Clinical and Sociodemographic Factors Associated With Human Donor Milk Supplementation in Term Newborns.

OBJECTIVES: To identify differences between healthy term newborns supplemented with human donor milk (HDM) and those supplemented with infant formula. We hypothesized that sociodemographic and clinical distinctions exist between newborns receiving different milk types. METHODS: This retrospective study included term newborns admitted to the postpartum unit between March 2017 and April 2019 with ≥1 supplemental feeding with HDM or formula for indications other than hypoglycemia. Maternal and newborn data were abstracted from the electronic medical record. RESULTS: Five hundred eighty-four dyads met inclusion criteria. More newborns received supplementation with formula than with HDM (57.7% vs 42.3%; P < .001). Infants undergoing phototherapy who required supplementation were more likely to receive HDM (P < .001). Newborns born to white and non-Hispanic mothers were more likely to receive HDM than those born to African American (adjusted odds ratio [aOR] 5.6; P = .007), Hispanic (aOR 3.0; P = .001), or Asian American mothers (aOR 2.7; P = .007). Newborns born to primiparous women (aOR 1.6; P = .03), those born to women with private insurance (aOR 3.7; P < .001), and those born via cesarean delivery (aOR 2.0; P < .001) were more likely to receive HDM. HDM use was more likely in primary English- or Spanish-speaking households (aOR 8.5; P = .009). Newborns receiving their first supplemental feeding during the day (aOR 1.9; P = .001) were more likely to be supplemented with HDM. CONCLUSIONS: There are clinical and sociodemographic differences between healthy term newborns supplemented with HDM and formula. These findings reveal that there are disparities in current supplementation practices for healthy newborns.

A preliminary survey of pediatricians' experiences with and preferences for communication with mental health specialists.

INTRODUCTION: Pediatricians are more likely than mental health (MH) specialists to manage children's MH concerns, and multiple factors complicate their abilities to do so adequately. Integrated care initiatives mitigate systems-related shortcomings that hamstring MH management in primary care. These initiatives, which improve outcomes for adults, are not widespread for youth. Integrated health care for children with MH concerns requires regular collaborative communication among pediatricians and MH specialists. The nature and quality of this communication in typical practice are not fully clear. METHOD: We conducted an anonymous pilot survey of 123 pediatric primary care providers from 41 states. We examined respondents' experiences with and attitudes about collaborative communication barriers and strategies. RESULTS: Respondents estimated that 28% of their patients had MH concerns. Nearly 30% reported discomfort treating these concerns, 54% described MH care resources in their communities as inadequate, and 24% of pediatricians reported no communication at all with MH specialists about shared patients. Actual contact among communicators was less frequent than desired. Satisfaction with communication was low. Barriers to satisfactory communication included systems factors, inconsistent/nontimely responses from specialists, and the perception that MH specialists are unwilling to communicate. DISCUSSION: Many pediatricians appear to view communication with MH specialists as less systematic than it ought to be. Efforts to address communication barriers may advance integrated care aims and mitigate pediatricians' perceptions of MH treatment resource inadequacy. As an important step toward integration, MH specialists should consider prioritizing systematic ongoing collaborative communication about shared patients. (PsycINFO Database Record