488 - Multivariate Analysis of Factors Associated with Feeding Mother’s Own Milk (MOM) at Discharge in Preterm Infants: Retrospective Cohort Study

Poster Number: 488
Publication Number: 488.2207

Background: The WHO and AAP recommend that all preterm infants receive human milk feeds, including donor human milk (DHM) if MOM is not available. However, implementation of a DHM program can have variable effects on MOM feeding. Disparities in MOM feeding practices may be mediated by social determinants of health (SDOH).

Objective: The primary objective was to assess the association of SDOH and maternal and neonatal factors with MOM feeding at discharge among very preterm (VP, < 33 weeks’ gestational age (GA)) and/or very low birth weight (VLBW, < 1500 grams) infants. The secondary objective was to assess factors associated with time to first MOM expression.

Design/Methods: Secondary analysis of a retrospective cohort study designed to assess growth before (Epoch-1, 2018-2019) and after (Epoch-2, 2020-2021) implementing a DHM program in VP-VLBW infants at Parkland Hospital. In a subset, data was extracted from the electronic health record (EHR) to analyze timing of initiation of MOM expression.

Results: Among 1025 infants, 514 were born in Epoch-1 and 511 in Epoch-2 (Table 1). Initiation of MOM expression, assessed in 448 women, started later in association with severe preeclampsia, cesarean section, higher GA and female infants (Table 2). Feeding any MOM was more frequent in Hispanic than in Non-Hispanic Black infants (P < 0.001) but did not change with epoch (P=0.81) (Table 1). Continuation of MOM feeding to discharge was less frequent in Non-Hispanic Black than in Hispanic infants (46/124 or 37% vs 169/310 or 55%, P=0.001). The adjusted odds of feeding MOM at discharge was negatively associated with SDOH including neighborhood with higher poverty index, lack of prenatal care, maternal parity, drug abuse, Non-Hispanic Black vs Hispanic, and young maternal age but not with maternal insurance (Table 3). Feeding MOM at discharge was lower with later initiation of MOM feeding and higher level of respiratory support and increased with GA but was not associated with or epoch. Kitagawa-Blinder-Oaxaca decomposition analysis showed that 19.5% of the difference in feeding MOM at discharge between Hispanics and Non-Hispanics could be explained by later initiation of MOM feeding.

Conclusion(s): Feeding MOM at discharge was associated with several SDOH and neonatal factors. Its frequency did not change after implementing DHM. Decomposition analysis showed that disparity in MOM feeding at discharge is associated with later initiation of MOM feeding. This is an important modifiable risk factor that could be addressed to decrease disparity of MOM feeding at discharge.