Targeting the Disparity in the Rates of Receiving Mothers’ Own Milk at Discharge from the NICU by Very Low Birthweight (VLBW) Infants
A series of externally funded studies by the Rush NICU Human Milk Research Team has revealed that high-dose, long-exposure to mothers’ own milk (MOM; excluding donor human milk) feedings during the NICU hospitalization reduces the risk of numerous potentially preventable complications of prematurity. These complications, which include necrotizing enterocolitis, late onset sepsis, bronchopulmonary dysplasia, and neurodevelopmental problems in childhood, increase the costs of health care and education for families, hospitals, and society at large. The 430 racially and ethnically diverse (Black = 52%; Hispanic = 27%; White = 19%; Other = 2%) VLBW infants who participated in the team’s first study constitute the LOVE MOM (Longitudinal Outcomes of Very Low Birthweight Infants Exposed to Mothers’ Own Milk) cohort (Meier, PI: NIH grant NR010009). In this 5-year NIH-funded study, 97% of LOVE MOM infants received MOM, without racial/ethnic differences in this high initiation rate. However, despite high initiation rates and receiving very high doses of MOM during the first 28 days of life, LOVE MOM infants were much less likely to receive MOM through to NICU discharge.
This month’s HOT OFF THE PRESS publication, with Dr. Aloka Patel as primary author, sought to understand high initiation but low NICU discharge rates for MOM feedings in 415 LOVE MOM mothers (Patel,PI: NICHD 1R03HD081412I). Of particular concern was that the already lower discharge rates revealed a racial disparity with Black VLBW infants significantly less likely to receive MOM at NICU discharge than were non-Black (White, Hispanic) infants. The team’s previous studies (Hoban, 2015) indicated that 87% of Black mothers expressed a goal to continue exclusive or partial MOM feedings through to NICU discharge; however only 23% of Black infants (versus 43% of non-Black infants) received MOM at NICU discharge. Thus, Black mothers wanted to continue MOM provision, but did not achieve their own self-stated goals.
Dr. Patel’s innovative study examined five sets of factors that might affect receipt of MOM at NICU discharge
Social Factors
Neighborhood Structural Factors
Maternal Health Factors
Pumping Factors
Maternal Demographic Factors
The findings from each factor separately have been reported in a series of publications, for which Dr. Patel mentored many Rush students and medical residents as co-authors. The newest HOT OFF THE PRESS paper, published in Pediatric Research, used statistical modeling of findings from each of the separate factors, and found that low SES (socioeconomic status) and perceived support from the maternal grandmother predicted lack of MOM feeding at NICU discharge among Black mothers, while greater maternal age and higher pumping frequency predicted continued MOM feeding at NICU discharge. These findings can inform the design and testing of interventions to mitigate the racial/ethnic disparity in receipt of MOM at NICU discharge, thus promoting lifelong health for ALL VLBW infants.
Rush University NICU Human Milk Research Team
The overarching goal for this clinically-based multidisciplinary human milk research team is removal of barriers to high-dose human milk feeding for infants hospitalized in the neonatal intensive care unit (NICU). This team has worked together since 2000 and has conducted research about topics as diverse as the effect of early diet on the gut microbiome in preterm infants and the impact of breastfeeding peer counselors on maternal provision of human milk for their very low birthweight (VLBW; <1500 g birthweight) infants. This team has also completed multiple studies that have adapted research-based diagnostic instruments and analyses to the clinical setting to better manage the complicated human milk feeding strategies for NICU infants.
The Rush NICU human milk research team has received multiple competitive federal grants, industry funding, and philanthropic dissemination awards to conduct its numerous studies. In 2007, the team was funded by the United States National Institutes of Health (NIH) to conduct a 5-year study, “Health Outcomes and Cost of Human Milk Feeding for Very Low Birthweight Infants” (P. Meier, PI). In 2010, Dr. Tricia Johnson received internal funding to conduct a 2-year study, “Human Milk Feeding as a Primary Prevention Strategy” that focused on economic modeling methodologies. In 2014, Dr. Aloka Patel received NIH funds to study “Barriers to Continued Provision of Human Milk for Black Mothers of VLBW Infants”. Cumulatively, the team has conducted multiple additional studies during this time frame, and has published 37 peer-reviewed papers from these awards since 2007.