344 - Quality Improvement Project to Improve Breastfeeding Rates on Discharge from the NICU for Infants <33 Weeks

Publication Number: 3331.344

Elizabeth Hammond, The Children’s Medical Center at NYU Winthrop Hospital, Mineola, NY, United States; Joy Pavsic, NYU Langone Health, Mineola, NY, United States; Rebecca Goodman, The Children’s Medical Center at NYU Winthrop Hospital, Northport, NY, United States; Sonia Gil, The Children’s Medical Center at NYU Winthrop Hospital, Hempstead, NY, United States; Ulka Kothari, NYU, Glen Cove, NY, United States; Amrita Nayak, The Children’s Medical Center at NYU Winthrop Hospital, Mineola, NY, United States

Background: There are many known benefits to mother's own milk (MOM) feeding including optimal provision of nutrition, decreased duration of central line infections, decreased incidence of late onset sepsis, and immunoprotective effects against intestinal pathogens. Barriers include lack of lactation education or maternal breast milk supply. For premature infants, lactation consultations and support for breastfeeding mothers are extremely vital aspects of care in the NICU. This quality improvement project was conducted to increase the number of infants feeding MOM on discharge from the NICU.

Objective: The smart aim was to improve the percentage of babies, gestational age < 33 weeks, discharged from the NICU on mother's breastmilk by at least 10% in one year. The secondary aims are an increase in weight gain and head circumference z-scores. Our balancing measures were a decrease in donor breast milk and formula usage.

Design/Methods: We obtained baseline data from April 2024 through April 2025. An interdisciplinary team of high-stake holders met to create an electronic note template consisting of triage questions focused on type of pump used, pumping duration and frequency, and quantity of milk being produced. This template was used for weekly lactation triage phone calls to mothers with the intention to breastfeed.

Results: Our baseline data from April 2024 to April 2025 demonstrated that the average percentage of infants discharged from the NICU feeding MOM was 40%. After six months of our interventions, the average percentage has increased to 49%. Formula usage had a net zero change over the course of the first cycle. There was a reduction in the usage of donor milk by 4% as the usage of MOM improved. There was a positive correlation between both birth and discharge weight and head circumference z-scores.

Conclusion(s): After only six months of our intervention, we have increased the average percentage of infants discharged from the NICU feeding mother's breastmilk by 9%. During our first PDSA cycle we noticed an initial decline, and this was addressed with the addition of a certified bilingual staff member and targeted parental education. Upon discharge, formula is offered as a supplement when mother's supply is less than necessary, a likely reason for formula usage on discharge being documented. Limitations included difficulties completing weekly phone calls and a lack of initial awareness of the project. Future plans include implementation of interdisciplinary huddles, increasing bedside nurse participation, and extending triage phone calls to all gestational ages in the NICU.

Figure 1. Percentage of MOM on discharge.
Percent of infants less than or equal to 32 and 6/7 weeks gestational age discharged feeding mother's breastmilk.

Table 1. Change in weight and head circumference over time.
Comparison birth versus discharge z-scores for both weight (A) and head circumference (B).