Conclusion The findings of this study demonstrate a link between participation in direct breast-feeding in the NICU and duration of breast milk feedings, as well as success with continued breast milk feedings until NICU discharge. The gestational age of the first direct breast- feeding and the first oral suckling feeding being at the breast are associated with the duration of breast milk feedings, as well as with the number of times the infant is directly breast-fed in the NICU. Based on positive associations with breast milk feeding outcome, direct breast-feeding in the NICU could be a valuable breast-feeding intervention. Future studies are warranted to further investigate factors that can positively influence breast milk feedings in the NICU and to investigate the effects of direct breast-feeding on infant and mother