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Racial Disparities in Breastfeeding Initiation and Formula Use: Examining Neonatal Intensive Care Unit Design Transitions

Sat, August 9, 2:00 to 3:30pm, East Tower, Hyatt Regency Chicago, Floor: Ballroom Level/Gold, Grand Ballroom A

Abstract

Neonatal intensive care units (NICUs) seek to provide optimal care to sick and premature neonates. A common trend in the design of NICUs is transitioning from an open-bay (OPBY) design with multiple neonates in a large room with multiple attending nurses to a single-family room (SFR) design with each neonate having a private room that accommodates at least one parent to stay with the neonate. Few studies have examined the impact of transitioning NICU designs from OPBY to SFRs on the feeding outcomes of neonates, and few studies have examined Black breastfeeding initiation rates outside of the context of WIC. In this study, we examined the impact of a transition from OPBY to SFR on the types of feeding neonates received during their care in a NICU in a community with a high percent Black, thereby allowing us to examine breastfeeding initiation by Black mothers. We extracted measures from electronic health records for all neonates who received care in a NICU during a two-year period, including one year in OPBY and one year in SFRs. Our first hypothesis was that breastfeeding initiation will increase and formula feeding will decrease for neonates when the NICU transitions from OPBY to SFRs. We did not find support for our first hypothesis. Controlling for other factors, we generally found that breastfeeding initiation decreased and formula feeding increased when the NICU transitioned from OPBY to SFRs. It is important to note that the transition from OPBY to SFRs occurred during the COVID-19 pandemic, which highlights the important role of context on breastfeeding initiation and formula use. Our second hypothesis was that in both OPBY and SFR settings, breastfeeding initiation will be higher and formula feeding will be lower for White neonates than Black neonates. Controlling for other factors, we generally found lower breastfeeding initiation and higher formula feeding for Black mothers compared to White mothers.

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