O0114 Oct.3: 3:54pm - Nourishing Neonates and Improving Outcomes with Human Milk

Background:
Growth and nutrition are critical aspects of care for all infants in the neonatal intensive care unit, especially for infants considered very low birth weight (VLBW; birth weight less than 1500 grams). These infants are at increased risk for prematurity-related morbidities, including bronchopulmonary dysplasia, necrotizing enterocolitis, retinopathy of prematurity, and late-onset sepsis. Human milk has been shown to reduce the incidence and severity for some of these morbidities. In 2017, our unit had only 19% of VLBW infants receiving maternal milk at the time of discharge. The aim of this project was to double the percentage of VLBW infants receiving maternal milk at the time of discharge in 2 years’ time.

Methodology:
Multiple small PDSA cycles were utilized prior to implementing unit wide changes. These small PDSA cycles included 3-5 patients at a time. These cycles were developed by a multidisciplinary team that included parental input. Practice changes focused on improving antenatal breastfeeding discussions and parental education. Also, lactation support was improved after delivery with frequent parent/provider check-ins, frequent lactation visits, and improved skin-to-skin contact. In addition, PDSA cycles were conducted to improve the use of donor human milk within the first week of life, as this promoted and supported human milk use until the mother’s milk supply increased. Additional PDSA cycles focused on the initiation of early enteral feeds, faster daily advancement of feeding volumes, and a higher final volume goal. After multiple PDSA cycles, these changes were implemented in the unit for all eligible VLBW infants.

Discussion:
In 2019, the percentage of VLBW infants receiving maternal milk at the time of discharge had increased to 41%. In addition, improvements in growth were noticed. The number of VLBW infants discharged below the 10th percentile for weight reduced from 61% in 2017 to 44% in 2019. Furthermore, the duration of parenteral nutrition was reduced. Prior to practice change, the average VLBW infant received 10.6 days of parenteral nutrition, with a reduction to 5.7 days after these changes. In addition, there was a unit reduction in necrotizing enterocolitis (NEC), from 5.8% in 2017 to 2.9% in 2019. Length of hospitalization stay was monitored as a balancing measure. In 2017, the average length of stay was 65 days, which decreased in 2018 to an average length of stay of 46 days.

Conclusion:
This project demonstrated an improvement in the number of VLBW infants receiving maternal milk at the time of discharge from 19% in 2017 to 41% in 2019. The success of this project was dependent on a multidisciplinary approach, parental involvement, and small tests of change prior to unit wide implementation.