313 - Evaluation of Key Barriers to Breast Milk Provision in a Level IV NICU

Publication Number: 3302.313

Shayda Ebrahimi, Phoenix Children's Hospital, Phoenix, AZ, United States; Shelley Akey, Phoenix Children's Hospital, Phoenix, AZ, United States; Amy Brown, Phoenix Children's Hospital, Phoenix, AZ, United States; Pamela Griffiths, Phoenix Children's Hospital, Gilbert, AZ, United States; Sheralyn Kaprolet, Phoenix Children's Hospital, Phoenix, AZ, United States; Gregory Martin, Phoenix Children's Hospital, Cave Creek, AZ, United States; Hemananda Muniraman, Los Angeles General Medical Center, los angeles, CA, United States; Michelle Weller, Phoenix Children's Hospital, Phoenix, AZ, United States; Jessica Wickland, Phoenix Children's Hospital, Phoenix, AZ, United States; Navin Bhopal, Phoenix Children's Hospital, Phoenix, AZ, United States

Background: Human milk is the standard for infant nutrition and is particularly beneficial for premature infants due to its protective effects against co-morbidities. However, breast milk provision in the NICU is challenging due to barriers, such as mother-infant separation, maternal health issues, inability to directly breastfeed, and prolonged hospital stays.

Objective: We sought to identify local barriers to breastfeeding and pumping and to detect disparities based on social determinants of health.

Design/Methods: A 36-question survey assessing breastfeeding goals, knowledge, barriers, and demographics was administered to mothers of infants admitted to Phoenix Children's level IV NICU within the first 7 days of life who remained for >7 days. Comments were thematically categorized using ChatGPT. Sub-group analysis of survey responses was then performed using the Kruskal-Wallis and Fisher Exact tests to evaluate continuous and categorical variables, respectively.

Results: 30 of 76 mothers completed the survey, all of whom agreed that their infants should receive breast milk. Participants were 50% Caucasian; the remainder identified as African American (3%), Hispanic (27%), Native American (10%), Asian (7%), or unspecified (3%). ChatGPT analysis of participants' comments identified major themes (Figure 1). Sub-group analysis revealed differences in survey responses based on race, insurance type, and lactation consultation (Figure 2, Table 1). African Americans and those describing their race as "other" were more likely to agree that water could be given to their babies. Hispanics were less likely to receive a lactation consult than other races, but language was surprisingly not identified as a major barrier. Mothers with public insurance were more likely to agree that formula is acceptable and more likely to stop pumping due to fatigue. Notably, 85% of mothers cited lack of family support as a barrier to pumping with no significant differences in responses based on race or insurance type.

Conclusion(s): Our Level IV NICU faces multifaceted barriers to breast milk provision, with disparities linked to race and insurance. One of the most frequently reported barriers was lack of family support, which was pervasive across all demographics analyzed. Disparities in breastfeeding knowledge and perceived difficulties in pumping highlight the need for tailored, equity-focused interventions, such as incorporating family members into initial lactation consultations and enhancing educational outreach to underrepresented groups. Future efforts should address social support systems as critical components in breastfeeding success.

Figure 1: ChatGPT analysis of survey responses identified predominant themes impacting breast milk provision in the NICU
a) Environmental/privacy barriers (36%): Difficulty pumping due to staff interruptions or lack of privacy.
b) Emotional/psychological impact (27%): Stress, guilt, or separation from baby affecting milk expression.
c) Equipment-related issues (18%): Problems with flange sizing and access to pumping supplies.
d) Lack of communication or involvement (18%): Mothers not informed of feeding plans or formula introduction.
e) Physical/medical challenges (18%): Health conditions interfering with supply or causing discomfort.
f) Positive feedback/support (18%): Some mothers expressed satisfaction with NICU staff or resources.

Figure 2: Responses to select survey questions stratified by race and insurance type
Responses to questions involving a Likhert scale are described as values between 1 and 5, where 1 represents "Strongly Disagree" and 5 represents "Strongly Agree." Values are shown as median and interquartile ranges. The * indicates a p-value < 0.05.

Table 1: Responses to select survey questions stratified by race, insurance type, and lactation consultation
Yes/no questions are described as counts (n) and percentages (%). The * indicates a p-value < 0.05.