Medical Student Texas A&M Health Science Center College of Medicine Spring, Texas, United States
Background: The early consumption of exclusive human milk (HM) in preterm infants during the first few weeks after birth promotes the colonization of a healthy gut microbiota, resulting in a significant probiotic effect. This effect plays a crucial role in preventing the growth of potential pathogenic bacteria and reducing the risk of complications such as necrotizing enterocolitis. While donor breast milk is a viable alternative when mother's own milk (MOM) is unavailable, the pasteurization process diminishes the probiotic benefits of HM. Thus, in our Neonatal Intensive Care Unit (NICU), we aimed to increase the use of MOM during the critical initial two weeks of life. Objective: Increase the proportion of infants with a birth gestational age (GA) of less than 35 weeks who receive at least 70% of their total enteral nutrition from MOM during the first two weeks of life by 20% compared to the baseline. Design/Methods: A multidisciplinary team of neonatologists, nurses, and lactation consultants (LC) identified key factors for increasing breast milk production and developed relevant interventions. The effectiveness of each intervention was assessed through Plan-Do-Study-Act (PDSA) cycles, with interventions initiated at specific time points (Fig 2). The study included all infants admitted to the 22-bed Level 3 NICU with GA <= 35 weeks and a minimum hospital stay of 14 days. Infants who were transferred or died within14 days of life were excluded. The study period was divided into three phases: Pre-QI (May 2020 - November 2020), QI (December 2020 - November 2022), and Surveillance (December 2022 - June 2023). Data collected: Process Measures: 1. number of mothers who pumped within 2hrs of delivery, 2. number of weekly calls made by LC to mothers. The LC calls were scripted to encourage frequent pumping and maintaining pumping logs. Outcome Measure: number of infants who receive at least 70% of their total enteral feeds as MOM in the first two weeks of life. Results: Data was collected from a total of 308 study participants. Pre QI: 52% of mom’s pumped within 2 hours. QI: 66 %. LC calls tracked since December 2020; 96% post-discharge mothers received ≥1 call/week. Infants with ≥70% MOM feeds during the first 2 weeks of life increased from 35% (Pre-QI) to 69% (QI) (p <= 0.05). Summary data shown in Figure 2.
Conclusion(s): MOM feeds increased by more than 20% from baseline in 12 months and this positive trend continued to strengthen throughout the surveillance period. These findings affirm the sustained effectiveness of our interventions over time, underlining the enduring impact of our quality improvement efforts.
.png)
.png)