P1.195: Breastfeeding Preterm Infants at 6 Months among Mother-Infant Dyads in the PeliCaN Trial of Doula and Midwifery Postpartum Care in the NICU

Background: Feeding mothers’ own milk is particularly important for promoting the development of preterm infants in NICUs. While lactation support efforts have resulted in higher rates of NICU breastfeeding initiation, rates of human milk feeding at time of NICU discharge remain suboptimal, with stark racial disparities. Black infants are half as likely to receive maternal milk at time of NICU discharge compared to White infants. The racial disparity in breastfeeding at NICU discharge is similar to disparities among all infants in the US at 6 months of age, the American Academy of Pediatrics recommended duration of exclusive breastmilk feeding. We hypothesized that optimizing postpartum care in the NICU with doula and midwifery support would improve long-term breastfeeding rates.

Methods: We conducted a secondary analysis of a completed randomized clinical trial of Postpartum Care in the NICU (PeliCaN). PeliCaN implemented doula-coordinated, midwife-delivered postpartum care in a level III NICU of a tertiary hospital in Philadelphia, Pennsylvania, with the goal of expediting and improving comprehensiveness of postpartum care for parents of preterm neonates ( < 34 weeks of gestation) with long term (≥1 week) NICU hospitalizations. Participants completed the National Health and Nutrition Examination breastfeeding survey at 6 months postpartum. Fisher's exact tests and log-binomial regression models compared proportions and calculated prevalence ratios (PRs) of breastfeeding between intervention and control participants.

Results: There were 20 intervention and 17 control participants enrolled from November 2022 to November 2023. The mean (SD) number of days postpartum at time of randomization for intervention and control participants was 5.1 (2.1) and 4.8 (1.8) days, respectively. There were 34 (92%, n=17 intervention and n=17 control) participants who completed the breastfeeding survey at 6 months postpartum (median 6.4 months, IQR 6.2-7.0). Among respondents, 14 (70%) intervention and 15 (88%) control participants reported ever providing breastmilk and were included in the analytic sample. The sample was majority publicly insured (89.7%) and identified as Black (75.9%). Intervention participants (50%) were significantly more likely to be actively breastfeeding at 6 months postpartum compared to control participants (13%) (p=0.05). In models adjusted for parity and infant age at time of survey, the association persisted (PR: 4.89, 95% CI: 1.24, 19.3).

Conclusion: PeliCaN increased the proportion of NICU parents who continued to breastfeed at 6 months, often well after NICU discharge. All intervention participants who were still actively breastfeeding at 6 months identified as Black, suggesting that long-term breastfeeding outcomes and associated disparities are modifiable. Further qualitative work to understand the reasons PeliCaN was successful at improving breastfeeding rates long after the intervention concluded, as well studies across many NICUs, are necessary to inform broad feasibility and effectiveness of PeliCaN to improve long-term breastfeeding for NICU dyads.