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Palmquist AE, Asiodu IV, Tucker C, Tully KP, Asbill DT, Malloy A, Stuebe AM. Racial Disparities in Donor Human Milk Feedings: A Study Using Electronic Medical Records. Health Equity 2022; 6:798-808. [PMID: 36338802 PMCID: PMC9629910 DOI: 10.1089/heq.2022.0085] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2022] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION The aim of this study was to evaluate differences in the use of pasteurized donor human milk (PDHM) by maternal race-ethnicity during postpartum hospitalization using electronic medical records (EMRs). MATERIALS AND METHODS A retrospective cohort study of all live-born infants at our academic research institution from July 1, 2014, to June 30, 2016, was conducted. EMR data were used to determine whether each infant received mother's own milk (MOM), PDHM, or formula. These data were stratified based on whether the infant received treatment in the Neonatal Critical Care Center. Generalized estimating equation models were used to calculate the odds of receiving PDHM by maternal race-ethnicity, adjusting for gestational age, birth weight, insurance, preferred language, nulliparity, and mode of delivery. RESULTS Infant feeding data were available for 7097 infants, of whom 49% were fed only MOM during their postpartum hospitalization. Among the 15.9% of infants admitted to neonatal critical care, infants of non-Hispanic Black (odds ratio [OR] 0.47, 95% confidence interval [CI] 0.31-0.72), Hispanic (OR 0.65, 95% CI 0.36-1019), and Other (OR 0.63, 95% CI 0.32-1.26) mothers had lower rates of PDHM feedings than infants of non-Hispanic White mothers in the adjusted models. Among well infants, the use of PDHM was lower among non-Hispanic Black and Hispanic mothers (OR 0.25, 95% CI 0.18-0.36, and OR 0.38, 95% CI 0.26-0.56) compared with non-Hispanic White mothers. CONCLUSIONS Inequities in exclusive human milk feeding and use of PDHM by maternal race-ethnicity were identified. Antiracist interventions are needed to promote equitable access to skilled lactation support and counseling for PDHM use.
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Affiliation(s)
- Aunchalee E.L. Palmquist
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Address correspondence to: Aunchalee E.L. Palmquist, PhD, MA, IBCLC, Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, CB-7445, Chapel Hill, NC 27599-7400, USA.
| | - Ifeyinwa V. Asiodu
- Department of Family Health Care Nursing, University of California, San Francisco, California, USA
| | - Christine Tucker
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Kristin P. Tully
- Department of Obstetrics and Gynecology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | | | - Angela Malloy
- Momma's Village of Fayetteville, Fayetteville, North Carolina, USA
| | - Alison M. Stuebe
- Department of Obstetrics and Gynecology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Ellsworth L, Sturza J, Stanley K. An Alternative to Mother's Own Milk: Maternal Awareness of Donor Human Milk and Milk Banks. J Hum Lact 2021; 37:62-70. [PMID: 32735504 DOI: 10.1177/0890334420939549] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The use of donor human milk is rising. Maternal awareness of donor human milk use, milk donation, and milk banks has not been well described in the United States. RESEARCH AIMS To explore maternal experience, knowledge, and attitudes regarding donor human milk use and milk donation. We also assessed counseling by medical providers about donor human milk use and donation. METHODS A cross-sectional prospective survey design was used in this study. We anonymously surveyed mothers (N = 73) attending the 1 to 2-week well newborn appointment. Analyses were completed using one-way ANOVA and logistic regression. RESULTS Participants' infants primarily received their own mother's milk (87%, n = 61). No infants received donor human milk, but 4% (n = 3) of participants donated milk. The majority of participants had positive responses to attitudinal statements about donor milk. When presented with a hypothetical scenario, participants chose formula (89%, n = 59) over donor human milk (11%, n = 7) for their infant. Moreover, if donor human milk was the only option available, they chose donor human milk from a relative or friend (60%, n = 40) over a milk bank (40%, n = 26). Medical providers had discussed donor human milk use or donation with 4% (n = 3) of participants. CONCLUSIONS The majority of participants previously had minimal experience using donor human milk and limited knowledge regarding donor human milk and milk banks. According to participants, medical providers did not routinely discuss milk donation and the role of donor human milk with families.
