47 - Maternal and Infant Predictors of Exclusive Expressed Breast Milk Feeding at NICU Discharge

Publication Number: 2044.47

Sheetal Sriraman, Columbia University Irving Medical Center, New York, NY, United States; Elisheva Rosner, NewYork-Presbyterian Morgan Stanley Children's Hospital, Clifton, NJ, United States; Sandhya S.. Brachio, Columbia University Vagelos College of Physicians and Surgeons, 622 W. 168th St, PH17, NY, United States; Thomas Hays, Columbia University Irving Medical Center, New York, NY, United States; Marianne Garland, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States

Background: Feeding exclusive expressed breast milk (EBM) at neonatal intensive care unit (NICU) discharge is associated with improved outcomes for preterm infants, yet rates vary widely, and sustaining lactation in the NICU is challenging. Identifying predictors of exclusive EBM use at discharge can guide targeted support.

Objective: To evaluate maternal and infant factors associated with exclusive EBM feeding at discharge in a level IV NICU.

Design/Methods: This retrospective cohort included infants born 22-32 weeks' gestation admitted to a level IV NICU between February and May 2024. Exclusions were maternal age < 18 years or delivery at >32 weeks. Maternal and infant data were collected from electronic health records. We examined the primary outcome of exclusive EBM feeding at discharge. We first compared maternal and infant characteristics of infants receiving all EBM vs those receiving some formula. We next constructed a stepwise logistic regression model, selecting characteristics that best predicted exclusive EBM feeding at discharge.

Results: Of 67 mother-infant dyads, 37 (55.2%) infants were discharged on exclusive EBM, 16 (23.8%) partially, and 14 (20.8%) not at all. Infants discharged on exclusive EBM had a higher median gestational age (29.6 vs. 28.1 weeks, p = 0.03). Low EBM volume on day of life (DOL) 7 ( < 350 mL) occurred more frequently among non-exclusive dyads (60.0% vs. 32.4%, p=0.04). Our model identified higher gestational age (aOR = 1.33, 95% CI = 1.04-1.68, p = 0.02) and first delivery (aOR = 4.59, 95% CI = 1.19-17.71, p = 0.03) as factors associated with exclusive EBM feeding at discharge. Low EBM volume at DOL 7 (aOR = 0.19, CI = 0.05-0.74, p = 0.02) and overnight delivery (aOR = 0.26, CI = 0.08-0.91, 0.04) were associated with reduced odds of exclusive EBM feeding. Multiparity and fewer than seven lactation consults were also included in the model, but were not statistically significant.

Conclusion(s): Just over half of preterm infants were discharged on exclusive EBM. Low EBM volume at DOL 7 and overnight delivery were strong risk factors for non-exclusive EBM. This may indicate that improved lactation support for overnight deliveries and in the first week after delivery could improve exclusive EBM feeding at discharge.

Table 1. Characteristics of Infants Stratified by Feeding Exclusively Breast Milk at Discharge
Abbreviations: EBM (expressed breast milk), DOL (day of life), TPN (total parenteral nutrition)
1 Values are shown as mean (SD) or n (%)
2 P-value calculated by chi-square or T-test as indicated

Table 2. Characteristics Associated with Feeding Exclusively Breast Milk at Discharge in a Stepwise Logistic Regression Model.
Abbreviations: aOR (adjusted odds ratio), CI (confidence interval), EBM (expressed breast milk), DOL (day of life)
1 Model selection by bidirectional stepwise regression, iteratively adding/removing predictors based on fit (Akaike Information Criterion), 95% confidence intervals, and p-values determined by Wald method