Using Early Breast Milk Expression to Improve Breast Milk Use Rates at Discharge from a Multi-Site Quality Improvement Initiative

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Breast milk is the normative standard for infant feeding and nutrition. Unfortunately, rates of breastfeeding and human milk use remain suboptimal in the United States. Certain populations, e.g., infants admitted to the Neonatal Intensive Care Unit (NICU), are at risk for lower breast milk use rates compared to their well newborn counterparts. Since infants often cannot feed directly at the breast immediately after birth due to infant illness or prematurity, mothers need to express their breast milk to establish and maintain an adequate supply. Early expression of breast milk can lead to improved breast milk supply and subsequently a longer duration of breast milk use. The purpose of this quality improvement initiative was to increase breast milk use rates at discharge over multiple units covered by a private practice group, Onsite Neonatal Partners. Nurses and lactation consultants in each unit were educated about the importance of early breast milk expression and the upcoming quality initiative via an 8-minute video. Clinicians then distributed an education card to the support person at time of NICU admission explaining that breast milk expression within two hours of birth can lead to a better breast milk supply. Baseline data was collected from February 2020 through June 2020. Education for nurses and physicians occurred during June 2020. The education cards were then distributed to support persons beginning in July 2020. Post-intervention data were collected from July 2020 to mid-October 2020. Results from this quality initiative showed that early breast milk expression within 2 hours of birth had more exclusive breast milk feeds and less formula use than breast milk expression that occurred greater than 6 hours (p=0.03). Expressing breast milk earlier appeared to be more beneficial for late preterm infants compared to term infants. Finally, a racial disparity between African American and Caucasian mothers emerged with Caucasian mothers being more than twice as likely to have an infant on exclusive breast milk feeds and half as likely to be on formula at the time of NICU discharge (p<0.001). Opportunities exist to improve breast milk use rates at hospital discharge. This will ultimately help to improve the health of our population, while in turn lowering health care costs.



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