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Racial Disparities in Breastmilk Receipt and Extremely Low Gestational Age Neonatal Morbidities in an Asian Pacific Islander Population

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Abstract

Background

Racial disparities in breastmilk provision and neonatal morbidities of extreme prematurity have been documented in previous studies but are not as well-documented in Asian and Pacific Islander (API) infants. The objectives of this study were to evaluate a predominantly API neonatal intensive care unit (NICU) population for racial disparities in (1) the receipt of breastmilk within 24 h of admission and at discharge and (2) neonatal morbidities among infants ≤ 28 weeks gestational age.

Methods

A retrospective chart review of 2528 infants from 2018 to 2020 born at the largest level 3 NICU in Honolulu, Hawai’i, was conducted. Multivariable logistic regression analysis was performed on NICU outcomes to calculate adjusted odds ratios (aOR) and confidence intervals (CI).

Results

Native Hawaiian (NH) (aOR 0.73 [0.54, 0.98]), Pacific Islander (PI) (aOR 0.57 [0.41, 0.79]), and Filipino infants (aOR 0.66 [0.49, 0.89]) were less likely to receive breastmilk at discharge compared to Asian infants. PI infants were also more likely to experience necrotizing enterocolitis (aOR 7.89 [1.07, 58.10]) and intraventricular hemorrhage (aOR 3.86 [1.15, 13.02]) compared to Asian infants.

Conclusion

In a predominantly API population, disparities in breastmilk receipt and neonatal morbidities exist among NH, PI, and Filipino infants in the NICU. Our findings call for better understanding of the underlying inequities to guide directed efforts, including standardization of care through staff trainings on implicit biases and trauma-informed care, as well as provision of culturally sensitive education and lactation support for these patients.

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Data Availability

This data is not available publicly.

References

  1. Duale A, Singh P, Al Khodor S. Breast milk: a meal worth having. Front Nutr. 2021;8:800927.

    Article  PubMed  Google Scholar 

  2. Fox M, Siddarth P, Oughli HA, Nguyen SA, Milillo MM, Aguilar Y, et al. Women who breastfeed exhibit cognitive benefits after age 50. Evol Med Public Health. 2021;9:322–31.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Yang Y, Brandon D, Lu H, Cong X. Breastfeeding experiences and perspectives on support among Chinese mothers separated from their hospitalized preterm infants: a qualitative study. Int Breastfeed J. 2019;14:45.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Nayeri UA, Buhimschi CS, Zhao G, Buhimschi IA, Bhandari V. Components of the antepartum, intrapartum, and postpartum exposome impact on distinct short-term adverse neonatal outcomes of premature infants: a prospective cohort study. PloS One. 2018;13:e0207298.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Carome K, Rahman A, Parvez B. Exclusive human milk diet reduces incidence of severe intraventricular hemorrhage in extremely low birth weight infants. J Perinatol Off J Calif Perinat Assoc United States. 2021;41:535–43.

    Google Scholar 

  6. Sullivan S, Schanler RJ, Kim JH, Patel AL, Trawöger R, Kiechl-Kohlendorfer U, et al. An exclusively human milk-based diet is associated with a lower rate of necrotizing enterocolitis than a diet of human milk and bovine milk-based products. J Pediatr United States. 2010;156:562-567.e1.

    CAS  Google Scholar 

  7. Sato R, Malai S, Razmjouy B. Necrotizing enterocolitis reduction using an exclusive human-milk diet and probiotic supplementation in infants with 1000–1499 gram birth weight. Nutr Clin Pract Off Publ Am Soc Parenter Enter Nutr. United States. 2020;35:331–4.

    Google Scholar 

  8. Maffei D, Schanler RJ. Human milk is the feeding strategy to prevent necrotizing enterocolitis! Semin Perinatol United States. 2017;41:36–40.

    Article  Google Scholar 

  9. Wertheimer F, Arcinue R, Niklas V. Necrotizing enterocolitis: enhancing awareness for the general practitioner. Pediatr Rev United States. 2019;40:517–27.

