P3A093: Exclusive Breastfeeding in the Bronx – Successes and Shortcomings

Background: Despite efforts to maximize breastfeeding, exclusive breastfeeding (EBF) rates in the Bronx remain suboptimal. Hospital restrictions and uncertainty surrounding the side effects of COVID-19 greatly impacted the mother-infant dyad during the postpartum hospitalization. Preliminary studies found an initial decrease in EBF rates, but it is unclear if this effect was sustained after the initial wave of the pandemic.

The Bronx, NY is one of the poorest districts in the country with a racially and ethnically diverse population. Minority and socioeconomically disadvantaged patients are more likely to face barriers to breastfeeding. Moreover, as the epicenter of the pandemic, this population was particularly impacted by its effects. This study aimed to investigate the effect of the COVID-19 pandemic on birth hospitalization EBF rates among a high-risk urban patient population.

Methods: A retrospective chart review was conducted on newborns at an urban medical center between 2019 and 2021. Exclusionary criteria included neonatal demise, NICU admissions, and maternal HIV. Patients that delivered between March and July 2020 were also excluded to control for interruptions to EBF during the initial phase of the pandemic. Patients were separated into pre-pandemic and pandemic cohorts. Patient demographics, maternal comorbidities, length of stay, feeding method, and newborn characteristics, including those at high risk for hypoglycemia, were collected. EBF was defined as receiving only mother’s milk during the birth hospitalization. Descriptive statistics and bivariate analysis were used to examine the data.

Results: 630 pre-pandemic and 643 pandemic newborns were included. Baseline maternal characteristics did not differ between cohorts. Pandemic infants were more likely to be high risk for hypoglycemia (29.4% vs. 23.3%, p= 0.01), less likely to see the hospital lactation consultant (24% vs. 53.2%, p< 0.001), and had a decreased average length of stay (2.1 vs. 2.5 nights, p< 0.001). Most infants in both cohorts received some breastmilk during the hospitalization (94.6% vs 97.6%, NS). There was no significant difference in EBF rates between cohorts (11.4% vs. 9.5%, p= 0.29).

Conclusion: In contrast to the decreases in EBF seen at several other institutions, the pandemic incidence of EBF in the Bronx, NY did not significantly differ from pre-pandemic rates, despite an increase in high-risk newborns and fewer lactation consultations. Early discharges during the pandemic may have acted as a protective factor to counteract pandemic-related interruptions to breastfeeding.

While EBF rates were preserved, they remained below public health recommendations. Strategies to improve this outcome among a high-risk patient population may include increasing lactation consultation availability during the birth hospitalization and more thorough prenatal education. Maternal race, ethnicity, and primary language should also be further explored to better understand the implications of healthcare disparities on EBF and on the mother-infant dyad.