PC2021: Assessing Gaps in Human Milk and Breastfeeding Education Among Neonatal-perinatal Medicine Fellows and Early Career Neonatologists

Background: Less than half of infants discharged home from the NICU receive human milk. Direct breastfeeding increases maternal milk production and promotes maternal-infant bonding and maternal empowerment. Evidence shows physician education and support increases breastfeeding rates, however, there is a lack of formalized lactation education during medical training. We aim to address this gap by evaluating the knowledge, skills, and attitudes among current Neonatal-Perinatal Medicine fellows (NPMF) and early career neonatologists (ECN) to guide a breastfeeding educational curriculum for NPMF.

Methods: A confidential needs assessment was distributed electronically using Qualtrics Software to NPMF and ECN via the American Academy of Pediatrics Organization of Neonatal Training Program Directors Counsel and the Trainees and Early Career Neonatologists group email listservs. It consisted of 31 questions grouped by demographics, knowledge, skills, and attitudes regarding human milk and breastfeeding. Composite scores were created and compared for each section. Participants were also asked to share their beliefs regarding barriers and potential solutions to direct breastfeeding in the NICU. Aggregated data was analyzed using mixed methods analysis comprised of descriptive statistics and qualitative thematic analysis.

Results: A total of 131 participants completed the questionnaire. The majority of participants were parents (66%) with breastfeeding experience (90%). Over half were ECN (Table 1). Mean overall knowledge scores were significantly greater for ECN compared to NPMF (p=0.03), and parents compared to non-parents (p=0.003). Notable areas of weakness in knowledge and experience were observed in assessment of human milk expression, goal production, storage, composition, and counseling for preterm infants. Participants with breastfeeding experience had better practical knowledge (p < 0.02) and significantly higher confidence levels when counseling and helping mothers breastfeed preterm infants (p < 0.01). Common barrier themes included lack of parental presence, safety concerns, culture, staffing, and education deficits. Common solution themes included culture change, support of the mother-infant dyad, implementation of standardized protocols, improved staffing, and education (Table 2).

Conclusion: To ensure all NPMF receive breastfeeding education, training programs should consider using a formalized curriculum rather than relying on personal experience. This cohort study identified several potential areas of weaknesses and strategies to overcome barriers to direct breastfeeding that could be highlighted in this curriculum.