Human and Donor Milk Use Post NICU Discharge

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Elaine Ellis, MD, Christine Aune, MD, Mario Fierro, MD, Cathleen Roberts, DO, Mary Allare, MD, Bradlee Drabant, MD, Amy S. Kelleher, MSHS, Christina Sanchez, Cheryl McDuffie, FNP

Abstract:

Background: The health benefits of feeding all infants human milk are well established but the use of human milk after infants are discharged from the Neonatal Intensive Care Unit (NICU) remains low.

Aims: Our aim was to investigate which infants were receiving human milk at discharge from the NICU and at varying times after discharge and to explore factors that foster or inhibit increasing human milk use in NICU graduates.

Methods: We conducted a prospective, observational study and collected data on the use of human milk at hospital discharge and during follow-up visits in five developmental follow-up programs. These follow up programs were in 5 different large cities in 3 different states in the United States.

Results: The overall rate of use of any human milk decreased from 841/1160 (72. 5%) at discharge to 233/791 (29.5%) in participants who were followed for >4 and ≤7 months after birth and this trend continued with later follow-up. In a multivariate logistic analysis, the factors found to be independently associated with the use of human milk at follow-up were: use of human milk at discharge (AOR=39.3, 14-162); White race compared to all other races/ethnicity (AOR= 2.97, 2.1-4.2); being reported preterm at birth (<=32 weeks) compared to more mature gestational age infants (AOR= 2.02, 1.4-2.9); and mother having received a breast pump within 12 hours of the birth of her infant (AOR=1.90, 1.2-3).

Conclusions: Health care practices within the NICU affect the continued use of human milk after infants are discharged from the hospital. These practices could be enhanced to increase human milk usage in NICU graduates.

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References:

  1. Lowenstein LM, Brown KH, Barrows D et al. Continuous quality improvement in a level IIIB NICU to increase human milk use at day of life 14, day of life 28, and discharge. Infant, Child, and Adolescent Nutrition 2014;6:337-143.
  2. Breastfeeding and the use of human milk. Pediatrics 2012;129:e827-e841.
  3. Lechner BE, Vohr BR. Neurodevelopmental Outcomes of Preterm Infants Fed Human Milk: A Systematic Review. Clin Perinatol. 2017;44:69-83.
  4. Vohr BR, Poindexter BB, Dusick AM et al. Benefcial 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.
  5. Vohr BR, Poindexter BB, Dusick AM et al. Persistent benefcial efects of breast milk ingested in the neonatal intensive care unit on outcomes of extremely low birth weight infants at 30 months of age. Pediatrics. 2007;120:e953-e959.
  6. Briere CE, McGrath JM, Cong X, Brownell E, Cusson R. Direct-Breastfeeding Premature Infants in the Neonatal Intensive Care Unit. J Hum Lact. 2015;31:386-392.
  7. LoVerde B, Falck A, Donohue P, Hussey-Gardener B. Supports and Barriers to the Provision of Human Milk by Mothers of African American Preterm Infants. Adv Neonatal Care. 2018;18:179-188.
  8. Ellsbury DL, Clark RH, Ursprung R, Handler DL, Dodd ED, Spitzer AR. A Multifaceted Approach to Improving Outcomes in the NICU: The Pediatrix 100000 Babies Campaign. Pediatrics. 2016;137:e20150389.
  9. Hoban R, Bigger H, Patel AL, Rossman B, Fogg LF, Meier P. Goals for Human Milk Feeding in Mothers of Very Low Birth Weight Infants: How Do Goals Change and Are They Achieved During the NICU Hospitalization? Breastfeed Med. 2015;10:305-311.
  10. Briere CE, McGrath JM, Cong X, Brownell E, Cusson R. Direct-breastfeeding in the neonatal intensive care unit and breastfeeding duration for premature infants. Appl Nurs Res. 2016;32:47-51.
  11. Flacking R, Ewald U, Wallin L. Positive efect of kangaroo mother care on long-term breastfeeding in very preterm infants. J Obstet Gynecol Neonatal Nurs. 2011;40:190-197.
  12. Fugate K, Hernandez I, Ashmeade T, Miladinovic B, Spatz DL. Improving Human Milk and Breastfeeding Practices in the NICU. J Obstet Gynecol Neonatal Nurs. 2015;44:426- 438.
  13. 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.
  14. Davanzo R, Monasta L, Ronfani L, Brovedani P, Demarini S. Breastfeeding at NICU discharge: a multicenter Italian study. J Hum Lact. 2013;29:374-380.
  15. Olsen IE, Groveman SA, Lawson ML, Clark RH, Zemel BS. New intrauterine growth curves based on United States data. Pediatrics. 2010;125:e214-e224.
  16. Jayaraman D, Mukhopadhyay K, Bhalla AK, Dhaliwal LK. Randomized Controlled Trial on Efect of Intermittent Early Versus Late Kangaroo Mother Care on Human
    Milk Feeding in Low-Birth-Weight Neonates. J Hum Lact. 2017;33(3):533-539.
  17. Spatz DL, Froh EB, Schwarz J, et al. Pump Early, Pump Often: A Continuous Quality Improvement Project. J Perinat Educ. 2015;24:160-170.
  18. Kalluri N, Burnham L, et al. A Quality Improvement Project to Increase Mother’s Milk Use in an Inner-City NICU. Pediatr Quality Saf. 2019;4(5):e204.
  19. Parker MG, Gupta M, 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;204:134-141
  20. Meier PP, Johnson TJ, Patel AL, et al. Evidenced-based Methods that Promote Human Milk Feeding of Preterm Infants: An Expert Review. Clin Perinatol. 2017;44:122.
  21. Rossman B, Meier PP, Spatz DL A Wake-up Call: Persistent Barriers to the Provision of Evidence-based Lactation Support and Education in the NICU. J Perinatol. 2018;38:773-774.
  22. Hoban R, Bigger H, Schoeny M, Engstrom J, Meier P, Patel AL Milk Volume at 2 Weeks Predicts Mother’s Own Milk Feeding at Neonatal Intensive Care Unit Discharge for Very Low Birthweight Infants. Breastfeeding Med. 2018;13(2):135-141.
  23. Patel AL, 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. 2019;85(5):662-670