Proactive Lactation Care is Associated With Improved Outcomes in a Referral NICU

Abstract

Background Mother’s milk improves outcomes. Referral neonatal intensive care units face unique lactation challenges with maternal–infant separation and maternal pump dependency. Little is known about lactation resource allocation in this high-risk population. Research Aims To determine differences in human milk outcomes, (1) the proportion of infants fed exclusive or any mother’s milk and (2) recorded number and volume of pumped mothers’ milk bottles, between two models of lactation care in a referral neonatal intensive care unit. Methods This retrospective, longitudinal, two-group comparison study utilized medical record individual feeding data for infants admitted at ≤ Day 7 of age and milk room storage records from reactive and proactive care model time periods (April, 2017–March, 2018; May, 2018–April, 2019). The reactive care model ( n = 509 infants, 58% male, median birth weight and gestational age of 37 weeks,) involved International Board Certified Lactation Consultant referral for identified lactation problems; whereas, the proactive model ( n = 472 infants, 56% male, median birth weight and gestational age 37 weeks) increased International Board Certified Lactation Consultant staffing, who then saw all admissions. Comparisons were performed using chi square, Mann Whitney, and t-tests. Results A proactive lactation approach was associated with an increase in the receipt of any mother’s milk from 74.3% to 80.2% ( p = .03) among participants in the proactive model group. Additionally, their milk room mean monthly bottle storage increased from 5153 ( SD 788) to 6620 ( SD 1314) bottles ( p < .01). Conclusions In this retrospective study at a tertiary referral neonatal intensive care unit, significant improvement inhuman milk outcomes suggests that increased resources for proactive lactation care may improve mother’s milk provision for a high-risk population.

Maternity Care Practices Supportive of Breastfeeding in U.S. Advanced Neonatal Care Units, United States, 2022

“…While practices such as expressing milk within one hour of birth and kangaroo care may depend on the individual clinical context, they also require more active professional support, relying on staff time and availability, technical skill and competency of nurses and lactation support providers, and staff and patient buy-in. Studies have found that increasing the number of staff whose roles are fully dedicated to providing lactation support improves breastfeeding outcomes (25); similarly, adequate nurse sta ng ratios and nursing staff with higher levels of education are also associated with higher rates of infants with VLBW receiving human milk at discharge (7).…”

“…Although medical complications can make these practices more challenging for families whose infants require advanced neonatal care, hospital practices and policies can facilitate and support lactation management. Providing families with proactive lactation support in the NICU setting that includes education on the importance of providing mother's own milk and the recommended frequency of pumping has been found to improve the likelihood of infants receiving their mother's own milk while in the NICU (25).…”