WIP 7 - Improving Breastfeeding Rates for Preterm Infants in the Neonatal Intensive Care Unit: A Quality Improvement Initiative

Poster Number: WIP 7
Publication Number: WIP 7.2590

Background: It has been well established that breastfeeding (BF) has numerous benefits for preterm infants and it empowers mothers to become effective primary caregivers. Although our prior endeavors in quality improvement (QI) yielded success in promoting the utilization of human milk in our Neonatal Intensive Care Unit (NICU), the rates of initiating and sustaining breastfeeding in preterm infants have continued to be suboptimal.

Objective: In a 12 month period, the goal was to improve the following:
1. Increase the BF initiation rate during transition from nasogastric to PO from 10% to 50%
2. Increase the overall rate of BF in the NICU by 10% from baseline
3. Increase the average number of BF attempts per infant by 20% from baseline

Design/Methods: A multidisciplinary team collaborated on this QI initiative, which encompassed three distinct periods: pre-QI (baseline; 06/2021-12/2021), QI-study (01/2022-12/2022), and surveillance (01/2023-12/2023). One of the key interventions involved the implementation of the 'BF Pathway' algorithm, which provided clinical guidance for staff to promote and support BF in preterm infants. The primary focus of the BF Pathway was to encourage exclusively BF attempts in mothers intending to breastfeed during the first three days of PO readiness (‘breast first’).

Study population: All infants admitted to the NICU with gestational age < 35 weeks and was initiated on PO feeding prior to discharge were included. Mothers who had contraindications to breastfeeding, infants transferred/died prior to PO readiness and infants who were unable to PO feed at all during the initial NICU stay were excluded. Outcome measures included the percent of babies who had any BF prior to NICU discharge, average number of BF attempts per infant during NICU stay. Process measure included the percent of infants whose first oral feeding was BF (‘breast first’ group). Balancing measure was length of NICU stay. Demographic data and additional data (Age at first PO attempt, anthropometrics) were collected and compared between the two groups: ‘breast first’ and ‘bottle first’.