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Affiliation(s)
- Lindsay Ellsworth
- 1259 Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Michigan, Ann Arbor, MI, USA
| | - Julie Sturza
- 21634 Center for Human Growth and Development, University of Michigan, Ann Arbor, MI, USA
| | - Kate Stanley
- 1259 Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Michigan, Ann Arbor, MI, USA
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3
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Bramer S, Boyle R, Weaver G, Shenker N. Use of donor human milk in nonhospitalized infants: An infant growth study. MATERNAL AND CHILD NUTRITION 2021; 17:e13128. [PMID: 33404169 PMCID: PMC7988867 DOI: 10.1111/mcn.13128] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 11/20/2020] [Accepted: 12/02/2020] [Indexed: 12/23/2022]
Abstract
When mother's own milk (MOM) is unavailable or insufficient, donor human milk (DHM) is recommended as the next best alternative for low birthweight infants. DHM use for healthy, term infants is increasing, but evidence for growth and tolerability is limited. This retrospective study evaluated growth in term infants in the community who received DHM from a UK milk bank. Mothers of infants receiving DHM between 2017 and 2019 were contacted (n = 49), and 31 (63.2%) agreed to participate. Fourteen infants received DHM as a supplement to other feeds (MOM and/or infant formula) and 17 were exclusively fed DHM where breastfeeding was impossible (range: 3–6 weeks). Growth was assessed by deriving z‐scores using the WHO standard for infant growth and compared with 200 exclusively breastfed infants. Multivariate regression analysis revealed no feeding method‐specific association between z‐score and age, nor between weight and age, suggesting that z‐scores and growth velocity were not affected by feeding exclusive MOM, supplemental DHM or exclusive DHM. DHM was well‐tolerated with no adverse events that led to early cessation. After receiving supplemental DHM group, 63% of infants whose mothers had no physical barrier to breastfeeding (5/8 infants) were exclusively breastfed. This novel study reports adequate growth outcomes of healthy nonhospitalized infants receiving DHM, either as the sole milk source or supplement. Prospective studies are needed to confirm whether DHM is a suitable feeding alternative for term infants in the community, optimal durations, as well as the impact of DHM availability on breastfeeding rates and maternal mental health. DHM recipients were compared with the who infant growth standard (World Health Organization, 2020) by deriving z‐scores. The WHO Anthro Macro (World Health Organization, 2011 ) was used to calculate weight‐for‐age, length‐for‐age and head circumference‐for‐age z‐scores; z‐scores are the standard deviation of an infant's anthropometric measurements when compared with the WHO standard for infant growth and are gender and age specific.
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Affiliation(s)
- Solange Bramer
- Imperial College London Medical School, St Mary's Hospital, London, UK
| | - Robert Boyle
- Department of Paediatrics, Imperial College London, St Mary's Hospital, London, UK
| | - Gillian Weaver
- The Human Milk Foundation, Daniel Hall Building, Rothamsted Institute, Herts, UK
| | - Natalie Shenker
- The Human Milk Foundation, Daniel Hall Building, Rothamsted Institute, Herts, UK.,Department of Surgery and Cancer, Imperial College London, London, UK
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4
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McCune S, Perrin MT. Donor Human Milk Use in Populations Other than the Preterm Infant: A Systematic Scoping Review. Breastfeed Med 2021; 16:8-20. [PMID: 33237802 DOI: 10.1089/bfm.2020.0286] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Introduction: Exclusive breastfeeding is recommended for an infant's first 6 months of life. If unable to breastfeed, expressed breast milk, including donor human milk (DHM), is recommended for optimal nutrition. Benefits of DHM in preterm infants have been established by extensive research. However, less is known about DHM use in other populations. Objective: To conduct a scoping review of the literature regarding DHM use in populations other than preterm infants. Materials and Methods: PubMed and Clinicaltrials.gov were used to search for articles and clinical trials published between January 1, 2000 and February 29, 2020. In total, 182 articles and reports were identified and screened by 2 independent reviewers. Results: Twenty-six articles met inclusion criteria and were reviewed. Studies were mostly observational in design and included infants born >35 weeks gestational age with health risks (9/26) and healthy infants (14/26). Most studies in infants with health risks (7/9) investigated clinical outcomes, with small, observational studies suggesting potential improvements in feeding tolerance and gastrointestinal health. Regarding healthy infants, no studies addressed growth, only one study measured clinical outcomes, and findings related to breastfeeding outcomes were conflicting. Over half of the studies reviewed (15/26) were not designed to establish a potential relationship between DHM use and relevant health-related outcomes. Conclusion: The current evidence of DHM use in populations other than preterm infants is limited by lack of direct health measures and infrequent use of randomized trials. More research is warranted to investigate clinical, growth, and breastfeeding outcomes.
