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

描述(由申请人提供)：这项研究的目的是确定为什么早产极低出生体重儿(VLBW，出生体重和体重；1500克或3磅)的黑人母亲比例不成比例。5盎司。)在婴儿从新生儿重症监护病房(NICU)出院之前停止提供母乳(HM；来自婴儿自己的母亲的母乳)，尽管开始提供母乳的比率与非黑人(白人和西班牙裔)母亲相同。在美国，黑人妇女生下极低出生体重婴儿的频率是非西班牙裔白人(白人)妇女的3.4倍，但黑人早产儿患HM的比例明显低于非黑人早产儿。这种种族差异增加了黑人极低出生体重儿与早产相关的短期和长期严重并发症的风险，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不利的并发症的风险。通过最先进的循证哺乳护理，NICU中VLBW婴儿的黑人母亲中有96%开始哺乳，这一比例与VLBW婴儿的非黑人母亲相似。然而，尽管绝大多数黑人母亲(87%)表示，她们希望在婴儿出院后继续提供HM，但只有少数人在延长NICU住院期间继续提供HM，只有28%的人在NICU出院时提供HM，而非黑人母亲的这一比例为50%。这些数据表明，与非黑人女性相比，黑人在整个NICU住院期间维持HM供应的障碍可能不同。这项研究将检查大量先前存在的详细数据库，这些数据库来自最近一项大型的预期极低出生体重儿队列研究，以确定导致黑人母亲及早停止提供HM的障碍。这项研究将调查四类控制母亲人口学的因素：a.社区结构因素：到NICU的距离、公共交通工具、哺乳资源、集中的不利条件和犯罪；b.HM吸奶因素：吸奶器的类型、出生后开始吸奶的时间、吸奶频率、每天吸奶的分钟数、以及NICU住院期间每天产生的HM量c.母亲健康因素：孕前体重指数、糖尿病、高血压和/或先兆子痫、分娩方式、多胎d.社会因素：母亲教育、朋友/家人/伴侣支持、重返工作或学校、HM喂养目标离NICU出院最近、以前的HM喂养经验，以前的配方奶喂养经验这些分析的结果将为针对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.