Download PDF
Am J Perinatol
DOI: 10.1055/s-0044-1787895
Original Article

Multivariate Analysis of Factors Associated with Feeding Mother's Own Milk at Discharge in Preterm Infants: A Retrospective Cohort Study

Jordan D. Reis
1   Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas
2   Department of Pediatrics, Baylor Scott & White Health, Dallas, Texas
,
Mariela Sánchez-Rosado
1   Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas
3   Division of Neonatology, Joe DiMaggio Children's Hospital, Hollywood, Florida
,
Daizy Mathai
4   Parkland Hospital and Health System, Dallas, Texas
,
Isabelle Kiefaber
5   Health Systems Research, University of Texas Southwestern Medical Center, Dallas, Texas
,
L Steven Brown
4   Parkland Hospital and Health System, Dallas, Texas
,
Cheryl S. Lair
4   Parkland Hospital and Health System, Dallas, Texas
,
David B. Nelson
6   Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, University of Texas Southwestern Medical Center, and Parkland Health, Dallas, Texas
,
Patti Burchfield
1   Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas
,
Luc P. Brion 
1   Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas
› Author Affiliations Funding None.
› Further Information
Also available at
    Permissions and Reprints

Abstract

Objective This study aimed to develop a predictive model of feeding mother's own milk (MOM) at discharge using social determinants of health (SDOH), maternal and neonatal factors after deliveries at <33 weeks of gestational age (GA), or birth weight <1,500 g.

Study Design Secondary analysis of a retrospective cohort in an inner-city hospital before (Epoch-1, 2018–2019) and after (Epoch-2, 2020–2021) implementing a donor human milk (DHM) program.

Results Among 986 neonates, 495 were born in Epoch-1 (320 Hispanic White, 142 Non-Hispanic Black, and 33 Other) and 491 in Epoch-2 (327, 137, and 27, respectively). Feeding any MOM was less frequent in infants of non-Hispanic Black mothers than in those of Hispanic mothers (p < 0.05) but did not change with epoch (p = 0.46). Among infants who received any MOM, continued feeding MOM to the time of discharge was less frequent in infants of non-Hispanic Black mothers versus those of Hispanic mothers, 94/237 (40%) versus 339/595 (57%; p < 0.05), respectively. In multivariate analysis including SDOH and maternal variables, the odds of feeding MOM at discharge were lower with SDOH including neighborhoods with higher poverty levels, multiparity, substance use disorder, non-Hispanic Black versus Hispanic and young maternal age and increased with GA but did not change after implementing DHM. The predictive model including SDOH, maternal and early neonatal variables had good discrimination (area under the curve 0.85) and calibration and was internally validated. It showed the odds of feeding MOM at discharge were lower in infants of non-Hispanic Black mothers and with feeding DHM, higher need for respiratory support and later initiation of feeding MOM.

Conclusion Feeding MOM at discharge was associated with SDOH, and maternal and neonatal factors but did not change after implementing DHM. Disparity in feeding MOM at discharge was explained by less frequent initiation and shorter duration of feeding MOM but not by later initiation of feeding MOM.

Key Points

  • In this cohort study of preterm infants, factors of feeding MOM at discharge included (1) SDOH; (2) postnatal age at initiation of feeding MOM; and (3) maternal and neonatal factors.

  • Feeding MOM at the time of discharge was less frequent in infants of non-Hispanic Black mothers versus those of Hispanic mothers.

  • Disparity in feeding MOM at discharge was explained by less frequent initiation and shorter duration of MOM feeding but not by later postnatal age at initiation of feeding MOM.

Keywords

social determinants of health - formula - mother's own milk - preterm - donor human milk - neonatal intensive care unit - prognostic model research

Data Availability

The datasets generated and/or analyzed during the current study are available from the corresponding author upon reasonable request.


