Infant Care Practices Research Articles

Impact of nutritional interventions among lactating mothers on the growth of their infants in the first 6 months of life: a randomized controlled trial in Delhi, India

ABSTRACTBackgroundIn lower-middle-income settings, growth faltering in the first 6 mo of life occurs despite exclusive breastfeeding.ObjectiveThe aim was to test the efficacy of an approach to improve the dietary adequacy of mothers during lactation and thus improve the growth of their infants.MethodsEligible mother–infant dyads (infants ≤7 d of age) were randomly assigned to either intervention or control groups. Mothers in the intervention group received snacks that were to be consumed daily, which provided 600 kcal of energy—with 25–30% of energy derived from fats (150–180 kcal) and 13% of energy from protein (80 kcal). Micronutrients were supplemented as daily tablets. We provided counseling on breastfeeding and infant-care practices to mothers in both groups. The primary outcome was attained infant length-for-age z scores (LAZ) at 6 mo of age. Secondary outcomes included exclusive breastfeeding proportion reported by the mother, maternal BMI and midupper arm circumference (MUAC), hemoglobin concentrations in mothers and infants, and the proportion of anemic infants at 6 mo of age.ResultsWe enrolled 816 mother–infant dyads. The intervention did not achieve a significant effect on LAZ at 6 mo (adjusted mean difference: 0.09; 95% CI: −0.03, 0.20). Exclusive breastfeeding at 5 mo was higher (45.1% vs. 34.5%; RR: 1.31; 95% CI: 1.04, 1.64) in the intervention group compared with the controls. There were no significant effects on mean hemoglobin concentration or the proportion of anemic infants at 6 mo of age compared with the control group. We noted significant effects on maternal nutritional status (BMI, MUAC, hemoglobin concentration, and proportion anemic).ConclusionsPostnatal supplementation of 600 kcal energy, 20 g protein, and multiple micronutrients daily to lactating mothers did not affect infant LAZ at age 6 mo. Such supplementation may improve maternal nutritional status. This trial was registered at Clinical Trials Registry–India as CTRI/2018/04/013095.

Caregiver experiences and healthcare worker perspectives of accessing healthcare for low-birthweight

ABSTRACT Background Low-birthweight (LBW) infants (<2500 g) are at greatest risk of mortality in the neonatal period, particularly in low- and middle-income countries. Timely access to quality healthcare averts adverse outcomes. Aim: To explore caregiver experiences and healthcare provider perspectives of accessing healthcare for LBW infants in rural Kenya. Methods This qualitative study was undertaken in Homa Bay County of in rural western Kenya in June 2019. In-depth interviews with eleven caregivers and four healthcare providers were conducted by a trained research assistant. All interviews were transcribed verbatim, and transcripts in the local languages were translated into English. A thematic framework was used to analyse the data. Results At the community and individual level,community misconceptions about LBW infants, inadequate infant care practices after discharge, lack of maternal support networks, long distances from healthcare facilities and lack of financial support were key challenges. In addition, long hospital waiting times, healthcare worker strikes and the apparent inadequate knowledge and skills of healthcare providers were disincentives among caregivers. Among healthcare providers, health system deficiencies (staff shortages and inadequate resources for optimal assessment and treatment of LBW infants) and maternal illiteracy were key challenges. Education by staff during antenatal visits and community support groups were enablers. Conclusion Accessing healthcare for LBW infants in this community is fraught with challenges which have implications for their post-discharge outcome. There is an urgent need to develop and test strategies to address the barriers at the community and health system level to optimise outcome..

Awareness of infant safe sleep messages and associated care practices: findings from an Australian cohort of families with young infants

ObjectiveTo investigate primary infant caregiver awareness of the current national public health safe sleep messages and the associations of awareness with care practices.Design and settingA cross-sectional survey in Queensland, Australia....

Determinants of severe acute malnutrition among children aged 6-59 months in the pastoral community of Liban District, Guji Zone, Oromia Regional State, Southeastern Ethiopia: a case-control study.

