P0338 - Predictors of Mother's Milk Feeding in Early Preterm Infants in an Urban Neonatal Intensive Care Unit

Background/Purpose: Greater use of mother’s milk (MM) is associated with improved outcomes for preterm infants admitted to neonatal intensive care units (NICUs). Racial, mental-health, and socioeconomic disparities exist in provision of MM to preterm infants. Further research is needed to better identify modifiable barriers to providing MM in these high-risk populations. Our Level IV NICU serves a predominantly urban, underserved, low socioeconomic-status patient population, allowing us to better study this important demographic. The objective of this study was to evaluate incidence and predictors of provision of MM to early preterm infants in an urban, underserved NICU.

Methods: We performed a retrospective medical record review of all infants born early preterm, <34 weeks gestational age (GA), between 6/2016 – 12/2017 in an urban Level IV NICU. We performed bivariate analyses of clinical and demographic variables comparing: 1) characteristics of mothers who did provide MM at any point during NICU admission vs. those who did not, and 2) neonatal outcomes based on exposure to any MM vs. none. Chi-square, T-test, Wilcoxon Rank Sum Tests were performed as appropriate.


Results: Of the 313 neonates identified, 54% (n=169) were non-Hispanic Black, 34% (n=107) were non-Hispanic White, and overall 84.4% (n=264) received MM at some point during NICU admission. Two mothers were HIV positive and based on our policy, MM was not offered to their neonates. Significant maternal predictors of not providing MM during admission included having limited or no prenatal care (p<0.0001), single relationship status (p=0.009), higher gravidity (p<0.0001), higher parity (p=0.0002), cigarette use (p<0.0001), marijuana use (p=0.0388), and alcohol use (p=0.0176) during pregnancy. Race was not a significant predictor with 87% of non-Hispanic White mothers and 80% of non-Hispanic Black mothers providing MM (p=0.16). Maternal age, chronic hypertension, diabetes, and pre-eclampsia were not significant. Mothers with a bipolar diagnosis were less likely to provide MM (p=0.009), while those with pre-existing anxiety were more likely to provide MM (p=0.0178). Mothers who provided MM were significantly more likely to have received dedicated lactation consultations during NICU admission than those who did not provide MM (96% vs. 37%, p<.0001). Neonates who received MM had lower birth GA (p=0.0159) and lower birth weights (p=0.0054) though were not more likely to require respiratory support or develop bronchopulmonary dysplasia.

Conclusion: Identifying significant barriers to MM provision in early preterm infants will allow researchers and clinicians to focus supportive and educational interventions on these populations. Interestingly, race and maternal age were not significant predictors, while cigarette smoking, alcohol use, and marijuana use did predict lower rates of MM, as did limited prenatal care. Inpatient lactation consultation had one of the strongest associations, so enhancing access to inpatient lactation consultation may significantly increase MM provision in early preterm neonates.