Note

Preliminary results were presented as follows: (1) Reis J.D., Sanchez-Rosado M., Kiefaber I., Brion L.P. Time of initiation of pumping versus breastfeeding at discharge of preterm infants. E-poster presentation at the American Academy of Pediatrics National Conference and Exhibition, October 8, 2021. (2) Reis JD, Sánchez-Rosado M, Mathai D, Kiefaber I, Brion LP. Time of Initiation of Pumping vs Breastfeeding at Discharge of Preterm Infants, Poster presentation, Pediatric Academic Societies Meeting, Denver, CO, April 24, 2022.


Authors' Contributions

J.D.R. and M.S-R. conceptualized and designed the study, collected and reviewed data from the medical records, and wrote the first draft of the manuscript. L.P.B. and L.S.B. conducted statistical analyses. P.B., D.M., and I.K. extracted data from the EHR. All authors participated in the interpretation of the data, critically reviewed the revisions, and approved the final manuscript as submitted.


Supplementary Material



Publication History

Received: 31 December 2023

Accepted: 29 May 2024

Article published online:
11 July 2024

© 2024. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Martin JA, Hamilton BE, Osterman MJK. Births in the United States, 2022. NCHS Data Brief No. 477. Hyattsville, MD: National Center for Health Statistics; 2023. . Accessed September 12, 2023 at: https://www.cdc.gov/nchs/products/databriefs/db477.htm
    CrossrefGoogle Scholar
  • 2 Hamilton BE, Martin JA, Osterman MJK. Births: Provisional data for 2022. Vital Statistics Rapid Release; no 28. Hyattsville, MD: National Center for Health Statistics; . June 2023. Accessed September 12, 2023 at: https://www.cdc.gov/nchs/data/vsrr/vsrr028.pdf
    Google Scholar
  • 3 Barfield WD. Public health implications of very preterm birth. Clin Perinatol 2018; 45 (03) 565-577
    CrossrefPubMedGoogle Scholar
  • 4 World Health Organization. WHO recommendations for care of the preterm or low-birth-weight infant. World Health Organization; 2022. . Accessed April 11, 2023 at: https://apps.who.int/iris/handle/10665/363697 . License: CC BY-NC-SA 3.0 IGO
    Google Scholar
  • 5 Meek JY, Noble L. Section on Breastfeeding. Policy Statement: Breastfeeding and the use of human milk. Pediatrics 2022; 150 (01) e2022057988
    CrossrefPubMedGoogle Scholar
  • 6 Parker MG, Greenberg LT, Edwards EM, Ehret D, Belfort MB, Horbar JD. National trends in the provision of human milk at hospital discharge among very low-birth-weight infants. JAMA Pediatr 2019; 173 (10) 961-968
    CrossrefPubMedGoogle Scholar
  • 7 Liu J, Parker MG, Lu T. et al. Racial and ethnic disparities in human milk intake at neonatal intensive care unit discharge among very low birth weight infants in California. J Pediatr 2020; 218: 49-56.e3
    CrossrefPubMedGoogle Scholar
  • 8 Parker MG, Gupta M, Melvin P. et al. Racial and ethnic disparities in the use of mother's milk feeding for very low birth weight infants in Massachusetts. J Pediatr 2019; 204: 134-141.e1
    CrossrefPubMedGoogle Scholar
  • 9 Boundy EO, Perrine CG, Nelson JM, Hamner HC. Disparities in hospital-reported breast milk use in neonatal intensive care units - United States, 2015. MMWR Morb Mortal Wkly Rep 2017; 66 (48) 1313-1317
    CrossrefPubMedGoogle Scholar
  • 10 Esquerra-Zwiers A, Schoeny ME, Engstrom J. et al. The interaction of donor human milk availability and race/ethnicity on provision of mother's own milk for very low birth weight infants. Breastfeed Med 2021; 16 (01) 46-53
