Table 4.
Joint effects of maternal, neonatal, infant feeding, and lactation support factors on no breast milk at discharge among all infants admitted to the NICU.
| All infants | Extremely preterm infants | Late preterm infants | Term infants | |||||
|---|---|---|---|---|---|---|---|---|
| aOR (95% CI) | P value | aOR (95% CI) | P value | aOR (95% CI) | P value | aOR (95% CI) | P value | |
| Maternal factors | ||||||||
| Black race | 0.30 (0.10–0.93) | 0.04* | 0.11 (0.01–0.83) | 0.03* | NS | NS | ||
| Public health insurance | 0.48 (0.29–0.77) | <0.01** | 0.52 (0.17–0.57) | 0.25 | 0.09 (0.02–0.53) | <0.01** | 0.44 (0.19–1.02) | 0.06 |
| Transportation factors | 0.53 (0.31–0.93) | 0.03* | NS | NS | 0.41 (0.17–0.97) | 0.04* | ||
| Neonatal factors | ||||||||
| Outborn | 0.37 (0.20–0.70) | <0.01** | 0.54 (0.13–2.16) | 0.38 | 0.24 (0.06–1.04) | 0.06 | 0.34 (0.13–0.91) | 0.03* |
| Multiple births | 1.26 (0.61–2.64) | 0.53 | 6.03 (1.19–30.5) | 0.03* | NS | NS | ||
| Need for resuscitation | NS | 0.09 (0.02–0.31) | <0.01** | NS | NS | |||
| Gestational age (< 30 weeks) | 0.32 (0.13–0.78) | 0.01* | NA | NA | NA | |||
| Gestational age (34–36 weeks) | 0.46 (0.23–0.94) | 0.03* | NA | NA | NA | |||
| Sepsis | 0.43 (0.19-0.96) | 0.04* | 0.35 (0.10–1.23) | 0.10 | 0.19 (0.01–5.49) | 0.34 | NS | |
| Chronic lung disease | 0.08 (0.02–0.31) | <0.01** | 0.05 (0.01–0.29) | <0.01** | NS | NS | ||
| Necrotizing enterocolitis | 0.21 (0.06–0.69) | <0.01** | 0.15 (0.03–0.62) | <0.01** | NS | NS | ||
| Retinopathy of prematurity | 0.51 (0.20–1.32) | 0.17 | 0.72 (0.28–1.90) | 0.51 | NS | NS | ||
| Discharged on oxygen | 1.15 (0.38–3.47) | 0.80 | NS | NS | ||||
| Gastrostomy tube feeds at discharge | 0.36 (0.18–0.71) | <0.01** | 0.40 (0.12–1.30) | 0.13 | NS | NS | ||
| Nasogastric tube feeds at discharge | 0.64 (0.35–1.17) | 0.14 | 1.06 (0.33–3.43) | 0.93 | NS | 0.27 (0.11–0.69) | <0.01** | |
| Length of stay (days) | 0.98 (0.97–0.99) | <0.001*** | 0.97 (0.97–0.98) | <0.001*** | 0.97 (0.95–0.99) | 0.001** | 0.97 (0.96-0.99) | <0.0001*** |
| Weight at discharge (grams) | 0.99 (0.99–0.99) | <0.001*** | 0.99 (0.99–0.99) | <0.001*** | 0.99 (0.99–0.99) | 0.02* | 0.99 (0.99–0.99) | <0.008*** |
| Apnea on admit | 0.05 (0.01–0.30) | <0.01** | NS | 0.08 (0.01–0.71) | 0.02* | |||
| Hypoglycemia on admit | NS | NS | NS | 0.12 (0.03–0.55) | <0.01** | |||
| Infant feeding | ||||||||
| Donor milk | 0.22 (0.11–0.45) | <0.01** | 0.23 (0.07–0.71) | <0.01** | NS | NS | ||
| Formula | 0.12 (0.05–0.29) | <0.01** | 0.04 (0.00–0.50) | 0.01* | 0.03 (0.01–0.13) | <0.01** | ||
| Number of days to first feed | 0.93 (0.88–0.99) | 0.03* | 0.96 (0.87–1.07) | 0.47 | 0.92 (0.80–1.05) | 0.23 | 0.92 (0.79–1.08) | 0.35 |
| Lactation support factors | ||||||||
| Hours to first IBCLC visit after birth | 1.00 (0.99–1.00) | 0.54 | 1.01 (0.99–1.02) | 0.36 | 0.99 (0.98–1.00) | 0.48 | 0.99 (0.99–1.00) | 0.72 |
| Age at first IBCLC visit (days) | 1.01 (0.97–1.05) | 0.56 | 1.10 (0.83–1.46) | 0.49 | 0.94 (0.73–1.19) | 0.61 | 0.99 (0.97–1.02) | 0.68 |
| Number of IBCLC visits per week of hospitalization | 2.54 (1.81–3.57) | <0.0001*** | 5.27 (1.95–14.3) | <0.001*** | 7.63 (2.01–27.8) | 0.02* | 2.34 (1.43–3.85) | <0.01** |
| Frequency of IBCLC support in the first week | 1.21 (1.04–1.40) | 0.01* | 1.05 (0.81–1.35) | 0.70 | 1.81 (1.11–2.94) | 0.02* | 1.22 (0.94–1.58) | 0.13 |
| Frequency of IBCLC support during the hospital stay | 1.05 (0.99–1.10) | 0.10 | 1.09 (1.00–1.18) | 0.04* | 1.44 (1.07–1.93) | 0.01* | 1.02 (0.89–1.17) | 0.72 |
| Lack of IBCLC support at discharge | 0.30 (0.16–0.59) | <0.01** | 0.18 (0.04–0.84) | 0.03* | 0.07 (0.01–0.62) | 0.02* | 0.27 (0.09–0.75) | 0.02* |
| Lack of direct breastfeeding in the NICU | 0.08 (0.04–0.20) | <0.01** | 0.20 (0.05–0.78) | 0.02* | 0.11 (0.02–0.61) | 0.01* | 0.03 (0.00–0.21) | <0.01** |
*p < 0.05, **p < 0.01, ***p < 0.001, NS Not significant, NA Not applicable, and IBCLC International Board-Certified Lactation Consultant.
Adjusted for infant’s gestational age, gender, maternal race, maternal age, multiple births, and insurance factors.