New recommendations to improve “mother's own milk” for premature infants

For premature infants who can't breastfeed on their own, "mother's own milk" (MOM) is by far the best nutrition. There's an urgent need for effective ways to increase the relatively low rates of MOM feeding for preterm infants born to Black and Hispanic mothers.

But so far, research has offered little or no specific guidance, concludes an evidence-based review in Advances in Neonatal Care, the official journal of the National Association of Neonatal Nurses. The journal is published in the Lippincott portfolio by Wolters Kluwer.

Until studies of targeted, culturally appropriate interventions are performed, the available evidence points to some promising approaches to overcoming obstacles and facilitating MOM feedings for premature infants of Black or Hispanic mothers, according to the review by Diana Cartagena, Ph.D., RN, CPNP, of Old Dominion University, Virginia Beach, Va., and colleagues.

No studies specifically designed to encourage MOM feedings for Black or Hispanic preterm infants Provided primarily by expressing (pumping) the mother's breast milk, MOM feedings have critical benefits for preterm infants - ranging from a lower risk of prematurity-related complications to fewer neurodevelopmental difficulties and disabilities later in childhood. The higher the "dose" of breast milk, the better the outcomes.

Minority mothers of premature infants may face special challenges in providing MOM feedings. "In the United States, Hispanic and Black preterm infants are less likely than their white counterparts to receive feedings consisting of MOM," Dr. Cartagena and coauthors write. They performed a comprehensive review of the past decade of research, looking for evidence-based strategies to encourage and improve MOM feedings to this group of infants.

However, the initial search identified "zero articles" - not a single study evaluating specific programs designed to promote MOM feedings in Black or Hispanic preterm infants.

All current strategies to encourage and improve breast milk expression and feeding in minority mothers are based on programs developed and tested mainly in White mothers."

Diana Cartagena, PhD, RN, CPNP, Old Dominion University

Thus the researchers broadened their search for promising approaches to decreasing racial/ethnic disparities in breast milk expression - focusing on studies that included at least 30 percent Black or Hispanic mothers. Based on ten such studies, Dr. Cartagena and colleagues make some recommendations to improve MOM feedings, including:

• Providing a welcoming, family-centered neonatal ICU environment. Professional lactation support is essential for all mothers of premature infants, including early help with breast milk expression and access to breast pumps and supplies. Giving mothers the opportunity to provide skin-to-skin care for their babies is a promising approach to establishing and maintaining the milk supply.
• Addressing language and cultural barriers. For Hispanic mothers, having translators and providing educational materials in the mother's native language are important strategies to reduce disparities. In one study, providing lactation support from bilingual counselors increased MOM feeding at discharge. In another study, Black women who set an initial goal to provide any breast milk for their premature infant were more likely to provide MOM after leaving the hospital.
• Providing social and emotional support. Black women may lack breastfeeding role models and experience; their own mothers (the baby's grandmother) may be an especially important source of support. For younger mothers, social media and even mobile apps may be appealing options. Emotional and technical support from hospital staff may help to overcome barriers to providing MOM, such as obtaining and learning to use a breast pump or challenges in the home environment.

"Limited evidence suggests that variation in neonatal ICU breastfeeding support practices may explain (in part), variation in disparities and supports further research in this area," Dr. Cartagena and colleagues write. They emphasize the need for rigorous, well-designed studies "to evaluate the effectiveness of targeted and culturally sensitive lactation support interventions in Hispanic and Black mothers."