Parker Margaret G, Greenberg Lucy T, Edwards Erika M, Ehret Danielle, Belfort Mandy B, Horbar Jeffrey D
Department of Pediatrics, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts.
Vermont Oxford Network, Burlington, Vermont.
JAMA Pediatr. 2019 Oct 1;173(10):961-968. doi: 10.1001/jamapediatrics.2019.2645.
Human milk confers important health benefits to very low-birth-weight (VLBW) infants (≤1500 g). The extent to which the use of human milk has changed over time and the factors associated with human milk use nationally in this population are poorly understood.
To describe US trends in the provision of human milk at hospital discharge for VLBW infants during the past decade according to census region and maternal race/ethnicity, quantify associations of census region and maternal race/ethnicity with the provision of human milk at hospital discharge, and examine regional and state variations in any provision of human milk at hospital discharge among racial/ethnic groups.
DESIGN, SETTING, AND PARTICIPANTS: A cohort study was conducted of 346 248 infants, born at 23 to 29 weeks' gestation or with a birth weight of 401 to 1500 g, who were cared for at 802 US hospitals in the Vermont Oxford Network from January 1, 2008, to December 31, 2017. The US census region was categorized as West, Midwest, Northeast, and South (reference). Maternal race/ethnicity was categorized as non-Hispanic white (reference), non-Hispanic black, Hispanic, Asian and Pacific Islanders, and Native American.
Any provision of human milk at hospital discharge, defined as the use of human milk as the only enteral feeding or the use of human milk in combination with fortifier or formula.
Of the 346 248 infants in the study (172 538 boys and 173 710 girls), 46.2% were non-Hispanic white, 30.1% were non-Hispanic black, 18.3% were Hispanic of any race, 4.7% were Asian and Pacific Islanders, and 0.8% were Native American. Any provision of human milk at hospital discharge increased steadily among all infants, from 44% in 2008 to 52% in 2017. There were increases across all US census regions and racial/ethnic groups. Any provision of human milk at hospital discharge was higher in the West (among singleton births: adjusted prevalence ratio, 1.32; 95% CI, 1.25-1.39; among multiple births: adjusted prevalence ratio, 1.28; 95% CI, 1.21-1.35) and Northeast (among singleton births: adjusted prevalence ratio, 1.11; 95% CI, 1.04-1.19; among multiple births: adjusted prevalence ratio, 1.11; 95% CI, 1.04-1.19), compared with the South, and was higher among Asian mothers (among singleton births: adjusted prevalence ratio, 1.21; 95% CI, 1.18-1.25; among multiple births: adjusted prevalence ratio, 1.12; 95% CI, 1.09-1.15) and lower among Hispanic (among singleton births: adjusted prevalence ratio, 0.98; 95% CI, 0.96-1.01; among multiple births: adjusted prevalence ratio, 0.88; 95% CI, 0.86-0.91), Native American (among singleton births: adjusted prevalence ratio, 0.64; 95% CI, 0.59-0.70; among multiple births: adjusted prevalence ratio, 0.59; 95% CI, 0.50-0.69), and non-Hispanic black mothers (among singleton births: adjusted prevalence ratio, 0.67; 95% CI, 0.65-0.70; among multiple births: adjusted prevalence ratio, 0.57; 95% CI, 0.54-0.60), compared with non-Hispanic white mothers. These results were robust to adjustment for birth year and infant characteristics. Wide regional and state variations were found in any provision of human milk at hospital discharge.
Overall prevalence of any provision of human milk at hospital discharge among VLBW infants has steadily increased during the past decade. Disparities by US region and race/ethnicity in the provision of human milk exist and have not diminished over time.
母乳对极低出生体重（VLBW）婴儿（≤1500克）具有重要的健康益处。随着时间的推移，母乳使用情况的变化程度以及全国该人群中与母乳使用相关的因素尚不清楚。
根据人口普查区域和母亲种族/民族，描述过去十年美国极低出生体重婴儿出院时母乳供应的趋势，量化人口普查区域和母亲种族/民族与出院时母乳供应之间的关联，并研究种族/民族群体在出院时母乳供应方面的区域和州差异。
设计、设置和参与者：对2008年1月1日至2017年12月31日期间在佛蒙特牛津网络的802家美国医院接受护理的346248名婴儿进行了队列研究，这些婴儿的孕周为23至29周或出生体重为401至1500克。美国人口普查区域分为西部、中西部、东北部和南部（参考）。母亲种族/民族分为非西班牙裔白人（参考）、非西班牙裔黑人、西班牙裔、亚裔和太平洋岛民以及美洲原住民。
出院时任何母乳供应情况，定义为将母乳作为唯一的肠内喂养方式或与强化剂或配方奶联合使用。
在该研究的346248名婴儿中（172538名男孩和173710名女孩），46.2%为非西班牙裔白人，30.1%为非西班牙裔黑人，18.3%为任何种族的西班牙裔，4.7%为亚裔和太平洋岛民，0.8%为美洲原住民。所有婴儿出院时任何母乳供应情况均稳步增加，从2008年的44%增至2017年的52%。美国所有人口普查区域和种族/民族群体均有增加。与南部相比，西部（单胎出生：调整后的患病率比值，1.32；95%置信区间，1.25 - 1.39；多胎出生：调整后的患病率比值，1.28；95%置信区间，1.21 - 1.35）和东北部（单胎出生：调整后的患病率比值，1.11；95%置信区间，1.04 - 1.19；多胎出生：调整后的患病率比值，1.11；95%置信区间，1.04 - 1.19）出院时任何母乳供应情况更高；与非西班牙裔白人母亲相比，亚裔母亲（单胎出生：调整后的患病率比值，1.21；95%置信区间，1.18 - 1.25；多胎出生：调整后的患病率比值，1.12；95%置信区间，1.09 - 1.15）出院时任何母乳供应情况更高，而西班牙裔（单胎出生：调整后的患病率比值，0.98；95%置信区间，0.96 - 1.01；多胎出生：调整后的患病率比值，0.88；95%置信区间，0.86 - 0.91）、美洲原住民（单胎出生：调整后的患病率比值，0.64；95%置信区间，0.59 - 0.70；多胎出生：调整后的患病率比值，0.59；95%置信区间，0.50 - 0.69）和非西班牙裔黑人母亲（单胎出生：调整后的患病率比值，0.67；95%置信区间，0.65 -
