To determine factors that predict the initiation and frequency of breastfeeding, attitudes about breastfeeding, and the self-efficacy of mothers of preterm infants in a neonatal intensive care unit.

A structured survey using two measurement points.

A university hospital in Finland.

Mothers (N = 124) and their infants born at less than 35 weeks gestation.

Structured questionnaires were used during the first week postpartum and at discharge of infants from the hospital. Neonatal and breastfeeding data were collected from patient records.

Preterm infants initiated breastfeeding at the median postnatal age of 4 days (range = 0–70 days). The factors that predicted earlier initiation of breastfeeding were greater gestational age, no ventilator treatment, early physical contact, and greater maternal education level. Greater gestational age, early physical contact, and a breastfeeding-favorable attitude also predicted the frequency of breastfeeding. The attitudes of the mothers regarding breastfeeding immediately after birth were generally positive but decreased during their infants’ hospital stays.

Gestational age and early physical contact seemed to be the strongest predictors of breastfeeding initiation and frequency in the NICU. In addition, the role of the mother's attitude regarding breastfeeding was significant. Current care practices should be critically reviewed with emphasis on early physical contact at the time of birth.