Effectiveness of Combining LATCH and Bristol Breastfeeding Assessment Scales in Predicting Exclusive Breastfeeding

Abstract

Background:

Early identification of breastfeeding difficulties is crucial for targeted interventions. However, the comparative effectiveness of these assessment tools remains unclear.

Objective:

To compare the predictive validity of the LATCH and Bristol Breastfeeding Assessment Tool (BBAT) scores measured at 24 hours and day 7 postpartum for exclusive breastfeeding at 42 days and to evaluate their combined predictive performance.

Methods:

This prospective cohort study included 157 mother–infant dyads (September 2024–March 2025) at a university hospital in Turkey. LATCH and BBAT scores were assessed at 24 hours and on day 7 postpartum. The primary outcome was exclusive breastfeeding at 42 days. Receiver operating characteristic (ROC) analysis was used to determine the optimal cut-off values and predictive performance.

Results:

The rate of exclusive breastfeeding (EBF) was 83.4% (n = 132) in the first 24 hours and 68.8% (n = 108) on day 42 of life. The LATCH score in the first week showed the highest specificity for predicting EBF on day 42. (cut-off value ≥10: area under the curve [AUC] 0.671 (95% CI: 0.582–0.760; p < 0.001), sensitivity 55.6%, specificity 72.3%, false positive rate 27.7%). A multiple ROC analysis was conducted to determine which of the four scores was better at predicting EBF on the 42nd day. The cutoff values were 8 for the first-week Bristol score alone, 10 for the first-week LATCH score, 5 for the first 24-hour Bristol score, and 7 for the first 24-hour LATCH score.

Conclusions:

Combined early assessment using LATCH and BBAT scores provides a superior prediction of EBF at 42 days compared with single indicators. The implementation of systematic screening using these tools may facilitate targeted lactation support for at-risk dyads.