P3.A020: Targeted Interventions Associated with Reduced Disparities in Mother’s Own Milk Provision for High-Risk Infants

Purpose/Objectives: Mother’s own milk (MOM) is associated with improved short- and long-term morbidity and mortality for infants admitted to the neonatal intensive care unit (NICU). MOM provision reflects disparate community, workplace, and health system factors that enable a breastfeeding environment. In this safety net delivery hospital with a level 3 NICU, most mothers (80%) separated from their infants initiate milk expression. Only 55% meet early initiation goals, with lower rates for Black (52%), Hispanic (42%), and non-English speaking (40%) mothers. We sought to 1) improve overall MOM provision and 2) reduce racial, ethnic, and language-based disparities in MOM provision.

Design/Methods: Common barriers to early milk expression included “mother medically unstable” and “mother declined.” Common barriers to establishing and maintaining a full milk supply included insufficient/absent breastpumping supplies, lactation support, or breastfeeding education. Thus, we designed a family-directed educational intervention to increase awareness of the importance of early milk expression, set expectations for early milk volumes, and equip families with troubleshooting information. Materials were available in Spanish and English. Verbal and written education was provided at prenatal Neonatology consults regardless of gestational age or expected NICU length of stay.

Common barriers to obtaining breastpumping supplies included inadequate or absent insurance coverage for an appropriate breast pump. A second intervention was the direct provision of a double-electric breast pump and accessories prior to maternal discharge through philanthropic funding and partnership with a local breast pump provider.

Results: Fifty-four families received prenatal education June 2023-January 2024 (4% Asian, 7% Hispanic, 30% Black, 59% white). Most (96%) were English-speaking. Of 40 delivered infants, most (78%) required NICU admission and 25% were very low birth weight (VLBW), weighing < 1500 grams. Among mothers who received prenatal education, 39% met early initiation goals; rates were higher in white (43%) versus Black mothers (25%). Most infants (66%) received MOM at NICU discharge; rates were similar in white (65%) and Black mothers. Most VLBW infants (71%) were receiving MOM at NICU discharge. Rates were slightly higher in white (72%) compared to Black mothers (67%). MOM provision increased in multiple groups post-intervention, with a larger increase among Black infants (55% combined, 69% white, 36% Black).

Thirty-one pumps were distributed February 2023-January 2024 (average gestational age 33 weeks; average NICU length of stay 32 days). Mothers were primarily Black (32%) or Hispanic (45%); 45% were non-English speaking. The primary reasons for pump distribution were lack of insurance coverage for a pump (29%) or uninsured status (26%). Of infants discharged home (n=24), most (63%) were receiving MOM at discharge.

Conclusion/Discussion: MOM provision at discharge increased in mothers who received targeted prenatal education or an appropriate breast pump prior to discharge. These interventions preferentially benefitted non-white and non-English speaking mothers.