Barriers to Continued Provision of Human Milk for Black Mothers of VLBW Infants

描述（由申请人提供）：本研究的目的是确定为什么早产极低出生体重婴儿（VLBW，出生体重<1500 g或3 lbs）的黑人母亲比例不成比例。5盎司）停止母乳喂养（HM;在婴儿从新生儿重症监护室（NICU）出院之前，婴儿的母亲（即婴儿自己的母亲的母乳）供应不足，尽管开始母乳供应的比率与非黑人（白色和西班牙裔）母亲相同。在美国，黑人女性生育极低出生体重儿的频率是非西班牙裔白色（白色）女性的3.4倍，但与非黑人早产儿相比，接受人乳的黑人早产儿明显较少。这种种族差异增加了黑人VLBW婴儿短期和长期早产相关严重并发症的风险，包括感染、坏死性小肠结肠炎、再住院和神经发育延迟，因为HM喂养以剂量反应方式降低了这些昂贵和妨碍性并发症的风险。通过最先进的循证哺乳护理，新生儿重症监护病房中极低出生体重婴儿的黑人母亲中有96%开始哺乳，这一比例与极低出生体重婴儿的非黑人母亲相似。然而，尽管绝大多数（87%）的黑人母亲表示，他们希望在婴儿从NICU出院后继续提供人乳，但只有少数人在延长的NICU住院期间继续提供人乳，只有28%的黑人母亲在NICU出院时提供人乳，而非黑人母亲的比例为50%。这些数据表明，在整个新生儿重症监护病房住院期间，黑人与非黑人妇女维持HM供应的障碍可能不同。这项研究将检查广泛的预先存在的详细数据库，从一个大型的前瞻性极低出生体重婴儿队列研究，以确定障碍，促进黑人母亲提前停止HM提供。该研究将调查四类因素，同时控制产妇人口统计学：邻里结构因素：距新生儿重症监护室的距离、公共交通的便利性、哺乳资源、集中劣势和犯罪B。HM泵送系数：吸奶器的类型、出生后开始吸奶器的时间、吸奶器频率、每天吸奶器花费的分钟数以及在NICU住院期间每天产生的人乳体积。孕妇健康因素：孕前BMI、糖尿病、高血压和/或先兆子痫、分娩方式、多胎妊娠d。社会因素：母亲教育、朋友/家庭/伴侣支持、重返工作或学校、最接近NICU出院的人乳喂养目标、之前的人乳喂养经验、之前的配方奶粉喂养经验这些分析的结果将为针对所确定的最相关障碍的干预措施的未来发展提供信息。

DESCRIPTION (provided by applicant): The objective of this study is to identify why a disproportionate proportion of Black mothers of premature very low birth weight infants (VLBW, birth weight <1500g or 3 lbs. 5 oz.) discontinue human milk (HM; breast milk from the infant's own mother) provision prior to their infants' discharge from the neonatal intensive care unit (NICU), despite initiating HM provision at the same rates as non-Black (White and Hispanic) mothers. In the United States, Black women give birth to VLBW infants 3.4 times more often than non-Hispanic White (White) women, yet significantly fewer Black premature infants receive HM compared to non-Black premature infants. This racial disparity increases the risk of short and long term prematurity-related serious complications for Black VLBW infants, including infections, necrotizing enterocolitis, rehospitalizations, and neurodevelopmental delay because HM feedings reduce the risk of these costly and handicapping complications in a dose-response manner. With state-of-the art, evidence-based lactation care, 96% of Black mothers of VLBW infants in the NICU initiated lactation, a rate similar to that found in non-Black mothers of VLBW infants. However, although the vast majority (87%) of Black mothers stated that they would like to continue to provide HM after their infant's discharge from the NICU, only a minority of them continued to provide HM during the prolonged NICU hospitalization, with only 28%providing HM at NICU discharge compared to 50% of non-Black mothers. These data suggest that the barriers to maintaining HM supply throughout the NICU hospitalization may be different for Black compared to non-Black women. This study will examine the extensive preexisting detailed database from a large recent prospective VLBW infant cohort study to identify barriers contributing to early discontinuation of HM provision by Black mothers. The study will investigate four categories of factors while controlling for maternal demographics: a. Neighborhood Structural Factors: distance to NICU, access to public transportation, lactation resources, concentrated disadvantage, and crime b. HM Pumping Factors: type of breast pump, time to pumping initiation after birth, pumping frequency, minutes spent pumping daily, and HM volume produced daily over the NICU hospitalization c. Maternal Health Factors: pre-pregnancy BMI, diabetes mellitus, hypertension and/or preeclampsia, mode of delivery, multiple gestations d. Social Factors: maternal education, friend/familial/partner support, return to work or school, HM feeding goal closest to NICU discharge, previous HM feeding experience, previous formula feeding experience The results of these analyses will inform the future development of interventions targeting the most relevant barriers identified.