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. 2012 Dec;130(6):e1679-87.
doi: 10.1542/peds.2012-0547. Epub 2012 Nov 5.

A quality improvement project to increase breast milk use in very low birth weight infants

Henry C Lee  1 , Paul S Kurtin, Nancy E Wight, Kathy Chance, Tracey Cucinotta-Fobes, Tara A Hanson-Timpson, Courtney C Nisbet, William D Rhine, Kate Risingsun, Matthew Wood, Beate H Danielsen, Paul J Sharek
Affiliations

A quality improvement project to increase breast milk use in very low birth weight infants

Henry C Lee et al. Pediatrics. 2012 Dec.

Abstract

Objective: To evaluate a multihospital collaborative designed to increase breast milk feeding in premature infants.

Methods: Eleven NICUs in the California Perinatal Quality of Care Collaborative participated in an Institute for Healthcare Improvement-style collaborative to increase NICU breast milk feeding rates. Multiple interventions were recommended with participating sites implementing a self-selected combination of these interventions. Breast milk feeding rates were compared between baseline (October 2008-September 2009), implementation (October 2009-September 2010), and sustainability periods (October 2010-March 2011). Secondary outcome measures included necrotizing enterocolitis (NEC) rates and lengths of stay. California Perinatal Quality of Care Collaborative hospitals not participating in the project served as a control population.

Results: The breast milk feeding rate in the intervention sites improved from baseline (54.6%) to intervention period (61.7%; P = .005) with sustained improvement over 6 months postintervention (64.0%; P = .003). NEC rates decreased from baseline (7.0%) to intervention period (4.3%; P = .022) to sustainability period (2.4%; P < .0001). Length of stay increased during the intervention but returned to baseline levels in the sustainability period. Control hospitals had higher rates of breast milk feeding at baseline (64.2% control vs 54.6% participants, P < .0001), but over the course of the implementation (65.7% vs 61.7%, P = .049) and sustainability periods (67.7% vs 64.0%, P = .199), participants improved to similar rates as the control group.

Conclusions: Implementation of a breast milk/nutrition change package by an 11-site collaborative resulted in an increase in breast milk feeding and decrease in NEC that was sustained over an 18-month period.

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Figures

FIGURE 1
FIGURE 1
Annotated run chart of breast milk feeding at discharge for collaborative participants.
FIGURE 2
FIGURE 2
Percent of eligible infants with NEC by collaborative participation.
FIGURE 3
FIGURE 3
Mean length of stay for eligible infants by collaborative participation.
FIGURE 4
FIGURE 4
Percent of processes adopted by collaborative participants before and during the intervention.
See this image and copyright information in PMC

References

    1. Section on Breastfeeding . Breastfeeding and the use of human milk. Pediatrics. 2012;129(3). Available at: www.pediatrics.org/cgi/content/full/129/3/e827 - PubMed
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