Current Funded Research Projects

Health Benefits and Cost of Human Milk Feeding for Very Low Birthweight Infants
Principal Investigator
  • Paula Meier, RN, DSNc, FANN
Co-Principal Investigator
  • Janet L. Engstrom, RN, PhD, CNM, WHNP
  • Aloka Patel, MD, FAAP
  • Tricia Johnson, PhD
  • Louis Fogg, MD
  • Harold R. Bigger, MD, FAAP

October 2007 to September 2012

A series of small studies has suggested that human milk (HM) feedings protect very low birthweight (VLBW; birthweight <1500 g) infants from prematurity-specific morbidities that are costly and handicapping.  However, no previous research has conclusively linked HM feedings with improved infant health outcomes and lower neonatal intensive care unit (NICU) cost of care for this population, or has addressed whether longer and/or critical periods of exposure to HM feedings are necessary to achieve these beneficial outcomes.  In the absence of this evidence, the costs of providing HM, most of which are borne by mothers rather than public and private insurers, serve as barriers to the initiation and maintenance of lactation for mothers of VLBW infants, who are disproportionately likely to be low-income and African American.  The overall objective of this 5-year study is to examine the relationship between the independent variables of dose and exposure period of HM feedings, and the dependent variables of infant health outcomes and cost savings of HM feedings for VLBW infants throughout their stay in the neonatal intensive care unit (NICU).  The proposed project will follow a prospective cohort of 600 VLBW infants born to racially and economically diverse mothers (40% African American; 40% non-Hispanic Caucasian; 20% Hispanic; 60% low-income) throughout the NICU stay to test 3 major hypotheses:  that higher doses and longer and/or critical periods of exposure to HM feedings are associated with 1) a lower relative risk of mortality and prematurity-specific morbidities; 2) shorter length of NICU stay and appropriate infant growth; and 3) lower total NICU costs.   Eligible infants and their mothers who consent to participate in the study will be enrolled upon the infant’s admission to the NICU.  Data addressing the independent variables of dose and exposure period of HM feedings will be collected electronically for each enteral feeding throughout the infant’s entire NICU stay.  Data addressing the dependent variables of infant health outcomes and costs will be collected electronically at regular intervals, and will include the short-term costs of providing HM, such as breast pump rental, number of HM storage containers, and access to lactation experts, as well as total NICU health care costs.  Statistical analyses will include structural equation modeling, risk analysis, multiple regression analysis, and cost-effectiveness analysis.  


Significance:  This research is the first prospective study to examine the relationship between dose and exposure period of HM feedings and infant health outcomes and costs of HM feedings, for a large sample of VLBW infants born to representative numbers of African American and low-income women.  The findings from this study will translate readily into health policy and NICU protocols for this vulnerable population.

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Psychological distress in mothers of very low birth weight infants: association with parenting, breastmilk and maternal role development
Principal Investigator
  • Beverly Rossman
Co-Principal Investigator
  • Michelle Greene
  • Paula Meier
  • Michael Nelson
  • Kousiki Patra
  • Amanda Kratovil


Maternal psychological distress (MaPD) is seen in roughly 50% of mothers with infants in the NICU and can last for years after NICU discharge. MaPD does not consistently relate to infant medical severity; however, it is known to relate to NICU-related stress, such as altered maternal role development. MaPD symptoms (avoidance, hypervigilance, negative affect, social withdrawal) have been associated with altered parenting and parent-child relationships and, therefore, have been targeted by several NICU-based parent interventions.

The present study aims to prospectively investigate MaPD; i.e., anxiety, depression and post-traumatic symptomatology and its association with parent-child relationships and caretaking behaviors, including providing breastmilk and maternal role development among mother- very low birth weight (VLBW) infant dyads. The study proposes to investigate how providing breastmilk and maternal role development may mitigate MaPD.

In order to improve understanding of MaPD predictors and sequelae and inform future intervention, the study aims to: 1) examine the association between MaPD and avoidance of hospitals and medical appointments;  2) analyze the association between MaPD and parent-child relationship problems such as parental perception of child vulnerability during the first year of life; 3) better understand maternal role development through qualitative interview, and, 4) investigate whether alteration of maternal role mediates the association between providing breastmilk and MaPD.

60 mother- VLBW infant dyads will be recruited for participation. Twenty (20) of the 60 mothers will participate in a qualitative interview about maternal role development during infant NICU hospitalization. Maternal report of MaPD, and parenting data will be obtained via questionnaire data at 4 time points (2 during inpatient NICU hospitalization, 2 at infant outpatient follow-up appointments). Other psychological, medical, developmental and breastmilk data will be obtained through collaboration with Dr. Paula Meier’s pre-existing, NIH breastmilk database, and inpatient and outpatient medical chart review.

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