TOP 15 - Lactation and maternal factors associated with maternal human milk use in preterm and very low birth weight infants

Publication Number: 2767.TOP 15

Sarah Song, Johns Hopkins Children's Center, Baltimore, MD, United States; Mackenzie Petersen, Johns Hopkins, Grafton, WI, United States; Amanda Finney, Johns Hopkins University School of Medicine, Columbia, MD, United States; Sean Tackett, Johns Hopkins University School of Medicine, Baltimore, MD, United States; Khyzer B. Aziz, Johns Hopkins University School of Medicine, Baltimore, MD, United States; Jennifer Fundora, Johns Hopkins University School of Medicine, Baltimore, MD, United States

Background: Human milk use is associated with numerous benefits for both infants and lactating parents. These benefits are increasingly crucial amongst infants born premature or with very low birth weight (VLBW) and include lower incidence of serious neonatal comorbidities, such as necrotizing enterocolitis, late-onset sepsis, chronic lung disease, retinopathy of prematurity, and neurodevelopmental impairment.

However, lactating parents of preterm and VLBW infants often face challenges in providing human milk. This includes perinatal maternal medical morbidities that contribute to delayed or reduced milk production; prolonged mother-infant separation, often requiring dependence on pumping to maintain milk production; and increased maternal stress and fatigue related to caring for an infant in the NICU. Studies have also found racial and socioeconomic disparities related to human milk provision in preterm infants.

Early milk expression, lactation consultant support, optimizing infant feeding practices, and maternal-infant skin-to-skin contact are felt to be promising interventions that may increase human milk provision, but limited research has been done in preterm and VLBW infants. Investigating factors associated with human milk use at discharge of preterm and VLBW infants could help identify key determinants of successful milk provision and potential areas for improvement in clinical practice and ultimately in neonatal outcomes.

Objective: To determine the association of maternal and early lactation factors with maternal human milk provision in preterm and VLBW infants.

Design/Methods: We conducted a retrospective cohort study of preterm ( < 34 weeks gestational age) and VLBW (birth weight < 1500 grams) infants admitted to Johns Hopkins Hospital NICU between October 2022 and January 2025. For each infant-mother dyad, we included variables related to perinatal and postnatal infant and maternal characteristics, such as demographic and hospitalization data. We also included variables related to early lactation support, such as lactation consultant visits, volume and frequency of maternal milk expression, and use of hospital-grade breast pumps. The primary study outcome was if the infant was receiving any maternal milk at NICU discharge. The proportion of enteral feeds that were given as maternal milk during the NICU hospitalization and at time of discharge was calculated as a secondary outcome. We are examining associations between demographic and lactation variables with our outcomes using bivariate and regression analyses.