Abstract
Background
The impact of human milk use on racial/ethnic disparities in necrotizing enterocolitis (NEC) incidence is unknown.
Methods
Trends in NEC incidence and human milk use at discharge were evaluated by race/ethnicity among 47,112 very low birth weight infants born in California from 2008 to 2017. We interrogated the association between race/ethnicity and NEC using multilevel regression analysis, and evaluated the effect of human milk use at discharge on the relationship between race/ethnicity and NEC using mediation analysis.
Results
Annual NEC incidence declined across all racial/ethnic groups from an aggregate average of 4.8% in 2008 to 2.6% in 2017. Human milk use at discharge increased over the time period across all racial groups, and non-Hispanic (NH) black infants received the least human milk each year. In multivariable analyses, Hispanic ethnicity (odds ratio (OR) 1.27, 95% confidence interval (CI) 1.02–1.57) and Asian or Pacific Islander race (OR 1.35, 95% CI 1.01–1.80) were each associated with higher odds of NEC, while the association of NH black race with NEC was attenuated after adding human milk use at discharge to the model. Mediation analysis revealed that human milk use at discharge accounted for 22% of the total risk of NEC in non-white vs. white infants, and 44% in black vs. white infants.
Conclusions
Although NEC incidence has declined substantially over the past decade, a sizable racial/ethnic disparity persists. Quality improvement initiatives augmenting human milk use may further reduce the incidence of NEC in vulnerable populations.
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Acknowledgements
This work was supported by the March of Dimes Prematurity Research Center at Stanford University and by the Stanford Maternal and Child Health Research Institute. Drs. J.P., K.S., H.C.L., and J.L. and Mrs. L.B.V. are supported by grants from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (R01 HD083368-01, PI J.P.). Dr. K.S. is also supported by a postdoctoral support award from the Stanford Maternal Child Health Research Institute. Dr. G.P.G. is supported, in part, by a clinical trainee award from the Stanford Maternal Child Health Research Institute. Dr. V.V.P. is supported by a postdoctoral fellowship grant from the National Institutes of Health (F32 HD096778-01). The publication of this article was sponsored by the Necrotizing Enterocolitis (NEC) Society, Patient-Centered Outcomes Research Institute, and National Institutes of Health Eunice Kennedy Shriver National Institute of Child Health and Human Development.
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G.P.G., J.P., J.L., H.C.L., K.G.S., and G.M.S. participated in the planning and design of the study. J.P., J.L., and H.C.L. participated in acquisition of the data. J.L. and G.P.G. analyzed the data. G.P.G. and V.V.P. participated in the primary manuscript writing. All authors participated in editing the manuscript. G.P.G. and J.P. had primary responsibility for the final content. All authors read and approved the final manuscript.
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K.G.S. serves on the advisory board of Evolve, is a paid consultant of Avexegen, received lecture fees from Mednax, and receives grant support from Sera Care. H.C.L. is on the advisory board of Lansinoh Laboratories, Inc. The authors declare no further conflicts of interest.
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This study was approved by the Stanford University Institutional Review Board on Human Subjects Research and the State of California Committee for the Protection of Human Subjects.
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Goldstein, G.P., Pai, V.V., Liu, J. et al. Racial/ethnic disparities and human milk use in necrotizing enterocolitis. Pediatr Res 88 (Suppl 1), 3–9 (2020). https://doi.org/10.1038/s41390-020-1073-5
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DOI: https://doi.org/10.1038/s41390-020-1073-5
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