113 - A multicenter safety-net NICU quality improvement collaborative shows sustained and equitable improvement in maternal milk at discharge rates in VLBW infants.

Publication Number: 3108.113

Kurlen Payton, Cedars-Sinai Health Sciences University, Los Angeles, CA, United States; Jessica Liu, Stanford University School of Medicine, Palo Alto, CA, United States; Audrey J. Buckland, Stanford University School of Medicine, Palo Alto, CA, United States; Janice K. Seto, Stanford University School of Medicine, Stanford, CA, United States; Courtney Breault, Stanford University School of Medicine, Palo Alto, CA, United States; Jochen Profit, Stanford University, Palo Alto, CA, United States

Background: Maternal milk is associated with reduced risk of NEC, BPD, late onset sepsis, and mortality in very low birth weight infants (VLBW). Rates of any human milk at discharge vary widely among California NICUs and are lower in safety net NICUs. A multicenter quality improvement collaborative was conducted to improve maternal milk intake among preterm VLBW infants in safety-net NICUs.

Objective: The SMART aim was to increase and sustain rates of any maternal milk at discharge from baseline 67% to 75% for all eligible VLBW infants born at participating safety-net NICUs by June 1, 2025.

Design/Methods: The IHI model for improvement was implemented with the active period from June, 2024 to June, 2025, and a sustainability period starting in July, 2025. The driver diagram displays the potentially better practices, and drivers (Fig 1). The primary outcome measure was the proportion of VLBW infants each month who received any human milk within 24 hours of discharge. Process measures included proportion of infants with skin to skin within 72 hours, hour of first colostrum administration, weekly lactation time outs, and at least one 24-hour period of milk expression >500 ml during the first 2 weeks of life. Balancing measures were growth velocity, change in z-score from birth to discharge, and length of stay. Measures were analyzed using statistical process control P-charts. Aggregate data were analyzed by month. Individual race/ethnicity data were analyzed by quarter. Sustained improvement was defined as eight or four consecutive points above the centerline for aggregate monthly data or individual race/ethnicity quarterly data respectively.

Results: 25 safety-net NICUs participated. The aggregate maternal milk at discharge rate increased from 68.9% during the baseline period to 76.8% during the active phase. Analysis stratified by the three race/ethnicity groups all showed five quarters of the active phase period above the centerline. There was also sustained improvement in time to first colostrum. There was no improvement with skin to skin or milk volume measures. Growth velocity and NEC rates were unchanged.

Conclusion(s): This preliminary data analysis after one year of a multi-center safety-net NICU VLBW maternal milk quality improvement collaborative shows a sustained 11.5% increase in maternal milk at discharge. There was equitable improvement among the three race/ethnicity groups analyzed.

MOMMs Diver Diagram


P-Chart for all participating infants
P-Chart for the primary outcome for all participating infants, by discharge month

P-chart by race/ethnicity
P-Chart for the primary outcome for all participating infants, by quarter and race/ethnicity