Impact of a Lactation Consultant Support Program on Breastfeeding Rates, Infant Growth, and Morbidity: A Randomized Clinical Trial

ABSTRACT Purpose: This study evaluates the effectiveness of a Breastfeeding Support and Promotion Program (PAP-LM), led by an International Board Certified Lactation Consultant (IBCLC), on exclusive breastfeeding (EBF) rates, morbidity, and hospital readmissions in preterm infants. Background: Breastfeeding is a key preventive strategy for preterm infants. However, the integration of IBCLCs into neonatal units is variable, and the evidence regarding their impact on morbidity in this high-risk population remains inconsistent. Methods: In this parallel-group randomized clinical trial, 162 preterm infants (32 + 0 to 36 + 6 gestation weeks) were randomly assigned (1:1) to receive either the PAP-LM intervention or standard care. The study followed CONSORT guidelines. Primary outcomes included breastfeeding rates; secondary outcomes encompassed growth, neonatal morbidity, and hospital readmissions. Results: Significant differences in EBF rates were observed between the intervention group (IG) and the control group (CG) at discharge (98.8% vs 21.2%; P < 0.001), at 3 months (98.8% vs 10%; P < 0.001), and at 6 months (91.4% vs 3.8%; P < 0.001). First-year morbidity was significantly lower in the IG compared with the CG (32.1% vs 66.2%; P < 0.001), particularly for bronchitis and bronchiolitis. Conclusions: A structured IBCLC-led support program, initiated in the neonatal unit and continued through 6 months of home-based follow-up, promotes sustained EBF and reduces neonatal morbidity and hospital readmissions. Implications for research and practice: The results support the implementation of structured breastfeeding support programs within public health policies targeting high-risk newborns and encourage the expansion of IBCLC-led services to additional neonatal units. Trial registration: gov, NCT06653595.