112 - Improving Lactation Outcome in Parents of Preterm Infants Through Documentation of First Pump

Publication Number: 4110.112

Kate Tauber, Albany Medical Center, Glenmont, NY, United States; Gillian Bremer, Albany Medical College, Albany, NY, United States; Kristina Wise, Albany Medical College, Niskayuna, NY, United States

Background: Human milk is essential for optimal growth and neurodevelopment in very low birth weight (VLBW) infants, yet parents of these infants often face challenges establishing supply. Evidence shows that initiating milk expression within 6 hours of birth improves milk volumes by day 7. To promote earlier initiation and enhance lactation outcomes, the NICU and Labor & Delivery (L&D) teams collaborated to improve documentation of the first pumping session and reinforce nurse-led early pumping parent education.

Objective: To assess whether increased documentation of time of first pump improves amount of breast milk produced in the first month after delivery.

Design/Methods: A retrospective chart review 9/2022 to 2/2024 was conducted for infants born < 33 weeks' gestation. Pre-intervention data included time of birth, documentation of first pump, achievement of Coming To Volume (CTV) (>500ml produced in 24 hours), and cumulative milk volumes (CMV) at days 7, 14, 21, and 28. In March 2024, a new EMR was implemented and data collection was paused. In October 2024, a new documentation workflow for pumping documentation was implemented and nursing staff were educated on the importance of early pumping. Post-intervention data was collected 1/1/2025 through 9/30/2025 and was analyzed using factorial ANOVA and pairwise comparisons in SPSS.

Results: 171 charts were reviewed pre-intervention and 74 charts post-intervention. Documentation rates increased from 23% pre-intervention to 67% post-intervention. A factorial ANOVA revealed that documentation of the first pump was associated with significantly higher CMV at day 7 (F(1,116) = 2.96, p = 0.033, partial η² = 0.036) and day 14 (F(1,116) = 2.75, p = 0.043, partial η² = 0.033) (Table 1). Volumes remained higher at days 21 and 28, but was not statistically significant (p = 0.097). Pairwise comparisons showed that pre-intervention participants who initiated pumping within 6 hours produced significantly more milk at day 7 compared to those with no documentation (p = 0.029). Post-intervention, the < 6-hour group continued to outperform the pre-intervention no documentation group at day 28 (p = 0.03). CTV rates between the pre and post interventions groups was not statistically significant (Table 2).

Conclusion(s): Documentation of first pump time and targeted nurse education were associated with earlier initiation and improved milk production, particularly during the first two weeks postpartum. Data collection is ongoing, and the small sample size post intervention may be contributing to the lack of significance seen in several comparisons that were done.

Table 1: Average Cumulative Milk Volumes (CMV) in mL at days 7, 14, 21, and 28 pre-intervention and post-intervention.
CMV pre and post-intervention

Table 2: Rate of Coming to Volume (CTV) defined as >500ml milk produced in 24 hours achieved by day 7 and day 28.
CTV pre and post-intervention