107 - Improving Early Colostrum Feeding in Preterm Infants: A NICU Quality Improvement Initiative

Publication Number: 4105.107

Sara Ali, University of Miami Leonard M. Miller School of Medicine, Miami, FL, United States; Noor Mehandi, University of Miami Leonard M. Miller School of Medicine, Miami, FL, United States; Tania Fontanez-Nieves, University of Miami, Miami, FL, United States; Laura Chavez, University of Miami Leonard M. Miller School of Medicine, Hallandale Beach, FL, United States; Teresa Del-Moral, University of Miami, MIAMi, FL, United States; Karen C. Young, Division of Neonatology, Department of Pediatrics, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, United States

Background: Early colostrum feeding reduces infection, supports gut maturation, and improves outcomes in preterm infants. A baseline audit revealed that less than 15% of extremely preterm infants in our Level IV NICU received colostrum within the first 48 hours of life, highlighting a critical quality gap.

Objective: Our goal was to achieve up to 60% increase in the proportion of preterm infants ≤ 30 weeks' gestation admitted to our NICU who receive their first enteral feed with colostrum within 48 hours of life in 24 months.

Design/Methods: Baseline data on percentages of preterm infants ≤ 30 weeks gestation that received colostrum within 48 hours of life was collected retrospectively for 6 months. Bundles of better practices were introduced, including (1) standardized documentation and nurse education by lactation specialists; (2) parent educational brochures and distribution of colostrum collector kits; (3) improved communication between NICU and postpartum nurses to facilitate timely colostrum delivery to the bedside; and (4) ensuring timely feeding order placement by the medical team. Post-intervention data was collected prospectively for 20 months after 1st intervention. Sequential Plan-Do-Study-Act cycles were performed to sustain improvement. Data was analyzed using run charts.

Results: Baseline data was collected on 40 infants, and prospective data after the 1st intervention included 162 infants. Early rates were low with a baseline median of 12.5 %, highlighting a significant quality gap in timely colostrum feeding. After PDSA cycle 1 (nurse documentation improvement), no sustained change was observed. With PDSA cycles 2 and 3, rates increased intermittently, reaching 30% in several months. The highest peak occurred after PDSA cycle 4, although consistency remained a challenge. Despite monthly variation, the overall trend demonstrated improvement above the baseline median, reflecting early but measurable system-level gains.

Conclusion(s): Implementation of structured, evidence-based interventions led to a modest but measurable improvement in early colostrum feeding rates for preterm infants in our NICU. Although the target of 60% has not yet been achieved, the upward trend demonstrates meaningful progress. Persistent barriers include limited staffing and lactation resources, language differences, and fragmented coordination among multiple stakeholders. Next steps include strengthening collaboration with postpartum staff, increasing NICU nursing leadership involvement, and sustaining progress through monthly data audits, ongoing education, maternal recognition, and continued multidisciplinary collaboration.

Figure 2. Run Chart of Early Colostrum Feeding Rates Over Time
Monthly proportion of infants ≤30 weeks receiving colostrum within 48 hours, showing improvement after PDSA interventions.

Figure 1. Key Driver Diagram for Early Colostrum Feeding Initiative
The diagram illustrates the project aim, primary and secondary drivers, and associated interventions implemented to increase colostrum feeding