O2206: Association of Maternal Compliance with Tele-lactation Visit and Availability of Breastmilk for Infants at Two, Four, and Six Months Post-Discharge from the Neonatal Intensive Care Unit.

Background: Breastmilk feeding is associated with improved neurodevelopmental outcomes in infants discharged from the NICU. While all mothers should ideally receive support for breastmilk feeding after NICU discharge, logistical factors (e.g., transportation needs, care of other children) and concerns for additional infectious exposures create barriers to in-person appointments for lactation support. Therefore, starting in 2020, the Transition To Home (T2H) program, through which we followed up with all infants via a virtual visit after discharge from the NICU, added a tele-lactation component to the program in late 2023. The same NICU provider evaluated both members of the mother-baby dyad: the Infant for follow-up and the mother for lactation support via telemedicine.

Methods: This Institutional Review Board-approved retrospective cohort study occurred at a NICU embedded within a large urban health system. All infants receiving breastmilk at discharge from this NICU and followed up in the hospital system were included and followed until 6 months. Data about the percentage of infants still receiving breastmilk were collected from their pediatrician visit documentation at 2, 4 and 6 months. The group with mothers who attended a post-discharge follow-up virtual lactation appointment (completed within a week after discharge) was compared to the group of mother/infant dyads who did not. Convenience sampling and Fisher’s exact test (2-sided) were utilized for statistical analyses.

Results: A total of 86 dyads were included during the study period. Of the 86 dyads, 58 (67.5%) attended the tele-lactation/post-discharge combined visit. Overall, the percentage of infants receiving breastmilk decreased from 70.9% at 2 months post-discharge to 51.1 at 6 months. The decline in breast milk feeding was disproportionately higher in the group that did not attend (64.3% to 35.7%) than those that attended visits (74.1% to 56.9%). A small percentage (17.4%) of mothers were seen in person after the tele-lactation consultation (19% vs 14 in each group) without a significant difference. Infants receiving tele-lactation visits were significantly more likely to receive breast milk in months 4 (63.8% vs 39.3%, p=0.03) and 6 (58.6% vs 35.7%, p=0.04).

Conclusion: To our knowledge, this is the first known program that combines the virtual visits of the Infant and mother after discharge from the NICU with a tele-lactation component. Infants who attended the telehealth appointment with their mother for the tele-lactation consultation were more likely to still receive breastmilk at 6 months. A small percentage of mothers needed in-person follow-up after the tele-lactation visit. Introducing tele-lactation into virtual NICU discharge follow-up visits represents a successful strategy to facilitate sustained breastmilk feeding following NICU discharge.