Clinical and Sociodemographic Factors Associated With Human Donor Milk Supplementation in Term Newborns

McKittrick, Megan; Khaki, Sheevaun; Gievers, Ladawna; Larson, Ilse

doi:10.1542/hpeds.2019-0259

Cited by 9 publications

(5 citation statements)

References 18 publications

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“…Conversely, affordability may be an obstacle for those with lower incomes, which motivates them to feed the mothers’ own milk. Other studies have shown that when PDM is paid for by private health insurance, this is the case [ 30 , 31 ]. Similarly, disparities in access to PDM according to race/ethnicity, socio-economic status, and access to private health insurance has been reported in the United States [ 15 , 16 , 17 ].…”

Section: Discussionmentioning

confidence: 99%

Factors Associated with the Use of Pasteurized Donor Milk for Healthy Newborns: Experience from the First Human Milk Bank in Vietnam

Tran

Nguyen²,

Giang

et al. 2021

Nutrients

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Background: Pasteurized donor milk (PDM) is typically prescribed to preterm or low birthweight newborns when their mother’s own milk is unavailable. In surplus, PDM is prescribed to meet the nutritional needs of healthy newborns in the first few days of life. However, its overuse can undermine efforts to promote and support breastfeeding, waste resources, and reduce the availability of PDM for at-risk newborns. We conducted this study to examine factors associated with the prescription and prolonged use (>48 h) of privately purchased PDM to healthy newborns. Methods: Prospective observational study of 2440 mothers of healthy, term, and normal birthweight newborns born at Da Nang Hospital for Women and Children between April and August 2019. In addition to the descriptive analysis, we performed multiple logistic regressions to examine factors associated with the prescription of PDM (n = 2440) and prolonged PDM use among those who used PDM (n = 566). Results: Twenty-three percent (566/2440) of healthy, term, and birthweight ≥2500 g newborns received PDM and were included in the study. The prevalence of PDM use was higher for cesarean births (OR: 2.05; 95% CI: 1.66, 2.55) and among male newborns (OR: 1.33; 95% CI: 1.09, 1.62), but lower for farmers or workers (vs. other jobs; OR: 0.71; 95% CI: 0.54, 0.93), family income <10 million VND (vs. ≥10 million VND; OR: 0.67; 95% CI: 0.55, 0.82), and duration of skin-to-skin ≥90 min (vs. <90 min; OR: 0.54; 95% CI: 0.39, 0.76). Prolonged PDM use (12.4% of 566 newborns who used PDM) was associated with the mother having a higher socioeconomic status job (professional, small trader or homemaker; OR: 4.00; 95% CI: 1.39, 12.5), being a first-time mother (OR: 3.39; 95% CI: 1.92, 6.01) or having a cesarean birth (OR: 2.09; 95% CI: 1.02, 4.28). Conclusions: The prescription and prolonged use of privately purchased PDM was associated with non-medical factors unrelated to the ability to breastfeed effectively. The findings suggest the need for improved breastfeeding communication, counseling and support skills for health staff, development, and application of strict criteria on PDM use for healthy newborns and better routine monitoring of PDM use over time.

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Section: Discussionmentioning

confidence: 99%

Factors Associated with the Use of Pasteurized Donor Milk for Healthy Newborns: Experience from the First Human Milk Bank in Vietnam

Tran

Nguyen²,

Giang

et al. 2021

Nutrients

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“…Policies and protocols to expand PDHM supplementation to infants in postnatal units may be similarly ineffective in closing gaps in its access and utilization due to structural racism, institutional racism, and individual health care provider racial biases. 35 , 50 , 61 , 62 Although well infants at NCWH may receive supplementation with PDHM when it is available, its use may depend on prenatal communication of this health care service, whether a health care provider offers it, or if a parent requests PDHM.…”

Section: Discussionmentioning

confidence: 99%

“… 60 Nonetheless, even in hospitals with policies that make it possible for well newborns to receive PDHM, there have been reports of racial and ethnic disparities in its use. 61 , 62 …”

Section: Introductionmentioning

confidence: 99%

Racial Disparities in Donor Human Milk Feedings: A Study Using Electronic Medical Records

et al. 2022

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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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“…In recent qualitative studies of mothers, authors reported a range of perceptions including beliefs that donor milk was temporary and formula was the ongoing plan, donor milk was unfamiliar, and donor milk was "healthier" and "natural." 34,35 In recent studies, researchers have also reported lower use of donor milk in the level 1 nursery setting among nonwhite, 14,36 non-English-speaking mothers 36 and those with public insurance, 14,36 suggesting that maternal cultural differences or biases against donor milk use may exist or that nursery providers may have biases in delivery of education or recommendations for donor milk use toward certain groups of mothers.…”

Section: Discussionmentioning

confidence: 99%

“…11 Generalizability of these findings to the rest of the United State is limited because responses were restricted to a single geographic area and donor milk use is known to vary by US region. Other evidence of dissemination of donor milk use in the level 1 nursery setting includes a published report of donor milk polices among 15 hospitals, 12 a report of donor milk used to treat hypoglycemia 13 and other conditions 14 at a single center, and reports from individual hospitals describing their donor milk programs. [15][16][17] Estimation of the national prevalence of donor milk programs in level 1 nurseries is needed to understand the extent that this practice has emerged in the past decade.…”

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confidence: 99%

National Prevalence of Donor Milk Use Among Level 1 Nurseries

Parker

Burnham

Kerr

et al. 2020

Hospital Pediatrics

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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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Clinical and Sociodemographic Factors Associated With Human Donor Milk Supplementation in Term Newborns

Cited by 9 publications

References 18 publications

Factors Associated with the Use of Pasteurized Donor Milk for Healthy Newborns: Experience from the First Human Milk Bank in Vietnam

Factors Associated with the Use of Pasteurized Donor Milk for Healthy Newborns: Experience from the First Human Milk Bank in Vietnam

Racial Disparities in Donor Human Milk Feedings: A Study Using Electronic Medical Records

National Prevalence of Donor Milk Use Among Level 1 Nurseries

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