    CrossrefPubMedGoogle Scholar
  • 11 Palmquist AEL, Asiodu IV, Tucker C. et al. Racial disparities in donor human milk feedings: a study using electronic medical records. Health Equity 2022; 6 (01) 798-808
    CrossrefPubMedGoogle Scholar
  • 12 Patel AL, Schoeny ME, Hoban R. et al. Mediators of racial and ethnic disparity in mother's own milk feeding in very low birth weight infants. Pediatr Res 2019; 85 (05) 662-670
    CrossrefPubMedGoogle Scholar
  • 13 U.S. Department of Health and Human Services. Healthy People 2030. Accessed December 7, 2023 at: https://health.gov/healthypeople/objectives-and-data/browse-objectives/infants/increase-proportion-infants-who-are-breastfed-1-year-mich-16/data?group=Country%20of%20birth%20(of%20mother)&from=2015&to=2019&tab=data-table&state=United%20States&populations=#edit-submit
    PubMedGoogle Scholar
  • 14 Safon CB, Heeren T, Kerr S. et al. Racial and ethnic disparities in breastfeeding continuation among U.S. Hispanic mothers: identification of mechanisms. Breastfeed Med 2023; 18 (01) 3-13
    CrossrefPubMedGoogle Scholar
  • 15 Safon CB, Heeren TC, Kerr SM. et al. Disparities in breastfeeding among U.S. Black mothers: identification of mechanisms. Breastfeed Med 2021; 16 (02) 140-149
    CrossrefPubMedGoogle Scholar
  • 16 McKinney CO, Hahn-Holbrook J, Chase-Lansdale PL. et al; Community Child Health Research Network. Racial and ethnic differences in breastfeeding. Pediatrics 2016; 138 (02) e20152388
    CrossrefPubMedGoogle Scholar
  • 17 Kulka TR, Jensen E, McLaurin S. et al. Community based participatory research of breastfeeding disparities in African American women. Infant Child Adolesc Nutr 2011; 3 (04) 233-239
    CrossrefPubMedGoogle Scholar
  • 18 Flacking R, Wallin L, Ewald U. Perinatal and socioeconomic determinants of breastfeeding duration in very preterm infants. Acta Paediatr 2007; 96 (08) 1126-1130
    CrossrefPubMedGoogle Scholar
  • 19 Flacking R, Nyqvist KH, Ewald U. Effects of socioeconomic status on breastfeeding duration in mothers of preterm and term infants. Eur J Public Health 2007; 17 (06) 579-584
    CrossrefPubMedGoogle Scholar
  • 20 Cook NR. Statistical evaluation of prognostic versus diagnostic models: beyond the ROC curve. Clin Chem 2008; 54 (01) 17-23
    CrossrefPubMedGoogle Scholar
  • 21 de Hond AAH, Steyerberg EW, van Calster B. Interpreting area under the receiver operating characteristic curve. Lancet Digit Health 2022; 4 (12) e853-e855
    CrossrefPubMedGoogle Scholar
  • 22 Sanchez-Rosado M, Lair CS, Edwards A. et al. Growth after implementing a donor breast milk program in neonates <33 weeks gestational age or birthweight <1500 grams: retrospective cohort study. J Perinatol 2023; 43 (05) 608-615
    CrossrefPubMedGoogle Scholar
  • 23 Steyerberg EW, Moons KG, van der Windt DA. et al; PROGRESS Group. Prognosis Research Strategy (PROGRESS) 3: prognostic model research. PLoS Med 2013; 10 (02) e1001381
    CrossrefPubMedGoogle Scholar
  • 24 Collins GS, Reitsma JB, Altman DG, Moons KG. Transparent Reporting of a multivariable prediction model for Individual Prognosis Or Diagnosis (TRIPOD): the TRIPOD Statement. Br J Surg 2015; 102 (03) 148-158
    CrossrefPubMedGoogle Scholar
  • 25 Sivarajan M, Schneider JH, Johnson KA. et al. Decreasing early hypoglycemia frequency in at-risk newborns after implementing a new hypoglycemia screening algorithm. J Perinatol 2021; 41 (12) 2840-2846
