Structured promotion of breastmilk expression is associated with shortened hospitalisation for very preterm infants

Healy, David B.; Brennan, Ann-Marie; O'Donovan, Rebecca; Daly, Veronica; Doolan, Anne; Dempsey, Eugene M.

doi:10.1111/apa.13399

Cited by 11 publications

(12 citation statements)

References 30 publications

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“…[9]. Similar to the results in previous studies [9,18], birth weight was regained earlier in the intervention group, babies also had lesser duration of hospital stay, and there appeared to be a decreased trend in neonatal morbidities such as NEC and sepsis in comparison to the control cohort, although the results were not statistically significant.…”

Section: Discussionsupporting

confidence: 85%

“…With our simple QI initiative for a short period of three months, we could demonstrate that the formation of a dedicated breastfeeding support group, structured counseling, and presentation of informative leaflets and videos helped in increasing the early and frequent milk expression in mothers and hence increasing the exclusive breastfeeding rates in preterm babies in a busy unit. This QI initiative was based on previously published QI projects on early milk expression in preterm mothers, how special care bundles and structured approach affects MOM use, and benefits of exclusive MOM in preterm and very-low-birth-weight babies [[5], [6], [7], [8], [9], [10], [11]].…”

Section: Discussionmentioning

confidence: 99%

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A quality initiative to improve exclusive breast milk feeding in preterm neonates

Bagga

Nadipineni

Mohamed

et al. 2018

International Journal of Pediatrics and Adolescent Medicine

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Background and Objective Preterm babies thrive well on exclusive breastfeeding with fewer complications. In a retrospective analysis, challenges were noticed in the form of delayed first milk expression and frequency of expression, which was limited to 2–3 times a day. A quality improvement initiative was designed to increase the exclusive breast milk feeding rates in admitted preterm babies. The purpose of the present study is to evaluate the proportion of preterm neonates receiving mother's own milk by day 7 of life after such an initiative. Methods The quality improvement initiative was conducted at a level 3 neonatal intensive care unit from May 10, 2018, to August 10, 2018. Inborn preterm neonates <34 weeks with a minimum hospital stay of 7 days were included. Neonates of critically sick mothers and neonates having major congenital malformations were excluded. Mothers were given structured antenatal counseling regarding expressing breast milk (EBM). Postnatal visits were conducted to provide information through a video and a leaflet and formation of breastfeeding support group. Results A total of 30 babies were recruited during a period of 3 months and compared to historical controls. The median age of the first EBM improved from 2.5 days to 1.16 days, and the amount of EBM on the first day improved from 0.24 ml to 2.6 ml ( p = .002). The proportion of babies receiving EBM on the first day improved from 24% to 80% ( p = .0001), and at the end of 7 days, it increased to 73% from 46% ( p = .02). The factors time to reach full enteral feeds, time to regain birth weight, rate of necrotizing enterocolitis, rate of sepsis, and proportion of babies on exclusive mother's milk during discharge appear comparable in both the groups. Conclusions A simple quality improvement approach through the formation of breastfeeding support group, antenatal counseling, and postnatal support for breast milk expression has made a significant improvement in milk expression from mothers delivered prematurely. It reflects on a team approach using the available resources.

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Section: Discussionsupporting

confidence: 85%

Section: Discussionmentioning

confidence: 99%

A quality initiative to improve exclusive breast milk feeding in preterm neonates

Bagga

Nadipineni

Mohamed

et al. 2018

International Journal of Pediatrics and Adolescent Medicine

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“…This work confirms the literature data on significant reductions in the incidence of NEC with the implementation of the use of human milk; however, it also focuses on the utility of the presence of a milk bank as an integral part of the NICU, which is a very interesting aspect indeed [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15].…”

Section: Discussionsupporting

confidence: 81%

“…Where there is a tradition or culture for breastfeeding and milk donation, mother's milk or human milk feeding rates are much higher with better VLBW performance in terms of neonatal morbidity and mortality [15,16].…”

Section: List Of Abbreviationsmentioning

confidence: 99%

Does the Opening of a Milk Bank in NICU Cancel the Incidence of NEC?