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Affiliation(s)
- Sydney McCune
- Department of Nutrition, University of North Carolina Greensboro, Greensboro, North Carolina, USA
| | - Maryanne T Perrin
- Department of Nutrition, University of North Carolina Greensboro, Greensboro, North Carolina, USA
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5
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Parker MG, Burnham LA, Kerr SM, Belfort MB, Perrin MT, Corwin MJ, Heeren TC. National Prevalence of Donor Milk Use Among Level 1 Nurseries. Hosp Pediatr 2020; 10:1078-1086. [PMID: 33144332 DOI: 10.1542/hpeds.2020-001396] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND OBJECTIVES Donor milk use has increased among very preterm infants because of mounting evidence of health benefits; however, the extent that donor milk is used among healthy term infants in level 1 nurseries is unclear. We aimed to determine (1) national prevalence of and (2) hospital factors associated with donor milk use in level 1 nurseries. METHODS Among 3040 US birthing hospitals, we randomly selected hospitals from each of 4 US regions (119 in northeast, 120 in Midwest, 116 in west, and 103 in south) for a total of 458 hospitals. We surveyed the nursing leaders of these hospitals from October to December 2017 regarding routine use of donor milk in the level 1 nursery (yes or no). To estimate national prevalence, we weighted responses according to the number of birthing hospitals within each region. We examined relationships between routine donor milk use in the level 1 nursery and hospital characteristics using multivariable logistic regression. RESULTS In total, 214 of 458 (47%) nursing leaders responded. The national prevalence of routine donor milk use in level 1 nurseries was 17.6%. Eighty-five percent of donor milk programs were ≤5 years old. Donor milk use occurred more often in hospitals with ≥1500 annual births (41.7%), compared to ≤500 annual births (6.3%) (adjusted odds ratio 7.8; 95% confidence interval 1.8-34.4), and in the west (30.9%), compared to the northeast (10.5%) (adjusted odds ratio 4.1; 95% confidence interval [1.1-14.9]). CONCLUSIONS Although there is limited evidence to support donor milk for healthy infants in the nursery, nearly one-fifth of level 1 US nurseries routinely used donor milk in 2017.
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Affiliation(s)
- Margaret G Parker
- Department of Pediatrics, Boston Medical Center and School of Medicine and .,Slone Epidemiology Center, Boston University, Boston, Massachusetts
| | - Laura A Burnham
- Department of Pediatrics, Boston Medical Center and School of Medicine and
| | - Stephen M Kerr
- Slone Epidemiology Center, Boston University, Boston, Massachusetts
| | - Mandy B Belfort
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital and Harvard Medical School, Harvard University, Boston, Massachusetts; and
| | - Maryanne T Perrin
- Department of Nutrition, School of Health and Human Sciences, University of North Carolina Greensboro, Greensboro, North Carolina
| | - Michael J Corwin
- Department of Pediatrics, Boston Medical Center and School of Medicine and.,Slone Epidemiology Center, Boston University, Boston, Massachusetts
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6
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Kair LR, Phillipi CA, Lloyd-McLennan AM, Ngo KM, Sipsma HL, King BA, Flaherman VJ. Supplementation Practices and Donor Milk Use in US Well-Newborn Nurseries. Hosp Pediatr 2020; 10:767-773. [PMID: 32778567 PMCID: PMC7842181 DOI: 10.1542/hpeds.2020-0037] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND OBJECTIVES Guidelines encourage exclusive breastfeeding for healthy newborns but lack specificity regarding criteria for medically indicated supplementation, including type, timing, and best practices. We set out to describe practice patterns and provider perspectives regarding medically indicated supplementation of breastfeeding newborns across the United States. METHODS From 2017 to 2018, we surveyed the Better Outcomes through Research for Newborns representative from each Better Outcomes through Research for Newborns hospital regarding practices related to medically indicated supplementation. We used descriptive statistics to compare practices between subgroups defined by breastfeeding prevalence and used qualitative methods and an inductive approach to describe provider opinions. RESULTS Of 96 providers representing discrete hospitals eligible for the study, 71 participated (74% response rate). Practices related to criteria for supplementation and pumping and to type and caloric density of supplements varied widely between hospitals, especially for late preterm infants, whereas practices related to lactation consultant availability and hand expression education were more consistent. The most commonly reported criterion for initiating supplementation was weight loss of ≥10% from birth weight, and bottle-feeding was the most commonly reported method; however, practices varied widely. Donor milk use was reported at 20 (44%) hospitals with ≥81% breastfeeding initiation and 1 (4%) hospital with <80% breastfeeding initiation (P = .001). CONCLUSIONS Strategies related to supplementation vary among US hospitals. Donor milk availability is concentrated in hospitals with the highest prevalence of breastfeeding. Implementation of evidence-based management of supplementation among US hospitals has the potential to improve the care of term and late preterm newborns.
