Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Published:

Barriers to optimal breast milk provision in the neonatal intensive care unit

Journal of Perinatology volume 42, pages 1076–1082 (2022)Cite this article

Subjects

Abstract

Objective

This study examines comprehensive patient and process factors that influence breast milk use in the NICU setting.

Study design

We examined the association of maternal, neonatal, and family factors and lactation support systems to identify gaps in breast milk use in a retrospective study of 865 infants born in 23–41 weeks gestation admitted to the NICU.

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 0.31 [0.17–0.56]), low birth weight, morbidities, Black maternal race (OR 0.20 [0.07–0.57]) and public insurance (OR 0.54 [0.34–0.85]) were associated with decreased breast milk use. Early initiation of feeds was associated with increased breast milk use.

Conclusions

There is a need to increase social as well as hospital support systems to address gaps in breast milk use in the NICU.

Access through your institution
Buy or subscribe

This is a preview of subscription content, access via your institution

Access options

Access through your institution

Buy this article

  • Purchase on SpringerLink
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Similar content being viewed by others

References

  1. Lucas A, Cole TJ. Breast milk and neonatal necrotizing enterocolitis. Lancet. 1990;336:1519–23.

    Article  CAS  Google Scholar 

  2. Meinzen-Derr J, Poindexter BB, Wrage L, Morrow AL, Stoll B, Donovan EF. Role of human milk in extremely low birth weight infants’ risk of necrotizing enterocolitis or death. J Perinatol. 2009;29:57–62.

    Article  CAS  Google Scholar 

  3. Vohr BR, Poindexter BB, Dusick AM, McKinley LT, Wright LL, Langer JC, et al. Beneficial effects of breast milk in the neonatal intensive care unit on the developmental outcome of extremely low birth weight infants at 18 months of age. Pediatrics 2006;118:e115–e123.

    Article  Google Scholar 

  4. Gharib S, Fletcher M, Tucker R, Vohr B, Lechner BE. Effect of dedicated lactation support services on breastfeeding outcomes in extremely-low-birth weight neonates. J Hum Lact. 2018;34:728–36.

    PubMed  Google Scholar 

  5. Alves E, Magano R, Amorim M, Nogueira C, Silva S. Factors influencing parent ‘reports of facilitators and barriers to human milk supply in neonatal intensive care units. J Hum Lactation. 2016;32:695–703.

    Article  Google Scholar 

  6. Greene MM, Rossman B, Patra K, Kratovil AL, Janes JE, Meier PP. Depression, anxiety, and perinatal-specific posttraumatic distress in mothers of very low birth weight infants in the neonatal intensive care unit. J Developmental Behav Pediatrics. 2015;36:362–70.

    Article  Google Scholar 

  7. Kair LR, Colaizy TT. Breastfeeding continuation among late preterm infants: barriers, facilitators, and any association with NICU admission? Hosp Pediatr. 2016;6:261–8.

    Article  Google Scholar 

  8. Oras P, Thernstrom Blomqvist Y, Hedberg Nyqvist K, Gradin M, Rubertsson C, Hellstrom-Westas L, et al. Skin-to-skin contact is associated with breastfeeding attainment in preterm infants. Acta Paediatr. 2016;105:783–9.

    Article  Google Scholar 

  9. Baley J. & Committee of Fetus and Newborn. Skin-to-skin care for term and preterm infants in the neonatal ICU. Pediatrics 2015;136:596–9.

    Article  Google Scholar 

  10. Kachoria R, Oza-Frank R. Trends in breastfeeding initiation in the NICU by gestational age in Ohio, 2006–2012. Birth 2015;42:56–61.

    Article  Google Scholar 

  11. Pineda RG, Foss J, Richards L, Pane CA. Breastfeeding changes for VLBW infants in the NICU following staff education. Neonatal Netw. 2009;28:311–9.

    Article  Google Scholar 

  12. Murphy L, Warner DD, Parks J, Whitt J, Peter-Wohl S. A quality improvement project to improve the rate of early breast milk expression in mothers of preterm infants. J Hum Lact. 2014;30:398–401.

    Article  Google Scholar 

  13. Castrucci BC, Hoover KL, Lim S, Maus KC. Availability of lactation counseling services influences breastfeeding among infants admitted to neonatal intensive care units. Am J Health Promotion. 2007;21:410–5.

    Article  Google Scholar 

  14. Casavant SG, McGrath JM, Burke G, Briere CE. Caregiving factors affecting breastfeeding duration within a neonatal intensive care unit. Adv Neonatal Care. 2015;15:421–8.

    Article  Google Scholar 

  15. Herich LC, Cuttini M, Croci I, Franco F, Di Lallo D, Baronciani, Zeitlin J. Maternal education is associated with disparities in breastfeeding at time of discharge but not at initiation of enteral feeding in the neonatal intensive care unit. J Pediatrics. 2017;182:59–65. e7.

    Article  Google Scholar 

  16. Lee HC, Kurtin PS, Wight NE, Chance K, Cucinotta-Fobes T, Hanson-Timpson TA, et al. A quality improvement project to increase breast milk use in very low birth weight infants. Pediatrics 2012;130:e1679–87.

    Article  Google Scholar 

  17. Sisk PM, Lovelady CA, Dillard RG, Gruber KJ. Lactation counseling for mothers of very low birth weight infants: effect on maternal anxiety and infant intake of human milk. Pediatrics 2006;117:e67–e75.

