Barriers to Human Milk Feeding at Discharge of Very Low–Birthweight Infants: Evaluation of Neighborhood Structural Factors

Abstract

Background: Although 98% of mothers in our cohort initiated human milk (HM) provision for their very lowbirthweight (VLBW) infants, fewer black infants received HM at neonatal intensive care unit (NICU) discharge than non-black infants. This study examined neighborhood structural factors associated with HM feeding at discharge to identify potential barriers. Materials and Methods: Sociodemographic and HM data were prospectively collected for 410 VLBW infants and mothers. Geocoded addresses were linked to neighborhood structural factors. Bivariate and multivariate logistic regression analyses were conducted for the entire cohort and racial/ethnic subgroups. Results: HM feeding at discharge was positively correlated with further distance from Women, Infants, and Children (WIC) office, less violent crime, less poverty, greater maternal education, older maternal age, greater infant gestational age, and shorter NICU hospitalization. Multivariate analysis demonstrated that only maternal race/ethnicity, WIC eligibility, and length of NICU hospitalization predicted HM feeding at discharge for the entire cohort. The interaction between access to a car and race/ethnicity significantly differed between black and white/Asian mothers, although the predicted probability of HM feeding at discharge was not significantly affected by access to a car for any racial/ethnic subgroup. Conclusions: Neighborhood structural factors did not significantly impact HM feeding at discharge. However, lack of access to a car may be a factor for black mothers, potentially representing restricted HM delivery to the NICU or limited social support, and warrants further study.

Racial and socioeconomic disparities in breast milk feedings in US neonatal intensive care units

“…Low SES may have also been reflected by access to a car, and black mothers were significantly less likely to have access to a car than white or Hispanic mothers. 91 Furthermore, black mothers and families visited the NICU 20% less frequently than mothers and families of non-black VLBW infants, 92 suggesting that black mothers and families were less likely to bring MOM from home to the NICU.…”

“…Mothers of VLBW infants incur additional out-of-pocket costs to provide MOM that are not required by mothers of healthy term infants, including breast pump rental, transport of MOM to the NICU 91 and the opportunity (time) cost of MOM provision that may exceed that of mothers of healthy term infants. The barriers to sustaining MOM provision through to NICU discharge are sizeable for all mothers but disproportionately impact black mothers who are more likely to be low income.…”

“…Common proxies for poverty include eligibility for the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) and Medicaid, and both have been shown to have a negative association with MOM feedings. 29,32 However, it is not clear whether the association between MOM provision and WIC and Medicaid eligibility is due to barriers to accessing high-quality equipment and services, such as NICU lactation experts, hospitalgrade breast pumps, and other resources, such as a car to facilitate NICU visits, 91 or due to breastfeeding promotion practices at WIC agencies. 108 Access to high-quality, hospital-grade breast pump The quality of breast pumps varies in terms of effectiveness, efficiency, comfort and convenience, with high-quality, hospitalgrade electric breast pumps facilitating sustained MOM provision.…”

Predictors of Prolonged Breast Milk Provision to Very Low Birth Weight Infants

“…Previous work has identified associations between provision of maternal BM in the NICU and infant characteristics (eg, gestational age [GA] or birth weight), maternal characteristics (e.g., maternal age or maternal race), and environmental factors (e.g., site of care, social support, or access to breastfeeding education). 22–26 However, many of these studies failed to distinguish between VLBW and term infants and vary with respect to the duration of maternal BM provision during the hospitalization, such as initiation or maintenance to hospital discharge. 27,28…”

Barriers to Human Milk Feeding at Discharge of Very-Low-Birth-Weight Infants: Maternal Goal Setting as a Key Social Factor

“…Non-NICU factors, for example, those that are independent of NICU lactation resources, may include neighborhood structural factors 13 or social factors. Studies of social factors and lactation in mothers of term and preterm infants suggest differences in prevalence of these factors among different racial/ethnic groups, including the following: (1) previous experience with HM feeding in mothers of preterm infants, 14,15 (2) previous experience with formula feeding in mothers of term infants, 16 (3) return to work/school in mothers of preterm infants, 15,17 (4) the role of social support of breastfeeding and pumping in mothers of preterm infants, 17,18 (5) HM provision goal in mothers of term and preterm infants, 14,19 (6) maternal education in mothers of preterm infants, 15,18 and (7) public perception and attitudes on breastfeeding.…”