Malnutrition remains one of the most common causes of morbidity and mortality among children, particularly in Ethiopia. The present study aimed to assess determinants of severe acute malnutrition among children aged 6-59 months in the pastoral community of Liban District, Southeastern Ethiopia. A case-control study design was conducted on 89 cases and 177 controls from 1-30 December 2020. A simple random sampling technique was used to select study participants. Data collected using interviewer-administered structured questionnaire were used, and anthropometric measurements were done by standardised calibrated instruments to collect data. Data were entered into EPI data version 3.1 and then exported to SPSS version 25.0 software for analysis. All candidate variables with P < 0⋅25 in bivariate analysis were then entered into multivariable logistic regression. Associated factors were identified at P < 0⋅05 and 95% CI. A total of 266 (89 cases and 177 controls) having a response rate of 96⋅6% being underweight [adjusted odds ratio (AOR) = 11⋅8, 95% CI 3⋅17, 43⋅89], illness previous 2 weeks (AOR = 3⋅47, 95% confidence interval (CI) 1⋅34, 8⋅99), family member with malnutrition (AOR = 4⋅52, 95% CI 1⋅45, 14⋅01), greater than five family size, (AOR = 5⋅33, 95% CI 2⋅08, 13⋅66), mothers unable to read and write (AOR = 3⋅66, 95% CI 1⋅27, 10⋅56), mothers with low decision autonomy (AOR = 5⋅67, 95% CI 2⋅26, 14⋅27), not handwashing at all critical time (AOR = 7⋅23, 95% CI 2⋅74, 19⋅07), not feeding child animal source (AOR = 7⋅13, 95% CI 1⋅98, 25⋅59), bottle feeding (AOR = 7⋅06, 95% CI 2⋅34, 21⋅28) and being married (AOR = 0⋅05, 95% CI 0⋅02, 0⋅19) were significantly associated with acute malnutrition. The present study has confirmed the association of acute malnutrition with maternal education, underweight, family size and inappropriate infant caring practices.

Prevalence and perceptions of infant massage in India: study from Maharashtra and Madhya Pradesh states

BackgroundKnowledge of the prevailing infant care practices and their effects is important to inform practice and public programs. Infant massage is a traditional practice in India but remains less studied. This study was conducted to study the prevalence and perceptions of infant massage practices in two states of India.MethodsA total of 1497 caretakers of children under 18 months of age were interviewed in a cross-sectional study at immunisation units of medical schools in Maharashtra (MH) and Madhya Pradesh (MP) states and through home visits in villages in MH during March through August 2018.ResultsInfant massage was a prevalent practice (93.8% [95%CI: 92.4,94.9]) in both study states – 97.9%[95%CI:96.9,98.8] in MH and 85.3%[95%CI: 81.9,88.3] in MP – and the prevalence did not vary between male (94.5%) and female (93.5%) infants (p = 0.44). Massage was mostly initiated in the first week of life (82%); it is widely viewed as a traditional practice. It was common to massage the baby once daily (77%), before bathing (77%), and after feeding (57%). Massage was mostly conducted using oils (97%). In MH, preferred oils were a sesame oil-based proprietary traditional medicine oil (36%) and coconut oil (18%) while olive (29%) and mustard (20%) oils were most popular in MP. Commonly reported application techniques included gentle massage with minimal pressure, pressing (30%) and manually stretching certain joints (60%). Commonly reported perceived benefits of infant massage included increased bone strength, better sleep and growth, while no harm was perceived (95%).ConclusionInfant oil massage is a highly prevalent traditional practice in MH and MP. Clear guidance on the use of massage, choice of oil, and techniques for application is required to optimize benefits and minimize risks of this popular traditional practice.

The mPINC survey: Impacting US maternity care practices.

The Centers for Disease Control and Prevention administered the original Maternity Practices in Infant Nutrition and Care (mPINC) survey, a census of all US birth facilities, from 2007 to 2015 to monitor infant feeding‐related maternity care practices and policies. The purpose of this paper is to describe the many uses of mPINC data. Hospitals, organizations and governments (federal, state and local) have used the mPINC survey as a tool for improving care among the populations they serve. Nationally, the mPINC survey has been used to document marked improvements in infant feeding‐related maternity care. Researchers have used the mPINC data to examine a variety of questions related to maternity care practices and policies. The newly revised mPINC survey (2018) has been designed to capture changes that have occurred over the past decade in infant feeding‐related US maternity care. Hospitals, organizations, governments and researchers will be able to continue using this important tool in their efforts to ensure US maternity care practices and policies are fully supportive of breastfeeding.

