Patterns and predictors of donor human milk non-consent in the neonatal ICU

Previous research has not evaluated predictors of donor human milk (DHM) non-consent status in a neonatal intensive care unit (ICU) setting within the United States. The purpose of this study is to identify and describe maternal and infant factors associated with DHM consent status in a Level IV inner-city neonatal ICU.

Demographics and additional maternal/infant data were stratified by DHM consent and compared with the appropriate parametric/nonparametric hypothesis testing statistic. A predictive multivariable logistic regression model was constructed, adjusted for independent predictors identified in the bivariate analysis (p≤0.2) using a backwards selection process (retention threshold p≤0.1). The adjusted odds ratios generated from the multivariable model identified predictors independently associated with DHM non-consent.

Data were analyzed for 113 mother-infant dyads from the first 18 months of a DHM program, with 65 mothers consenting to DHM and 48 not consenting. Race, ethnicity, marital status, education, delivery mode, and presence of a breastfeeding duration goal qualified for inclusion into the multivariable model. Only race and marital status were retained in the final model. In this sample, black race, other race, and being married are all independent predictors for DHM non-consent.

Black race, other race, and marital status statistically predicted DHM non-consent in a Level IV inner-city neonatal ICU. These results are relevant to all neonatal ICUs who use DHM and to those who are developing DHM programs.