In-hospital direct breastfeeding is linked to improved oral feeding and human milk intake at discharge and beyond in neonates with CHD

Abstract Background: Feeding neonates with CHD is clinically and emotionally challenging. Although human milk improves outcomes—including reduced necrotising enterocolitis, sepsis, and neurodevelopmental delays—its use remains suboptimal. Prior studies have focused on clinical endpoints, with limited attention to modifiable maternal or prenatal influences on feeding. Objective: To evaluate how maternal expectations, prenatal counselling, and early lactation behaviours affect feeding outcomes in infants with prenatally diagnosed CHD. Methods: We conducted a prospective cohort study of 49 mother–infant dyads with prenatally diagnosed CHD in a tertiary neonatal ICU and paediatric cardiac ICU. Mothers completed structured surveys during hospitalisation. Feeding outcomes were assessed through chart review over six months post-discharge. Primary outcomes included human milk volume at day of life 14, feeding type at discharge, and direct breastfeeding. Multivariable logistic regression and CHD risk stratification were used for analysis. Results: Direct breastfeeding during hospitalisation predicted oral feeding at discharge (77% vs. 28%, p = 0.0006) and ongoing human milk use. Early milk exposure (<72 hours) increased likelihood of human milk use at discharge ( p = 0.0158). Strong maternal intent and prior breastfeeding experience were linked to sustained lactation. Prenatal counselling (reported by 68%) was not associated with outcomes. Higher Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery scores correlated with delayed achievement of 500 mL/day by day of life 14 ( p = 0.0405). Conclusions: Direct breastfeeding, early milk exposure, and maternal intent are key modifiable drivers of feeding success in neonates with CHD. Standard prenatal counselling alone is insufficient. Targeted, risk-informed lactation support is needed to optimise outcomes.