Attitudes of Black South African Mothers towards the Use of Indigenous Healing and Western Medicine in the Treatment of Newborn Infants

While the infant mortality rate in South Africa has decreased, it remains a concern. Although there may not be any direct link between infant mortality and maternal infant-care practices, the health-seeking behaviour of mothers of newborn infants is a neglected area of research. Consequently, there is a need to understand the persons that mothers approach to prevent ill-health and restore and promote their infants’ health and well-being. The study therefore explored the attitudes of Black South African mothers regarding the use of indigenous and/or Western medicine for the treatment of childhood or infancy conditions. The study adopted a qualitative approach, guided by an Afrocentric perspective. Interviews were conducted with 18 participants and responses were analysed using thematic analysis. A key finding was that participants viewed monthly visits to Western-based healthcare clinics as necessary to monitor the development of their children. Consultations with traditional healers were intended to protect their infants against evil spirits. The main conclusion reached was that the use of traditional healing and Western medicine are not necessarily mutually exclusive. Mothers were able to see the value of both approaches, despite a preference for biomedicine.

Barriers and facilitators of exclusive breastfeeding: Findings from a Barrier Analysis Conducted in Mwenezi and Chiredzi Districts, Zimbabwe

A barrier analysis study was carried out in Mwenezi and Chiredzi Districts of Zimbabwe, to guide the development of a community-based behaviour change program. The aim of the barrier analysis was to identify factors that influenced a woman’s infant feeding and care practices. This paper reports the findings for one behaviour, exclusive breastfeeding. The study was based on the methodology from “A Practical Guide to Conducting a Barrier Analysis” (Kittle 2013). Structured in-depth interviews were administered to 91 women who were mothers of infants under the age of six months, 46 of whom who were exclusively breastfeeding and 45 who were not. Issues pertaining to self-efficacy, social support and perceived risks and benefits, as well as cultural and community norms and rules were identified. The qualitative analysis included sorting and identifying themes. Common barriers for exclusive breastfeeding were influence from the mother-in-law, high maternal workload, and perceived breast milk insufficiency. The main enablers were breastfeeding knowledge, the presence of a spouse/partner who assisted with chores and nurses who provided breastfeeding information. The insights gained from this study were used by Nutrition Action Zimbabwe to develop a behaviour change programme that was implemented from 2018-2020.

Association between Neonatal Intensive Care Unit Admission and Supine Sleep Positioning, Breastfeeding, and Postnatal Smoking among Mothers of Late Preterm Infants

To evaluate the association between neonatal intensive care unit (NICU) admission and breastfeeding practices, infant supine sleep positioning, and postnatal smoking among mothers of late preterm infants. Data from 36 states using the 2000-2013 Pregnancy Risk Assessment Monitoring System were analyzed. χ2 tests and 95% CI assessed infant and maternal characteristics and recommended care practices for late preterm infants based on NICU admission after birth. Adjusted prevalence ratios (APR) for breastfeedinginitiation and continuation at 10weeks, supine sleep position, and postnatal smoking were estimated using multivariable logistic regression models, controlling for infant and maternal characteristics. Analyses were weighted and SEs accounted for the complex survey design. Our sample included 62 494 late preterm infants, representing a weighted population of 1 441 451 late preterm infants. In the adjusted analysis, mothers of late preterm infants admitted to a NICU were more likely to initiate breastfeeding (APR 1.07; 95% CI 1.05-1.09) and place their infants in supine sleep position (1.04; 95% CI 1.01-1.06) than mothers of late preterm infants not admitted to a NICU. There was no significant difference between groups for breastfeeding continuation or postnatal smoking. Mothers of late preterm infants admitted to a NICU were more likely to initiate breastfeeding and practice supine sleep position than mothers of late preterm infants not admitted to a NICU. Future work should seek to identify the drivers of these differences to develop effective strategies to engage mothers in these health promoting infant care practices.

Introducing the Eating, Sleeping, Consoling Care Tool at The University of Vermont Children's Hospital (UVMCH)

Introduction: Given wide variation in care practices for infants with Neonatal Abstinence Syndrome (NAS) many clinicians aim to improve care through standardization. The Eating, Sleeping, Consoling (ESC) Care Tool standardizes both non-pharmacologic and pharmacologic care based on assessment of functional symptoms of opioid withdrawal and has been associated with a decrease in length of stay and pharmacologic treatment. Goal: Decrease the median percent of newborns who receive methadone postnatally for NAS by 30% between July, 2018 and January, 2019 by implementing the ESC Care Tool. Setting: At UVMCH, opioid exposed infants are routinely monitored on Labor and Delivery and the Newborn Nursery …

Infant Care Practices among Resettled Refugee Mothers from East and Central Africa.

