Improving Mother’s Milk Supply in the NICU with Hospital Grade Pump Loan Program

Purpose/Objectives: Human milk is important for preterm infants, not only for growth and nutrition, but it has also been shown to reduce rates of NEC, BPD, late onset sepsis, and ROP. Insufficient milk volume is a universal concern amongst mothers of preterm infants. In 2020, our level IV NICU at University Hospital, had an average of 37% of infants born ≤1500g receiving breastmilk at the time of discharge. The majority of our population is Hispanic, insured by Medicaid, from San Antonio and other surrounding cities in Texas and Mexico. While donor milk is used to maintain exclusive human milk diet, pasteurization changes many beneficial human milk properties. Mother’s own milk is most desirable for preterm infants. Personal breast pumps are not designed to be sufficiently durable for pump dependent mothers. We created a pump loaning program to provide hospital grade breast pumps to help establish mothers’ of very low birthweight infants milk supply and increase the rate of breastmilk at discharge for very low birthweight infants from 37% to 47% by January 2022.

Design/Methods: In Spring 2021 we received a donation of Medela Symphony breast pumps. We constructed a hospital grade loaner pump program inclusive of mothers of singleton infants born ≤1000g or multiples ≤1500g who intend to provide breast milk. Mothers are excluded if any contraindications to providing breast milk exist. Mothers are contacted at post-partum day 3, 7 and 14 in order to assess progress towards a goal volume of 750mL by 2 weeks and any additional concerns.

Results: The loaner pump program began March 2021. Thus far, we have distributed a total of 4 pumps to mothers who are providing milk to 6 babies with a mean gestational age of 26.5±2.5 weeks and birth weight of 978±261.3g. One mother was uninsured, without access to an electric breast pump; 4 mothers meeting criteria received a hospital grade pump via insurance prior to discharge. The max estimated volumes that were reached amongst those who received a pump was 180 ml at day 3, 450 ml at day 7 and 800-900 ml at day 14.

Conclusion/Discussion: Our program has been well received and the mothers receiving pumps successfully provided breast milk. Nevertheless, these mothers have continued difficulty reaching goal volumes and maintaining breast milk supply to discharge. A large barrier that has been identified is not reaching 8 pumping occasions in a day. This population remains at high risk for breastfeeding challenges and requires robust lactation support.