P3C072: Breastfeeding in Infants with Life Limiting Conditions: Examining Health Disparities and Facilitators

Background: Family Centered Care (FCC) is the gold standard of neonatal medicine, bestowing valuable strategies when especially treating those with life-limiting conditions (LLC). Many studies have established disparities in healthcare, but few have explored them amongst patients with a LLC, or used lactation support as a proxy measure to provide objective data of the quality of FCC provided to our many families. This scoping review addresses prenatal breastfeeding preferences and breastmilk (BM) provided at discharge, various health and sociodemographic disparities and facilitators in the medically complex neonate in our Neonatal Intensive Care Unit with the goal of optimizing FCC and closing the gap in healthcare disparities.

Aims:
Aim 1: Examine differences in prenatal preferences for breastfeeding by maternal demographics and infant conditions
Aim 2: Identify differences in percentage of breastmilk at discharge by maternal demographics and infant condition
Aim 3: Examine relative contribution of early, modifiable engagement factors on percentage of breastmilk at discharge

Methods: This was a single center retrospective chart review from 2015 to 2022 of infants with LLC as defined by Fraser et al. 2014 LLC. We included as part of LLC (lethal and nonlethal), patients with diagnosis of moderate/severe Hypoxic Ischemic Encephalopathy (HIE). 

We examined preferences for breastfeeding by maternal demographics and infant condition prenatally and also BM at discharge and evaluated the impact of the medical team's contribution of early, modifiable engagement factors. We analyzed the groups using Chi squared test, ANOVA with Tukey's post hoc testing and a Hierarchical linear regression.

Results: Prenatally - Lactation preferences differed by maternal race/ethnicity, income and language but not the neonatal LLC.

At discharge - Income was not significant but English speakers had higher BM rates compared to the Spanish. The type of LLC predicted % of BM in infants. A hierarchical linear regression conducted investigated maternal demographics, maternal engagement and provider engagement and this predicted 16.9% of the variance in BM.

Conclusion: Aim 1: Prenatal breastfeeding preferences
- African American mothers and mothers on Medicaid preferred formula over BM
- Infant condition did not predict maternal BM preference 

Aim 2: Breastmilk at discharge
- Breastmilk at discharge matched prenatal preferences for breastmilk with the exception of Spanish speaking mothers who preferred BM but were less likely to provide BM at discharge
- Infants with nonlethal LLC were most likely to receive higher % of BM at discharge > infants with HIE > infants with lethal LLC conditions

Aim 3: Early engagement matters
- Maternal engagement (E.g. skin-to-skin) predicted BM at discharge regardless of maternal racial demographics
- Provider early engagement augmented BM at discharge
- Families without prenatal BM preference documented were significantly less likely to provide breast milk