Department of Pediatrics, Rush University Children's Hospital, Chicago, IL, USA.
College of Nursing, Rush University Medical Center, Chicago, IL, USA.
Pediatr Res. 2019 Apr;85(5):662-670. doi: 10.1038/s41390-019-0290-2. Epub 2019 Jan 18.
Despite high initiation rates for mother's own milk (MOM) provision, MOM feeding at discharge from the neonatal intensive care unit (NICU) drops precipitously and reveals a racial/ethnic disparity. This study sought to identify factors that (1) predict MOM feeding at NICU discharge, and (2) mediate racial/ethnic disparity in MOM feeding at discharge.
Secondary analysis of prospective cohort study of 415 mothers and their very low birth weight infants. Variables were grouped into five categories (demographics, neighborhood structural, social, maternal health, and MOM pumping). Significant predictors from each category were entered into a multivariable logistic regression model.
Although 97.6% of infants received MOM feedings, black infants were significantly less likely to receive MOM feeding at discharge. Positive predictors were daily pumping frequency, reaching pumped MOM volume ≥500 mL/day by 14 days, and maternal age. Negative predictors were low socioeconomic status (SES) and perceived breastfeeding support from the infant's maternal grandmother. Low SES, maternal age, and daily pumping frequency mediated the racial/ethnic differences.
Multiple potentially modifiable factors predict MOM feeding at NICU discharge. Importantly, low SES, pumping frequency, and maternal age were identified as the mediators of racial and ethnic disparity. Strategies to mitigate the effects of modifiable factors should be developed and evaluated in future research.
尽管母亲提供母乳（MOM）的初始率很高，但从新生儿重症监护病房（NICU）出院时，MOM 喂养率急剧下降，并显示出种族/民族差异。本研究旨在确定（1）预测 NICU 出院时 MOM 喂养的因素，以及（2）调解出院时 MOM 喂养的种族/民族差异的因素。
对 415 名母亲及其极低出生体重婴儿的前瞻性队列研究进行二次分析。将变量分为五类（人口统计学、邻里结构、社会、产妇健康和 MOM 泵吸）。从每个类别中选择有意义的预测变量并输入多变量逻辑回归模型。
尽管 97.6%的婴儿接受了 MOM 喂养，但黑皮肤婴儿在出院时接受 MOM 喂养的可能性明显较小。阳性预测因素是每天泵吸频率、在 14 天内达到泵吸 MOM 量≥500ml/天，以及产妇年龄。负预测因素是低社会经济地位（SES）和婴儿的祖母对母乳喂养的感知支持。低 SES、产妇年龄和每日泵吸频率介导了种族/民族差异。
多种潜在的可改变因素可预测 NICU 出院时的 MOM 喂养。重要的是，低 SES、泵吸频率和产妇年龄被确定为种族和民族差异的中介因素。应制定并在未来研究中评估减轻可改变因素影响的策略。