    Article  Google Scholar 

  10. Patel AL, Johnson TJ, Robin B, Bigger HR, Buchanan A, Christian E, et al. Influence of own mother’s milk on bronchopulmonary dysplasia and costs. Arch Dis Child Fetal Neonatal Ed. 2017;102:F256–61.

    Article  PubMed  Google Scholar 

  11. Belfort MB, Anderson PJ, Nowak VA, Lee KJ, Molesworth C, Thompson DK, et al. Breast milk feeding, brain development, and neurocognitive outcomes: a 7-year longitudinal study in infants born at less than 30 weeks’ gestation. J Pediatr. 2016;177:133-139.e1.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Sigurdson K, Mitchell B, Liu J, Morton C, Gould JB, Lee HC, et al. Racial/ethnic disparities in neonatal intensive care: a systematic review. Pediatrics. 2019;144:e20183114.

  13. Horbar JD, Edwards EM, Greenberg LT, Profit J, Draper D, Helkey D, et al. Racial segregation and inequality in the neonatal intensive care unit for very low-birth-weight and very preterm infants. JAMA Pediatr. 2019;173:455–61.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Patel AL, Johnson TJ, Meier PP. Racial and socioeconomic disparities in breast milk feedings in US neonatal intensive care units. Pediatr Res. 2021;89:344–52.

    Article  PubMed  Google Scholar 

  15. Hoban R, Bowker RM, Gross ME, Patel AL. Maternal production of milk for infants in the neonatal intensive care unit. Semin Perinatol United States. 2021;45:151381.

    Article  Google Scholar 

  16. Liu J, Parker MG, Lu T, Conroy SM, Oehlert J, Lee HC, et al. Racial and ethnic disparities in human milk intake at neonatal intensive care unit discharge among very low birth weight infants in California. J Pediatr. 2020;218:49-56.e3.

    Article  PubMed  Google Scholar 

  17. Parker MG, Gupta M, Melvin P, Burnham LA, Lopera AM, Moses JM, et al. Racial and ethnic disparities in the use of mother’s milk feeding for very low birth weight infants in Massachusetts. J Pediatr United States. 2019;204:134-141.e1.

    Google Scholar 

  18. CDC. Breastfeeding Among U.S. Children Born 2010–2017, CDC National Immunization Survey [Internet]. 2020. Accessed June 23, 2021. Available from: https://www.cdc.gov/breastfeeding/data/nis_data/results.html

  19. Parker MG, Greenberg LT, Edwards EM, Ehret D, Belfort MB, Horbar JD. National trends in the provision of human milk at hospital discharge among very low-birth-weight infants. JAMA Pediatr. 2019;173:961–8.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Boghossian NS, Geraci M, Lorch SA, Phibbs CS, Edwards EM, Horbar JD. Racial and ethnic differences over time in outcomes of infants born less than 30 weeks’ gestation. Pediatrics. 2019;144:e20191106.

  21. Janevic T, Zeitlin J, Auger N, Egorova NN, Hebert P, Balbierz A, et al. Association of race/ethnicity with very preterm neonatal morbidities. JAMA Pediatr. 2018;172:1061–9.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Santos P, Joglekar G, Faughnan K, Darden J, Hendrich A. Disproportionate preterm delivery among black women: a state-level analysis. J Racial Ethn Health Disparities Switzerland. 2020;7:290–7.

    Article  Google Scholar 

  23. Grobman WA, Parker CB, Willinger M, Wing DA, Silver RM, Wapner RJ, et al. Racial disparities in adverse pregnancy outcomes and psychosocial stress. Obstet Gynecol. 2018;131:328–35.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Howell EA, Janevic T, Hebert PL, Egorova NN, Balbierz A, Zeitlin J. Differences in morbidity and mortality rates in black, white, and hispanic very preterm infants among New York city hospitals. JAMA Pediatr. 2018;172:269–77.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Wallace ME, Mendola P, Kim SS, Epps N, Chen Z, Smarr M, et al. Racial/ethnic differences in preterm perinatal outcomes. Am J Obstet Gynecol. 2017;216:306.e1-306.e12.

