Late preterm infants (34-37 weeks gestation) account for the fastest growing, largest cohort of preterm births in the U.S. Despite comparable outward appearances, late preterm infants lack the developmental maturity of their term counterparts, predisposing them to unique, often unrecognized medical vulnerabilities and a concomitant high incidence of morbidity. One striking paradox emergent from these data is that late preterm infants who are breastfed tend to present with diagnoses of failure to thrive, jaundice, and dehydration at much higher rates than those who are not breastfed, a finding largely attributed to insufficient breast milk intake. Consequently, it is difficult to recommend breastfeeding as the optimal method of feeding and encourage its more widespread uptake among the late preterm population, despite the many, irrefutable long- and short-term health benefits that breastfeeding provides, particularly for infants born prematurely. While late preterm breastfeeding complications are often traced to infant-related issues, breastfeeding is a complex, reciprocal activity involving both infant and mother. It has become crucial, therefore, to understand the processes leading to both breastfeeding success and breastfeeding failure stemming from insufficient breast milk intake within the late preterm population. Accordingly, the primary aim of this qualitative, grounded theory study is to describe and explain the process of breastfeeding initiation and continuation among late preterm mother-infant dyads. Secondary aims are, 1) to place breastfeeding within the broader context of mothering a late preterm infant;and 2) to identify factors influencing the late preterm mother's decision to initiate and continue breastfeeding. Based mainly on the grounded theory techniques proposed by Strauss &Corbin, the study will utilize serial postpartum semi-structured interviews, observational field-notes, and secondary data collection methods (e.g., self-audio recordings, video review/reflection) for an estimated 10-18 mothers of late preterm infants in the development of a substantive theory. Theoretical sampling, memoing, and systematic coding utilizing the constant comparative method will be employed. This proposal satisfies two NINR objectives: 1) to identify and ameliorate the long-term consequences of prematurity, including complications of near-term infants;and 2) identify influences on decision-making that result in behavioral changes that promote health and prevent disease and disability. Results from this study are expected to provide a foundation for future research efforts seeking to narrow or eliminate breastfeeding health disparities for the late preterm populace. Additionally, this study will contribute to the currently underdeveloped knowledgebase surrounding late prematurity in general, and breastfeeding within this group, in particular.

National Institute of Health (NIH)
National Institute of Nursing Research (NINR)
Predoctoral Individual National Research Service Award (F31)
Project #
Application #
Study Section
National Institute of Nursing Research Initial Review Group (NRRC)
Program Officer
Banks, David
Project Start
Project End
Budget Start
Budget End
Support Year
Fiscal Year
Total Cost
Indirect Cost
University of Pittsburgh
Schools of Nursing
United States
Zip Code
Radtke Demirci, Jill; Happ, Mary Beth; Bogen, Debra L et al. (2015) Weighing worth against uncertain work: the interplay of exhaustion, ambiguity, hope and disappointment in mothers breastfeeding late preterm infants. Matern Child Nutr 11:59-72
Demirci, Jill Radtke; Sereika, Susan M; Bogen, Debra (2013) Prevalence and predictors of early breastfeeding among late preterm mother-infant dyads. Breastfeed Med 8:277-85
Tate, Judith A; Sereika, Susan; Divirgilio, Dana et al. (2013) Symptom communication during critical illness: the impact of age, delirium, and delirium presentation. J Gerontol Nurs 39:28-38
Demirci, Jill Radtke; Braxter, Betty J; Chasens, Eileen R (2012) Breastfeeding and short sleep duration in mothers and 6-11-month-old infants. Infant Behav Dev 35:884-6
Radtke, Jill V (2011) The paradox of breastfeeding-associated morbidity among late preterm infants. J Obstet Gynecol Neonatal Nurs 40:9-24
Radtke, Jill V; Terhorst, Lauren; Cohen, Susan M (2011) The Menopause-Specific Quality of Life Questionnaire: psychometric evaluation among breast cancer survivors. Menopause 18:289-95