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Affiliation(s)
- Laura R Kair
- Department of Pediatrics, School of Medicine, University of California, Davis, Sacramento, California;
| | - Carrie A Phillipi
- Department of Pediatrics, School of Medicine, Oregon Health & Science University, Portland, Oregon
| | - Allison M Lloyd-McLennan
- Department of Pediatrics, University of California, San Francisco, Benioff Children's Hospital Oakland, Oakland, California
| | - Kimberly M Ngo
- Department of Pediatrics, School of Medicine, University of California, Davis, Sacramento, California
| | - Heather L Sipsma
- Department of Public Health, College of Education and Health Services, Benedictine University, Lisle, Illinois
| | - Beth A King
- Academic Pediatric Association, McLean, Virginia; and
| | - Valerie J Flaherman
- Departments of Pediatrics and Epidemiology & Biostatistics, University of California, San Francisco, San Francisco, California
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7
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The impact on the exclusive breastfeeding rate at 6 months of life of introducing supplementary donor milk into the level 1 newborn nursery. J Perinatol 2020; 40:1109-1114. [PMID: 32231257 DOI: 10.1038/s41372-020-0657-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 02/16/2020] [Accepted: 03/11/2020] [Indexed: 11/08/2022]
Abstract
OBJECTIVES This study explored whether donor-milk supplementation increases breastfeeding exclusivity at 6 months of life. In 10/2015, we implemented donor milk for breastfed newborns who needed nutritional supplements for hypoglycemia, hyperbilirubinemia, and >8% weight loss at 40 h of life. STUDY DESIGN We conducted a retrospective chart review on 122 qualified neonates admitted to newborn nursery at University of Florida Jacksonville 4 months before donor-milk implementation and 6 months after. RESULTS 73 (60%) of the neonates received formula and 49 (40%) received donor milk. 39 (54%) in the formula group and 33 (46%) in the donor-milk group were surveyed after 6 months of life. Multivariate logistic regression showed that newborns who received donor milk had five times greater odds of being exclusively breastfed at 6 months of life. CONCLUSIONS Donor milk as feeding supplementation for newborns is associated with increased exclusive breastfeeding at 6 months of life.
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8
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Kair LR, Nidey NL, Marks JE, Hanrahan K, Femino L, Fernandez Y Garcia E, Ryckman K, Wood KE. Disparities in Donor Human Milk Supplementation Among Well Newborns. J Hum Lact 2020; 36:74-80. [PMID: 31770064 PMCID: PMC7015767 DOI: 10.1177/0890334419888163] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Donor human milk supplementation for healthy newborns has increased. Racial-ethnic disparities in supplementation have been described in the neonatal intensive care unit but not in the well newborn setting. RESEARCH AIM The aim of this study was to identify maternal characteristics associated with donor human milk versus formula supplementation in the well newborn unit. METHODS This retrospective cohort study includes dyads of well newborns and their mothers (N = 678) who breastfed and supplemented with formula (n = 372) or donor human milk (n = 306) during the birth hospitalization at a single hospital in the midwestern United States. Maternal characteristics and infant feeding type were extracted from medical records. Chi-square and logistic regression were used to examine associations between maternal characteristics and feeding type. RESULTS Nonwhite women were less likely to use donor human milk. Compared to non-Hispanic white women, the largest disparity was with Hispanic (adjusted odds ratio [OR] = 0.28, 95% CI [0.12, 0.65]), then non-Hispanic black (adjusted OR = 0.32, 95% CI [0.13, 0.76]) and Asian women (adjusted OR = 0.34, 95% CI [0.16, 0.74]). Lower donor human milk use was associated with primary language other than English and public versus private insurance. CONCLUSION The goal of improving public health through breastfeeding promotion may be inhibited without targeting donor human milk programs to these groups. Identifying the drivers of these disparities is necessary to inform person-centered interventions that address the needs of women with diverse backgrounds.
