783 - Improving the Provision of Mother’s Own Milk in a Referral Level IV NICU

Publication Number: 1759.783

Melissa Bush, St. Christopher's Hospital for Children, Philadelphia, PA, United States; Gabrielle Burns, St. Christopher's Hospital for Children, Ewing, NJ, United States; Michelle Iannarelli, St. Christopher's Hospital for Children, North Wales, PA, United States; Katherine Breznak, St. Christopher's Hospital for Children, Philadelphia, PA, United States; Abigail Thomas, St. Christopher's Hospital for Children, Philadelphia, PA, United States; Kathryn Ryan, St. Christopher's Hospital for Children, Levittown, PA, United States; Nilda I. Ortiz Rosario, St. Christopher's Hospital for Children, Philadelphia, PA, United States; Hye Young Cho, St. Christopher's Hospital for Children, Philadelphia, PA, United States; Amanda Carroll, St. Christopher's Hospital for Children, Philadelphia, PA, United States; Swosti Joshi, Drexel University College of Medicine/St. Christophers hospital for Children, Philadelphia, PA, PA, United States; Vilmaris Quinones-Cardona, Drexel University College of Medicine, Philadelphia, PA, United States

Background: Mother's own breastmilk (MoM) is the gold standard nutrition for infants, particularly those born preterm, and confers protection against necrotizing enterocolitis, late onset sepsis, among other complications. Mothers of infants transferred to outborn referral NICUs face unique challenges in providing MoM due to separation and maternal stress, high infant acuity, and barriers to lactation support and milk transport.

Objective: To increase the percentage of infants admitted < 7 days old who receive MoM at enteral feed initiation, by 20% within 2 years, in a level IV NICU.

Design/Methods: An observational quality improvement initiative in a referral-based Level IV NICU from Jan 2024 to Oct 2025. A multidisciplinary team of nurses, neonatologists, dietician, and certified breastfeeding counselors (CBC) utilized multivote and a rank order table to select high priority interventions. A key driver diagram displayed change ideas starting from providing breastfeeding/pumping supplies and CBC consults within 72hrs on all admissions (Fig 1). Rapid cycle testing revealed the need to streamline CBC consult notes and for daily breastmilk huddles for just-in-time education. Outcome measures were % of infants with MoM at feeding initiation, % MoM available at 72 hrs, 7, 14, 28 days, and discharge. Process measures included % with documented lactation education, % with double electric pump, and % breastfeeding at start of oral feeds. Breastmilk errors and donor breastmilk utilization were balancing measures.

Results: A total of 190 infants transferred to our NICU < 7days were included. After interventions, there was special cause improvement in the percent of infants with MoM at the time of feed initiation from 65% to 79% (Fig 2). The percent of any MoM available at 72hrs was 68%, 7 and 14 days was 74%, 28 days was 64% and discharge 68%. The percent of admissions with lactation documentation within 72 hrs improved from 14% to 47% (Fig 3). The percent of mothers with a double electric breast pump and who breastfed at the time of oral feed initiation remained at 80% and 16%, respectively. There were no changes in breastmilk errors or donor breastmilk utilization.

Conclusion(s): A multidisciplinary team approach optimizing early lactation education workflow, and access to supplies improves the provision of MoM in high acuity neonates transferred to a referral level IV NICU. Sustaining lactation and encouraging breastfeeding at the start of oral feeds remain a challenge. Next steps include the involvement of speech therapists and expanding the CBC team to increase capacity of lactation support.

Figure 1.
Key Driver Diagram

Figure 2.
P-chart of infants with improvement in Mothers own Milk at the start of enteral feeds from 65% to 75% after interventions.

Figure 3.
P-chart of documentation of mothers receiving lactation support within 72 hours of admission improving from 14% to 47%.