Factors Influencing Breast Milk versus Formula Feeding at Discharge for Very Low Birth Weight Infants in California
Received 5 February 2009; received in revised form 8 April 2009; accepted 29 April 2009. published online 23 July 2009.
Objective
To investigate incidence and factors influencing breast milk feeding at discharge for very low birth weight infants (VLBW) in a population-based cohort.
Study design
We used data from the California Perinatal Quality Care Collaborative to calculate incidence of breast milk feeding at hospital discharge for 6790 VLBW infants born in 2005–2006. Multivariable logistic regression was used to examine which sociodemographic and medical factors were associated with breast milk feeding. The impact of removing risk adjustment for race was examined.
Results
At initial hospital discharge, 61.1% of VLBW infants were fed breast milk or breast milk supplemented with formula. Breast milk feeding was more common with higher birth weight and gestational age. After risk adjustment, multiple birth was associated with higher breast milk feeding. Factors associated with exclusive formula feeding were Hispanic ethnicity, African American race, and no prenatal care. Hospital risk-adjusted rates of breast milk feeding varied widely (range 19.7% to 100%) and differed when race was removed from adjustment.
Conclusions
A substantial number of VLBW infants were not fed breast milk at discharge. Specific groups may benefit from targeted interventions to promote breast milk feeding. There may be benefit to reporting risk-adjusted rates both including and excluding race in adjustment when considering quality improvement initiatives.
aDepartment of Pediatrics, Division of Neonatology, University of California, San Francisco, San Francisco, CA
bDepartment of Pediatrics, Division of Neonatal and Developmental Medicine, Perinatal Epidemiology and Health Outcomes Research Unit, Stanford University, Stanford, CA
Reprint requests: Henry Chong Lee, MD, Department of Pediatrics, Division of Neonatology, University of California, San Francisco, 533 Parnassus Ave, Room U503, San Francisco, CA 94143-0734.
ABSTRACT