Refugees often parent under extreme circumstances. Parenting practices have implications for child outcomes, and parenting in the context of refugee resettlement is likely to be dynamic as parents negotiate a new culture. This study examined African origin mothers’ infant care values and practices related to feeding, carrying, and daily activities following resettlement in the Southeastern region of the U.S. Ten African origin mothers were asked about their infant care practices through semi-structured interviews. Results indicated that mothers valued breastfeeding but often chose to use formula as a supplement or instead of breastfeeding. In addition, participants valued carrying their infants close to the body but used equipment such as strollers. Mothers expressed that perceptions of American culture and rules, social support, interactions with community agencies, and the need to engage in formal employment were factors that influenced their infant care practices.

Nurture Early for Optimal Nutrition (NEON) programme: qualitative study of drivers of infant feeding and care practices in a British-Bangladeshi population.

ObjectivesTo explore optimal infant feeding and care practices and their drivers within the British-Bangladeshi population of East London, UK, as an exemplar to inform development of a tailored, coadapted participatory community intervention.DesignQualitative community-based participatory research.SettingCommunity and children’s centres and National Health Service settings within Tower Hamlets, London, UK.Participants141 participants completed the community study including: British-Bangladeshi mothers, fathers, grandmothers and grandfathers of infants and young children aged 6–23 months, key informants and lay community members from the British-Bangladeshi population of Tower Hamlets, and health professionals working in Tower Hamlets.Results141 participants from all settings and generations identified several infant feeding and care practices and wider socioecological factors that could be targeted to optimise nutritional outcomes. Our modifiable infant feeding and care practices were highlighted: untimely introduction of semi and solid foods, overfeeding, prolonged parent-led feeding and feeding to ‘fill the belly’. Wider socioecological determinants were highlighted, categorised here as: (1) society and culture (e.g. equating ‘chubby baby’ to healthy baby), (2) physical and local environment (e.g. fast food outlets, advertising) and (3) information and awareness (e.g. communication with healthcare professionals around cultural norms).ConclusionsParenting interventions should be codeveloped with communities and tailored to recognise and take account of social and cultural norms and influence from different generations that inform infant feeding and care practices and may be of particular importance for infants from ethnically diverse communities. In addition, UK infant feeding environment requires better regulation of marketing of foods for infants and young children if it is to optimise nutrition in the early years.

Effect of community-based nutrition on infant nutrition and associated health practices in Narok, Kenya.

Lack of knowledge, and poor attitudes and practices among rural women have been shown to negatively influence maternal, infant and young child nutrition outcomes as well as child health and cognitive development. The aim of the study was to assess the impact of community-based nutrition on infant nutrition. A mixed method approach using a structured questionnaire to collect quantitative data (n=234) and Focus Group Discussions (FGDs) for qualitative data was used in Narok County, Kenya. About 57% of the participants received nutrition and health information from hospital trained health personnel. Whereas most women indicated having attended antenatal clinics, very few delivered in the hospital (17%). Exclusive breastfeeding knowledge was below 50%, although not statistically significant (p=0.584) across the education spectrum as opposed to identification of malnutrition signs, which was significant (p<0.05). Whereas 74% of the participants had knowledge about signs of malnutrition, only 58% could identify the causes. Rating for complementary feeding among the study participants was about 61% for introduction of complementary foods and 80% for frequency of feeding. Vitamin A supplementation knowledge, antenatal clinic attendance and type of waste disposal were statistically significant (p<0.05) in relation to education level of the study participants. This study reveals the need to educate rural women for increased understanding and practice of appropriate infant and nutrition care through sustainable and effective essential nutrition actions.

Investigating Mechanisms for Maternal Education Disparities in Enacting Health-Promoting Infant Care Practices.