    Article  PubMed  Google Scholar 

  26. Travers CP, Carlo WA, McDonald SA, Das A, Ambalavanan N, Bell EF, et al. Racial/ethnic disparities among extremely preterm infants in the United States from 2002 to 2016. JAMA Netw Open. 2020;3:e206757.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Townsel C, Keller R, Kuo C-L, Campbell WA, Hussain N. Racial/ethnic disparities in morbidity and mortality for preterm neonates admitted to a tertiary neonatal intensive care unit. J Racial Ethn Health Disparities Switzerland. 2018;5:867–74.

    Article  Google Scholar 

  28. Ayers BL, Purvis RS, Bing WI, Rubon-Chutaro J, Hawley NL, Delafield R, et al. Structural and socio-cultural barriers to prenatal care in a US Marshallese Community. Matern Child Health J United States. 2018;22:1067–76.

    Article  Google Scholar 

  29. Okamoto SK, Kulis SS, Helm S, Chin SK, Hata J, Hata E, et al. An Efficacy Trial of the Ho’ouna Pono Drug Prevention Curriculum: an evaluation of a culturally grounded substance abuse prevention program in rural Hawai’i. Asian Am J Psychol. 2019;10:239–48.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Hayes DK, Boundy EO, Hansen-Smith H, Melcher CL. Maternal race trends in early infant feeding patterns in Hawai’i using newborn metabolic screening-birth certificate linked data 2008–2015. Hawaii J Health Soc Welf. 2020;79:42–50.

    PubMed  PubMed Central  Google Scholar 

  31. Goldstein GP, Pai VV, Liu J, Sigurdson K, Vernon LB, Lee HC, et al. Racial/ethnic disparities and human milk use in necrotizing enterocolitis. Pediatr Res. 2020;88:3–9.

    Article  PubMed  PubMed Central  Google Scholar 

  32. United States Census Bureau. U.S. Census Bureau QuickFacts: Hawaii [Internet]. U. S. Census Bur. 2010. Accessed August 17, 2021. Available from: https://www.census.gov/quickfacts/fact/table/HI/RHI525219#RHI525219

  33. Gibby CLK, Palacios C, Campos M, Lim E, Banna J. Breastfeeding discontinuation not associated with maternal pregravid BMI but associated with native Hawaiian or other Pacific Islander Race in Hawaii and Puerto Rico WIC Participants. Matern Child Health J. 2019;23:19–29.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Hayes DK, Mitchell KM, Donohoe-Mather C, Zaha RL, Melcher C, Fuddy LJ. Predictors of exclusive breastfeeding at least 8 weeks among Asian and Native Hawaiian or other Pacific Islander race subgroups in Hawaii, 2004–2008. Matern Child Health J. 2014;18:1215–23.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Estrada P, Ahn HJ, Harvey SA. Racial/ethnic disparities in intensive care admissions in a pregnant and postpartum population, Hawai’i, 2012–2017. Public Health Rep Wash DC 1974. United States; 2021;333549211021146.

  36. Hayes D, Shor R, Pieron P, Roberson E, Fuddy L. Premature birth fact sheet. Honolulu, HI: Hawai’i Department of Health, Family Health Services Division; 2010.

  37. Horbar JD, Edwards EM, Ogbolu Y. Our responsibility to follow through for NICU infants and their families. Pediatrics. United States; 2020;146:e20200360.

  38. Edwards EM, Horbar JD. Following through: interventions to improve long-term outcomes of preterm infants. Semin Perinatol United States. 2021;45:151414.

    Article  Google Scholar 

  39. Rich BS, Dolgin SE. Necrotizing enterocolitis Pediatr Rev United States. 2017;38:552–9.

    Google Scholar 

  40. Sharma M, VanderVeen DK. Identification and treatment of retinopathy of prematurity: Update 2017. NeoReviews. 2017;18:e84-90.

