442 - Time of Initiation of Pumping vs Breastfeeding at Discharge of Preterm Infants

Poster Number: 442
Publication Number: 442.334

Mariela O. Sanchez Rosado, University of Texas Southwestern Medical School, Dallas, TX, United States; Jordan D. Reis, Baylor Scott & White, Prosper, TX, United States; isabelle M. Kiefaber, University of Texas Southwestern Medical School, Dallas, TX, United States; Larry S. Brown, Parkland Health & Hospital System, Dallas, TX, United States; Luc P. Brion, University of Texas Southwestern Medical School, Dallas, TX, United States

Background: The AAP policy statement on breastfeeding recommends that all preterm infants receive breast milk (BM) feeds. However, mothers delivering prematurely often have difficulty establishing full milk supply. Early BM expression within 1-6 hours of delivery is associated with increased BM production. In some NICUs, introduction of donor BM led to decreased maternal BM production. Donor BM (DBM) was introduced in our NICU in January 2020.

Objective: We aimed to (1) assess what characteristics are associated with longer time to first BM expression and (2) implement QI interventions to decrease time to first BM expression, with the goal of helping mothers establish supply to provide BM for their preterm baby beyond NICU discharge.

Design/Methods: Retrospective cohort study of deliveries at < 33 weeks gestational age (GA) or birthweight < 1500 g at Parkland Hospital between 03/2019 and 02/2021. A QI project aiming at encouraging NICU mothers to express BM as soon as possible after delivery was initiated in 09/2019 (Epoch-2) to limit changes after implementing a donor BM (DBM) program January 1st, 2020. Interventions included education of personnel and mothers, increased number of breast pumps, and earlier in-person contact between mothers and lactation consultants.

Results:
Among 522 neonates, 15 died during the first day of life and were excluded from the analysis. Among 507 infants, 130 were born in Epoch-1 and 377 in Epoch-2; time to first BM expression was available in 453 mothers. Demographics were similar among both Epochs (Table 1). The median time to first BM expression did not change significantly over time (Figure 1a); however, the range decreased transiently in Epoch-2 and increased again when DBM was introduced and during the COVID-19 pandemic (Figure 1b). In multivariate analysis, time to first BM expression increased with increasing GA, severe preeclampsia, and cesarean section (CS), did not decrease in Epoch-2 and was not affected by DBM (Table 2a). The odds of receiving BM feeds at NICU discharge increased with increasing GA and were higher in Hispanics and lower with DBM (Table 2b); the odds were not affected by time of first BM expression, or epoch.
Conclusion(s): Time to first BM expression increased with increasing GA, CS, and preeclampsia. It is possible that limited access of lactation consultants to mothers during the COVID-19 pandemic negated the initial benefits observed during QI initiation. The odds of BM feeding at time of NICU discharge increased with increasing GA and were highest in Hispanics and infants receiving DBM but were not associated with time of first BM expression. 
Figure 1. Median and Range of Times to First Breastmilk Expression X and R Charts
Table 1. Maternal and Neonatal Characteristics