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Affiliation(s)
- Laura R Kair
- University of California, Davis, Sacramento, CA, USA.,University of Iowa, Iowa City, IA, USA
| | - Nichole L Nidey
- University of Iowa, Iowa City, IA, USA.,Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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9
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Ferrarello D, Schumacher A, Anca R. Nurse-Driven Initiative to Increase Exclusive Human Milk Feeding by Using Pasteurized Donor Human Milk to Treat Hypoglycemic Term Neonates. Nurs Womens Health 2019; 23:316-326. [PMID: 31251932 DOI: 10.1016/j.nwh.2019.05.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 03/10/2019] [Accepted: 05/01/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To increase exclusive breastfeeding by offering pasteurized donor human milk (PDHM) to newborns with hypoglycemia. DESIGN Quality improvement project. SETTING/LOCAL PROBLEM A Baby-Friendly Hospital Initiative-designated urban academic medical center in the northeastern United States serving a diverse population where, by policy, virtually all newborns with hypoglycemia received supplemental infant formula. Approximately 85% of women cared for at this center initiate breastfeeding, but many struggle with exclusive breastfeeding during the hospital stay. PARTICIPANTS All staff members in the labor and delivery unit and the mother/baby unit, including registered nurses, unit clerks, patient care technicians, and lactation consultants. Term, breastfed newborns identified as being hypoglycemic per our guidelines were eligible to receive PDHM. INTERVENTION/MEASUREMENTS Registered nurses provided education about PDHM to parents of newborns who were hypoglycemic, obtained consent, and initiated the order. We offered PDHM instead of infant formula when mother's own milk was not available in sufficient quantity per our hypoglycemia guidelines. We measured newborns' glucose levels and monitored breastfeeding outcomes, including continued breastfeeding. RESULTS During the 4-month trial, 83 newborns were eligible for PDHM. Of those, 76% of parents opted for PDHM rather than formula. Most newborns in both groups were still breastfeeding at discharge, and 53% of those who received PDHM were fed human milk exclusively during their hospital stays. CONCLUSION A nurse-driven protocol offering PDHM to otherwise healthy newborns with hypoglycemia is a viable option for increasing exclusive breast milk feeding during the hospital stay.
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10
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Kair LR, Flaherman V, Colaizy T. Effect of Donor Milk Supplementation on Breastfeeding Outcomes in Term Newborns: A Randomized Controlled Trial. Clin Pediatr (Phila) 2019; 58:534-540. [PMID: 30688082 PMCID: PMC6456417 DOI: 10.1177/0009922819826105] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Pasteurized donor human milk (DHM) use for healthy newborns is increasing; however, no studies have explored its effect on breastfeeding outcomes. PATIENTS AND METHODS We enrolled 60 healthy, term breastfeeding newborns with ≥4.5% weight loss in the first 36 hours in a randomized controlled trial. Thirty newborns were randomly assigned to early limited-volume DHM supplementation and 30 newborns to exclusive breastfeeding. Mothers were surveyed at 1 week and 1, 2, and 3 months regarding the mode of infant feeding. Comparing infants randomized to DHM supplementation with those exclusively breastfeeding, there was no significant difference in the proportion using formula at 1 week (21% vs 7%, P = .15), nor in the proportion of any breastfeeding (79% vs 90%, P = .30) or breastfeeding without formula at 3 months (62% vs 77%, P = .27). Conclusion For newborns with ≥4.5% weight loss in the first 36 hours, early limited-volume supplementation with DHM is unlikely to have a significant favorable impact on breastfeeding outcomes.
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Affiliation(s)
- Laura R. Kair
- University of Iowa Stead Family Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, IA 52242
- University of California Davis Medical Center, 2516 Stockton Blvd., Ticon II, Room 341, Sacramento, CA 95817, Phone: (916) 734-7308, Fax: (916) 456-2236,
| | - Valerie Flaherman
- University of California, San Francisco, 3333 California St., Box 0503, San Francisco, CA 94118, Phone: (415) 502-6266, Fax: (415) 476-6106
| | - Tarah Colaizy
- Division of Neonatology, Stead Family Department of Pediatrics, Carver College of Medicine, University of Iowa, 8809 JPP, Iowa City, IA 52242, Phone: (319) 356-3508,
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Belfort MB, Drouin K, Riley JF, Gregory KE, Philipp BL, Parker MG, Sen S. Prevalence and Trends in Donor Milk Use in the Well-Baby Nursery: A Survey of Northeast United States Birth Hospitals. Breastfeed Med 2018; 13:34-41. [PMID: 29064280 PMCID: PMC5770118 DOI: 10.1089/bfm.2017.0147] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND AND OBJECTIVES Pasteurized donor human milk ("donor milk") is an alternative to formula for supplementation of breastfed infants. We conducted a survey to determine (1) prevalence, trends, and hospital-level correlates of donor milk use for healthy newborns in the northeast United States and (2) clinician knowledge and opinions regarding this practice. METHODS We conducted parallel surveys of clinicians (88% nurse and/or lactation consultant) at (1) all birth hospitals in Massachusetts (MA) and (2) all birth hospitals served by a northeast United States milk bank. We asked about hospital use of donor milk for newborns ≥35 weeks' gestation and receiving Level I care in well nursery, hospital-related factors we hypothesized would be associated with this practice, and clinician knowledge and opinions about donor milk use. RESULTS 35/46 (76%) of MA birth hospitals and 51/69 (74%) of hospitals served by the milk bank responded; 71 unique hospitals were included. Twenty-nine percent of MA birth hospitals and 43% of hospitals served by the milk bank reported using donor milk for healthy newborns. Hospitals that used donor milk for healthy newborns had higher exclusive breastfeeding at hospital discharge than hospitals that did not (77% versus 56%, p = 0.02). Eighty-three percent of respondents agreed or strongly agreed that using donor milk is an effective way to increase the hospital's exclusive breastfeeding rate. CONCLUSIONS Many northeast United States birth hospitals currently use donor milk for healthy newborns. This practice is associated with higher exclusive breastfeeding at hospital discharge. Relationships with breastfeeding after discharge and related outcomes are unknown.
