Reducing Disparity in Receipt of Mother’s Own Milk in Very Low Birth Weight Infants: An Economic Intervention to Improve Adherence to Sustained Maternal Breast Pump Use

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Project Summary In the US, the burden of very low birth weight (VLBW; <1500 g) birth is borne disproportionately by black (non-Hispanic black/African American) mothers who are 2.2-2.6 times more likely than nonblack mothers to deliver VLBW infants, with 31% of all VLBW infants born to black mothers. This disparity is amplified because black VLBW infants are significantly less likely to receive mother’s own milk (MOM) feedings from birth until neonatal intensive care unit (NICU) discharge than nonblack infants, which precludes exclusive MOM feedings for the first 6 months of life as recommended by authorities and adds to the lifelong burden of VLBW birth. In addition, VLBW infants are susceptible to potentially preventable morbidities including late onset sepsis, necrotizing enterocolitis, bronchopulmonary dysplasia and long-term neurodevelopmental problems, which all increase risks of rehospitalization. A dose-response relationship exists between the amount of MOM feedings and a reduction in the risk of these morbidities and their associated costs, with the greatest risk reduction for all four morbidities afforded by high-dose MOM through to NICU discharge. Even though black mothers of VLBW infants initiate MOM provision at rates similar to nonblack mothers and have similar goals to sustain MOM provision through to NICU discharge, there is a significant disparity in MOM feedings at NICU discharge. Only the mother can mitigate the disparity in MOM feedings at NICU discharge for the VLBW infant, and this maternal behavior involves adhering to a two-part regimen: 1) sustaining breast pump use (6-8 times/day) for the entire NICU hospitalization (average = 73 days), and 2) transporting the MOM that is pumped in the home to the NICU for infant feedings. These behaviors are associated with out-of-pocket and opportunity costs that are borne by mothers, unlike inferior feeding alternatives such as donor human milk and formula, which are paid for by NICUs. This randomized control trial will test an intervention (NICU acquires MOM) developed to facilitate maternal adherence to this two-part regimen by offsetting the aforementioned costs that serve as barriers to sustaining MOM feedings: a) free hospital-grade electric breast pump, b) pickup of MOM, and c) payment for opportunity costs compared to current standard of care (mother provides MOM). The primary outcome will be receipt of MOM at NICU discharge, with secondary outcomes of volume of MOM pumped and total duration of pumping, infant’s receipt of any MOM feedings, duration of MOM feedings, and cumulative dose of MOM received at NICU discharge. Cost analyses will be performed to: 1) describe and compare the cost of the NICU acquiring MOM versus NICU acquiring donor human milk if MOM is not available; and 2) compare the cost effectiveness of NICU acquiring MOM versus mother providing MOM. This innovative trial will determine the effectiveness of the intervention in reducing the disparity in MOM feedings and provide an economic analysis of the interventions, yielding critical data impacting generalizability and likelihood of implementation of results.