    CrossrefPubMedGoogle Scholar
  • 26 Lober A, Harmon D, Thomas-Jackson SC. Position paper-professional lactation support staffing in the hospital setting. Clin Lact (Amarillo) 2021; 12: 157-158
    PubMedGoogle Scholar
  • 27 Parkland Health. Parkland receives state designation as Texas Ten Step facility. Posted March 1, 2017. Accessed September 5, 2021 at: https://www.parklandhospital.com/news-and-updates/parkland-receives-state-designation-as-texas-ten-s-924
    PubMedGoogle Scholar
  • 28 Parkland Health. Parkland recognized as a designated Baby-Friendly birth facility. Posted August 19, 2019. Accessed September 4, 2021 at: https://www.parklandhospital.com/news-and-updates/parkland-recognized-as-a-designated-babyfriendly-b-1619
    PubMedGoogle Scholar
  • 29 American College of Obstetricians and Gynecologists. Joint Statement: Collective Action Addressing Racism. Accessed December 8, 2023 at: https://www.acog.org/news/news-articles/2020/08/joint-statement-obstetrics-and-gynecology-collective-action-addressing-racism
    PubMedGoogle Scholar
  • 30 U.S. Department of Health and Human Services. Social Determinants to Health. Healthy People 2030. Accessed December 7, 2023 at: https://health.gov/healthypeople/priority-areas/social-determinants-health
    PubMedGoogle Scholar
  • 31 DFWHC Foundation. People living below poverty level. Healthy North Texas. Accessed September 26, 2023 at: https://www.healthyntexas.org/indicators/index/view?indicatorId=347&localeId=37943
    PubMedGoogle Scholar
  • 32 Olsen IE, Groveman SA, Lawson ML, Clark RH, Zemel BS. New intrauterine growth curves based on United States data. Pediatrics 2010; 125 (02) e214-e224
    CrossrefPubMedGoogle Scholar
  • 33 Sanchez AM, Jimenez JM, Manroe BL, Rosenfeld CR, Tyson TE. Systems approach to the evaluation of maternal and neonatal care. Paper presented at: Proceedings of the 12th Hawaii International Conference on System Sciences. Selected Papers in Medical Information Processing. 1979; III: 140-151
    PubMedGoogle Scholar
  • 34 Kaiser JR, Tilford JM, Simpson PM, Salhab WA, Rosenfeld CR. Hospital survival of very-low-birth-weight neonates from 1977 to 2000. J Perinatol 2004; 24 (06) 343-350
    CrossrefPubMedGoogle Scholar
  • 35 Nelson DB, McIntire DD, Leveno KJ. Reply. Am J Obstet Gynecol 2018; 218 (03) 360-362
    CrossrefPubMedGoogle Scholar
  • 36 Leveno KJ, McIntire DD, Bloom SL, Sibley MR, Anderson RJ. Decreased preterm births in an inner-city public hospital. Obstet Gynecol 2009; 113 (03) 578-584
    CrossrefPubMedGoogle Scholar
  • 37 Austin PC, Steyerberg EW. Graphical assessment of internal and external calibration of logistic regression models by using loess smoothers. Stat Med 2014; 33 (03) 517-535
    CrossrefPubMedGoogle Scholar
  • 38 Rahimi E, Hashemi Nazari SS. A detailed explanation and graphical representation of the Blinder-Oaxaca decomposition method with its application in health inequalities. Emerg Themes Epidemiol 2021; 18 (01) 12
    CrossrefPubMedGoogle Scholar
  • 39 Gould JB, Bennett MV, Profit J, Lee HC. Cohort selection and the estimation of racial disparity in mortality of extremely preterm neonates. Pediatr Res 2024; 95 (03) 792-801
    CrossrefPubMedGoogle Scholar
  • 40 Lewis T, Ezoua S. A Simple SAS Macro to Perform Blinder-Oaxaca Decomposition. 2016 . Accessed June 4, 2024 at: https://www.lexjansen.com/sesug/2016/SD-162_Final_PDF.pdf
