TOP 69 - More Mother's Own Milk: A Quality Improvement Project to Increase Hand Expression of Breast Milk within One Hour of Life in Infants at UIC NICU

Publication Number: 4773.TOP 69

Mayra A. Matar, University of Illinois College of Medicine, Chicago, IL, United States; Amy Pham, Children's Hospital of the University of Illinois, Chicago, IL, United States

Background: The World Health Organization recommends initiating breastfeeding within the first hour of life, and exclusively breastfeeding from birth to six months of age. Hand expression of breast milk is an effective way to increase breast milk volume, therefore increasing breast milk feeding in infants by time of discharge. As healthcare providers, we play a vital role in addressing these challenges including closing the gaps that exist in the necessary training to effectively support breastfeeding mothers.

Objective: This quality improvement project aims to increase the percentage of infants receiving breast milk by improving direct breastfeeding rates and initiating hand expression within the first hour of life. The goal is to improve these rates by 20% in infants born at UIC and admitted to the NICU.

Design/Methods: This quality improvement project utilizes the Plan-Do-Study-Act (PDSA) framework to target interdisciplinary collaboration and nursing staff in both the L&D and NICU through multiple interventions. Interventions include a "Golden Hour" algorithm (Figure 1), using a decision making tree to promote skin-to-skin contact and hand expression in medically stable newborns, and collaboration with lactation consultants to enhance nursing education in the NICU. Newborns were screened during a retrospective EPIC chart review starting from January 2025. All infants born at UI Health Hospital and admitted to the Neonatology Unit who were either exclusively breast fed or combo fed were included. Infants who were admitted directly to the Mother/Baby Unit and infants of mothers wanted to exclusively formula feed were excluded. We ran PDSA cycles including staff education and implemented the algorithm in L&D rooms to initiate skin to skin contact along with breastfeeding/hand expression within the first hour of life to improve breastfeeding rates. Ongoing data analysis will be complete by January 2026 and will be presented using a run chart to display when interventions were implemented and their effects over time.

Golden Hour Algorithm
Golden Milk Algorithm[77].pdfThe Golden Hour Algorithm uses a decision-making tree to guide L&D nursing staff to determine how and when to start the "Golden Hour". If baby is unstable, this also guides nursing staff to initiate hand expression with moms. If baby is stable, but requires NICU admission, this helps guide nursing staff to support moms with initiating breast feeding, if desired, and skin-to-skin for at least 30 minutes prior to transporting to the NICU.

Baseline/Preliminary Data on Hand Expression
Baseline data show that prior to implementation of interventions, 0% of mothers were successful in hand expressing breastmilk within the first hour of life.