Early Enteral Feeds Achievement by Reducing Time to Obtain Donor Human Milk Consents and Early Enteral Feed Initiation in Preterm Infants

Purpose/Objectives: The primary aim was to achieve full enteral feeds faster in preterm infants born with birth weight (BW) less than 1800 grams in a level IV Neonatal Intensive Care Unit (NICU).

Design/Methods: In 2020, a multidisciplinary team initiated a quality improvement project to improve enteral feeding in preterm infants with BW <1800 grams and admitted to our NICU. All infants with BW <1800g or GA <32 weeks are eligible to receive donor human milk (DHM) if mother’s milk is unavailable. Infants are fed DHM only after maternal consent has been obtained. The drivers to reach our aim are 1. Early DHM consent before 9 hours of life (HOL); 2. Early initiation of trophic feeds within 12 HOL; and 3. Revision of feeding guideline to reduce trophic feeds duration and faster feeding advancement. The intervention included easy accessibility of consent forms, combine consents with prenatal consultation, all staff mandatory education, and reminders through NICU bulletins. Baseline data were collected retrospectively from 5/1/2020 to 11/23/2020. Prospective ongoings data collection occurred from 11/24/2020 to 06/30/2021. Data on outcomes measures including time of DHM consent and trophic feed initiation and balancing measures including need for DHM use, and incidence of feeding intolerance and necrotizing enterocolitis were collected in real time and reviewed at monthly meetings.

Results: 132 infant data were analyzed; 62 baseline and 70 post intervention. DHM consent time improved from 3.5 hours prior to birth (HPB) in baseline group to 49.5 HPB after intervention (Figure 1). Trophic feeds initiation improved from 30 HOL to 18 HOL (40% improvement, Figure 2). These interventions resulted in improvement in early full enteral feeds of 150 ml/k/day from 13.3 days to 10.9 days (22% improvement). There was no increase in incidence of feeding intolerance or necrotizing enterocolitis.

Conclusion/Discussion: In our NICU, through small changes in optimization of DHM consents and trophic feeds initiation, we showed improvements in time to full enteral feeds in preterm infants. Our multidisciplinary team is implementing revision of feeding guidelines as the next intervention in this quality improvement project.