    PubMedGoogle Scholar
  • 41 Peduzzi P, Concato J, Kemper E, Holford TR, Feinstein AR. A simulation study of the number of events per variable in logistic regression analysis. J Clin Epidemiol 1996; 49 (12) 1373-1379
    CrossrefPubMedGoogle Scholar
  • 42 Asiodu IV, Bugg K, Palmquist AEL. Achieving breastfeeding equity and justice in black communities: past, present, and future. Breastfeed Med 2021; 16 (06) 447-451
    CrossrefPubMedGoogle Scholar
  • 43 Gyamfi A, O'Neill B, Henderson WA, Lucas R. Black/African American breastfeeding experience: cultural, sociological, and health dimensions through an equity lens. Breastfeed Med 2021; 16 (02) 103-111
    CrossrefPubMedGoogle Scholar
  • 44 Johnson AM, Menke R, Handelzalts JE, Green K, Muzik M. Reimagining racial trauma as a barrier to breastfeeding versus childhood trauma and depression among African American Mothers. Breastfeed Med 2021; 16 (06) 493-500
    CrossrefPubMedGoogle Scholar
  • 45 Alshaikh BN, Sproat TDR, Wood C. et al. A quality improvement initiative to reduce necrotizing enterocolitis in very preterm infants. Pediatrics 2023; 152 (06) e2023061273
    CrossrefPubMedGoogle Scholar
  • 46 Livewire Calgary. 'One in ten' Calgarians in poverty shows 2021 Poverty Snapshot. 2022 . Accessed November 20, 2023 at: https://livewirecalgary.com
    PubMedGoogle Scholar
  • 47 Russell BK, Aviles M, Brion LP. Relationship between perinatal counseling and incidence of breastfeeding in an inner-city population. J Perinatol 1999; 19 (07) 501-504
    CrossrefPubMedGoogle Scholar
  • 48 Ikonen R, Paavilainen E, Helminen M, Kaunonen M. Preterm infants' mothers' initiation and frequency of breast milk expression and exclusive use of mother's breast milk in neonatal intensive care units. J Clin Nurs 2018; 27 (3–4): e551-e558
    CrossrefPubMedGoogle Scholar
  • 49 Santoli CMA, Taylor-Cho IA, Darling AJ. et al. Predictors of breastfeeding among patients admitted with preterm prelabor rupture of membranes. Am J Perinatol 2024; 41 (Suppl. 01) e3196-e3201
    Article in Thieme ConnectPubMedGoogle Scholar
  • 50 Seshadri N, Kim LY, McGrath-Morrow SA, Collaco JM. Human milk cessation in the NICU in Infants with Bronchopulmonary Dysplasia. Am J Perinatol 2024; 41 (04) 452-457
    Article in Thieme ConnectPubMedGoogle Scholar
  • 51 Bresesti I, Morlacchi L, Cazzaniga C. et al. Breastfeeding and human milk bank in a neonatal intensive care unit: impact of the COVID-19 pandemic in an Italian cohort of very low birth weight infants. Int Breastfeed J 2022; 17 (01) 94
    CrossrefPubMedGoogle Scholar
  • 52 Castellano Yáñez C, Castillo Barrio B, Muñoz Labián MDC. et al. Providing very preterm infants with donor human milk led to faster breastfeeding rates but worse biometric gains. Acta Paediatr 2019; 108 (04) 766-767
    CrossrefPubMedGoogle Scholar
  • 53 Arslanoglu S, Moro GE, Bellù R. et al. Presence of human milk bank is associated with elevated rate of exclusive breastfeeding in VLBW infants. J Perinat Med 2013; 41 (02) 129-131
    CrossrefPubMedGoogle Scholar
  • 54 Parker MG, Burnham L, Mao W, Philipp BL, Merewood A. Implementation of a donor milk program is associated with greater consumption of mothers' own milk among VLBW infants in a US, level 3 NICU. J Hum Lact 2016; 32 (02) 221-228
    CrossrefPubMedGoogle Scholar
  • 55 Corallo J, Bieda A, Garland M, Dowling D, Timoney P, Bateman DA. The impact of a Donor Human Milk Program on the provision of mothers' own milk at discharge in very low birth weight infants. J Perinatol 2022; 42 (11) 1473-1479