Quitadamo¹,

Palumbo²,

Villani³

et al. 2018

Journal of Pediatric Disorders and Neonatal Care

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“…An element which favours the use of human milk in NICU is the presence in our structure of the Milk Bank with spaces, management, and a dedicated staff that (we believe) has encouraged the production, the maintenance, and the donation. It should be recalled, in this regard, that the presence of a HMB [53, 54] does not interfere with the feeding of premature babies but promotes it. Indeed, the milk banks are a valid system for the collection, the treatment, and the storage of the milk and represent an excellent method to promote the breastfeeding [36].…”

Section: Discussionmentioning

confidence: 99%

Might the Mothers of Premature Babies Feed Them and Devote Some Milk to the Milk Bank?

Quitadamo

Palumbo

Cianti

et al. 2018

International Journal of Pediatrics

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The breast milk is the gold standard food for the feeding of the premature baby: it is the natural way to provide excellent nutritional, immunological, and biological nutriment so as to facilitate a healthy growth and the development of the infants. When the breast milk is not available, the alternative is represented by the donated milk. The mothers of premature infants are important opportunity if we consider the fact that they could devote some milk both because they provide a food which is closer to the needs of the vulnerable category of newborns and because it is, for the mothers, a way to overcome the detachment and the psychological trauma of a premature birth. There are no data on this kind of donation. The aim of the study is to evaluate the contribution of the milk donation to the HMB of CSS by women who gave birth to premature infants of gestational age <35 weeks and to analyze the macronutrient composition of the “preterm” donated milk. The CSS HMB has recruited 659 donors totalling 2236 liters of donated milk over a period of 7 years. 38 donors (5.7%) gave birth to a gestational age <35 weeks. Almost 20% of the donated milk comes from mothers of premature babies and this is a very important fact because it shows the huge potential belonging to this category of mothers. Taking into account the parameter regarding the birth weight, it was found that VLBW mothers contributed for 56% to preterm donation while ELBW mothers contributed for 41%. By evaluating the variable gestational age, about 40% of the average total donation derives from mothers who gave birth before the 25 weeks, while a contribution of 46% is attributable to the category of newborns with a GA between 25 and 32 weeks. Besides, some other exceptional examples can be outlined. Regarding the correlation analysis DM resulted in negative correlation with GA weeks (r=-0.31, p=0.058) and with BW g (r=-0.30, p=0.068) achieving values which are very close to the significance. The comparison between the donor volume averages of the preterm and full-term groups is statistically significant. The composition data are in line with the literature: there is an increase by 18 % in the protein component of the milk deriving from the mothers of the premature infants; the gap in carbohydrates is less significant (5-6%) and the gap in calories is similarly low being only 2% higher than the single donor milk and 11% more than the pooled milk. The data on the lipids line up to single donor term milk, while it grows by 24% compared to the pooled one. The study shows that even at very low or extreme gestational age it is possible to obtain an appropriate production of breast milk. This awareness becomes a fundamental starting point for the activation in a standardized way of all the strategies of promotion and support of food that have proven effective with the HM in NICU.

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Structured promotion of breastmilk expression is associated with shortened hospitalisation for very preterm infants

Abstract: A structured, focussed, multimodal approach to enhance breastmilk production has shown potential for producing positive end outcomes, particularly, a significant reduction in duration of hospitalisation.

Cited by 11 publications

References 30 publications

A quality initiative to improve exclusive breast milk feeding in preterm neonates

A quality initiative to improve exclusive breast milk feeding in preterm neonates

Does the Opening of a Milk Bank in NICU Cancel the Incidence of NEC?

Might the Mothers of Premature Babies Feed Them and Devote Some Milk to the Milk Bank?

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