Although higher education and healthier practices are positively associated, the explanatory mechanisms for this association remain unclear. The purpose of this study was to better understand mechanisms underlying this association by examining maternal adherence to 2 health-promoting infant care practices: supine placement and breastfeeding. We analyzed nationally representative data from the Study of Attitudes and Factors Effecting Infant Care, which surveyed US mothers after infant birth and 2 months thereafter. Using the Theory of Planned Behavior as a framework, we used structural equation models to elucidate mediational pathways from maternal education to supine infant placement or any breastfeeding. Data from 3297 mothers demonstrated 77.0% of infants usually were placed supine, and 57.8% received any breastfeeding. The overall direct effect of maternal educational level on supine placement and any breastfeeding was odds ratio (OR) 1.31 (95% confidence interval [CI] 1.11-1.54) and OR 2.82 (95% CI 2.35-3.37), respectively. In pathway analyses, the strongest associations with both supine position and breastfeeding were seen with positive attitudes (supine: aOR 18.96, 95% CI 9.00-39.92; breastfeeding: aOR 3.86, 95% CI 2.19-6.82) and positive social norms (supine: aOR 6.69, 95% CI 4.52-9.89; breastfeeding: aOR 5.17, 95% CI 4.28-6.23). Mothers with more education had higher odds of both positive attitudes and positive norms for the 2 practices. The associations linking educational attainment with health practices are intricate, with multiple mediating pathways. Attitudes and social norms are powerful forces that mediate the association between maternal educational attainment and both infant supine positioning and breastfeeding, and may be important mediators for other health behaviors.

Back to the Breast: An Historical Overview of the Perceived Connections Between Sudden Infant Death Syndrome and Breastfeeding.

In the late 19th century, physicians in the United States and Europe grew concerned about an increasingly visible subset of infant mortality: sudden infant death. Over the next 100 years, physicians worked variably to combat the problem, modifying and refining their conceptions of sudden infant mortality many times over the process. Physicians' overlapping revisions of sudden infant mortality ultimately helped to produce the categorization of Sudden Infant Death Syndrome (SIDS), and their ensuing, fluctuating efforts to resolve this problem shed light on social and medical perceptions of the roles that biology, the environment, and infant care practices played in sudden infant death. SIDS's official medical classification was a watershed; not only did the formal medical label establish its "authenticity" as a medical phenomenon, but the label also asserted the inexplicability of (at least some) sudden infant death episodes while simultaneously conveying that affected parents were deserving victims of a tragic loss. In the modern history of sudden infant death in the United States, breastfeeding, in particular, was understood variably as a possible cause for unnecessary infant mortality in the decades surrounding 1900; inconsequential to the occurrence of SIDS in the mid 1900s; and finally as an important and healthful way to reduce the risk for SIDS beginning in the late 1900s.

A Collaborative Learning Assessment of Developmental Care Practices for Infants in the Cardiac Intensive Care Unit

Assess differences in approaches to and provision of developmental care for infants undergoing surgery for congenital heart disease. A collaborative learning approach was used to stratify, assess, and compare individualized developmental care practices among multidisciplinary teams at 6 pediatric heart centers. Round robin site visits were completed with structured site visit goals and postvisit reporting. Practices of the hosting site were assessed by the visiting team and reviewed along with center self-assessments across specific domains including pain management, environment, cue-based care, and family based care coordination. Developmental care for infants in the cardiac intensive care unit (CICU) varies at both a center and individual level. Differences in care are primarily driven by variations in infrastructure and resources, composition of multidisciplinary teams, education of team members, and use of developmental care champions. Management of pain follows a protocol in most cardiac intensive care units, but the environment varies across centers, and the provision of cue-based infant care and family-based care coordination varies widely both within and across centers. The project led to proposed changes in clinical care and center infrastructure at each participating site. A collaborative learning design fostered rapid dissemination, comparison, and sharing of strategies to approach a complex multidisciplinary care paradigm. Our assessment of experiences revealed marked variability across and within centers. The collaborative findings were a first step toward strategies to quantify and measure developmental care practices in the cardiac intensive care unit to assess the association of complex inpatient practices with long-term neurodevelopmental outcomes.

Outcomes and care practices for preterm infants born at less than 33 weeks' gestation: a quality-improvement study.

Preterm birth is the leading cause of morbidity and mortality in children younger than 5 years. We report the changes in neonatal outcomes and care practices among very preterm infants in Canada over 14 years within a national, collaborative, continuous quality-improvement program. We retrospectively studied infants born at 23-32 weeks' gestation who were admitted to tertiary neonatal intensive care units that participated in the Evidence-based Practice for Improving Quality program in the Canadian Neonatal Network from 2004 to 2017. The primary outcome was survival without major morbidity during the initial hospital admission. We quantified changes using process-control charts in 6-month intervals to identify special-cause variations, adjusted regression models for yearly changes, and interrupted time series analyses. The final study population included 50 831 infants. As a result of practice changes, survival without major morbidity increased significantly (56.6% [669/1183] to 70.9% [1424/2009]; adjusted odds ratio [OR] 1.08, 95% confidence interval [CI] 1.06-1.10, per year) across all gestational ages. Survival of infants born at 23-25 weeks' gestation increased (70.8% [97/137] to 74.5% [219/294]; adjusted OR 1.03, 95% CI 1.02-1.05, per year). Changes in care practices included increased use of antenatal steroids (83.6% [904/1081] to 88.1% [1747/1983]), increased rates of normothermia at admission (44.8% [520/1160] to 67.5% [1316/1951]) and reduced use of pulmonary surfactant (52.8% [625/1183] to 42.7% [857/2009]). Network-wide quality-improvement activities that include better implementation of optimal care practices can yield sustained improvement in survival without morbidity in very preterm infants.