    Article  Google Scholar 

  41. Whitelaw A. Core Concepts: Intraventricular Hemorrhage. NeoReviews. 2011;12:394.

    Article  Google Scholar 

  42. Kim F, Bateman DA, Goldshtrom N, Sahni R, Wung JT, Wallman-Stokes A. Revisiting the definition of bronchopulmonary dysplasia in premature infants at a single center quaternary neonatal intensive care unit. J Perinatol Off J Calif Perinat Assoc United States. 2021;41:756–63.

    Google Scholar 

  43. Scott A, Shreve M, Ayers B, McElfish P. Breast-feeding perceptions, beliefs and experiences of Marshallese migrants: an exploratory study. Public Health Nutrition. 19:3007–16.

  44. Wood KM, Qureshi K. Facilitators and barriers for successful breastfeeding among migrant Chuukese mothers on Guam. SAGE Open Nursing. 2017;3:1–9.

    Article  Google Scholar 

  45. Edwards EM, Greenberg LT, Profit J, Draper D, Helkey D, Horbar JD. Quality of care in US NICUs by race and ethnicity. Pediatrics. 2021;148:e2020037622.

  46. Hermosura AH, Haynes SN, Kaholokula JK. A preliminary study of the relationship between perceived racism and cardiovascular reactivity and recovery in native Hawaiians. J Racial Ethn Health Disparities. 2018;5:1142–54.

    Article  PubMed  PubMed Central  Google Scholar 

  47. Morey BN, Tulua ’Alisi, Ong E, Kaholokula JK. Structural racism and its effects on native Hawaiians and pacific islanders in the United States: Issues of health equity, census undercounting, and voter disenfranchisement. AAPI Nexus: Policy, Practice and Community. 2020;17.

  48. Braun KL, Kim BJ, Ka’opua LS, Mokuau N. Native Hawaiian and Pacific Islander Elders: what gerontologists should know. The Gerontologist. 2014;55:912–9.

    Article  PubMed  PubMed Central  Google Scholar 

  49. United States Census Bureau. Race and ethnicity in the United States: 2010 census and 2020 census [Internet]. 2021. Accessed September 12, 2021. Available from: https://www.census.gov/library/visualizations/interactive/race-and-ethnicity-in-the-united-state-2010-and-2020-census.html

  50. US Department of Health and Human Services Office of Minority Health. Profile: Native Hawaiians/Pacific Islanders [Internet]. 2021. Accessed September 12, 2021. Available from: https://minorityhealth.hhs.gov/omh/browse.aspx?lvl=3&lvlid=65

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Acknowledgements

The authors would like to thank the faculty, staff, and generous donors of the Hawai’i Pacific Health Summer Student Research Program for their support of this project.

Author information

Authors and Affiliations

  1. Hawai’i Pacific Health, Honolulu, HI, USA

    Megan Y. Kawamura

  2. Patient Safety & Quality Services, Hawai’i Pacific Health, Honolulu, HI, USA

    Chieko Kimata

  3. Department of Pediatrics, John A. Burns School of Medicine, Hawai’i Pacific Health Kapi’olani Medical Center, Honolulu, HI, USA

    Kara Wong Ramsey

Authors
  1. Megan Y. Kawamura
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  3. Kara Wong Ramsey
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Contributions

The study conception and design were performed by Kara Wong Ramsey, MD. Material preparation, data collection, and analysis were performed by Chieko Kimata, PhD, MPH, MBA, and Megan Kawamura. The first draft of the manuscript was written by Megan Kawamura and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Megan Y. Kawamura.

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Ethics Approval

This study was reviewed by the Hawai’i Pacific Health Research Institute and determined to be exempt from institutional review board review.

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The authors declare no competing interests.

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Kawamura, M.Y., Kimata, C. & Wong Ramsey, K. Racial Disparities in Breastmilk Receipt and Extremely Low Gestational Age Neonatal Morbidities in an Asian Pacific Islander Population. J. Racial and Ethnic Health Disparities 10, 952–960 (2023). https://doi.org/10.1007/s40615-022-01283-w

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  • DOI: https://doi.org/10.1007/s40615-022-01283-w

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