The Babies Who Need It Most Get It Least: Breast Milk by Gestational Age, 2017

Breast milk is the best source of nutrition for babies, and for premature ones it does even more: it helps prevent sepsis and necrotizing enterocolitis — a serious disease of the gut in preterm infants — and supports brain development. Nearly one in 10 U.S. babies is born early each year. Yet the earlier a baby was born, the less likely it was to receive breast milk in its first days.

The first national picture

CDC used 2017 birth certificates from 48 states and the District of Columbia — 3,194,873 births, 82.7% of the total (California and Michigan data were not available) — which record whether a baby got any breast milk or colostrum, the mother's own or donated, before discharge. 83.9% did.

Who is missing out

• Among extremely preterm babies, 67.1% of those born to Black mothers and 60.7% of those born to American Indian/Alaska Native mothers received breast milk, against about 75% in other groups — a gap seen at every gestational age. These babies are also more likely to be born early, which compounds their risk of illness and death.
• At every gestational age, babies of mothers who were younger, less educated, unmarried, or on Medicaid or WIC were less likely to get breast milk.
• Late preterm and term babies not admitted to intensive care were more likely to receive it.

Why premature babies miss out

A very premature baby's gut or mouth may be too immature to feed, so nutrition goes into a vein. Mothers of preterm babies may not yet make enough milk and may lack access to donor milk. The American Academy of Pediatrics recommends breast milk for all preterm infants, and fortified, pasteurized donor milk when the mother's own is unavailable or unsuitable. In 2015, about 66% of hospitals with level 3 and 73% with level 4 neonatal intensive care units reported using any donor milk.

What hospitals can do

• Put in place maternity practices that support breastfeeding — proven to raise how often, how long and how exclusively full-term babies are breastfed — for every mother and baby.
• Give breastfeeding education throughout pregnancy, so mothers who deliver early are ready to breastfeed or pump.
• Widen access to donor milk so preterm babies get breast milk as soon as it is medically possible.
• Help mothers of babies in long hospital stays prepare for long-term pumping, with lactation follow-up throughout.
• Spread state perinatal quality collaboratives, which CDC supports, especially in hospitals serving groups with lower rates.

Limits

Birth certificates can't show how long or how exclusively babies were breastfed. They are filed within about 5–10 days, before some fragile babies can safely be fed, so later breast milk is missed. And checks against medical records found high agreement on gestational age and high sensitivity for breast milk, but 16–19% of birth-certificate records of breast milk were not confirmed in the chart. Overall, the 83.9% figure is close to CDC's survey estimate of breastfeeding initiation (83.2% for babies born in 2015).

Sources

Based on Chiang KV, Sharma AJ, Nelson JM, Olson CK, Perrine CG, "Receipt of Breast Milk by Gestational Age — United States, 2017," MMWR Morbidity and Mortality Weekly Report volume 68, number 22, Centers for Disease Control and Prevention; a work of the United States government in the public domain.