242 - Reducing Racial Disparities in Rates of Mother’s Milk Provided at Neonatal Intensive Care Unit (NICU) Discharge Using a Multifaceted Quality Improvement Initiative

Poster Number: 242
Publication Number: 242.128

Leah M. Jordan, University of Minnesota Masonic Children's Hospital, Shoreview, MN, United States; Lauren Buckley, University of Minnesota Medical School, Minneapolis, MN, United States; Tamika B. Lasege, Children's Hospitals and Clinics of Minnesota, Edina, MN, United States; Ann Downey, Children's Hospitals and Clinics of Minnesota, Minneapolis, MN, United States

Background: Maternal breast milk is the optimal source of nutrition for premature infants as it provides
protection against life-threatening infections, decreases hospital length of stay, and improves
neurodevelopmental outcomes in a dose-dependent fashion. Unfortunately, racial disparities in
rates of maternal breast milk provided to infants in the neonatal intensive care unit (NICU) are
documented across the United States with Black infants receiving significantly less maternal
breast milk than white infants. Perceived barriers to providing breast milk at the time of hospital discharge have been described at our institution (figure 1). Racial disparities in breast milk provision have not been previously described in Minnesota.

Objective: Increase the rate of any maternal breast milk provided at NICU discharge to infants of Black
mothers hospitalized at Children’s Minnesota for ≥ 7 days by 10% from baseline within twelve months.

Design/Methods: In this ongoing, equity-focused quality improvement initiative, we used the electronic medical
record (EMR) to assess rates of breastfeeding initiation and breastfeeding at
discharge for infants hospitalized ≥ 7 days. Results were stratified by maternal race. The first PDSA cycle was implemented in August 2021. Interventions in this first cycle included standardized inquiry about pumping during daily parent communication, a material supply closet, translated written resources on pumping and breastfeeding, as well as a letter to employers advocating for lactation protections.

Results: Pre-intervention, 42.2% of white infants and 29.5% of black infants were receiving any maternal breast milk at discharge. Following implementation of PDSA cycle #1, 41.2% of white infants and 44.8% of black infants were receiving maternal milk at discharge (figures 2 and 3). Process metrics include provider reporting of increased discussion of pumping, total value of breastfeeding supplies distributed, number of written resources and employee support letters distributed are being collected and will be available at the time of presentation. Balancing metrics include rates of breast milk feeding for white infants and infants whose parents are non-English speaking. Conclusion(s): Our first PDSA cycle improved rates of Black infants receiving maternal breast milk at NICU discharge in our population. However, rates of breast milk feeding at discharge remain low. Future interventions include scripted conversations for staff training, video materials, and coordination with maternal hospitals. Ongoing research is needed to provide equitable breastfeeding support in the NICU.
Figure 1Driver diagram was created with multidisciplinary key stakeholders including lactation specialists, physicians, social work, and nursing leadership.
Figure 2Pre- and post-intervention rates of breast milk feeding within 48 hours of infant discharge from the NICU.