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• W2571127158 abstract "See related article, p 59 See related article, p 59 For infants born very premature (<32 completed weeks of gestation) mother's milk feedings (direct breastfeeding and/or pumped human milk from the infant's own mother) during the neonatal intensive care unit (NICU) hospitalization reduce the incidence and severity of prematurity-associated morbidities and their associated costs.1Meinzen-Derr J. Poindexter B. Wrage L. Morrow A.L. Stoll B. Donovan E.F. Role of human milk in extremely low birth weight infants' risk of necrotizing enterocolitis or death.J Perinatol. 2009; 29: 57-62Crossref PubMed Scopus (395) Google Scholar, 2Patel A.L. Johnson T.J. Engstrom J.L. Fogg L.F. Jegier B.J. Bigger H.R. et al.Impact of early human milk on sepsis and health-care costs in very low birth weight infants.J Perinatol. 2013; 33: 514-519Crossref PubMed Scopus (193) Google Scholar, 3Johnson T.J. Patel A.L. Bigger H.R. Engstrom J.L. Meier P.P. Cost savings of human milk as a strategy to reduce the incidence of necrotizing enterocolitis in very low birth weight infants.Neonatology. 2015; 107: 271-276Crossref PubMed Scopus (101) Google Scholar, 4Patel A.L. Johnson T.J. Robin B. Bigger H.R. Buchanan A. Christian E. et al.Influence of own mother's milk on bronchopulmonary dysplasia and costs.Arch Dis Child Fetal Neonatal Ed. 2016; (Nov 2. pii: fetalneonatal-2016-310898; [Epub ahead of print])https://doi.org/10.1136/archdischild-2016-310898Crossref PubMed Scopus (64) Google Scholar Furthermore, evidence is accumulating that suggests exposure to mother's milk feedings during the NICU hospitalization improves long-term health outcomes including neurodevelopment in this vulnerable population.5Vohr B.R. Poindexter B.B. Dusick A.M. McKinley L.T. Wright L.L. Langer J.C. et al.Beneficial effects of breast milk in the neonatal intensive care unit on the developmental outcome of extremely low birth weight infants at 18 months of age.Pediatrics. 2006; 118: e115-23Crossref PubMed Scopus (437) Google Scholar, 6Vohr B.R. Poindexter B.B. Dusick A.M. McKinley L.T. Higgins R.D. Langer J.C. et al.Persistent beneficial effects of breast milk ingested in the neonatal intensive care unit on outcomes of extremely low birth weight infants at 30 months of age.Pediatrics. 2007; 120: e953-9Crossref PubMed Scopus (339) Google Scholar, 7Belfort M.B. Anderson P.J. Nowak V.A. Lee K.J. Molesworth C. Thompson D.K. et al.Breast milk feeding, brain development, and neurocognitive outcomes: a 7-year longitudinal study in infants born at less than 30 weeks' gestation.J Pediatr. 2016; 177: 133-139Abstract Full Text Full Text PDF PubMed Scopus (172) Google Scholar The mechanisms of protection afforded by mother's milk include immunologic, antimicrobial, anti-inflammatory, antioxidant, epigenetic, growth-promoting, and gut-colonizing functions, many of which are present in greater concentrations in the mother's milk of mothers who give birth prematurely. The protection from morbidities and their associated costs is a dose–response relationship, with the greatest doses of mother's milk providing the greatest protection.8Meier P.P. Patel A.L. Bigger H.R. Chen Y. Johnson T.J. Rossman B. et al.Human milk feedings in the neonatal intensive care unit.in: Rajendram R. Preedy V.R. Patel V.B. Diet and nutrition in critical care. Springer-Verlag, New York (NY)2015: 807-822Crossref Google Scholar Despite this evidence, achieving high-dose mother's milk feeding throughout the NICU hospitalization is challenging for mothers and NICU care providers. Mothers are dependent on the use of a breast pump to initiate and maintain lactation, often for an extended period of time while they are under the extraordinary stress of having an infant born very premature in the NICU.9Meier P.P. Patel A.L. Hoban R. Engstrom J.L. Which breast pump for which mother: an evidence-based approach to individualizing breast pump technology.J Perinatol. 2016; 36: 493-499Crossref PubMed Scopus (48) Google Scholar In addition, mothers frequently have health conditions such as pregnancy-induced hypertension that increase the risk of lactation problems. Thus, NICU care providers need specialized knowledge about breast pump dependency; the variability in the bioactive, nutritional, and caloric content of mother's milk; and the nuances of collecting, storing, and administering mother's milk to preserve the biological components in mother's milk that are associated with improved outcomes.8Meier P.P. Patel A.L. Bigger H.R. Chen Y. Johnson T.J. Rossman B. et al.Human milk feedings in the neonatal intensive care unit.in: Rajendram R. Preedy V.R. Patel V.B. Diet and nutrition in critical care. Springer-Verlag, New York (NY)2015: 807-822Crossref Google Scholar During the last 3 decades, researchers systematically have addressed the biological and mechanical barriers to mother's milk feedings in this population, and these findings have led to the development of best practices for mother's milk feeding that have been widely publicized, promoted, and translated to routine clinical care in some NICUs.10Meier P.P. Rossman B. Patel A.L. Johnson T.J. Engstrom J.L. Hoban R. et al.Human milk in the neonatal intensive care unit.in: A state-of-the-art view about human milk and lactation. Thieme, Stuttgart2017Google Scholar, 11Meier P.P. Patel A.L. Bigger H.R. Rossman B. Engstrom J.L. Supporting breastfeeding in the neonatal intensive care unit: Rush mother's milk club as a case study of evidence-based care.Pediatr Clin North Am. 2013; 60: 209-226Abstract Full Text Full Text PDF PubMed Scopus (71) Google Scholar, 12Meier P.P. Johnson T.J. Patel A.L. Rossman B. Evidence-based methods that promote human milk feeding of preterm infants.Clin Perinatol. 