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Affiliation(s)
- Mandy Brown Belfort
- 1 Department of Pediatric Newborn Medicine, Brigham and Women's Hospital , Boston, Massachusetts.,2 Harvard Medical School , Boston, Massachusetts
| | - Kaitlin Drouin
- 1 Department of Pediatric Newborn Medicine, Brigham and Women's Hospital , Boston, Massachusetts
| | - Jennifer F Riley
- 3 Department of Nursing, Brigham and Women's Hospital , Boston, Massachusetts
| | - Katherine E Gregory
- 1 Department of Pediatric Newborn Medicine, Brigham and Women's Hospital , Boston, Massachusetts.,2 Harvard Medical School , Boston, Massachusetts.,3 Department of Nursing, Brigham and Women's Hospital , Boston, Massachusetts
| | - Barbara L Philipp
- 4 Department of Pediatrics, Boston Medical Center , Boston, Massachusetts.,5 Boston University School of Medicine , Boston, Massachusetts
| | - Margaret G Parker
- 4 Department of Pediatrics, Boston Medical Center , Boston, Massachusetts.,5 Boston University School of Medicine , Boston, Massachusetts
| | - Sarbattama Sen
- 1 Department of Pediatric Newborn Medicine, Brigham and Women's Hospital , Boston, Massachusetts.,2 Harvard Medical School , Boston, Massachusetts
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12
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Abstract
BACKGROUND Many breastfed infants receive supplemental feeds during the birth hospitalization, either by maternal request or due to medical indications. Donor milk from a certified milk bank has become increasingly available and is now used in some settings for term and late preterm infants. No studies have explored maternal opinions about donor milk and formula as options for supplementary feedings. Research aim: This study aimed to explore maternal perceptions about donor milk and formula supplementation and implications for continued breastfeeding. METHODS The authors conducted semistructured interviews with 30 postpartum mothers of healthy newborns who breastfed and gave supplementary feedings with pasteurized donor milk and/or formula during the birth hospitalization. They analyzed transcripts using the constant comparative method and identified four major themes. RESULTS Identified themes included the following: (a) Donor milk is seen as temporary whereas formula is seen as an ongoing plan, (b) formula is viewed as familiar whereas donor milk is viewed as unfamiliar, (c) donor milk is costly and challenging logistically, and (d) donor milk is "healthier." CONCLUSION For mothers who view donor milk as temporary and formula as permanent, the provision of donor milk rather than formula when supplementation is medically indicated may have the potential to promote the return to exclusive maternal breastfeeding. Barriers to the use of donor milk include cost and lack of familiarity and access.
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Affiliation(s)
- Laura R Kair
- 1 Stead Family Department of Pediatrics, University of Iowa, Carver College of Medicine, Iowa City, IA, USA.,2 Department of Pediatrics, University of California Davis Medical Center, Sacramento, CA, USA
| | - Valerie J Flaherman
- 3 Department of Pediatrics and Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
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13
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Sen S, Benjamin C, Riley J, Heleba A, Drouin K, Gregory K, Belfort MB. Donor Milk Utilization for Healthy Infants: Experience at a Single Academic Center. Breastfeed Med 2017; 13:28-33. [PMID: 29072928 PMCID: PMC5770134 DOI: 10.1089/bfm.2017.0096] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Banked donor milk (BDM) has historically been used as an alternative to formula for preterm infants. Recently, BDM has been endorsed by two national organizations for use in healthy infants. We sought to quantify utilization trends and characteristics of mothers and their healthy newborns who received BDM during their postpartum stay between 2013 and 2016 at a single academic medical center. MATERIALS AND METHODS In this observational study, we used a clinical log to identify all infants who received BDM in the well-baby nursery between July 2013 and June 2016. From this log, we abstracted data on the numbers of babies who received BDM, the quantity of BDM provided, and indications for usage. We also collected clinical data from the medical records of a subset of corresponding mothers and infants. RESULTS BDM utilization increased over time in healthy infants, with 0.04% of infants before July 2014 receiving BDM compared with 4.7% in July 2015 to June 2016. During the same periods, the number of bottles provided per infant also increased, from 0.6 bottles per infant to 4.6 bottles per infant. The most common indications for providing BDM were parent/caregiver request (19%) and excessive weight loss/dehydration (17%). CONCLUSION At our center, the use of BDM for healthy infants increased substantially over the study period. More research is urgently needed to understand the repercussions of this practice on resource utilization as well as short- and long-term breastfeeding and health outcomes.
