Medical Student Oregon Health & Science University School of Medicine Portland, Oregon, United States
Background: The benefits of breastmilk for infants, particularly for those in the Neonatal Intensive Care Unit (NICU), are well-recognized. The CDC reports that in 2017, up to 84.6% of infants received some breastmilk in the NICU. However, data on direct breastfeeding (DBF) is less available and less emphasized in the NICU, with a common misconception that it increases the length of stay. Studies have found that DBF during NICU admission correlates with continued breastfeeding after discharge. Additional benefits of DBF include bonding between parent and baby and increasing parental agency in their babies’ care.
The Hillsboro Medical Center (HMC) is a community hospital in Hillsboro, Oregon with an 8 bed combined NICU and pediatric unit. Here, we found that while many babies were discharged with all human milk, only 34% of patients had documented breastmilk transfer by pre-post weights or LATCH score ≥ 7 in the 2 days prior to discharge. This made it difficult to advise families on how to transition to direct breastfeeding at home, impacting long term continuation of breastfeeding. Objective: Our goal is to increase successful DBF rates at discharge for infants born at ≤ 36 weeks gestational age (GA) from 34% to 75% by November 1, 2023. Design/Methods: We updated the HMC NICU feeding guidelines to introduce DBF before bottle feeding, encourage nuzzle nursing without pre-post weights to focus on quality over quantity, and include flexible feeding times. Training was done with all NICU nursing staff and the new feeding protocol was started May 2022, with additional changes based on feedback completed in June 2023.
Data is being reviewed for patients ≤ 36 weeks birth GA admitted to the HMC NICU from May 1, 2020 to November 1, 2023. Our process metric is adequate provision of breastmilk, measured by the percent of patients receiving all expressed mother’s milk at discharge. Our outcome measure is documentation of DBF with effective transfer or LATCH score ≥ 7 in the 48 hours prior to discharge. Balancing measure is GA at discharge. The IRB determined this project to be exempt.
