Published Research The Connecticut Human Milk Research Center has published several studies evaluating the effects of human milk in premature newborns. Brownell EA, Smith KC, Cornell EL, Esposito PA, Wiley CC, Wang Z, Bushley AW, Lussier MM, Hagadorn JI1. Five-Year Secular Trends and Predictors of Nonconsent to Receive Donor Milk in the Neonatal Intensive Care Unit. Breastfeed Med. 2016 May 18. [Epub ahead of print] In this study we identified independent maternal and infant factors associated with donor milk nonconsent and examined secular trends in nonconsent rates. Mothers of infants eligible to receive donor milk (≤32 weeks of gestation or ≤1,800g) born between August 2010 and 2015 were included. Multivariable logistic regression modeled odds of nonconsent. Of the 486 mother/infant dyads from the first 5 years of the donor milk program, nonwhite race (adjusted odds ratio [aOR] 1.69; 95% confidence interval [CI] 1.04–2.76) and increasing gestational age (aOR 1.11; 95% CI 1.03–1.21) independently predicted nonconsent. Each year the program existed, there was a 48% reduction in odds of nonconsent (aOR 0.52; 95% CI 0.43–0.62). The most common reason given for nonconsent was ‘‘it’s someone else’s milk.’’ Program duration was associated with reduced nonconsent rates and may reflect increased exposure to information and acceptance of donor milk use among neonatal intensive care unit staff and parents. Despite overall improvements in consent rates, race-specific disparities in rates of nonconsent for donor milk persisted after 5 years of this donor milk program. Further research is warranted to clarify the basis for racebased disparities in donor milk nonconsent rates, with the goal of designing interventions to reduce donor milk refusal among minority mothers. Cornell E, Lerer T, Hagadorn JI, Chapman DJ, Lussier M, Brownell E. A well-baby peer counseling program is not associated with human milk receipt in the NICU. J Perinatol. 2016 May 26. doi: 10.1038/jp.2016.75. [Epub ahead of print] In this study we evaluated the impact of a non-neonatal intensive care unit (NICU)-specific peer counseling (PC) program on the cessation of human milk receipt at and post-NICU discharge. A multivariable logistic regression model used data from 400 mother-infant dyads from a level IV NICU to compare cessation of human milk receipt at NICU discharge by PC program status. Kaplan-Meier distributions and a multivariable Cox proportional hazards model assessed the relationship between participants/non-participants and cessation of human milk post-NICU discharge. No statistically significant differences between groups in cessation of human milk either by or post-discharge were observed. Identified variables associated with the outcome(s) of interest included maternal and infant age, length of stay, presence of a breastfeeding duration goal and frequency of NICU lactation. Brownell EA, Hagadorn JI, Lussier MM, Goh G, Thevenet-Morrison KN, Lerer TJ, Herson VC, Howard CR. Optimal Periods of Exclusive Breastfeeding Associated with Any Breastfeeding Duration through One Year. J Pediatr. 2014 Dec 16 [EPub ahead of print]. In this study, we quantified optimal minimum durations of exclusive breastfeeding associated with maintenance of any breastfeeding at 15 time points during the first year of life. Mothers (n = 1189) from the prospective Infant Feeding Practices Study II cohort who initiated exclusive breastfeeding with healthy term infants were included. In a 80:20 split-sample validation study, receiver operating characteristic curves estimated optimal minimum durations of exclusive breastfeeding needed to predict maintenance of any breastfeeding at 15 time points during the first year (n = 951). Logistic regression estimated the predictive performance of the identified thresholds adjusted for maternal age, race, education, parity, support system, and return-to-work status. Results were validated in the remaining 20% (n = 238). Optimal minimum durations ranged from 4.0-17.1 weeks of exclusive breastfeeding associated with maintenance of any breastfeeding at 15 time points. All estimated threshold durations were not affected by maternal demographics or return to work status and were statistically significant after adjustment for those factors. Using a methodological approach unique to breastfeeding duration research, we identified optimal durations of exclusive breastfeeding associated with duration of any breastfeeding at time points throughout the first year. Perinatal clinicians, pediatricians, lactation professionals, policymakers, researchers, and families might apply these findings to achieve desirable collective breastfeeding duration outcomes. Hagadorn JI, Brownell EA, Lussier MM, Parker MG, Herson VC. Variability of Criteria for Pasteurized Donor Human Milk Use: A Survey of U.S. Neonatal ICU Medical Directors. JPEN J Parenter Enteral Nutr. 2014 Sep 29 [EPub ahead of print]. Use of donor