A Quality Improvement Project to Increase Mother’s Milk Use in an Inner-City NICU

Kalluri, Nikita S.; Burnham, Laura; Lopera, Adriana M.; Stickney, Donna; Combs, Ginny; Levesque, Bernadette M.; Philipp, Barbara L.; Parker, Margaret G.

doi:10.1097/pq9.0000000000000204

Cited by 19 publications

(32 citation statements)

References 26 publications

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“…After removing duplicates, the titles/abstracts of 69 articles were screened, and 49 articles were excluded. We reviewed the full text of 20 studies; 16 studies (17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32) were included in systematic review and four studies (33)(34)(35)(36) were excluded because of insufficient primary outcomes or same study cohort; 13 studies were included in the meta-analysis for the primary outcome (17-21, 23, 24, 27-32), another 3 studies were excluded due to insufficient dichotomous data. Figure 1 shows the detailed flow chart.…”

Section: Resultsmentioning

confidence: 99%

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Quality Improvement to Increase Breastfeeding in Preterm Infants: Systematic Review and Meta-Analysis

Fang¹,

Wu²,

Han

et al. 2021

Front. Pediatr.

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Background and Objective: Due to its numerous health benefits, breast milk (BM) is recommended for preterm infants. Despite such recommendations, the rates of breastfeeding in preterm infants are lower than that in term infants. Quality improvement (QI) bundles increase breastfeeding in preterm infants, but their replication in neonatal intensive care units has had inconsistent outcomes.Methods: We used the Population or Problem, Intervention, Comparison, and Outcomes (PICO) framework to develop our search strategy, and searched MEDLINE, Embase, and the Cochrane Library from inception through January 15, 2021. Studies describing any active QI intervention to increase BM use in preterm infants were included. The primary outcome measure was the rate of any breastfeeding or exclusive mother's own milk (MOM) at discharge or during hospitalization.Results: Sixteen studies were eligible for inclusion and showed an acceptable risk of bias, and included 1 interrupted time series, study 3 controlled before-and-after studies, and 12 uncontrolled before-and-after studies; of these, 3 studies were excluded due to insufficient dichotomous data, 13 were included in the meta-analysis. In the meta-analysis, the rate of any breastfeeding was significantly improved at discharge and during hospitalization after QI [risk ratio (RR) = 1.23, 95% confidence interval (CI): 1.14–1.32, P < 0.00001 and RR = 1.89, 95% CI: 1.09–3.29, P = 0.02, respectively]. The rate of exclusive MOM after QI was also significantly increased at discharge (RR = 1.51, 95% CI: 1.04–2.18, P = 0.03), but not during hospitalization (RR = 1.53, 95% CI: 0.78–2.98, P = 0.22). However, after sensitivity analysis, the comprehensive results still suggested that QI could significantly improve the rate of exclusive MOM during hospitalization (RR = 1.21, 95% CI: 1.08–1.35, P = 0.001). Funnel plots and Egger's test indicated publication bias in the rate of any BF at discharge. We corrected publication bias by trim and fill analysis, and corrected RR to 1.272, 95% CI: (1.175, 1.369), which was consistent with the results of the initial model.Conclusions: A QI bundle appears to be effective for promoting BM use in preterm infants at discharge or during hospitalization.

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Section: Resultsmentioning

confidence: 99%

“…Figure 1 shows the detailed flow chart. One study (36) was excluded because it was within the greater Neonatal QI Collaborative of Massachusetts human milk collaborative (26), three other studies (33)(34)(35) were excluded because of insufficient primary outcomes (see Supplementary Table 1).…”

Section: Resultsmentioning

confidence: 99%

Quality Improvement to Increase Breastfeeding in Preterm Infants: Systematic Review and Meta-Analysis

Fang¹,

Wu²,

Han

et al. 2021

Front. Pediatr.

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“…39,40 Studies have shown that multimodal approaches to breastfeeding, including peer counseling, breastfeeding teams, and hospital policy changes, yield better results than singular interventions in overcoming barriers to breastfeeding and improving infant health outcomes. [26][27][28][29][30][31][32][33][34][35]39,40 AA mothers face unique barriers to breastfeeding. Support from family, specifically fathers and maternal grandmothers, and friends; attendance of childbirth classes; and community support during prenatal and postnatal periods have been shown to be effective in improving breastfeeding rates among AA mothers.…”

Section: Discussionmentioning

confidence: 99%

“Liquid Gold” Lactation Bundle and Breastfeeding Rates in Racially Diverse Mothers of Extremely Low-Birth-Weight Infants

Obaid

Igawa

Maxwell

et al. 2021

Breastfeeding Medicine

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“…To bridge the demand supply gap of PDHM, we aimed to increase the donor milk collection at our centre, thus increasing the supply of PDHM at the human milk bank. Many quality improvement initiatives have been taken up to improve MOM and PDHM quality and usage in neonates, [9][10][11][12][13] but none address the issue of increasing donor milk collection from satellite collection centres.…”

Section: Introductionmentioning

confidence: 99%

Improving donor human milk collection in a hospital without a human milk bank: a quality improvement initiative at an urban tertiary-care teaching hospital

et al. 2021

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Feed intolerance and necrotising enterocolitis (NEC) are challenges while treating sick neonates. These can be reduced by giving human milk, but adequate availability of mother’s own milk or pasteurised donor human milk (PDHM) is a challenge in neonatal setups, like ours, without an attached human milk bank. Hence, this quality improvement initiative was taken to improve donor human milk collection in our urban tertiary-care teaching hospital, to at least 500 mL per week in 4 weeks. After analysing the problem, our quality improvement team identified a shortage of human milk donation that was due to low awareness among the stakeholders and lack of a system to collect and store human milk and transport it to a milk bank. The team first established a system of supplies needed for milk collection, storage and transportation. It then tested change idea of information, education and counselling to increase milk donation. The team carried out a few plan-do-study-act cycles (individual and group counsellings, and usage of videos and information leaflets) to test the change ideas and adapted a few and abandoned some. During this journey, the milk collection increased to above the target amount. Various challenges were addressed, and there was a need for constant motivation of the stakeholders, especially the mothers, and now there is sustained milk donation in the setup. This is incorporated in the standard operating procedure and as a quality indicator of the unit for sustaining the changes in the unit. Our initiative can be replicated in other setups for increasing collection of donor human milk. Greater PDHM availability for sick neonates will, in effect, reduce NEC and feeding intolerance rates, leading to reduced hospital stay, morbidity, mortality and economic burden.

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A Quality Improvement Project to Increase Mother’s Milk Use in an Inner-City NICU

Abstract: Supplemental Digital Content is available in the text.

Cited by 19 publications

References 26 publications

Quality Improvement to Increase Breastfeeding in Preterm Infants: Systematic Review and Meta-Analysis

Quality Improvement to Increase Breastfeeding in Preterm Infants: Systematic Review and Meta-Analysis

“Liquid Gold” Lactation Bundle and Breastfeeding Rates in Racially Diverse Mothers of Extremely Low-Birth-Weight Infants

Improving donor human milk collection in a hospital without a human milk bank: a quality improvement initiative at an urban tertiary-care teaching hospital

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