    Article  Google Scholar 

  18. Patel S, Patel S. The effectiveness of lactation consultants and counselors on breastfeeding outcomes. J Hum Lact. 2016;32:530–41.

    Article  Google Scholar 

  19. Parker MG, Gupta M, Melvin P, Burnham LA, Lopera AM, Moses JM, 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;204:134–41.

    Article  Google Scholar 

  20. Bixby C, Baker-Fox C, Deming C, Dhar V, Steele C. A multidisciplinary quality improvement approach increases breastmilk availability at discharge from the neonatal intensive care unit for the very-low-birth-weight infant. Breastfeed Med. 2016;11:75–79.

    Article  Google Scholar 

  21. Profit J, Gould JB, Bennett M, Goldstein BA, Draper D, Phibbs CS, et al. Racial/Ethnic Disparity in NICU Quality of Care Delivery. Pediatrics 2017;140:e20170918.

    Article  Google Scholar 

  22. Sigurdson K, Mitchell B, Liu J, Morton C, Gould JB, Lee HC, et al. Racial/ethnic disparities in neonatal intensive care: a systematic review. Pediatrics 2019;144:e20183114.

    Article  Google Scholar 

  23. Lee HC, Gould JB. Factors influencing breast milk versus formula feeding at discharge for very low birth weight infants in California. J Pediatr. 2009;155:657–62.

    Article  Google Scholar 

  24. Fleurant E, Schoeny M, Hoban R, Asiodu IV, Riley B, Meier PP, et al. Barriers to human milk feeding at discharge of very-low-birth-weight infants: maternal goal setting as a key social factor. Breastfeed Med. 2017;12:20–27.

    Article  Google Scholar 

  25. Riley B, Schoeny M, Rogers L, Asiodu IV, Bigger HR, Meier PP, et al. Barriers to human milk feeding at discharge of very low-birthweight infants: evaluation of neighborhood structural factors. Breastfeed Med 2016;11:335–42.

    Article  Google Scholar 

  26. Vohr BR, Poindexter BB, Dusick AM, McKinley LT, Wright LL, Langer JC, et al. NICHD neonatal research network. Beneficial effects of breast milk in the neonatal intensive care unit on the developmental outcome of extremely low birth weight infants at 18 months of age. Pediatrics 2006;118:e115–23.

    Article  Google Scholar 

  27. Reichman V, Brachio SS, Chinonyerem RM, Montoya-Williams D, Peña MM. Using rising tides to lift all boats: equity-focused quality improvement as a tool to reduce neonatal health disparities. Semin Fetal Neonatal Med. 2021:101198.

  28. Mercado K, Vittner D, McGrath J. What is the impact of NICU-dedicated lactation consultants? An evidence-based practice brief. Adv Neonatal Care. 2019;19:383–93.

    Article  Google Scholar 

  29. Mannel R, Mannel S. Staffing for hospital lactation programs: recommendations from a tertiary care teaching hospital. J Hum Lact. 2006;22:409–17.

    Article  Google Scholar 

  30. Brownell EA, Lussier MM, Hagadorn JI, McGrath JM, Marinelli KA, Herson VC. Independent predictors of human milk receipt at neonatal intensive care unit discharge. Am J Perinatol. 2014;31:891–8.

    PubMed  Google Scholar 

Download references

Funding

This work was supported by grant support from the Maternal and Child Health Research Institute, MCHRI, Stanford University. Award PTA 1177593-118-JHAGI to MNS.

Author information

Authors and Affiliations

  1. Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, USA

    Meera N. Sankar, Ya’el Weiner, Neha Chopra, Peiyi Kan & Henry C. Lee

  2. California Perinatal Quality Care Collaborative, Stanford, CA, USA

    Ya’el Weiner, Neha Chopra, Peiyi Kan & Henry C. Lee

  3. Lactation services, Lucile Packard Children’s Hospital, Stanford, CA, USA

    Zakiyah Williams

Authors
  1. Meera N. Sankar
    View author publications

    Search author on:PubMed Google Scholar

  2. Ya’el Weiner
    View author publications

    Search author on:PubMed Google Scholar

  3. Neha Chopra
    View author publications

    Search author on:PubMed Google Scholar

  4. Peiyi Kan
    View author publications

    Search author on:PubMed Google Scholar

  5. Zakiyah Williams
    View author publications

    Search author on:PubMed Google Scholar

  6. Henry C. Lee
    View author publications

    Search author on:PubMed Google Scholar

Contributions

MNS and HCL conceptualized and designed the study. MNS drafted the initial version of the manuscript, and MNS and HCL critically reviewed and revised the manuscript. YW, NC, and ZW collected data and critically reviewed the manuscript. PK performed the data analysis and critically reviewed the manuscript.

Corresponding author

Correspondence to Meera N. Sankar.

Ethics declarations

Competing interests

The other authors declare no conflicts of interest relevant to this article. Dr. Lee is a paid consultant to Lansinoh Laboratories, Inc, and received research grant funding from Mead Johnson Nutrition.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Sankar, M.N., Weiner, Y., Chopra, N. et al. Barriers to optimal breast milk provision in the neonatal intensive care unit. J Perinatol 42, 1076–1082 (2022). https://doi.org/10.1038/s41372-021-01275-4

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue date:

  • DOI: https://doi.org/10.1038/s41372-021-01275-4

Search

Advanced search

Quick links