human milk (DHM) is increasing, but criteria for its use are not well defined. In this study, we conducted a 34-question Internet-based survey of medical directors of U.S. level 3 and level 4 neonatal intensive care units (NICUs), with the goal of describing specifics of policies developed to guide DHM use in US NICUs. Respondents reported NICU characteristics and details of policies concerning DHM use. Respondents returned 153 (33%) surveys, with use of DHM reported by 91 (59%). Donor human milk use was more likely with more than 100 annual admissions Brownell EA, Lussier MM, Bielecki D, Proulx TA, Esposito P, Briere CE, Herson VC, Hagadorn JI. Patterns and Predictors of Donor Human Milk Non-consent in the Neonatal ICU. Breastfeed Med. 2014 Oct; 9:393-7. Previous research had not evaluated predictors of donor human milk (DHM) non-consent status in a neonatal ICU setting within the United States. The purpose of this study was to identify and describe maternal and infant factors associated with DHM consent status in a Level IV inner-city neonatal ICU. 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. 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. Marinelli KA, Lussier MM, Brownell E, Herson VC, Hagadorn JI. The Effect of a Donor Milk Policy on the Diet of Very Low Birth Weight Infants. J Hum Lact. 2014 Apr 18. In this study, we evaluated the effect a donor human milk program on the diet of very low birth weight infants. After introducing a donor human milk program in a level IV inner-city neonatal ICU, formula exposure significantly decreased and human milk exposure and the proportion of human milk diet increased. Also, the proportion of infants fed exclusively human milk increased and importantly, the consumption of maternal milk did not change. These results provide evidence that a donor human milk policy to supplement mother’s own milk for very low birth weight infants is desirable to increase human milk intake, decrease formula exposure and initiate enteral feeds with human milk earlier. Brownell EA, Lussier MM, Hagadorn JI, McGrath JM, Marinelli KA, Herson VC. Independent predictors of human milk receipt at neonatal intensive care unit discharge. Am J Perinatol. 2014 Nov; 31(10):891-8. Vermont Oxford Network clinical data were analyzed retrospectively for VLBW infants admitted 2002-2012 at an inner-city, level IV NICU with a well-established lactation program. We constructed a predictive model for very low birth weight (VLBW) infants’ receipt of mother’s own milk within 24 hours prior to Neonatal Intensive Care Unit discharge. We observed a 60.4% human milk feeding rate at discharge. Multiple independent maternal (black race, Hispanic ethnicity) and clinical factors (need for mechanical ventilation, patent ductus arteriosus, late-onset sepsis or discharge home on a cardio-respiratory monitor) positively predicted the outcome. Our results were inconsistent with previous studies and suggest that a strong Neonatal Intensive Care Unit lactation program in combination with a community-based peer counselor program may increase rates of human milk receipt among VLBW infants born to black/Hispanic mothers and those with more complicated neonatal courses. Brownell EA, Lussier MM, Herson VC, Hagadorn JI, Marinelli KA. Donor human milk bank data collection in North America: an assessment of current status and future needs. J Hum Lact. 2014 Feb; 30(1):47-53. The Human Milk Banking Association of North America (HMBANA) is a non-profit association that standardizes and facilitates the establishment and operation of donor human milk banks in North America. In 2010, the Food and Drug Administration recognized the need to collect and disseminate systematic, standardized donor human milk bank data and suggested that HMBANA develop a donor human milk data repository. The network of HMBANA milk banks each collect data on the donor human milk they receive and distribute, but a centralized data repository does not yet exist. In this study, we conducted phone interviews with individuals in different HMBANA milk banks to describe data currently collected by HMBANA donor human milk banks and to evaluate feasibility and interest in participating in a centralized data repository. Thirteen (61.5%) sites consented to participate. All respondents collected donor demographics, and half (50%; n=4) rescreened donors after six-months of continued donation. The definition of preterm milk varied between HMBANA banks (≤32 to ≤40 weeks). The specific computer program used to house the data also differed. Half (50%; n=4) indicated they would consider participation in a centralized repository. Without standardized data across all HMBANA sites, the creation of a centralized data repository is not yet feasible. Lack of standardization and transparency may deter implementation of donor milk programs in the NICU setting and hinder benchmarking, research and quality improvement initiatives.