2017; https://doi.org/10.1016/j.clp.2016.11.005Abstract Full Text Full Text PDF PubMed Scopus (98) Google Scholar Although many of the biological and mechanical barriers have been addressed, a remaining challenge has been the elimination of maternal educational, economic, and racial disparities in mother's milk provision. Women who are educationally and economically disadvantaged and those from some racial minority groups are less likely to provide mother's milk than their more advantaged counterparts.11Meier P.P. Patel A.L. Bigger H.R. Rossman B. Engstrom J.L. Supporting breastfeeding in the neonatal intensive care unit: Rush mother's milk club as a case study of evidence-based care.Pediatr Clin North Am. 2013; 60: 209-226Abstract Full Text Full Text PDF PubMed Scopus (71) Google Scholar Recent studies have demonstrated that innovative clinical programs can reduce disparities in the provision of mother's milk for economically disadvantaged and racial minority women.11Meier P.P. Patel A.L. Bigger H.R. Rossman B. Engstrom J.L. Supporting breastfeeding in the neonatal intensive care unit: Rush mother's milk club as a case study of evidence-based care.Pediatr Clin North Am. 2013; 60: 209-226Abstract Full Text Full Text PDF PubMed Scopus (71) Google Scholar, 13Rossman B. Engstrom J.L. Meier P.P. Vonderheid S.C. Norr K.F. Hill P.D. “They've walked in my shoes”: mothers of very low birth weight infants and their experiences with breastfeeding peer counselors in the neonatal intensive care unit.J Hum Lact. 2011; 27: 14-24Crossref PubMed Scopus (59) Google Scholar This volume of The Journal contains an original research report by Herich et al14Herich L.C. Cuttini M. Croci I. Franco F. Di Lallo D. Baronciani D. et al.Maternal education is associated with disparities in breastfeedings at time of discharge but not at initiation of enteral feeding in the neonatal intensive care unit.J Pediatr. 2017; 182: 59-65Abstract Full Text Full Text PDF PubMed Scopus (28) Google Scholar that further extends this research, documenting the elimination of educational disparities in the initiation of mother's milk feeding the NICU. Of particular note is that this research reports the outcomes for a population-based cohort from NICUs in 3 regions of Italy, demonstrating that disparities can be reduced in diverse clinical settings in different geographic regions. Interventions in these exemplary programs include providing consistent messaging about the importance of mother's milk for infants born very premature,15Hoban R. Bigger H. Patel A.L. Rossman B. Fogg L.F. Meier P. Goals for human milk feeding in mothers of very low birth weight infants: how do goals change and are they achieved during the NICU hospitalization?.Breastfeed Med. 2015; 10: 305-311Crossref PubMed Scopus (40) Google Scholar, 16Bixby C. Baker-Fox C. Deming C. Dhar V. Steele C. A multidisciplinary quality improvement approach increases breastmilk availability at discharge from the neonatal intensive care unit for the very-low-birth-weight infant.Breastfeed Med. 2016; 11: 75-79Crossref PubMed Scopus (34) Google Scholar access to NICU-specific lactation expertise,16Bixby C. Baker-Fox C. Deming C. Dhar V. Steele C. A multidisciplinary quality improvement approach increases breastmilk availability at discharge from the neonatal intensive care unit for the very-low-birth-weight infant.Breastfeed Med. 2016; 11: 75-79Crossref PubMed Scopus (34) Google Scholar, 17Lee H.C. Kurtin P.S. Wight N.E. Chance K. Cucinotta-Fobes T. Hanson-Timpson T.A. et al.A quality improvement project to increase breast milk use in very low birth weight infants.Pediatrics. 2012; 130: e1679-87Crossref PubMed Scopus (99) Google Scholar and providing culturally adapted lactation support services via the use of NICU based-breastfeeding peer counselors.13Rossman B. Engstrom J.L. Meier P.P. Vonderheid S.C. Norr K.F. Hill P.D. “They've walked in my shoes”: mothers of very low birth weight infants and their experiences with breastfeeding peer counselors in the neonatal intensive care unit.J Hum Lact. 2011; 27: 14-24Crossref PubMed Scopus (59) Google Scholar, 18Rossman B. Kratovil A.L. Greene M.M. Engstrom J.L. Meier P.P. “I have faith in my milk”: the meaning of milk for mothers of very low birth weight infants hospitalized in the neonatal intensive care unit.J Hum Lact. 2013; 29: 359-365Crossref PubMed Scopus (51) Google Scholar A unique and highly significant finding of the study by Herich et al14Herich L.C. Cuttini M. Croci I. Franco F. Di Lallo D. Baronciani D. et al.Maternal education is associated with disparities in breastfeedings at time of discharge but not at initiation of enteral feeding in the neonatal intensive care unit.J Pediatr. 