [CI]: 4.95-21.7; p < 0.001). In the no-intervention group, the risk of postpartum depression increased significantly during hospitalization (paired OR = 9.4; 95% CI: 3.7-23.6;p < 0.001), whereas a significant reduction was observed in the intervention group (paired OR = 0.04; 95% CI: 0.005-0.29; p < 0.001). No statistically significant changes in parental stress were observed in either group (no intervention: OR = 0.33; 95% CI: 0.07-1.65; p = 0.29; intervention: OR = 0.73; 95% CI: 0.30-1.80; p = 0.64). Breastfeeding self-efficacy declined significantly in the absence of intervention (OR = 0.23; 95% CI: 0.11-0.49, p < 0.001) and improved significantly among mothers who received the intervention (OR = 2.73; 95% CI: 1.36-5.42; p = 0.002). Effect sizes for breastfeeding knowledge were - 0.84 in the no-intervention group and 0.65 in the intervention group. CONCLUSIONS: The multimodal intervention was associated with significantly higher odds of exclusive breastfeeding at NICU discharge. Additionally, the intervention reduced the risk of postpartum depression and improved breastfeeding self-efficacy and knowledge among mothers.