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Affiliation(s)
- Sarbattama Sen
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, Massachusetts
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Charis Benjamin
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Jennifer Riley
- Department of Nursing, Brigham and Women's Hospital, Boston, Massachusetts
| | - Abigail Heleba
- Cornell University, College of Agriculture and Life Sciences, Ithaca, New York
| | - Kaitlin Drouin
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Katherine Gregory
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, Massachusetts
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
- Department of Nursing, Brigham and Women's Hospital, Boston, Massachusetts
| | - Mandy Brown Belfort
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, Massachusetts
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
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14
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Ramji N, Challa S, Murphy PA, Quinlan J, Crane JMG. A comparison of breastfeeding rates by obesity class. J Matern Fetal Neonatal Med 2017; 31:3021-3026. [PMID: 28760080 DOI: 10.1080/14767058.2017.1362552] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE The purpose of this study is to compare breastfeeding initiation rates for women across body mass index (BMI) classes, including normal BMI (18.50-24.99 kg/m2), overweight (25.00-29.99 kg/m2), obese (30.00-39.99 kg/m2), morbidly obese (40.00-49.99 kg/m2) and extreme obesity (≥50.00 kg/m2). MATERIALS AND METHODS Retrospective cohort of women with singleton pregnancies, delivering in St. John's, NL between 2002 and 2011. The primary outcome was any breastfeeding on hospital discharge. Breastfeeding rates across BMI categories were compared, using univariate analyses. Multivariate analysis included additional maternal and obstetric variables. RESULTS Twelve thousand four hundred twenty-two women were included: 8430 breastfed and 3992 did not breastfeed on hospital discharge. Progressively decreasing rates of breastfeeding were noted with increasing obesity class: normal BMI (71.1%), overweight (69.1%), obese (61.6%), morbidly obese (54.2%), and extremely obese women (42.3%). Multivariate analysis confirmed that increasing obesity class resulted in lower odds of breastfeeding: overweight (adjusted odds ratios (aOR) 0.86, 95%CI 0.76-0.98), obese (aOR 0.65, 95%CI 0.57-0.74), morbidly obese (aOR 0.57, 95%CI 0.44-0.74), and extreme obesity (aOR 0.37, 95%CI 0.19-0.74). CONCLUSION Women in higher obesity classes are progressively less likely to initiate breastfeeding. Women with the highest prepregnancy BMIs should be particularly counseled on the benefits of breastfeeding.
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Affiliation(s)
- Naila Ramji
- a Department of Obstetrics and Gynecology , Memorial University of Newfoundland , St. John's , Canada
| | - Satyadeva Challa
- b Newfoundland and Labrador Support Unit Strategy for Patient-Oriented Research (SPOR - CIHR) , Ottawa , Ontario , Canada.,c Department of Research, Grant and Contract Services , Memorial University of Newfoundland , St. John's , Canada
| | - Phil A Murphy
- a Department of Obstetrics and Gynecology , Memorial University of Newfoundland , St. John's , Canada.,d Perinatal Program Newfoundland and Labrador , Ottawa , Ontario , Canada.,e Department of Pediatrics , Memorial University of Newfoundland , St. John's , Canada
| | - James Quinlan
- f Department of Internal Medicine , Memorial University of Newfoundland , St. John's , Canada
| | - Joan M G Crane
- a Department of Obstetrics and Gynecology , Memorial University of Newfoundland , St. John's , Canada
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15
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Affiliation(s)
- Maya Bunik
- Department of Pediatrics, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, CO
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16
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Flaherman VJ, Maisels MJ, Noble L, Brent N, Bunik M, Harrel C, Lawrence RA, Marinelli KA, Reece-Stremtan S, Rosen-Carole C, Seo T, St. Fleur R, Young M. ABM Clinical Protocol #22: Guidelines for Management of Jaundice in the Breastfeeding Infant 35 Weeks or More of Gestation-Revised 2017. Breastfeed Med 2017; 12:250-257. [PMID: 29624434 DOI: 10.1089/bfm.2017.29042.vjf] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Valerie J Flaherman
- 1 Department of Pediatrics, School of Medicine, University of California , San Francisco, California
| | - M Jeffrey Maisels
- 2 Department of Pediatrics, William Beaumont School of Medicine, Oakland University , Royal Oak, Michigan
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17
