238 - Increasing Utilization of Maternal Breast Milk (MBM) by Early Initiation for Premature Infants <32 weeks or <1800 grams - a Quality Improvement Initiative

Poster Number: 238
Publication Number: 238.128

Sofya Ilmer, NYCH+H/ Jacobi, Queens, NY, United States; Tom Elena Dubov, NYCH+H/Jacobi, Bronx, NY, United States; Georges Compagnon, NYCH+H/ Jacobi, New York, NY, United States; Camille Rodriguez Gurdak, Albert Einstein College of Medicine, Bronx, NY, United States; Dore Dorzia, NYCH+H/Jacobi, Bronx, NY, United States; Taylor Offman, NYCH+H/Jacobi, New York, NY, United States; Karen Schaeffer, NYCH+H/ Jacobi, Bronx, NY, United States; Sadia Haleem, Jacobi Medical Centre Bronx Newyork, Hartsdale, NY, United States; Joseian A. Edwards, NYC H+H/Jacobi, Uniondale, NY, United States; Maloree Baxter-Williams, NYCH+H/Jacobi, Bronx, NY, United States; Gorda Peters-Joseph, Jacobi Medical Center, Bear, DE, United States; Carmen B. Sanchez, NYC H+H+ Jacobi, New York, NY, United States; Ryan C. Fraleigh, NYCH+H/JACOBI, Wappingers Falls, NY, United States; Yogangi Malhotra, NYCH+H/Jacobi, Bronx, NY, United States

Background: Early introduction of MBM to premature infants in the neonatal intensive care unit (NICU) is both important and challenging. Alternatives like formula or donor breast milk (DBM) can be clinically or financially detrimental. Focus on respiratory emergency detracts from the critical nutritional need in the first few days of life. Early feeding with MBM prevents surgical necrotizing enterocolitis and other long-term morbidities. NYCH+H/Jacobi is a public hospital with level III NICU, which offers DBM for infants < 1800 grams or < 32 weeks. 86% of our delivering mothers have Medicaid, >60% self-identify as African-American/Latino and >30% are immigrants, historically identified as at risk for low breastfeeding rates.

Objective: Our aim for this phase was to provide MBM as first feed for premature infants within 1 day of admission to NICU by Dec 2021.

Design/Methods: A team of neonatal and obstetric physicians, lactation consultants (LC) and nurses met regularly. Manual chart review was done for all newborns delivered from Dec 2020 - June 2021 (pre-intervention) and July - Dec 2021 (post-intervention). All newborns < 32 weeks gestation or < 1800 grams born at and discharged from our NICU were included.
Earlier initiation of feeding with MBM was identified as the most significant driver to increase MBM utilization. 
Tests of change: LC to teach hand expression on delivery (abandoned); educating stakeholders about colostrum and hand expression (adopted); distribution of colostrum care kits with video QR code & literature by NICU to mothers (adapted) and the default feeding order for all NICU admissions changed from NPO to “colostrum care” & then to “Colostrum - MBM 0.5ml q3hrs” (adopted).

Results: There were 347 newborns admitted to the NICU between Dec 1, 2020 to Nov 1, 2021. Among them, 26 were in the pre-intervention and 24 in post-intervention groups.
Time to first MBM/DBM order improved from baseline of 30.8 hrs to 22.3 hrs, median time to first MBM feeding from 49.5 hrs to 23.5 hrs. Newborns initiated on MBM vs MBM+DBM improved from 64% to 75%.Conclusion(s): Replacing the default feeding order on admission from NPO to MBM-Colostrum 0.5ml in addition to focus on hand expression while educating staff and mothers succeeded in providing exclusive MBM to premature newborns on Day 1. This may be the first step in increasing utilization of MBM during NICU stay.
Figure 1Fishbone diagram: causes of low usage of MBM in the NICU
Figure 2X-MR Chart - Hours to first MBM/DBM order by date