    CrossrefPubMedGoogle Scholar
  • 56 Fang L, Zhang M, Wu L. et al. Is preterm donor milk better than preterm formula for very-low-birth-weight infants?. Food Nutr Res 2021; 65
    PubMedGoogle Scholar
  • 57 Costa S, Maggio L, Alighieri G, Barone G, Cota F, Vento G. Tolerance of preterm formula versus pasteurized donor human milk in very preterm infants: a randomized non-inferiority trial. Ital J Pediatr 2018; 44 (01) 96
    CrossrefPubMedGoogle Scholar
  • 58 Colaizy TT, Poindexter BB, McDonald SA. et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network, MILK Trial Investigators, MILK Trial Investigators, Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Neurodevelopmental outcomes of extremely preterm infants fed donor milk or preterm infant formula: a randomized clinical trial. JAMA 2024; 331 (07) 582-591
    CrossrefPubMedGoogle Scholar
  • 59 O'Connor DL, Gibbins S, Kiss A. et al; GTA DoMINO Feeding Group. Effect of supplemental donor human milk compared with preterm formula on neurodevelopment of very low-birth-weight infants at 18 months: a randomized clinical trial. JAMA 2016; 316 (18) 1897-1905
    CrossrefPubMedGoogle Scholar
  • 60 American Academy of Pediatrics. FAQs: Management of infants born to mothers with suspected or confirmed COVID-19. May 21, 2020. Accessed June 4, 2024 at: https://www.aappublications.org/news/2020/05/21/covid19newborn052120
    PubMedGoogle Scholar
  • 61 Hoban R, Bigger H, Schoeny M, Engstrom J, Meier P, Patel AL. Milk volume at 2 weeks predicts mother's own milk feeding at neonatal intensive care unit discharge for very low birthweight infants. Breastfeed Med 2018; 13 (02) 135-141
    CrossrefPubMedGoogle Scholar
  • 62 Gribble K, Cashin J, Marinelli K, Vu DH, Mathisen R. First do no harm overlooked: analysis of COVID-19 clinical guidance for maternal and newborn care from 101 countries shows breastfeeding widely undermined. Front Nutr 2023; 9: 1049610
    CrossrefPubMedGoogle Scholar
  • 63 Preszler J, Schriever M, Terveen M. Effects of the COVID-19 pandemic on breastfeeding rates in a single tertiary health center. S D Med 2022; 75 (06) 263-267
    PubMedGoogle Scholar
  • 64 Fucile S, Heath J, Dow K. Impact of the Covid-19 pandemic on breastfeeding establishment in preterm infants: an exploratory study. Neonatal Netw 2023; 42 (01) 7-12
    CrossrefPubMedGoogle Scholar
  • 65 Nandula PS, Hudak ML. Remote lactation support in the COVID-19 era. Neoreviews 2021; 22 (06) e392-e397
    CrossrefPubMedGoogle Scholar
  • 66 Meier PP, Patel AL, Hoban R, Engstrom JL. Which breast pump for which mother: an evidence-based approach to individualizing breast pump technology. J Perinatol 2016; 36 (07) 493-499
    CrossrefPubMedGoogle Scholar
  • 67 Merewood A, Brooks D, Bauchner H, MacAuley L, Mehta SD. Maternal birthplace and breastfeeding initiation among term and preterm infants: a statewide assessment for Massachusetts. Pediatrics 2006; 118 (04) e1048-e1054
    CrossrefPubMedGoogle Scholar
  • 68 Wallby T, Hjern A. Region of birth, income and breastfeeding in a Swedish county. Acta Paediatr 2009; 98 (11) 1799-1804
    CrossrefPubMedGoogle Scholar
  • 69 Merten S, Wyss C, Ackermann-Liebrich U. Caesarean sections and breastfeeding initiation among migrants in Switzerland. Int J Public Health 2007; 52 (04) 210-222
    CrossrefPubMedGoogle Scholar