Clinical Associate Professor, Pediatrics/Neonatal/Perinatal Medicine Stanford University Stanford University Palo Alto , California, United States
Background: Breast milk use is associated with improved growth and outcomes in the vulnerable NICU population. There is a gap in our knowledge of comprehensive patient and process factors that influence breast milk use at discharge from the NICU.
Objective: This retrospective study examined patient factors and lactation systems factors associated with any breast milk use at discharge from a large regional NICU in California.
Design/Methods: 865 infants born at 23-41weeks gestation with no congenital anomalies and admitted to the NICU within 3 days of birth between 9/2015 and 6/2018 were included. We examined maternal factors such as age, race/ethnicity, complications during pregnancy, public insurance, neonatal factors such as gestational age, birth weight, diagnosis and family barriers to care (Table 1). We examined infant feeding, frequency of lactation support in the first week, frequency of lactation support during the weeks of hospital stay, lactation support at discharge and direct breast feeding in the NICU (Table 2). We examined the association of maternal race/ethnicity with lactation support factors and family barriers to care (Table 3). Logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for all factors associated with any breast milk use at discharge.
Results: Breast milk at discharge for all infants was 89.3%; for extremely preterm 82.3%, moderately preterm 91.4%, late preterm 86.5% and term 92.7%. Prematurity (OR 0.36 [0.21- 0.63]), low birth weight, morbidities and black race (OR 0.28 [0.10-0.76]) were associated with decreased breast milk use. Early initiation of feeds, volume of breast milk prior to discharge, lactation support at discharge, and direct breastfeeding in the NICU increased breast milk use. Public insurance (OR 0.54 [0.34-0.85]) and family transportation barriers (0.60 [0.36-0.98]) decreased breast milk use. Hispanic patients had significant barriers to care (P value < 0.001) such as transportation issues, need for interpreter support (36%) compared to non-Hispanic white (11%) and Asian (16%) mothers. Conclusion(s): Lactation support systems played a crucial role in increasing breast milk use in all infants including late preterm and term infants. Extremely preterm infants with morbidities had significant decrease in breast milk use. Racial/ethnic disparities were noted in any breast milk use at discharge. This study findings from a large NICU in California provides a foundation to develop successful targeted interventions to improve outcomes of high-risk infants.
Table 1: Neonatal and Maternal factors influencing breast milk use at discharge in all infants admitted to the NICU
Table 2: Infant feeding and Lactation support factors influencing breast milk use at discharge in all infants admitted to the NICU
Table 3: Association of Maternal race/ethnicity with Lactation support factors and barriers to care in all infants admitted to the NICU
Authors/Institutions: Meera N. Sankar, Stanford University, Palo Alto , California, United States; Ya'el E. Weiner, Stanford Medicine, Los Altos, California, United States; Neha Chopra, Stanford Medicine, Los Altos, California, United States; Zakiyah K. Williams, Lucile Salter Packard Children's Hospital at Stanford, Palo Alto, California, United States; Tara Hanson-Timpson, Lucile Salter Packard Children's Hospital at Stanford, Palo Alto, California, United States; Emma Bonasera, Lucile Salter Packard Children's Hospital at Stanford, Palo Alto, California, United States; Susan D. Crowe, Stanford University, Stanford, California, United States; Henry Lee, Stanford University, Stanford, California, United States