2017; 182: 59-65Abstract Full Text Full Text PDF PubMed Scopus (28) Google Scholar is the interaction between maternal education and early provision of mother's milk. Although the investigators found a significant positive impact of early exclusive mother's milk feedings on the provision of mother's milk through to NICU discharge, this effect was magnified greatly for mothers with the lowest educational levels. The translational implications of these findings are significant and provide potential interventions to combat the negative impact of limited maternal education. Although the elimination of educational, economic, and racial disparities in the initiation of mother's milk feeding during the critical period after birth is a significant accomplishment, in their research, Herich et al14Herich L.C. Cuttini M. Croci I. Franco F. Di Lallo D. Baronciani D. et al.Maternal education is associated with disparities in breastfeedings at time of discharge but not at initiation of enteral feeding in the neonatal intensive care unit.J Pediatr. 2017; 182: 59-65Abstract Full Text Full Text PDF PubMed Scopus (28) Google Scholar reported that education was associated with disparities in the continued provision of mother's milk at the time of NICU discharge. A similar pattern was reported by researchers who demonstrated the elimination of racial and economic disparities in the initiation of mother's milk feedings. Thus, this body of research suggests that the social determinants of health can be eliminated in the initiation of mother's milk feedings for infants born very premature, but these determinants continue to be associated with disparities in the continued provision of mother's milk through to NICU discharge, even when the mothers' goals were to continue providing their milk.14Herich L.C. Cuttini M. Croci I. Franco F. Di Lallo D. Baronciani D. et al.Maternal education is associated with disparities in breastfeedings at time of discharge but not at initiation of enteral feeding in the neonatal intensive care unit.J Pediatr. 2017; 182: 59-65Abstract Full Text Full Text PDF PubMed Scopus (28) Google Scholar, 15Hoban R. Bigger H. Patel A.L. Rossman B. Fogg L.F. Meier P. Goals for human milk feeding in mothers of very low birth weight infants: how do goals change and are they achieved during the NICU hospitalization?.Breastfeed Med. 2015; 10: 305-311Crossref PubMed Scopus (40) Google Scholar, 19Bigger H.R. Fogg L.J. Patel A. Johnson T. Engstrom J.L. Meier P.P. Quality indicators for human milk use in very low-birthweight infants: are we measuring what we should be measuring?.J Perinatol. 2014; 34: 287-291Crossref PubMed Scopus (32) Google Scholar, 20Briere C.E. McGrath J. Cong X. Cusson R. An integrative review of factors that influence breastfeeding duration for premature infants after NICU hospitalization.J Obstet Gynecol Neonatal Nurs. 2014; 43: 272-281Abstract Full Text Full Text PDF PubMed Scopus (45) Google Scholar, 21Fabiyi C. Rankin K. Norr K. Yoder J.C. Vasa R. White-Traut R. The association of low social support with breast milk expression in low-income mother-preterm infant dyads.J Hum Lact. 2015; 31: 490-497Crossref PubMed Scopus (8) Google Scholar, 22Fleurant E. Schoeny M. Hoban R. Asiodu I.V. Riley B. Meier P.P. et al.Barriers to human milk feeding at discharge of VLBW infants: maternal goal setting as a key social factor.Breastfeed Med. 2017; 12: 20-27Crossref PubMed Scopus (42) Google Scholar Although great progress has been made in the elimination of disparities in the initiation of mother's milk in the NICU, the continued provision of mother's milk feeding past thecritical period remains a challenge for many mothers and NICUs, and merits continued focus and the prioritization of research dollars. Although this task may seem daunting, not that long ago there were similar disparities in the initiation of mother's milk feedings in the NICU. These disparities were reduced by targeted clinical and research programs, which now must be adapted to address the disparities found in the continued provision of mother's milk through to NICU discharge for mothers of infants born very premature. Maternal Education Is Associated with Disparities in Breastfeeding at Time of Discharge but Not at Initiation of Enteral Feeding in the Neonatal Intensive Care UnitThe Journal of PediatricsVol. 182PreviewTo investigate the relationship between maternal education and breastfeeding in very preterm infants admitted to neonatal intensive care units. Full-Text PDF" @default.
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• W2571127158 title "Eliminating Disparities in Mother's Milk Feeding in the Neonatal Intensive Care Unit" @default.
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