Improving the Newborn Exclusive Breast Milk Feeding Rate at an Academic Medical Center

Purpose/Objectives: Despite a long history of breastfeeding promotion and support, UC San Diego Health (UCSDH) struggled to reach its exclusive breast milk feeding goals. Targets have been set by Healthy People 2020, the Joint Commission, and the California Public Hospital Redesign and Incentives in Medi-Cal (PRIME) program. Achievement of these goals can be tied to certifications, community recognition and even monetary incentives.

UCSDH is an academic medical center with approximately 3500 births per year. UCSDH achieved Baby-Friendly designation in 2006 and has a high breastfeeding initiation rate of nearly 97%. It is a referral center with specialty OB clinics for high-risk populations. Partly due to our high-risk patient population, about 50% of UCSDH mothers receive at least short-term supplementation. The aim was to increase our institution’s exclusive breast milk feeding rate to at least 70% as quickly as possible.

Design/Methods: Key players included newborn hospitalists, pediatric nurse practitioners, nurse managers, bedside nurses, lactation consultants, and dietitians. Cause analysis and suggestions for change occurred at monthly lactation and newborn management meetings. Change ideas included increasing nurse comfort with weight loss, introduction of glucose gel for hypoglycemia, and finally introduction of donor breast milk (DBM).

Feeding statistics entered into the EMR by providers at hospital discharge were used to calculate breast milk feeding rates. All infants discharged from the newborn nursery were included in our analysis regardless of their gestational age, underlying diagnoses, or time spent in the NICU. Donor breast milk use was calculated by the nutrition department via a milk tracking system.

Results: Multiple PDSA cycles (Table 1) were conducted. Initial interventions were unable to consistently increase our exclusive breast milk rate to goal. A change in policy around LPIs, which was not a part of this project, did increase the rate somewhat. Only after introduction of donor milk in March of 2019 were we able to consistently achieve our minimum goal of 70% exclusive breast milk feeding. Subsequently we have been able to increase our goal to 80%.

Conclusion/Discussion: The use of donor milk may be necessary for a high-risk population to achieve exclusive breast milk feeding targets. The cost of donor milk is significantly more than formula even for a Baby-Friendly institution. This can be an impediment for implementation. The average cost for an individual infant at our institution was $40. Compared to other costs associated with birth hospitalization, this is minimal. We found that with judicious use we have been able to limit the cost of DBM to a reasonable value. At the same time the fear of DBM replacing mothers own milk has not been realized.