(85) Quality Improvement Project: Human Milk feeding and Lactation Support in a Large Pediatric Cystic Fibrosis (CF) Clinic

Background: Breastfeeding or human milk are recommended for at least the first year of life based on well documented health benefits for both mother and child. Moreover, breastfeeding is often more meaningful to parents than can be expressed simply in terms of health statistics. Conversely, negative experiences from excess pressure to breastfeed have also been described. Evidence suggests that bottle feeding and formula supplementation may impede breastfeeding success. Even so, both are typically encouraged by all providers in our clinic because both careful monitoring of feeds and a very high-calorie intake are strongly recommended to achieve above average growth over the first two years of life.

Methods: We collected baseline data on infant feeding and lactation support during the first year of life via retrospective chart review. Included were infants visiting our center from 2016-2020. Infants presenting for their first visit after 3 months of age were excluded.

Results: Between September 2016 and September 2020, 49 infants entered care at our center at/near diagnosis and remained in our care until at least age 12 months. The average age of the infants on the first visit was 5 weeks (range 2-12 weeks) and the average age at the second visit was 10.5 weeks (range 8- 16 weeks).

At the first visit, 29 infants (59%) had any human milk feeding (AHM) including 17 infants (35%) that were only human milk feeding (HMO); 12 infants (24%) were human milk plus formula feeding (HMF) and 20 infants were formula feeding only (FO). At or before the first CF visit 37/49 (76%) had some lactation support, and 16/49 (43%) had used a breast pump. Of the AHM group, 13/29 families (45%) talked with the CF lactation consultant and 7/29 (24%) of these families used a baby scale at home to monitor intake or weight gain.

At the second visit, 9/49 infants (18%) were HMO and 25/49 infants (51%) were HMF. At 6 months, 20/49 (41%) were HMF and only 2/49 (4%) infants were HMO; however, the two HMO infants continued HMO until age 12 months.

Conclusions: The rate of AHM feeding at our center at any time during the first year of life is lower than national rates (59% versus 84%). HMO feeding at the second visit was especially low (18% versus ~46% nationally). AHM feeding also rapidly after the first visit. In-clinic lactation support was quite limited. Family input is needed to further characterize parent impressions of lactation support in our CF clinic as well as any feelings around pressure to provide human milk they may have experienced.

Next steps: Our QI team plans to obtain patient/family input to describe their experience of current lactation support at our center including potential negative impacts associated with pressure to provide human milk. We will use our baseline data and the family input to develop change ideas to support desirable outcomes for human milk feeding and a positive experience for families.

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