Infant care practices and parent uptake of safe sleep messages: a cross-sectional survey in Queensland, Australia

BackgroundGlobally, the incidence of sleep-related infant mortality declined dramatically following the first public health campaigns seen internationally in the 1990s to reduce the risks of sudden infant death. However, Australian Sudden Unexpected Death in Infancy (SUDI) rates have plateaued with little change in incidence since 2004 despite two further public health safe sleep campaigns. This study aims to describe contemporary infant care practices employed by families related to the current public health SUDI prevention program.MethodsA cross-sectional survey of 3341 Queensland primary caregivers with infants approximately 3-months of age was conducted using the Queensland Registry of Births, Deaths and Marriages as a sampling frame. Surveys were returned either via reply-paid mail or online. Questionnaires explored prevalence of infant care practices and awareness of safe sleep recommendations. Univariable analysis was used to generate descriptive statistics for key variables.ResultsOverall, only 13% of families routinely practised all six ‘Safe Sleeping’ program messages. More than one third (1118, 34%) of infants had slept in a non-supine sleep position at some time. Potentially hazardous sleep environments were common, with 38% of infants sleeping with soft items or bulky bedding, or on soft surfaces. Nearly half, for either day- or night-time sleeps, were routinely placed in a sleep environment that was not designed or recommended for safe infant sleep (i.e. a bouncer, pram, beanbag). Most babies (84%) were reportedly smoke free before and after birth. Sleeping in the same room as their caregiver for night-time sleeps was usual practice for 75% of babies. Half (1600, 50%) of all babies shared a sleep surface in the last two-weeks. At 8-weeks, 17% of infants were no longer receiving any breastmilk.ConclusionsThe prevalence rates of infant care practices among this Australian population demonstrate many families continue to employ suboptimal practices despite Australia’s current safe sleep campaign. Strategic approaches together with informed decisions about pertinent messages to feature within future public health campaigns and government policies are required so targeted support can be provided to families with young infants to aid the translation of safe sleep evidence into safe sleeping practices.

“A study to assess the effectiveness of structured teaching programme on knowledge and practice of infant care among primipara mothers” in Indira Gandhi Children Hospital, Bangalore

“A study to assess the effectiveness of structured teaching programme on knowledge and practice of infant care among primipara mothers” in Indira Gandhi Children Hospital, Bangalore

Center, Gestational Age, and Race Impact End-of-Life Care Practices at Regional Neonatal Intensive Care Units

To assess the impact of intercenter variation and patient factors on end-of-life care practices for infants who die in regional neonatal intensive care units (NICUs). We conducted a retrospective cohort analysis using the Children's Hospital Neonatal Database during 2010-2016. A total of 6299 nonsurviving infants cared for in 32 participating regional NICUs were included to examine intercenter variation and the effects of gestational age, race, and cause of death on 3 end-of-life care practices: do not attempt resuscitation orders (DNR), cardiopulmonary resuscitation within 6hours of death (CPR), and withdrawal of life-sustaining therapies (WLST). Factors associated with these practices were used to develop a multivariable equation. Dying infants in the cohort underwent DNR (55%), CPR (21%), and WLST (73%). Gestational age, cause of death, and race were significantly and differently associated with each practice: younger gestational age (<28weeks) was associated with CPR (OR 1.7, 95% CI 1.5-2.1) but not with DNR or WLST, and central nervous system injury was associated with DNR (1.6, 1.3-1.9) and WLST (4.8, 3.7-6.2). Black race was associated with decreased odds of WLST (0.7, 0.6-0.8). Between centers, practices varied widely at different gestational ages, race, and causes of death. From the available data on end-of-life care practices for regional NICU patients, variability appears to be either individualized or without consistency.