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Kair LR, Colaizy TT. Association Between In-Hospital Pacifier Use and Breastfeeding Continuation and Exclusivity: Neonatal Intensive Care Unit Admission as a Possible Effect Modifier. Breastfeed Med 2017; 12:12-19. [PMID: 27813671 DOI: 10.1089/bfm.2016.0137] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Breastfeeding dyads frequently use pacifiers during the birth hospitalization, but the relationships between this exposure and breastfeeding continuation and exclusivity remain unclear. MATERIALS AND METHODS In this secondary analysis of cross-sectional survey data from the CDC Pregnancy Risk Assessment Monitoring System (PRAMS) from 10 U.S. states (AK, AR, CO, ME, MN, NJ, NY, OR, TX, and VT) from 2009 to 2011, we assessed to what extent pacifier use during the birth hospitalization is independently associated with any and exclusive breastfeeding ≥10 weeks. RESULTS A total of 37,628 mothers who were chosen by random birth certificate sampling completed surveys at ∼4 months postpartum. Adjusting for multiple pro-breastfeeding hospital practices and maternal and infant demographic characteristics, pacifier exposure during the birth hospitalization was independently associated with decreased odds of breastfeeding ≥10 weeks (adjusted odds ratio [aOR]) 0.71, 95% confidence interval [CI] 0.63-0.80, p < 0.0001) and exclusive breastfeeding ≥10 weeks (aOR 0.70, 95% CI 0.63-0.79, p < 0.0001) among infants admitted to the well-baby nursery, but not among those admitted to the neonatal intensive care unit (NICU). CONCLUSIONS In this population study of mothers from 10 U.S. states, pacifier use during the birth hospitalization was associated with decreased odds of breastfeeding and exclusive breastfeeding ≥10 weeks among well-newborn, but not NICU-admitted infants. Pacifier use may be a marker rather than a cause of breastfeeding difficulties, but prospective, randomized studies are needed to help clarify this. Future studies exploring pacifier exposure and breastfeeding outcomes should account for NICU admission as an effect modifier.
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Affiliation(s)
- Laura R Kair
- 1 Stead Family Department of Pediatrics, University of Iowa , Iowa City, Iowa.,2 Department of Pediatrics, University of California Davis , Sacramento, California
| | - Tarah T Colaizy
- 1 Stead Family Department of Pediatrics, University of Iowa , Iowa City, Iowa
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18
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Kair LR, Colaizy TT. Breastfeeding Continuation Among Late Preterm Infants: Barriers, Facilitators, and Any Association With NICU Admission? Hosp Pediatr 2016; 6:261-8. [PMID: 27048247 DOI: 10.1542/hpeds.2015-0172] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND OBJECTIVES Late preterm birth (at 34-36 6/7 weeks' gestation) is a risk factor for early breastfeeding cessation. The objective of this study was to determine barriers to and facilitators of breastfeeding continuation among late preterm infants (LPI) and to compare the barriers faced by LPI admitted to the well nursery versus the NICU. METHODS The SAS Complex Survey was used to perform multivariable logistic regression analysis by using data from the Centers for Disease Control and Prevention's Pregnancy Risk Assessment Monitoring System. Data from 3 states (Illinois, Maine, and Vermont) for the years 2004 to 2008 were used. RESULTS A total of 2530 mothers of LPI were surveyed. Odds of breastfeeding initiation were similar among LPI admitted to the NICU versus the well nursery (adjusted odds ratio, 1.24 [95% confidence interval, 0.88-1.73]; P = .209). Odds of breastfeeding for ≥ 10 weeks were no different between LPI admitted to the NICU versus those admitted to the well-nursery (adjusted odds ratio, 1.02 [95% confidence interval, 0.73-1.43]; P = .904). Factors associated with increased odds of breastfeeding for ≥ 10 weeks among LPI were higher maternal education, mother being married, and normal maternal BMI. Regardless of NICU admission, the top reasons cited by mothers of LPI for early breastfeeding discontinuation were perceived inadequate milk supply and nursing difficulties. CONCLUSIONS Among LPIs, NICU admission was not associated with early breastfeeding cessation. Mothers of LPIs with lower odds of sustaining breastfeeding for at least 10 weeks were single mothers, those with a high school education only, and those who were obese. Breastfeeding support should be enhanced for LPIs and should address perceived maternal milk supply concerns and nursing difficulties.
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Affiliation(s)
- Laura R Kair
- Department of Pediatrics, University of Iowa Stead Family, Carver College of Medicine, Iowa City, Iowa, 52242, USA.
| | - Tarah T Colaizy
- Department of Pediatrics, University of Iowa Stead Family, Carver College of Medicine, Iowa City, Iowa, 52242, USA
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