749 - Social Drivers of Human Milk Expression and Association with In-Hospital Outcomes for Preterm Infants in Addis Ababa, Ethiopia

Publication Number: 749.6743

Krystle M.. Perez, University of Washington, Seattle, WA, United States; Merhawit Abadi, Saint Paul's Hospital Millennium Medical College, ADDIS ABABA, Adis Abeba, Ethiopia; Redeat Workneh, St Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia, Adis Abeba, Ethiopia; Olivia C. Brandon, University of Washington: Magnuson Health Sciences Center – RR 544A, Seattle, WA, United States; Gal Barbut, Golisano Children's Hospital at The University of Rochester Medical Center, Rochester, NY, United States; Daniel A. Enquobahrie, University of Washington, Seattle, WA, United States; Rebecca Hoban, Seattle Children's, Seattle, WA, United States; Arianna Rubin. Means, Universi, Seattle, WA, United States; Gesit Metaferia, St. Paul's Hospital Millennium Medical College, Addis Ababa, Adis Abeba, Ethiopia; Mahlet Abayneh, St Paul's Hospital Millennium Medical College, Addis ABABA, Adis Abeba, Ethiopia; Sharla Rent, Duke University School of Medicine, Durham, NC, United States; Gregory C.. Valentine, University of Washington School of Medicine, Tacoma, WA, United States

Background: In low resource settings (LRS) with limited access to breast pumps and lactation specialists, breastfeeding (BF) and human milk (HM) expression practices may be affected by social support networks. Few studies have evaluated factors and outcomes associated with early BF and HM expression practices among mothers of preterm infants in a LRS neonatal intensive care unit (NICU).

Objective: In a LRS NICU, to (1) evaluate maternal, social and infant characteristics associated with BF and HM expression, and (2) determine associations of early BF and HM expression with in-hospital outcomes.

Design/Methods: We performed a mixed-methods study using survey-based questions distributed to mothers of infants admitted to a tertiary referral hospital NICU at St. Paul’s Hospital Millennium Medical College (SPHMMC) in Addis Ababa, Ethiopia. After excluding incomplete responses and responses from mothers of infants with congenital anomalies, responses from 302 mothers were analyzed. Descriptive statistics were used to summarize survey responses. Adjusted logistic regression was used to evaluate associations of maternal and infant characteristics and outcomes with BF and HM expression practices.

Results: Surveys were completed at median postpartum day 4 (IQR: 0, 12). Median infant birthweight was 1900 grams (IQR: 1532, 2225) and median gestational age was 35 weeks (IQR: 33, 37). Of the 280 mothers who BF in the NICU, 172 manually pumped HM. None reported access to electric pumps and 22 (7.3%) of respondents were neither BF nor attempting HM expression at the time of survey completion. Overall, 248 (82.1%) planned to exclusively BF post-discharge. High social support was reported across all BF and HM expression categories (Table 1). There were no observed differences among BF and HM expression groups in maternal education or employment status (Table 1). BF and HM expression frequency correlated with birthweight, gestational age, Apgar scores, respiratory support needs, and pump access (Table 1). Mothers who reported BF and HM expression had lower mortality odds and reduced length of NICU stay compared to those not BF and/or not expressing HM (Table 2, Figure 1).

Conclusion(s): While most mothers at SPHMMC NICU hoped to exclusively breastfeed upon NICU discharge, none had access to electric breast pumps. BF and HM expression were not associated with social support, maternal education, or maternal employment status. Further investigation is warranted to explore our findings that BF and HM expression was associated with improved survival and reduced length of stay in this LRS.

Table 1: Associations between HM Practices and Maternal, Social and Neonatal Characteristics
Continuous variables analyzed using Kruskal Wallis test to determine p-value across column groups. Categorical variables analyzed using Fisher’s exact test to determine p-values across column groups.
*Treated unknown as >1 hour.
#Need for respiratory support defined as need for mechanical ventilation, CPAP or nasal cannula.
HM: human milk

Table 2: Logistic Regression Models Evaluating Breastfeeding (BF) and HM Expression and (a) All-Cause Mortality and (b) Length of Stay
#Covariates included within adjusted regression models: birthweight, gestational age, respiratory support during hospitalization, age at time of survey, placement at breast within 1 hour of birth, pump access, Apgar score at 1 minute and Apgar score at 5 minutes.
°Imputed assumption of 60 days length of stay for neonates who died

Figure 1. Mortality and Length of Stay by HM expression group, (a) Overall mortality by expression group; (b) Unimputed length of stay by expression group; (c) Imputed length of stay by expression group.