Increasing Mothers' Own Milk Feeding to Black Infants in the Neonatal ICU: Training a Lactation Team in a Culturally Informed Behavioral Intervention - Modified Project Summary/Abstract Section Mothers’ own (breast)milk (MOM) is superior to formula and donor human milk, particularly for infants hospitalized in a neonatal ICU (NICU), yet NICU infants receive less MOM compared to healthy, full-term infants—and, Black/African American (Black hereafter) infants receive the least amount of MOM compared to other infants. Black infants have the highest NICU-admission prevalence (12%) and their lower MOM-feeding disparity is associated with health risks, including sepsis, asthma, and necrotizing enterocolitis, and costly re-hospitalizations. Women who lactate (mothers hereafter) who do not initiate or prematurely stop MOM feeding do not benefit from lactation’s cardio-metabolic restorative effects, which may reduce risks for breast and ovarian cancers and cardiovascular disease—diseases for which Black women experience elevated mortality and disproportionate burden. Black mothers tend to have culturally specific unique attitudes and beliefs that may affect lactation decisions. An innovative, culturally informed behavioral intervention addressing these unique factors may mobilize Black mothers to initiate pumping and manage ongoing stress and MOM-related ambivalence. Specifically, motivational and acceptance-based strategies provided by NICU-based lactation specialists may increase MOM feeding, and improve NICU-admitted Black infants’ health, if strategies are culturally informed and adapted to Black mothers. Our overarching aims are to evaluate the feasibility and efficacy of training NICU nurses (i.e., lactation specialists) on a novel, culturally informed combination of Motivational Interviewing (MI) and Acceptance and Commitment Therapy (ACT) interventions (i.e., MIACT) to increase Black infant MOM-feeding by delivering MIACT during lactation visits. MIACT will enhance motivation and psychological flexibility to reduce avoidance behaviors (i.e., not pumping). We will develop and refine a hospital-based intervention, train lactation specialists, and test initial efficacy using a 1-arm, interrupted time-series design. Black mothers of NICU infants will be eligible for inclusion, with very few exclusions. Planned enrollment is 525 mothers (N=613 infants [due to multiple births]) over 15 months. Outcome assessments will occur during infant hospitalization and discharge and at 6 months postpartum. We will access infant-feeding data in the electronic health record (EHR) to evaluate primary and secondary outcomes, resulting in rigorous implementation and outcome assessment. NICU-based lactation specialists (N=8) will receive MIACT training from expert trainers, with ongoing consultation and support. Training feasibility, maternal and lactation specialist acceptability, as well as adherence to and competence with MIACT, will be assessed. The proportion of infants receiving MOM within 24 hours of NICU discharge is the primary outcome of this foundational work combining two evidence-based behavioral strategies to target NICU-based MOM feeding to improve vulnerable, Black infants’ (and their mothers’) health.
