Abstract
Background
Despite high initiation rates for mother’s own milk (MOM) provision, MOM feeding at discharge from the neonatal intensive care unit (NICU) drops precipitously and reveals a racial/ethnic disparity. This study sought to identify factors that (1) predict MOM feeding at NICU discharge, and (2) mediate racial/ethnic disparity in MOM feeding at discharge.
Methods
Secondary analysis of prospective cohort study of 415 mothers and their very low birth weight infants. Variables were grouped into five categories (demographics, neighborhood structural, social, maternal health, and MOM pumping). Significant predictors from each category were entered into a multivariable logistic regression model.
Results
Although 97.6% of infants received MOM feedings, black infants were significantly less likely to receive MOM feeding at discharge. Positive predictors were daily pumping frequency, reaching pumped MOM volume ≥500 mL/day by 14 days, and maternal age. Negative predictors were low socioeconomic status (SES) and perceived breastfeeding support from the infant’s maternal grandmother. Low SES, maternal age, and daily pumping frequency mediated the racial/ethnic differences.
Conclusions
Multiple potentially modifiable factors predict MOM feeding at NICU discharge. Importantly, low SES, pumping frequency, and maternal age were identified as the mediators of racial and ethnic disparity. Strategies to mitigate the effects of modifiable factors should be developed and evaluated in future research.
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18 September 2019
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Acknowledgements
Thank you to the patients and families who participated in this research. The research reported in this publication was supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development of the National Institutes of Health under Award Number R03HD081412. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
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A.L.P. conceptualized and designed the study, coordinated and supervised data collection, drafted the initial manuscript, and reviewed and revised the manuscript. M.E.S., R.H., and H.B. supervised data collection, carried out the initial analyses, and reviewed and revised the manuscript. T.J.J. and J.L.E. supervised data collection and reviewed and revised the manuscript. E.F. and B.R. made substantial contributions to data collection. P.P.M. conceptualized and designed the study, coordinated and supervised data collection, and revised the manuscript for important intellectual content. All authors approved the final manuscript as submitted.
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Patel, A.L., Schoeny, M., Hoban, R. et al. Mediators of racial and ethnic disparity in mother’s own milk feeding in very low birth weight infants. Pediatr Res 85, 662–670 (2019). https://doi.org/10.1038/s41390-019-0290-2
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DOI: https://doi.org/10.1038/s41390-019-0290-2
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